Psychosocial design as lived experience reciprocity: “having your humanity recognized”

Mental health peer support workers draw on lived experience to provide benefit to people experiencing mental distress. People living in rural areas are less likely than their urban counterparts to seek professional help for psychological distress. The aim of this study was to explore the perceived value of rural peer support workers as facilitators to rural mental health help-seeking. Data were gathered through a cross-sectional survey distributed by a social media boosted post. A total of 349 "small" rural towns in New South Wales as defined by the Modified Monash Model classification system as MMM5. A total of 765 adult, rural residents completed the survey. Participants were asked to select, from a list of potential facilitators, those which they felt would make mental health help-seeking easier or harder. Study participants felt that a help provider with lived experience of mental illness or distress would make mental health help-seeking easier. Similarly, rural life experience in a help provider was thought to facilitate help-seeking. Participants also believed that flexible and informal meeting settings would make it easier to seek help for mental distress. Engaging rural mental health peer support workers in a flexible/informal setting, as a complement to conventional health service provision, may increase rural help-seeking for mental distress. Increased mental health help-seeking is likely to have a positive impact on instances of serious mental illness.

BackgroundHistorically, researchers have been apt at conducting research on, rather than with, the people who are the focus of their efforts. Such approaches often fail to effectively support and benefit the populations they are intended to. This study aimed to explore the preferences of people with lived experience for engagement with research either as research participants within studies, or through active involvement in mental health research.MethodsData for this paper were collected in three separate lived experience agenda‐setting studies conducted over a 9‐year period from 2013 to 2022; two group discussions and an open‐ended online survey. Data were combined and thematic analysis undertaken.ResultsParticipants described the inclusion of lived experience as a critical ingredient and the highest level of knowledge and expertise in mental health research that should lead to knowledge generation and research agendas. Participants discussed the importance and value of research that enables sharing experiences and stories, expressed a need for flexibility in research methods for choice and agency, and support for greater active involvement of people with lived experience across all stages of research. Participants also spoke to the need for perspective and knowledge generated from people with lived experience to have equal power in research, making space for lived experience voices across multiple aspects of research, and greater respect and recognition of the value of lived experience.ConclusionLived experience in mental health research is coming of age, but dedicated, cocreated development is needed to get it right. People with lived experience increasingly understand the value their experiential knowledge brings to the mental health research effort, and describe a wide range of ways that researchers can support them to be research participants, and to get actively involved. Power‐sharing, respect and recognition of lived experience as central to effective mental health research are the keys to ‘keeping it real’.Patient or Public ContributionPeople with lived experience of mental health problems or distress either personally, and/or as carers, family and kinship group members, were involved in the coideation and codesign of this research. All authors identify as people with lived experience.

BackgroundThe mental health and TB syndemic is a topic that remains under-researched with a significant gap in acknowledging and recognizing patient experiences, particularly in the sub-Saharan African region. In this qualitative study conducted in Zambia, we aimed to explore the lived mental health experiences of TB patients focusing on their multi-layered drivers of distress, and by so doing highlighting contextual factors that influence mental distress in TB patients in this setting.MethodsThe study draws on qualitative data collected in 2018 as part of the Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening for active TB trial (TREATS) being conducted in Zambia. The data was collected through in-depth interviews with former TB patients (n = 80) from 8 urban communities participating in the TREATS trial. Thematic analysis was conducted. Additional quantitative exploratory analysis mapping mental distress symptoms on demographic, social, economic and TB characteristics of participants was conducted.ResultsMost participants (76%) shared that they had experienced some form of mental distress during their TB investigation and treatment period. The reported symptoms ranged in severity. Some participants reported mild distress that did not disrupt their daily lives or ability to adhere to their TB medication, while other participants reported more severe symptoms of distress, for example, 15% of participants shared that they had suicidal ideation and thoughts of self-harm during their time on treatment. Mental distress was driven by unique interactions between individual, social and health level factors most of which were inextricably linked to poverty. Mental distress caused by individual level drivers such as TB morbidity often abated once participants started feeling better, however social, economic and health system level drivers of distress persisted during and beyond TB treatment.ConclusionThe findings illustrate that mental distress during TB is driven by multi-layered and intersecting stresses, with the economic stress of poverty often being the most powerful driver. Measures are urgently needed to support TB patients during the investigation and treatment phase, including increased availability of mental health services, better social security safety nets during TB treatment, and interventions targeting TB, HIV and mental health stigma.Trial registration ClinicalTrials.gov NCT03739736. Trial registration date: November 14, 2018.

