Lived Experience Of Mental Distress Research Articles

A narrative journey into the borderland of patient safety: Toward an expanded, relational concept of safety.

"Patient safety" is routinely defined in health services globally as "safety for patients against harm and risk of injury in health care." (Danish Board of Quality in Health Care, 2022, p. 28; translated by the author). This is a standardized, broad, and general definition of what counts as safety. In this article, I argue for an expanded, relational concept of patient safety revolving around experienced patient safety. Recognizing safety as vital for all groups of patients, I follow a dialogical, critical-reflexive approach to focus on safety in a somatic hospital setting in Denmark as it is experienced by people with lived experience of mental distress. Safety in this context is often compromised, contributing to inequity in health for people with mental distress. I present and analyze the narratives of two experts by experience about their somatic hospital stay. As an analytical approach, I draw on Frank's dialogical narrative analysis together with elements from Bakhtin's theory of dialogue and Foucault's theory of power/knowledge. Forefronting voices of those rarely asked and seldom heard, dialogical narrative analysis provides insight into how "patient safety" is enacted through situated negotiations of meaning in the narratives of people with lived experience. The storytellers are continuously struggling to fit in and to be seen as human beings, trying to resist public narratives on mental distress that threaten to limit their scope of action and who they can become. The discussion highlights how unintended emotional and psychosocial harm limit the benefits of patient safety for certain groups in society. In particular, shame, individualized responsibility, and internalized inferiority hinder equity in health. Building on my analysis, I suggest a collaborative, participatory approach for coproducing further knowledge through joint analysis with people with lived experience and nurses from somatic hospital wards.

“Nothing's changed, baby”: How the mental health narratives of people with multiple and complex needs disrupt the recovery framework

The dominant narrative in mental health policy and practice has shifted in the 21st century from one of chronic ill health to a ‘recovery’ orientation. Knowledge of recovery is based on narratives of people with lived experience of mental distress. However the narratives of people experiencing structural inequalities are under-represented in recovery research. Meanwhile, uses of recovery narratives have been critiqued by survivor-researchers as a co-option of lived experience to serve neoliberal agendas.To address these twin concerns, we undertook a performative narrative analysis of two ‘recovery narratives’ of people with multiple and complex needs, analysing their co-construction at immediate/micro and structural/macro levels. We found two contrasting responses to the invitation to tell a recovery story: a narrative of personal lack and a narrative of resistance. We demonstrate through reflexive worked examples how the genre of recovery narrative, focused on personal transformation, may function to occlude structural causes of mental distress and reinforce personal responsibility in the face of unchanging living conditions. We conclude that unacknowledged epistemological assumptions may contribute to co-constructing individualist accounts of recovery. A critical, reflexive approach, together with transparent researcher positionality, is imperative to avoid the epistemic injustice of a decontextualised form of recovery narrative.

Co-design and evaluation of a multidisciplinary teaching resource on mental health recovery involving people with lived experience.

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.

Psychiatry and/or recovery: a critical analysis.

This perspective paper aims to present a personal viewpoint on the impact of psychiatric discourse on the principles of recovery in mental health care. Mental health services espouse these principles, yet psychiatric discourse remains the dominant model. A critical analysis will examine how psychiatry maintains this dominance. The aim is to examine how psychiatric discourse constructs both the nature of mental distress and its treatment, and how it maintains its power as the dominant authority and its relationship to recovery principles. The paper concludes that psychiatric discourse is the antithesis of recovery principles and that its authority is perpetuated through co-opting a medical explanatory model, claiming expertise in the ability to predict social risk, and maintaining a tightly controlled echo chamber. A way forward involves the dismantling of the hierarchical service delivery model based on psychiatric discourse and replacing it with a more horizontal service delivery model in which the lived experience of mental distress is central. Regular audit of services needs to prioritize recovery principles. The implications for mental health nursing are considered.

A Program for Valuing Mental Health Lived Experience in Social Work Education

ABSTRACT 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.

Kan civilsamfundet skabe mulighedsrum for samskabelse af viden til gavn for det fælles bedste?

Bringing knowledge of people with lived experience of mental distress at stake in developing psychiatric services has increased. The challenge thou are, that experienced knowledge is not recognized being as valid as professional knowledge. We will investigate how civil organizations can play an active role in developing communities of practice to underpin recovery processes of vulnerable people. By looking at capabilities, we look at what people are capable of, what interest and resources each person holds and what it takes to become participants of new communities of practice. Being a participant seems to strengthen a feeling of being a person of value and to be the driver of your recovery process, which is important knowledge for society to include in the strive of co-constructing ‘the common good’. So, what happens if we invite these people into co-construction of knowledge, practices, and policies for the sake of the ‘the common good’?

