“As services become more truly focused on service users’
needs and accept the value of ‘lived experience’, so there
are obvious implications for the composition of the
workforce …”
(Sainsbury Centre for Mental Health, Implementing Recovery. A framework for organisational change,
2010)
How Many Mental Health Professionals
Do You Need to Run a Mental Health
Service?
Rachel Perkins
Director of Quality Assurance and User Experience
South West London and St George’s Mental Health NHS Trust
‘Them’ and ‘us’ – ‘experts’ and ‘patients’
Traditionally it is assumed that mental health services
must be run by expert mental health professionals
Assumed that the expert professional has access to a
body of knowledge that cannot be understood by
non-experts
Therefore it is mental health workers to ‘fix’ people tell people what they should do and get them to
comply with their expert advice
But recovery is not about being ‘fixed’ by and
expert – like a refrigerator or a car
Recovery is about rebuilding your life.
Finding meaning in your distress.
Discovering and using your own resources and resourcefulness.
Finding a new sense of self, meaning and purpose - growing within and
beyond what has happened to you.
This requires not just the expertise of traditional mental health experts
The expertise of lived experience is critical.
Recovery is not a ‘professional intervention’ nor do
professionals hold the key
Technical treatment may be one thing that
people may find helpful in their journey of
recovery – but only one thing among many
“To me recovery means being in the driving seat of my life. I
don’t let my illness run me. Over the years I have learned
different ways of helping myself. Sometimes I use
medications, therapy, self-help, mutual support groups,
friends, my relationship with God, work, exercise, spending
time in nature – all of these measures help me remain
whole and healthy even though I have mental health
problems.”
(Deegan, 1993)
Expertise of lived experience is central to
recovery ...
• Valuing the experience gained from living with mental health problems –
using your experience to help others
• Reciprocity - moving beyond ‘them’ and ‘us’
• Feeling less alone
• ‘The gift of hope’ that people can give each other - images of possibility
• Sharing experiences and different ways of understanding what has
happened
• Sharing experience of different treatments and support
• Working out ways of dealing with problems
• Support from someone who understands what you are going through
Therefore we need to include the expertise of lived experience
in our workforce
Including the expertise of ‘lived experience’ in
the mental health workforce
Employing people with mental health problems in
existing positions in the workforce
… important, but not enough …
A nurse (or a psychologist, or a social worker or a doctor, or an
occupational therapist) with mental health problems is still a nurse
(or a psychologist, or a social worker or a doctor, or an
occupational therapist)
Traditional power, hierarchy, claims to special knowledge about others
etc. remain … and get in the way of people working together and
caring for themselves and each other
Including the expertise of ‘lived experience’ in
the mental health workforce
Creating new roles and relationships - employing ‘Peer
Support Workers’ to provide services
A relationship based on mutuality and a shared journey
Creating relationships where people can learn and grow as equals drawing on each other’s
expertise and experience
–
–
–
–
–
A way of sharing our personal story
A way of being in a relationship that empowers people to recover
A way of offering help and support as an equal
A way of teaching, learning and growing together
An attitude that values each person’s experience
“Peer support is about being an expert at not being an expert and that takes expertise.”
A ‘win-win’ arrangement promoting the recovery of those employed (by enabling them to use their
experience to help others) … promoting the recovery of those using services (by enabling
them to access the expertise of lived experience)
The dangers of professionalising distress:
deskilling individuals … deskilling communities … stopping
people from discovering and using their own resourcefulness
Mental health services – whether they be statutory or non-statutory and the mental health professionals who inhabit them can, albeit
often unwittingly, serve to perpetuate exclusion and marginalisation
in a kind of vicious cycle.
• People with mental health problems believe that experts hold the key
to all of our problems
• Our nearest and dearest believe we are unsafe in their untrained
hands.
• And we all become less and less used to finding our own solutions
and, embracing distress and human problems as a part of ordinary
everyday life
(O’Hagan, 2007)
The challenge
Handing over control to service users and communities by
fostering service user leadership, integrating with other
sectors and fostering community development and
inclusion ...
re-creating communities that can accommodate human
distress and human problems.
“People with mental health problems, as well as communities, need to
start believing they hold most of the solutions to human problems.”
(O’Hagan, 2007)
But what about traditional mental health workers?
“Professionals will remain important, but they will have to
recognise that their contribution needs to be made in a
different way, acknowledging service users’ self-defined
priorities.”
(Sainsbury Centre for Mental Health, Implementing Recovery. A framework for organisational change, 2010)
‘on tap’ not ‘on top’
putting our expertise at the disposal of those who be able to
make use of it ... we need to see ourselves as
“carriers of technologies that we may want to use at times,
just like architects, plumbers and hairdressers.”
(O’Hagan, 2007)
So how many mental health professionals do
you need to run a mental health service?
“ … we expect to see a greatly expanded role for ‘peer
professionals’ in the mental health service
workforce of the future. We recommend that
organisations should consider a radical
transformation of the workforce, aiming for perhaps
50% of care delivery by appropriately trained and
supported ‘peer professionals …”
(Sainsbury Centre for Mental Health, Implementing Recovery. A framework for organisational change, 2010)