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ABSTRACTLived experience workers are an integral part of mental health multidisciplinary teams, contributing unique insights and support grounded in personal experience and lived expertise. Despite their growing presence, challenges with the integration of lived experience workers into these teams persist. There is a gap in knowledge on lived experience workers' perspectives on their inclusion in multidisciplinary teams, as well as clinicians' views on the lived experience role. The aim for this qualitative descriptive study was to explore the experiences and perspectives of lived experience workers and clinicians regarding the integration of lived experience roles within multidisciplinary mental health teams, with a focus on identifying barriers, facilitators and impacts of role integration. Semi‐structured interviews were conducted with lived experience workers (n = 7) and mental health clinicians (n = 7). Framework Analysis of interviews resulted in four main themes: (1) Systemic barriers hinder integration; (2) Lack of lived experience workforce role clarity limits impact; (3) Discipline‐based defensiveness as a barrier to integration; and (4) Clinical and lived experience workforce perspectives clash. This study highlights that successful integration of the lived experience workforce in mental health care requires more than structural reform. Sustainable inclusion depends on role clarity, shared responsibility and accountability among multidisciplinary team members and relational trust. Without addressing differing attitudes and beliefs about authority and recovery, integration of lived experience into mental health risks being symbolic rather than transformative.

Introduction: Mental health of workers is an essential determinant of their workproductivity and their overall health. Poor mental health contributes meaningfully to arange of chronic physical illnesses such as hypertension, diabetes, and cardiovasculardisorders. Besides, mental health distress can severely impact the ability to work,leading to increased absenteeism and/or presenteeism. Consequently, employers andbusinesses are negatively affected by poor mental health among their employees due tothe lost productivity and profits, as well as the increased direct costs of managing thesehealth problems. Aim of work: To investigate the association between mental healthdistress and work productivity in terms of absenteeism and presenteeism. Materialsand Methods: One-hundred and eighty male shipyard-workers were interviewed usinga predesigned questionnaire for sociodemographic characteristics, work characteristics,lifestyle behaviors, perceived health status, and chronic diseases. Mental health distresswas measured using the Kessler psychological distress scale (K6), while measuresof work productivity (absenteeism and presenteeism) were calculated according tothe scoring guide of the Health and Work Performance Questionnaire (HPQ-shortform). Results: The mean age of participants was 48.3 years (± 8.17). Operators and service-workers constituted 73.3% of all participants, while professionals andadministrative workers represented 16.7% and 10%, respectively. Eight workers (4.4%)had high mental health distress, while 12.2% had moderate distress. The mean daysof absenteeism and presenteeism were significantly higher among participants withmoderate or high mental distress compared to low distress (p < 0.001). Further, withineach level of mental distress, the mean presenteeism days were significantly higher thanthe mean absenteeism days. Moderate and high mental distresses were associated with2.1 and 3.9 times greater rates of absenteeism and presenteeism compared to low mentaldistress. Conclusion: Mental health distress is associated with both higher absence andpresenteeism rates. Effective workplace policies for mental health promotion and casemanagement could yield substantial increases in worker’s productivity.

ABSTRACTThis article discusses insights arising from a Community of Practice (CoP) initiative within a mental health short stay inpatient unit adjacent to a major Emergency Department to explore how COVID‐19 has influenced engagement and support of people in mental distress. The present initiative was designed as a collaboration between the University of South Australia and SA Health. Community of Practice (CoP) is combined with a narrative review of current evidence to explain specific nursing care responses within an operating environment of pandemic‐induced fear and uncertainty. Meetings discussed the challenges associated with delivering mental health care for people experiencing mental health distress in the COVID‐19 context. Applying trauma‐informed principles to mental health care delivery was identified to be of relevance in the context of an ongoing pandemic. Humanizing nursing care and increasing people's sense of predictability and safety contributed to therapeutic engagement and support during COVID‐19. Factors discussed to mitigate the effects of safety measures include, for example, nuanced verbal and non‐verbal engagement of health workers with people in mental distress when wearing personal protective equipment (PPE). We highlight the need to ‘humanise’ nursing and openly communicating that both practitioners and people in distress are navigating special circumstances. The CoP participants additionally acknowledged that the experience of moral distress among frontline health workers needs to be addressed in future policy responses to COVID‐19. Person‐centred and trauma‐informed responses at the point of care might help to mitigate the pandemic short‐ and long‐term effects for both service users and frontline health workers.