Understanding the impact of expert by experience roles in mental health education

BackgroundPeople with lived experience of mental distress and mental health service use (known as Experts by Experience) in mental health education have demonstrated positive outcomes and attitudinal change in students. Despite these findings, academic positions for Experts by Experience remain limited in number and scope, and the implementation of positions has primarily been driven by supportive mental health academics (known as allies). Less is known about the impact on Experts by Experience themselves, their colleagues and the broader organisation. ObjectivesThe aim of this research is to better understand the impact of EBE on the universities they work in, from the perspectives of allies who have supported the implementation and sustainability of their positions. DesignQualitative exploratory. SettingsAcademic institutions providing education programs for health professionals, and had implemented academic positions for Experts by Experience, in Australia, Ireland and New Zealand. ParticipantsAllies involved in supporting the implementation of Experts by Experience roles in mental health education (n = 16). MethodsEthics approval was obtained prior to study commencement. Individual in-depth interviews were conducted with 16 participants, based on a broad interview guide. Data were analysed to identify main themes. Analysis was conducted independently by two researchers and reviewed by the team. ResultsParticipants described the impact of Experts by Experience in mental health education as positively influencing the participants themselves, the Experts by Experience, their colleagues, and the broader organisational culture. ConclusionsSupport for the implementation of Experts by Experience roles must move beyond the efforts of allies alone. Demonstrating the benefits beyond student outcomes is crucial to achieving this goal. The positive impact for a broader range of stakeholders provides further evidence of the value of Experts by Experience and supports the need to develop a more strategic approach to implementation of these roles.

Developing and evaluating mental health lived experience practitioner (LXP) roles in an NHS trust

Background The value of establishing roles for people with lived experience of mental distress within mental health services is increasingly being recognised. However, there is limited information to guide the introduction of these roles into mental health services. Aims This study details the development and evaluation of a new mental health peer worker role, the Lived Experience Practitioner (LXP), within an NHS Trust. Methods A three-phase exploratory mixed-methods approach was used. Qualitative data were collected and analysed in the first phase. The qualitative findings were then translated into the formal procedures for introducing LXPs into the Trust, with the approach examined quantitatively in the third phase. Results The qualitative analysis identified five themes; role design, training, piloting, career pathways and communication. These formed the basis for working groups (workstreams) which developed policies and procedures for introducing the LXP role into the Trust. Twenty-eight applicants commenced a training programme with 10 successful completions. Seven LXPs were employed by the Trust and were still in their posts after 2 years. Conclusion In this study, three areas were viewed as important when introducing LXP roles into mental health services; organisational support, the training programme and employment procedures.

Peer support work for people experiencing mental distress attending the emergency department: Exploring the potential.

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.

Something special, something unique: Perspectives of experts by experience in mental health nursing education on their contribution.

●Expert by Experience participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal. ●Involving mental health Experts by Experience in the education of nursing students demonstrates positive attitudinal change. ●The paper presents perspectives from Experts by Experience about the unique knowledge and expertise they derive from their lived experience of mental distress and mental health service use. As a result, they can make a unique and essential contribution to mental health nursing education. They utilize this knowledge to create an interactive learning environment and encourage critical thinking. ●The international focus of this research enriches understandings about how Experts by Experience might be perceived in a broader range of countries. ●Mental health policy articulates the importance of service user involvement in all aspects of mental health service delivery. This goal will not be fully achieved without nurses having positive attitudes towards experts by experience as colleagues. ●Positive attitudes are more likely to develop when nurses understand and value the contribution experts by experience bring by virtue of their unique knowledge and expertise. This paper provides some important insights to achieving this end. Introduction Embedding lived experience in mental health nursing education is increasing, with research findings suggesting the impact is positive. To date, research has primarily targeted the perspectives of nursing students and academics from the health professions. Aim To enhance understanding of the unique knowledge and expertise experts by experience contribute to mental health nursing education. Methods Qualitative exploratory research methods were employed. In-depth individual interviews were conducted with experts by experience who delivered a coproduced learning module to nursing students in Europe and Australia. Results Participants described their unique and essential contribution to mental health nursing education under four main themes: critical thinking, beyond textbooks; interactive and open communication; understanding personal recovery; and mental health is health. Conclusions These findings present an understanding of the unique knowledge and expertise Experts by Experience contribute to mental health education not previously addressed in the literature. Appreciating and respecting this, unique contribute is necessary as Expert by Experience contributions continue to develop. Implications for Practice Mental health services purport to value service user involvement. Identifying and respecting and valuing the unique contribution they bring to services is essential. Without this understanding, tokenistic involvement may become a major barrier.

