ABSTRACT Introduction Worldwide, mental health systems continue to grapple with providing recovery‐oriented services as part of broader reform efforts. Critical to the objective of transforming mental health services is the employment of a rights‐based, non‐clinical lived experience workforce. Vital to undertaking the roles, and supporting this workforce, is a comprehensive understanding of the knowledge and practices of the discipline, particularly in situations where rapid growth may see this workforce developing in an ad hoc way. The aim of this review was to determine how members of the mental health lived experience workforce describe and enact our discipline, by synthesising evidence and illustrations. Methods A narrative review methodology employed searches for international peer reviewed literature and policy documents related to lived experience work. Resources required at least one mental health lived experience author. We used a deductive approach to the categorisation of three designated mental health lived experience role types: service delivery (such as peer support); leadership; and Indigenous. An inductive approach was then taken to identify the knowledge and practices informing the three role types. Relevant texts were allocated amongst the research team, independently read, coded and themed, followed by team discussions to reach consensus where there were conflicts. Results After full text reading, we identified 25 resources. There were many more resources about the knowledge and practices of lived experience direct service delivery than about leadership roles. Three themes emerged from the knowledge and practices for each role type. For direct service roles knowledge was: having been there; knowing helpful qualities of relationships; and knowing how to use your own lived experience intentionally. Practices for direct service roles were: working relationally, sharing lived experiences in a meaningful way and working in a values and rights‐based way. Knowledge required for leadership was: ethical decision‐making; being informed by collective/shared history and knowing how to create change. Required practices were: transforming services from within; embedding the lived experience workforce and championing justice. Themes describing Indigenous knowledge were: challenging exclusively Euro‐centric modes of treatment, truth‐telling and self‐determination. Emerging themes on practices of designated Indigenous lived experience workforces were: relational and community approaches, trauma informed, and culturally sensitive and safe practices. Conclusion Articulation of the knowledge and practices underpinning the lived experience discipline is required for this workforce to be confident in the scope, purpose and history of their roles and for organisations to successfully establish them and provide effective supports. For Indigenous workers in designated lived experience roles, approaches to wellbeing and cultural practices cannot be separated from the way that the roles are carried out. Embedding Indigenous leadership, knowledge and practices would strengthen the human rights, justice‐based and non‐clinical nature of these roles, is a necessary response to colonial violence and would guide workforce development for other LE staff, mental health professionals, and mental health service development.

INTRODUCTION:Mental health legislation authorises involuntary psychiatric intervention in certain circumstances. Although human rights concerns are becoming more prominent, debates among legal experts, clinicians and activists continue to swirl around people's rights to equal recognition before the law, such as described in the (United Nations Convention on the Rights of Persons with disabilities, 2006). AIM:This qualitative descriptive study aimed to better understand diverse views of people known to hold a critique of coercion in mental health services, on the practical expression of upholding human rights in the context of mental health laws. METHOD:Individual semi-structured interviews were conducted with 15 key informants from five different countries and data was analysed using an inductive, thematic approach. RESULTS:Overall, informants characterised mental health laws as discriminatory, harmful and unjustifiable. Three themes and six sub-themes were identified. This study reports on the major themes which include: an ethical position (focusing on the present harms associated with mental health laws), strategies, (an expression of the opportunity to bring about change) and a visionary position. We explore these three features in the views of key informants as important positions in the field of abolition, and analyse each for the 'hermeneutic resources' - forms of collective interpretive resources - they provide. CONCLUSIONS:Abolition of mental health laws is often seen as not feasible in the context of psychiatry. However, abolition theories and practices are hermeneutic resources that need to be better understood because they offer social justice and community-led solutions beyond mental health laws and systems.

BackgroundThe experience of crisis is characterized by acuity of emotional pain and distress, often requiring immediate support. Gerald Caplan previously described the stages of mental health crises as a loss and return of homeostasis. This hermeneutic phenomenological study explored personal narratives of crisis to more deeply understand the temporal sequencing of crisis.MethodInterviews with 31 people provided rich reflections on their experiences of crisis and interaction with crisis care, which were analyzed using a reflexive thematic approach.FindingsFindings identify a temporal sequence involving i) a preliminary phase of build-up and increasing intolerability, followed by ii) a liminal phase or breaking point and a provocation to action, and then afterwards, iii) a post-liminal phase of meaning-making and potential emergence. It was noted that findings mirror a similar pattern to Joseph Campbell's A Hero's Journey, and therefore, the analysis included a theoretical overlay as the findings from the study were compared against the traditional stages of crisis by Gerald Caplan and the storytelling pattern of Joseph Campbell. Notably, the potential for transformation was amplified when the crisis experience was responded to with understanding and compassion.ConclusionFrom the study, a Hero's Journey became an alternate window to view the role of crisis and recognize within crisis an alchemical space of liminality and possibility during periods of intense emotional instability. Ultimately, the storytelling pattern of A Hero's Journey shapes the significance of the experience of a mental health crisis with greater verisimilitude.