This paper assesses the levels of antiretroviral treatment (ART) adherence and mental health distress among study participants in a national behavioural HIV-sero prevalence study South Africa. The study was a cross-sectional population-based multi-stage stratified cluster random survey, (SABSSM V, 2017). Structured questionnaires were used to collect information on socio-demographics, HIV knowledge, perceptions, HIV testing and HIV treatment history. Study participants were tested for HIV infection, antiretroviral use, viral suppression, and ART drug resistance. A total of 2155 PLHIV aged 15years or older who were on ART were included in the study. Incidence of either moderate or severe mental health distress was 19.7%. Self-reported ART adherence among study participants with no, mild, moderate, or severe mental distress was 82%, 83%, 86% and 78%, respectively. The adjusted odds ratio for ART non-adherence was 0.58 (95% CI 0.24; 1.40) for mild mental distress, 0.82 (95% CI 0.35; 1.91) for moderate mental distress and 2.19 (95% CI 1.14; 4.19) for severe mental distress groups compared to the no mental health distress group. The other factors that were associated with ART non-adherence in adjusted models included education level, alcohol use and province/region of residence. The study revealed that mental health remains a challenge to ART adherence in South Africa. To improve ART adherence, HIV continuum of care programs should include screening for mental health among people living with HIV.

We read with great interest Alison Sharpe's lived experience narrative, ‘My Journey Into Teaching’ (Sharpe 2025), which vibrantly exemplifies how personal recovery journeys can humanise mental health education. From the author's narrative, the role of inclusion lived experience educators serves as a possible antidote to stigma, reshaping student nurses' professional gaze towards the boys who became men misused alcohol. It is in that context that we would like to fare further and discuss a subtle yet often ignored philosophical dimension of the alignment—the epistemological and axiological structures of education as they intersect with mental health, focusing on the idea of education for all. From a philosophical perspective, education encompasses three interrelated objects: the material object (ontology), referring to the human as an imperfect, developing being; the formal object (epistemology), concerning the processes and means of acquiring knowledge; and the final object (axiology), relating to the moral and societal value of education (Rosida et al. 2023). The educational system should transform those who are ‘imperfect’—rather than ‘ignorant’—into knowledgeable individuals, and those considered ‘disadvantaged’ into prosperous and socially engaged citizens. At the same time, Sharpe's narrative of education presents a paradox only indirectly: despite its ontological promise of inclusion, its epistemological structure and manifestation of education often alienate people who do not ‘speak the language’, which often means being equipped with intellectual and economic power. This dissonance between the ontological promise of education and an epistemological organisation of education can undeniably cause mental distress both to the students and instructors. The misalignment of the formal and material objects of education can be emotionally devastating. When education for all turns into education exclusively for the able and affluent, these structural contradictions reinforce the systemic nature of inequality. As a result, students who experience socioeconomic, psychological or recovery-related challenges are robbed of self-worth and a sense of belonging (Biesta 2015). Training mental health professionals to identify and combat the structural contradictions that undermine empathy and directly contribute to the stigma that Sharpe wants to debug is one strategy to defeat the justification. Higher education institutions should be proactively integrating philosophy-informed mental health literacy to the nursing curricula. Here, higher-level integration is primarily about critical reflection on the ethical foundation of inclusion and the emotional labour of teaching with lived experience (Koch 2018). Universities and nursing programs should also be expanding pastoral counselling and peer support infrastructures; this is essential to ensure that both educators with lived experience and students are comprehensively sustained within an ecosystem of learning that appreciates human vulnerability as a vitally critical learning strength rather than a weakness. This expansion is supported by evidence indicating that educators and students engaged in lived experience teaching are exposed to heightened emotional labour and vulnerability, which, if unsupported, may lead to burnout, re-traumatization or diminished pedagogical effectiveness (Koch 2018; Biesta 2015). Pastoral counselling and structured peer support therefore function not merely as supplementary services, but as ethical infrastructures that sustain inclusion, well-being, and pedagogical integrity within mental health education (Situmorang 2022). In conclusion, then, rather than telling a story of recovery, Sharpe's article asks us to consider our education's very underlying homeroom regarding the ontological, epistemological, and axiological. For mental health nursing education to be honest in its commitment to education for all, it must resolve the contradictions that underpin its ontological with reflexive, compassionate, and ethically inclusive pedagogies, which discuss education in a way that supports, develops, and enhances learners' emotional and existential learning. All authors contributed substantially to the design, drafting, and final approval of the data and work. Dominikus David Biondi Situmorang wishes to express his gratitude to the Doctoral Scholarship Program for Indonesian Lecturers (BPDDI), the Center for Higher Education Funding and Assessment (PPAPT), and the Ministry of Higher Education, Science, and Technology of the Republic of Indonesia (Kemdiktisaintek) for sponsoring and funding the continuation of the Doctoral Program (with a double degree scheme) in Universitas Pendidikan Indonesia and Indiana University Bloomington, USA (No. 202508110452); as several courses supported the depth of analysis and discussion in this article. In addition, Nadiya Kurniati and Cece Rakhmat expressed their gratitude to the Doctoral Program in Guidance and Counselling, Faculty of Educational Sciences, Universitas Pendidikan Indonesia, for supporting this manuscript. The authors have nothing to report. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.