Uncovering the emotional labour of involvement and co-production in mental health research

This article explores the emotional labour of involvement and co-production in mental health research as experienced by service user/survivor researchers and research managers. It is based on a consultation aiming to explore some of the emotional implications raised by bringing lived experience into mental health research, through interviewing people with experience on all sides of the challenges raised. The aim was to develop a research proposal on the basis of the issues raised. Our analysis identified themes describing the negotiation of identity, the emotional work of using and embodying lived experience, and aspects of the working environment. This consultation highlights the intersectional complexities of identity and alienation experienced by people who bring their lived experience of mental distress or using services into unprepared workplaces. It also sheds light on the structural factors that mitigate against the successful integration of lived experience into mental health research. Points of interest In this article, we explore the emotional implications of being known to have experience of mental distress within the workplace and being expected/expecting to use this experience in your role as researcher. The following themes were identified from interviews: the need to negotiate a ‘mental illness’ identity alongside an identity as researcher; the emotional work needed to use lived experience in research; the emotional implications of being known to have experience of mental distress and of being expected to use that experience as part of your role as researcher; the implications of competitive working environments; and strategies for managing these complex experiences. We highlight the additional challenges affecting people from Black and minority ethnic communities working in predominantly white workplaces. We highlight the hierarchical and competitive features of academic institutions that prohibit the successful integration of lived experience into mental health research.

Contending with Spiritual Reductionism: Demons, Shame, and Dividualising Experiences Among Evangelical Christians with Mental Distress

The belief that mental distress is caused by demons, sin, or generational curses is commonplace among many evangelical Christian communities. These beliefs may have positive or negative effects for individuals and groups. Phenomenological descriptions of these experiences and the subjective meanings associated with them, however, remain somewhat neglected in the literature. The current study employed semi-structured interviews with eight evangelical Christians in order to idiographically explore their experiences of mental distress in relation to their faith and wider communities. Through an interpretative phenomenological analysis, two superordinate themes were constructed: negative spiritualisation and negotiating the dialectic between faith and the lived experience of mental distress. Participants variously experienced a climate of negative spiritualisation, whereby their mental distress was demonised and dismissed, and they were further discouraged from seeking help in secular institutions and environments. Participants often considered such dismissals of their mental distress as unhelpful and stigmatising and experienced heightened feelings of shame and suffering as a result. Such discouragement also contributed to the process of othering and relational disconnection. Alongside a rejection of church teachings, which exclusively spiritualised psychological distress, participants negotiated a nuanced personal synthesis of faith, theology, and distress, which assumed a localised and idiographic significance. This synthesis included advocating for the uptake of aetiological accounts, which contextualised mental distress in terms of the whole person and resisted de-politicised, dichotomised, and individualistic narratives. Results are discussed in relation to a broad range of literature in the field, while further research suggestions are provided.

Implementation, efficacy, costs and processes of inpatient equivalent home-treatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial

BackgroundOver the last decades, many high-income countries have successfully implemented assertive outreach mental health services for acute care. Despite evidence that these services entail several benefits for service users, Germany has lagged behind and has been slow in implementing outreach services. In 2018, a new law enabled national mental health care providers to implement team-based crisis intervention services on a regular basis, allowing for different forms of Inpatient Equivalent Home Treatment (IEHT). IEHT is similar to the internationally known Home Treatment or Crisis Resolution Teams. It provides acute psychiatric treatment at the user’s home, similar to inpatient hospital treatment in terms of content, flexibility, and complexity.Methods/designThe presented naturalistic, quasi-experimental cohort study will evaluate IEHT in ten hospitals running IEHT services in different German regions. Within a multi-method research approach, it will evaluate stakeholders’ experiences of care, service use, efficacy, costs, treatment processes and implementation processes of IEHT from different perspectives. Quantitative surveys will be used to recruit 360 service users. Subsequently, 180 service users receiving IEHT will be compared with 180 matched statistical ‘twins’ receiving standard inpatient treatment. Assessments will take place at baseline as well as after 6 and 12 months. The primary outcome is the hospital re-admission rate within 12 months. Secondary outcomes include the combined readmission rate, total number of inpatient hospital days, treatment discontinuation rate, quality of life, psycho-social functioning, job integration, recovery, satisfaction with care, shared decision-making, and treatment costs. Additionally, the study will assess the burden of care and satisfaction with care among relatives or informal caregivers. A collaborative research team made up of researchers with and without lived experience of mental distress will conduct qualitative investigations with service users, caregivers and IEHT staff teams to explore critical ingredients and interactions between implementation processes, treatment processes, and outcomes from a stakeholder perspective.DiscussionBy integrating outcome, process and implementation research as well as different stakeholder perspectives and experiences in one study, this trial captures the various facets of IEHT as a special form of home treatment. Therefore, it allows for an adequate, comprehensive evaluation on different levels of this complex intervention.Trial registrationTrial registrations: 1) German Clinical Trials Register (DRKS), DRKS000224769. Registered December 3rd 2020, https://www.drks.de/drks_web/setLocale_EN.do; 2) ClinicalTrials.gov, Identifier: NCT0474550. Registered February 9th 2021.

