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Binds, Mirrors and Integration: Reflections On Lived Experience In The Mental Health Professions

Continuing to get the message out about how #in2gr8mentalhealth stands for integrating the value of lived experience of mental health problems experienced by those within the mental health professions. I spoke virtually (winter lurgi prevented otherwise) on Friday at the UCL practitioner wellbeing conference, and Lancaster University conference celebrating the involvement of LUPIN with the clinical psychology training course,thinking also about lived experience of mental health problems in the profession. 

Lived experience of mental health problems in mental health professionals comes with differences in power and privilege to others experiencing mental health problems, these differences are ascribed by the ability to access and complete full time training, and then inhabiting a professional role which comes with some authority to act within existing mental health systems when working in a way that others might not have. However, this should not lead to a minimising of the severity of challenging events that professionals have experienced, nor the impact of those events on their wellbeing - I say this because ive encountered narratives of "oh they've probably just had the mental health equivalent of the common cold". This is not true, people have been through social and emotional traumas and devastations none would wish on any, I'm not going to list them here for fear of falling into a need to 'prove' ourselves worthy of 'madness' on the one hand, whilst at the same time fearing we fall far short of some kind of professional  'perfection' fallacy on the other. What a bind. Where are these pole ends coming from and why do they exist? It is painful for both who get stuck there, and unnuanced bearing little resemblance to our complex, multi-identitied, muti-feelinged, multi-experienced selves. We are all simply as we are, no? We are not binaries. 

There is an increasing wish to be able to bring all of the self to working as a professional in a way that can best help, to value lived and trained experiences together. The wish underlines a puzzlement as to why lived experience can be valued in some but not others working in mental health for example peer support workers. This strange dichotomy says, I am sure, more about the early learning state of the NHS on this issue than the actual distribution of lived experience and its value in people in all positions in the mental health scene. How do mental health professionals with lived experience, learn together with our peer support workers, to integrate training, theory and what we've been through, to best support others? Again, my thoughts are, that in silos we loose. We are wondering how to value this personal experience in general in our registered professions, it happens in many places, but it is not systematic, overly impacted on what your peers' attitudes are in local areas, and not championed overtly from the highest levels - this is a problem (particularly the latter - see Alex Haslam's Identity Leadership model). 

We are wondering also how best to work with our personal experience in the service of helping others. Where do we place ourselves in the therapeutic encounter if we value lived experience? How much is helpful to say? When is it helpful to say it (timing os also so important)? How openly can we think about that with our clients? Could a service be set up that clients can specifically says practioners have lived experience and inforgrapgics about what you can ask and know about that? Is that thought even helpful! I don't know I'm exploring! As we must! :) How can we research to know more about what those seeing us for help might think about all this?

Personally, I imagine it would be personal and nuanced for each client, and important to prevent fear for the person seeking help of  'role reversal' in therapy (see Jonny Lovell's PhD). To be able to contain the other's distress is the primary function of the person in the therapists role, we still must be able to do that. This is not questioning a fitness to practise, it is discriminating fitness to practice issues from the value of lived experience of having mental health problems the therapeutic encounter - can I shout louder about how important that difference is please! Because stigma still demands conflation of fitness to practice and lived experience and leaves us in wholly muddy, fearful waters. I am asking, what information - both experienced and trained - can we weave together in providing a framework for support for others, knowledge won by heart and mind.

How do we titrate out factors for 'use' that help, factors of 'hope' and 'alongsideness' that come from having walked through the fire too, which have been shown to support client recovery from peer support workers? Which models might these factors fit or extend nicely? And which not? And why the difference? What does it tell us about the epistemological stances in these models and what we might challenge or agree with to better evolve what we offer? We hope to open conversations and research integrated ways of working. We hope to stay open and curious about possibilities we perhaps can't see yet, but hope to imagine. Research is in it's infancy and will begin to help us understand this area, and it is exciting. In the meantime, we speak out from our hearts to the mental health scene at large against, at the very least, the repression, denial or stigmatising of the lived experience of mental health problems in professionals, particularly when it is being honoured elsewhere. 

We speak also to narrate what gets forgotten, that these challenging experiences can bring forth gifts of growth of help to others. We need to learn more about how we do that, but also we need to have narratives of post traumatic growth validated to stand against narrow stigmatised views of mental health problems. There is often little of the narrative of 'hope' and 'meaning' that gets left, after the bulldozing language of 'risk' runs amok in headlines and bylines and so in people's minds.

How do we stand by the courageous work and growth and possibility and personal wisdom of those we see when we are in a therapist role, and not stand by that in ourselves? How do we extol the effort, learning, flourishing that others do through adversity, and not honour that in ourselves as overt growth points in our training? How have we left this outside?

We are in a time of putting up a mirror to our own profession, to ourselves as professionals, to our persons in the professional, and we are learning where the books left off. 

But we have always been here, those many of us who are wounded healers, we have been doing good work for a long time. Perhaps it is just time now to speak a little louder and surprise the rest. 

With warmth as we draw towards the holiday season, and all best for some rest.

Dr Natalie Kemp 

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