Skin in the Game: The Professionalization of Lived Experience Roles in Mental Health

Should the Lived Experience workforce become more professionalized? 

Roennfeldt, H. & Byrne, L. (2021). Skin in the game: The professionalization of lived experience roles in mental health. International Journal of Mental Health Nursing. doi: 10.1111/inm.12898

Take home messages
  • The Lived Experience workforce is described as an emerging profession.

  • There are valid arguments provided for and against the professionalization of the Lived Experience workforce.

  • The debate about professionalization highlights how Lived Experience work centred on personal experience and relationships can struggle to find credibility in a system that prioritises formal knowledge.

  • Professionalization needs to be driven by Lived Experience leaders.

  • Professionalization could be the result of attempting to solve the ‘wrong’ problem. Instead of addressing the need for professionalization, perhaps the focus should shift to how we shape the work environment to greater value and acknowledge lived expertise as knowledge.

The arguments for and against professionalization are explored to understand the risks and benefits for the Lived Experience workforce.

Aim
Background

Lived Experience work developed as part of the consumer movement and the impact of deinstitutionalization. The employment of Lived Experience workers has greatly increased since their inclusion in mainstream mental health services. However, the growth and effectiveness of the workforce has been impacted by a lack of clear and shared understanding of Lived Experience roles.


Including Lived Experience workers is recommended as best practice in mental health service delivery in Australia. This is because of increasing evidence of the benefits of Lived Experience workers in improving outcomes for people receiving services, Lived Experience workers, colleagues and organisations. Despite evidence of the benefits of Lived Experience work, challenges exist. Several strategies support best practice in employing Lived Experience workers, including Lived Experience specific policies, supervision and training.


There is increasing pressure for the Lived Experience Workforce to become professionalized as Lived Experience work is more and more included as part of mainstream mental health services. Lived Experience workers have expressed fears of co-option if Lived Experience workers are heavily influenced by the dominant medical model and lose their unique way of working. There is also a concern about the power imbalance between Lived Experience workers and people accessing services. To reduce these concerns, Lived Experience work must be grounded in the history of the consumer movement and consumer/survivor culture in providing the foundation and values of Lived Experience work within a Human Rights and social justice framework.

What is a Profession?

A disciplined group of individuals who adhere to ethical standards and who hold themselves out as and are accepted by the public as possessing special knowledge and skills in a widely recognized body of learning derived from research, education and training at a high level, and who are prepared to apply this knowledge and exercise these skills in the interest of others (Australian Council of Profession 2003).

Lived Experience Work as a Developing Profession

Professions can be measured based on a range of factors associated with professionalization. The Lived Experience workforce in Australia is a developing profession based on the following stages of professionalization. This means the Lived Experience workforce has reached some but not all steps to becoming professionalized.

Formalised Collaboration  

Exists with state and national networks, but there is currentlyno National peak representing the Lived Experience workforce

Authorised practice

No registration or licencing requirement for the Lived Experience workforce. However state and national guidelines and standards are being developed.

Standardised qualifications

Increasing push to have standardised qualifications. Currently there is accredited Cert IV training

Educational Uniformity

 Nationally accredited training exists in Australia, NZ, UK and US.

Educational Identity

Lived Experience is not recognised as its own discipline

Consolidated Beliefs

Push to develop a core set of principles and values, but this has not been established

Enlarged Influence

Lived Experience work has shaped policy reforms and led to a greater recovery focus.

Enhanced Communication

 Lack of specialised Lived Experience journals

Specialisation

Limited senior Lived Experience roles. A small number of specialised Lived Experience roles exist eg: Youth

The Argument For and Against Professionalization

For

Against

Greater credibility and valued status

Collective identity as a discipline

Recognised skills and knowledge beyond the use of personal story

A platform for building evidence through standardised practice

Potential for greater funding

Attract more training and professional development

Guard against the workforce as a form of cheap labour

Greater potential for change within the system

Potential restrictions on political action

Demands for uniformity and less flexibility and creativity

Registration to a governing body may restrict the service reform agenda

Exclude those who do not have the entry requirements of the profession

Tension in who is included in the governing body and who will decide what is best practice

Reduce authenticity of Lived Experience roles and replicating clinical roles

Click here to go to a blog about this paper provided by Mad In America which also outlines the key points covered in the paper.

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