Does a comprehensive service user-led education programme effect more positive attitudes towards recovery and less stigmatising attitudes towards people with lived experience of mental distress in medical students? A comparative cohort study.

This study sought to investigate the impact of a service user-led anti-stigma and discrimination education programme, encompassing numerous interventions focused on facilitating multiple forms of social contact, the promotion of recovery, and respect for human rights, on medical student attitudes. A comparison cohort study was used to compare the attitudes of two cohorts of medical students who received this programme as part of their fifth (the fifth-year cohort) or sixth (the sixth-year cohort) year psychological medical education attachment (programme cohorts) with two cohorts of equivalent students who received a standard psychological medical attachment (control cohorts). Attitudes to recovery (using the Recovery Attitudes Questionnaire) and stigma (using the Opening Minds Scale for Healthcare Providers) were measured at the beginning and end of the attachments for each year and compared both within and between the cohorts using Wilcoxon signed-rank or Wilcoxon rank-sum tests. With sample sizes ranging from 46 to 70 across all cohorts, after their psychological medicine attachment both the programme and control cohorts showed more positive attitudes towards recovery and less stigmatising attitudes towards people with lived experience of mental distress. Significant differences between the programme cohorts and the control cohorts were found for recovery attitudes (median difference of 2, p < 0.05 in both fifth and sixth year), with particularly large differences being found for the 'recovery is possible and needs faith' subdomain of the Recovery Attitudes Questionnaire. There were no significant between cohort differences in terms of stigmatising attitudes as measured by the Opening Minds Scale for Healthcare Providers. The introduction of a comprehensive service user-led anti-stigma and education programme resulted in significant improvements in recovery attitudes compared to a control cohort. However, it was not found to be similarly superior in facilitating less stigmatising attitudes. Various possible reasons for this are discussed.

Speaking Truth to Power: Mental Health Service Users’ Experiences of Participation in their Diagnosis and Treatment

In a qualitative study, long-term mental health service users shared their views on the concept of ‘participation’ as shaped by their personal histories of contact with mental health services in Ireland. Adopting a narrative methodology, the study participants were asked to draw on their experiences with mental health services to illustrate their general views on participation by service users in mental health care contexts.In this study, the research participants recounted positive experiences of participation in which their expressed views regarding their symptoms and treatment needs were incorporated into the service responses they received. The data revealed that service users perceived open and inclusive communication by service providers as an important factor in optimising their ability to participate in help-seeking, diagnosis and treatment plans. However, the study also illuminated the chilling effect on participation when service users’ views were not heeded or acknowledged by service providers. The findings highlight how the failure to include service users’ insights can negatively encroach on service user participation. The service user narratives collected in this study exposed the often uneasy juxtaposition of the service user’s personally held ‘truth’ regarding their lived experience of mental distress versus the powerful system of expert diagnosis and treatment. This article focuses on reporting selective findings from the study regarding participation in the contexts of help-seeking, diagnosis and treatment decisions.

Linking coping strategies to locally-perceived aetiologies of mental distress in northern Rwanda

IntroductionHow and why people in a particular setting turn to a specific coping strategy for their distress is pivotal for strengthening mental healthcare and this needs to be understood from...