Gender differences on mental health distress: Findings from the economic recession in Portugal

Students from a range of health disciplines need to learn from people with lived experience of mental distress and recovery to develop recovery capabilities for mental health practice. The aims of this study are to describe the co-design of a teaching resource, to explore the experience of people with lived experience during the resource development, and to evaluate the outcome of the resource on student recovery capabilities. Using a sequential mixed method, a project group consisting of six people with lived experience and 10 academics from five health disciplines was convened to co-develop teaching resources. People with lived experience met independently without researchers on several occasions to decide on the key topics and met with the research team monthly. The teaching resource was used in mental health subjects for two health professional programmes, and the Capabilities for Recovery-Oriented Practice Questionnaire (CROP-Q) was used before and after to measure any change in student recovery capabilities. Scores were compared using the Wilcoxon signed rank test. The people with lived experience were also interviewed about their experience of being involved in constructing the teaching resources. Interviews were audiotaped, transcribed, and analysed thematically. The finished resource consisted of 28 short videos and suggested teaching plans. Occupational therapy and nursing student scores on the CROP-Q prior to using the educational resource (n = 33) were 68 (median) and post scores (n = 28) were 74 (median), indicating a statistically significant improvement in recovery capability (P = 0.04). Lived experience interview themes were (i) the importance of lived experience in education; (ii) personal benefits of participating; (iii) co-design experience; and (iv) creating the resource. Co-design of teaching resources with people with lived experience was pivotal to the success and quality of the final product, and people with lived experience described personal benefits of participating in resource development. More evidence to demonstrate the use of the CROP-Q in teaching and practice is needed.

Participation and involvement of service users, carers, and families into the design, delivery, evaluation, and development of mental health policy and services is now a standard expectation. As social workers are employed in mental health settings, it is vital that graduates understand and ethically engage with mental health consumers, survivors, ex-patients, and family (CSX + F) in a meaningful and authentic manner. We argue this extends to fostering critical understandings of dominant discourses about distress, trauma, diagnosis, and intervention as a routine component of social work education. The Valuing Lived Experience Program (VLEP) described in this article within the Curtin University School of Allied Health aims to meaningfully embed the voices of people with lived experience of mental distress, trauma, and service use into the education of tertiary students and academics. Lived experience education in social work is vitally important and requires appropriate resourcing, clear purpose and principles, and attention to the democratisation of knowledge in order to achieve epistemic justice. In this article, the authors describe and contextualise the VLEP as a contemporary example of how lived experience in social work education can occur and be developed. IMPLICATIONS Meaningful participation of people with mental health lived experience is important to social work education. Lived experience education needs to be underpinned by clear ethical and theoretical principles for teaching and learning. Programs that rigorously engage with lived experience in mental health education can make a positive contribution to critical understandings of mental distress.

