Embedding Peer Lived Experience Workforces into Statutory Mental Health Services

15 JUNE 2023

Embedding Peer Lived Experience Workforces into Statutory Mental Health Services:

Richard August Hendrie

Consumer

note: the PDF and word document contain references and footnotes, this does not.

Introduction:

Lived experience workforces (LEW) have played a vital role in good mental health services for a long time. [1] We bring unique insights, empathy, and support to individuals facing mental health challenges. We also have the unique ability, and I believe mandate, to speak truth to power. Recognising the value of peer support, there is a growing requirement on embedding LEW within statutory mental health services. [2]

Work involving Lived Experience Workforce (LEW) will, with shared understanding and agreement, aid in promoting recovery, improving the quality of services, and truly foster a trauma-informed and person-centred approach, going beyond mere words and mission statements.[3]

Understanding Peer Lived Experience Workforces:

LEWs comprise individuals who have personal encounters with mental health trauma, and personal recovery. We form a crucial segment of the mental health workforce, contributing unique firsthand experiences, viewpoints, and insights to support others navigating similar challenges. LEWs provide relatable and empathetic support, serving as advocates, role models, and guides for individuals using mental health services.

Benefits of Embedding Peer Lived Experience Workforces:

Before going into the implementation, it is worth remembering what LEW bring to the table.

1.    Enhancing Empowerment and Recovery:

LEWs can inspire hope and foster empowerment by sharing our personal recovery journeys, demonstrating that recovery is possible. Our capacity to connect on a personal level helps to establish trust, and create a safe environment where individuals can express their concerns, dreams, and aspirations. Empowerment is an aspect we often neglect; while recovery is indeed the main focus of an LEW, encouraging fellow consumers to assert themselves, express opinions, ask questions, and sometimes, challenge authority is invaluable.

One often overlooked role that peer workers can fulfill is helping consumers envision life beyond the dynamics of mental illness, and clinical recovery. Regrettably, I have often seen consumers' dreams crushed by health services that perceive them as too simple to achieve anything significant. We cannot allow the system to dictate our dreams and aspirations. If I had allowed this, I wouldn't be in the position I am in today.[4]

2.    Increasing Engagement and Retention:

LEWs typically possess profound insights into the difficulties we are forced to encounter while navigating mental health systems. We have not only experienced trauma, but our roles often necessitate that we disclose this trauma openly - we are exposed. As a result, I think our involvement within statutory services can promote improved engagement and retention due to raw authenticity. We act as a bridge between service users and providers, assisting in stigma reduction and navigating intricate processes. It's the old adage, 'if I can do it (in context), you can do it (in context) too!'.

3.    Improving Service Quality:

LEWs bring a unique perspective to the planning, delivery, and evaluation of services. Why? Because we've personally encountered the front lines and realities of those policies - often, we've been let down by them. By actively involving us in decision-making processes, health services can benefit from our insights. These aren't just words on a piece of paper from a complaint process, or a report by a professional from a detached clinical room, but lived experiences that we must responsive to the needs and preferences of consumers. Speaking truth to power can swiftly humble managers and executives - the good ones embrace it, while the reluctant ones are dragged, kicking and screaming, towards failure.

Strategies for Embedding Peer Lived Experience Workforces:

4.    Policy and Legislation:

Ensure that policies and legislation support the inclusion LEWs. This may involve creating specific job roles,[5] developing unique guidelines for recruitment and training,[6] and establishing pathways for career progression. Well, that should be the idea - it sounds obvious right? but I’ve seen really poor practice.

In terms of recruitment, I can't stress enough the importance of in-person interviews over conducting them over Skype/Zoom. NSW Community Services has an excellent method that uses assessment centres. Embrace neurodiversity, permit presentations, and even allow applicants to submit videos, if they prefer. Meet the applicants where they are most comfortable! This approach will help you uncover hidden gems.

TANGENT… WHAT NOT TO DO!

Experiences with Albury Wodonga Health in the NE of Victoria

First, the health service sought a co-production partner for a joint project.[7] They publicised a consumer-designated position, attracting applications from many qualified consumers. However, astonishingly, the health service selected an existing staff member for the partnership.[8] This decision not only revealed blatant nepotism but also sent a discouraging message to consumer applicants, suggesting they were deemed unfit for collaboration. It was later uncovered that the health service justified their selection of an incumbent due to the project's projected six-month duration,[9] a period considered insignificant for a consumer on a Disability Support Pension (DSP). This flawed decision led to a lost opportunity and a consequent decrease in consumer interest in a project falsely advertised as co-produced.

Second, the health service appointed a Director of Transformation tasked with implementing the royal commission's recommendations. This decision was necessitated by a prior unsuccessful attempt at redesigning the mental health system, which involved pre-emptively dismissing all experienced staff in anticipation of the royal commission's findings. The first appointee, a nursing unit manager with no personal or professional mental health experience, remained in the position for just seven months. Despite grand promises, her tenure ended in frustration and broken promises to consumers. The second appointee, despite being in the role for over seven months, has yet to engage with any consumers. The need to appoint several additional positions under this director underscores the health service's lack of expertise and idea of what they are doing.