Practitioner perspectives on service users experiences of targeted violence and hostility in mental health and adult safeguarding

People with lived experience of mental distress experience high rates of targeted violence and hostility based on their mental health status. This user-led study explored practitioners’ perceptions and experiences of supporting service users in these challenging situations and considered the role of adult safeguarding. Six focus groups with practitioners (n = 46) enabled them to respond to data documenting service user’s experiences. This process facilitated knowledge exchange between the research team and practitioners on the ground. The findings illuminate a complex picture where lack of effective structures and processes mitigate against service users in these difficult situations. Practitioners need to invest in trusting relationships, to optimise resources and actively help service users with lived experience of mental distress to find their own solutions. These should involve collaborative empowerment whereby feelings of isolation and rejection can be replaced with hope, a sense of agency and belief in personal control. Points of interest People with lived experience of mental distress are at a high risk of exposure to hate crimes, hostility and discrimination. These risks and those experiencing them, often go unrecognised. There is a lack of knowledge and understanding about what people need, how they cope and what helps in these situations. Professionals and practitioners from different disciplines face very complex challenges in responding to and helping people, resulting in service users falling through the net when they need it most. Services in the community and hospital are not working together effectively to support people experiencing targeted violence and hostility. There is a lack of coherence in the way that the criminal justice system and adult safeguarding frameworks support effective working. There is an urgent need to listen to and engage with service users’ own voices in these environments and to work with them to find solutions that help them feel safe and in control. These should particularly utilise relationship-based practice and peer support.

Expert by experience involvement in mental health nursing education: The co-production of standards between Experts by Experience and academics in mental health nursing.

Expert by Experience (EBE) involvement in mental health nursing education has demonstrated benefits, including enhancing understanding of holistic and recovery-focused practice and enhanced application of interpersonal skills. Structure and support for EBE involvement is lacking; often resulting in inadequate preparation and debriefing and tokenistic involvement. Service user involvement in mental health nursing education should be underpinned by lived experience perspectives. An exploration of EBE involvement in nursing education from the perspective of those with lived experience. The development of standards designed to provide structure to better support future EBEs involved in higher education. An exemplar for co-production of standards between EBE and nurse academics which has applicability for other contexts. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The standards could potentially strengthen EBE involvement in mental health nursing education, enhance their confidence and increase the retention of EBEs by creating an inclusive working culture. By increasing support for EBEs, the benefits to mental health nursing practice are likely to be maximized. Introduction Involving people with lived experience of mental distress in mental health nursing education has gained considerable traction yet broader implementation remains ad hoc and tokenistic. Effective involvement requires curricula be informed by lived experience of service use. Aim To develop standards to underpin expert by experience involvement in mental health nursing education based on lived experience of service use. Methods Phase one used qualitative descriptive methods, involving focus groups with service users (n=50) from six countries to explore perceptions of service user involvement in mental health nursing education. Phase two utilized these findings through consensus building to co-produce standards to support Experts by Experience involvement in mental health nursing education. Results Three themes emerged in Phase one: enablers and barriers, practical and informational support, and emotional and appraisal support. These themes underpinned development of the standards, which reflect nine processes: induction and orientation, external supervision, supportive teamwork, preparation for teaching and assessing, "intervision," mutual mentorship, pre- and post-debriefing, role clarity and equitable payment. Conclusions These standards form the framework entitled; Standards for Co-production of Education (Mental Health Nursing) (SCo-PE [MHN]). Implications for Practice The standards aim to support implementation of Expert by Experience roles in mental health nursing education.

A Case Study of a Peer Respite's Integration into a Public Mental Health System

Peer respites are short-term residential mental health programs staffed by peers with lived experience of mental distress. This case study examines qualitative data of peer staff and non-peer program directors' experiences working at the first peer respite in California. Throughout a five-year study (2010-2015), researchers conducted 20 semi-structured interviews and three focus groups with 25 peer staff and three program directors. The study found that peer staff reported differences in recovery-oriented service delivery between the county health system and their training in Intentional Peer Support. Peer staff indicated that such differences contributed, in part, to the program's gradual acceptance of the service delivery model promoted by the county, and the program's integration enabled its continued support via public funds. This paper concludes with policy recommendations to transform public mental health systems in collaboration with peer staff.

Developing a Common Vocabulary: Questions of Purpose and Priority

The “Standards and Guidelines” provide much-needed considerations for any agency or group undertaking the project of creating diagnostic/descriptive categories, including the vital assertion that those with lived experience of mental distress must be a valued part of the process. However, to fully take into account the unique needs of those with lived experience, we must also question the very assumption that diagnostic and descriptive systems are necessary to promote well-being. This article addresses the current tension in diagnostic priorities and explores the benefits of encouraging personal expressions of mental distress in the context of activism and peer support.