This study explored the benefits and limitations of employing peer support workers, who utilise their own lived experience of mental distress and recovery, to support people experiencing mental distress who are attending the ED. This co-produced qualitative study utilised four phases: (i) assemble a collaborative multi-disciplinary research team and Expert Panel, of which at least half identified as having lived experience; (ii) a site visit to an ED; (iii) focus groups with consumers, support persons and ED staff; and (iv) a learning workshop for peer workers. Focus groups were run for consumers (n=7), support persons (n=5) and ED staff (n=7). Eleven consumer peer workers participated in the learning workshop. Four themes were identified and triangulated: the individual in distress, peer support work, a 'Peers in EDs' service and the ED context. Overall, findings suggest that peer support workers contribute important skills including listening, de-escalation, relationship-building and empathy. This study identified that peer support workers would bring important skills to an ED (e.g. empathetic support, de-escalation). However, significant workforce and organisational support would be required.

WHAT IS KNOWN ON THE SUBJECT?: The involvement of those with lived experience is broadly understood to be beneficial to student learning. The consequence of the process and implications for learning are predominantly unexplored. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper explores an innovative co-produced model of involving people with lived experience in the assessment process of mental health nursing students. This method of assessment enables students to further critically analyze the application of humanistic skills and theories of person-centred care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The involvement of people with lived experience in the assessment process of students promotes self-awareness and empathy. It is questionable if learning which is potentially troublesome should act as a form of academic assessment which is exposed to the external judgement of another and awarded a credit-bearing grade. ABSTRACT: Introduction Despite a positive and established perception of people with lived experience of mental distress contributing to the assessment of healthcare professionals, the consequence and implications for learning are predominantly unexplored. Aim To gain a greater understanding of the influence of feedback given by people with lived experience, in the role of formative assessor, on student learning. Method Qualitative analysis, underpinned by the theory threshold concepts, was conducted on the written reflective assessments, submitted by students, following engaging in an assessment with a lived experience assessor. Results Student learning was influenced positively by the involvement of lived experience assessors in relation to person-centred care. However, students reported the experience to be anxiety provoking due to the desire to seek external approval and conceal personal challenges. Discussion The results indicate that the feedback from those with lived experience promotes greater self-awareness and empathy amongst students. The perceived expectation to present a competent and professional performance acts as a barrier to authentic person-centred practice. Implications for practice It is questionable if learning which is potentially troublesome should act as a form of academic assessment, which is exposed to the external judgement of another and awarded a credit-bearing grade.

Engaging people with lived experience of mental health system encounters in the design and actualization of continuing professional development initiatives for mental health professionals can have transformative systemic impacts. Yet, despite evidence that involving people with lived experience benefits mental health professional education, far less focus has been placed on how to engage people with lived experience in continuing professional development initiatives. Tensions persist regarding the role of lived experience perspectives in continuing professional development, as well as how to establish people with lived experience as partners, educators and leaders in a thoughtful way. We propose that meaningful and equitable partnerships with people with lived experience can be realized by engaging in critical reflexivity and by systematically challenging assumptions. This paper explores three topics: (1) the current state of engagement with people with lived experience in continuing professional development initiatives; (2) barriers to meaningful engagement and (3) recommendations for using critical reflexivity to support the involvement and leadership of people with lived experience in continuing professional development for mental health professionals.Patient or Public InvolvementThis viewpoint manuscript was co‐designed and co‐written by people with diverse lived and learned experiences. Each author's professional roles involve meaningfully and equitably partnering with and centring the perspectives of those with lived experience of mental health system encounters. In addition, approximately half of the authorship team identifies as having lived experience of accessing the psychiatric system and/or supporting family members who are navigating challenges related to mental health. These lived and learned experiences informed the conception and writing of this article.