Lastly, the health service chose a new Lived Experience Workforce Manager with minimal relevant experience and unfamiliarity with the regional area and cross-border health system. This individual was entrusted with the development of a health service-wide workforce after a brief 30-minute Zoom interview. Their initial action was a mass email to all consumer applicants for a peer worker position, who had applied four months prior without receiving a response. Some had not been employed for over 10-years. This email uniformly rejected their applications and encouraged them to apply for a less remunerative, part-time position. This communication lacked trauma-informed care, disregarding the vulnerability many feel when applying for lived experience positions. The hastily-assembled interview panel for this recruitment consisted of three mental health nurses and a psychiatrist, none of whom disclosed any lived experience, revealing a lack of comprehension of the role's requirements.

5.    Recruitment and Training:

Establish recruitment processes that prioritise the selection of peer workers based on our experience with your health service, [10]eagerness to improve academic and workplace skills and learn, and, despite some managers in people and culture, those who are unafraid to disagree with power.[11] Provide comprehensive training programs that focus on LEW principles, ethical considerations using a Socratic method, communication skills, self-care, and professional boundaries in the context of LEW work. Offer a pathway to higher education and realistic career advancement opportunities beyond lived experience mental health roles.

6.    Supervision:

Provide continual professional supervision in LEW to strengthen knowledge and build confidence. Regular supervision, peer-led and peer group sessions, should be offered to ensure well-being, offer guidance, and address any challenges we encounter in our roles. Remember, LEW workers don't switch off our mental health lens when we go home. It's astonishing how frequently health services simply delegate this task to non-LEW line managers - this is not only inappropriate, but it also diminishes the unique contributions of lived experience workers, reducing us to just another mental health worker.

7.    Supportive Work Environments:

Cultivate a supportive and inclusive work environment that recognizes the significant and personal contributions of LEWs. Foster a culture of respect, understanding, and shared learning, where all staff members appreciate the unique expertise and perspectives that peer workers bring to the team. However, this doesn't mean dumping all complex cases on a LEW worker, nor does it mean labeling a LEW as the expert in everything related to "lived experience." Too often, I see non-LEW members posing random questions to LEW workers, assuming we are omniscient and possess all the knowledge of lived experience since the dawn of human history. No, our lived experiences simply inform our practice.

8.    Evaluation and Feedback Mechanisms:

Implement strategies to assess the influence of LEW contributions on service delivery and outcomes. This could involve gathering feedback from service users, carrying out straightforward surveys, and engaging in participatory evaluation processes that include peer workers themselves. It also implies taking the real-time advice of LEWs seriously - if a LEW worker identifies a problem, it usually exists, especially when observing interactions between non-LEW workers and consumers.

9.    Continuous Learning and Improvement:

Regularly review and refine the integration of peer lived experience workforces within the  health services. Adapt policies, procedures, and practices based on emerging evidence,[12] best practices,[13] and the evolving needs of service users. Take feedback from LEW workers seriously. Instead of resorting to generic responses like "we continually aim to improve" - which essentially suggests that while your subjective opinion is noted, the status quo will persist - be proactive and take meaningful actions towards improvement.

Conclusion:

Embedding peer lived experience workforces within statutory mental health services is a powerful way to enhance service quality, promote recovery, and ensure person-centered care. By valuing our unique and deeply personal contributions, providing appropriate training and support, and fostering a collaborative environment, mental health services can leverage the expertise of those who have experienced mental health challenges, and the system, firsthand. This integration can bring about a more compassionate, empowering, and effective mental health system that truly meets the diverse needs of individuals seeking support.

Faithfully,

Richard and Havic

[1] Consider the example of Alcoholics Anonymous; in fact, formal peer workforces can be traced back to 18th-century France. For further reference, see works by Mead and McNeil (2006) and Epstein and Wadsworth (1996). Also, look at the advocacy of Judi Chamberlain in the 1960s/70s, the contributions of Howie the Harp Service and Sally Zinman, among others. These pioneers laid the foundation for the modern understanding of peer work, offering an interesting historical timeline. For an Australian perspective, refer to the 'Peer Work in Australia 2018' report.

[2] Royal Commission into Victoria’s Mental Health System, Final Report, (2021) (Web Page) https://finalreport.rcvmhs.vic.gov.au/download-report/

[3] Health services love rhetoric.

[4] Holding degrees in Arts, Psychology, and Social Work, currently studying law, and participating on various co-design teams, to name a few.

[5] Empowering consumers in the community first. Not your mates in the office.

[6] Not just added onto a PD Day for every other worker in the service - albeit this is also important.

[7] The first problem - they predetermined the project.

[8] They partnered with themselves. - figure that out.

[9] It went over 12-months

[10] Encourage consumers who have been through complaint procedures to apply

[11] The concept of line-management is interesting in peer work, perhaps another article.

[12] Including anecdotal - don’t get me started on peer review.

[13] Best practice is an interesting concept, many believe this to be best practice as compared to other health services… perhaps, but what is best practice at YOUR health service.