Coproduction has emerged as an important means of effective mental health service delivery. Unfortunately, this term is commonly misunderstood, with tokenistic participation too often presented as coproduction. Funding and resourcing have been identified as significant, and often insurmountable, barriers to achieving coproduction. This paper presents findings from a cooperative inquiry project, addressing ideas and strategies for working towards coproduction within an academic unit. Three consumer/lived Experience academics and three nonconsumer academics (from Nursing, Occupational Therapy and Social Work) participated in a series of in-depth conversations to consider and identify potential strategies to advance the faculty's progress towards coproduction. Conversations were transcribed and analysed using a thematic approach. Five main themes were identified: importance of coproduction; preparing for coproduction; barriers to coproduction; the need for university transformation; and power. A belief in the inherent value of coproduction was shared among the group, and strategies were identified to clarify the level of participation. Radical transformation of universities, aligned with contemporary industry practice, is essential to achieving coproduction. Strategies such as allocating vacant academic positions for health professionals to consumer academics are indicative of measures required for genuine aspirations for coproduction to be realised and to address the seemingly insurmountable funding issues. Universities must recognise power differences and remain honest about their position according to participation ladders. These findings provide guidance for academics who acknowledge the value of coproduction to address the commonly identified barriers to its implementation.

BACKGROUND:Medical interventions have a place in crisis support; however, narrow biomedical and risk-driven responses negatively impact people seeking crisis care. With increasing shifts towards involving people with lived experience (service users) in designing services, foregrounding people's desired responses is critical. Accordingly, the aim of the study was to explore the wished-for crisis responses from the perspective of people who have experienced crisis and accessed crisis care. METHOD:Using a hermeneutical phenomenological approach, in-depth interviews were conducted to determine the desired crisis responses of 31 people who self-reported experiencing mental health crises and accessed crisis services at ED, phone lines and/or crisis alternatives. RESULTS:The findings identified wished-for responses that gave a felt and embodied sense of their own safety influenced by a human-to-human response, emotional holding, a place of safety and choice within holistic care. For such responses to be possible, participants identified organising principles, including recognising crisis as meaningful and part of our shared human experience, understanding risk as fluid and a whole-of-community responsibility for responding to crises. CONCLUSION:This paper proposes how insights from people who have experienced crises can be translated into more beneficial crisis care. PATIENT OR CONSUMER CONTRIBUTION:Most authors are in identified lived experience roles. The first author engaged with participants during the recruitment and interviews and was explicit regarding their lived experience. Service users were involved as advisors, providing input throughout the study.

The ED is increasingly the first point of contact for people who have no alternative when they are in a mental health crisis. However, there is mounting evidence of inadequate and negative responses to mental health crises in the ED, which has been identified as a 'human rights flashpoint'. This paper presents the desired crisis support from people who have accessed the ED in a mental health crisis and offers significant opportunities to use lived experience knowledge to reshape crisis care. These key messages arise from a phenomenological analysis of in-depth interviews with 31 users of ED services, a PhD study conducted by a lived experience researcher. The paper concludes with six recommendations that combine collective wished-for responses with tangible examples of how these desired responses can be translated into crisis care practice.

Accessible Summary What is known about the subject? Most nurses who work in mental health in Australia have completed a comprehensive nursing programme at a university. This training has been widely criticized and has not produced “job‐ready” graduates. Public inquiries into mental health services have highlighted the need for transformation of mental health services and concern about future nursing shortages. What the paper adds to existing knowledge? This survey highlights what service users and supporters perceive are useful nursing skills and capabilities. The characteristics of helpful encounters with nurses are also described. What are the implications for practice? Helpful nursing practice is aligned with traditional nursing values and theory, rather than the performance of specific tasks. Improving the retention of nurses to this specialty area of practice requires educational processes to enable nurses to enact values, develop their therapeutic potential and undertake facilitative and supportive practices which are helpful to service users. Abstract Introduction Successive inquiries into mental health services in Australia have identified the need for major reform of services and proposed a return to direct‐entry nursing training. Aim/Question To identify what service users, family and supporters have found helpful in their encounters with nurses in mental health settings. Method A survey of 95 service users and supporters rated the importance of the capabilities and competencies of nurses. They also shared examples of helpful encounters with nurses which were subject to thematic analysis. Results The most highly rated competencies were around demonstrating caring, empathy and understanding, and responding effectively in crisis situations. Helpful encounters involved enacted values, highly skilful interpersonal and psychotherapeutic engagement and practices that were facilitative and supportive. Discussion The process and content of pre‐registration nursing training needs to refocus on the nurse meeting the needs of service users and supporters, rather than the instrumental needs of services today. Implications for Practice Educational reform may be necessary but insufficient to address anticipated nursing workforce shortages. Policymakers and health service directors need to align services with mental health nursing values and promote practices aligned with what service users and their supporters report as helpful.

Abstract Lived experience leadership is championed as key to realising progressive change across the mental health sector. This article represents an effort to diminish the hermeneutical lacuna associated with lived experience leadership, and so redress an identified barrier to its advancement. Herein, we present an analytic account of the defining features of lived experience leadership. Interviews were conducted with 19 people identified by their peers as lived experience leaders regarding their views on lived experience leadership and related concepts such as power, authority, influence and leadership more generally. Per our discursive analysis of interview data, lived experience leadership is constituted by acts realised via the use of a specific type of power- people with lived experience’s experience-based and systems-informed knowledge of and fidelity to themselves as both individuals and as a collective- and directed towards increasing others’ access to this power. Results suggest how lived experience leadership might be distinguished from other similar practices, and may be utilised as a tool with which to promote its proliferation.

Mental health nursing requires a specialist range of capabilities and values. In Australian contexts, the preparation of nurses to work in mental health settings has attracted criticism from government reviews, academics, and graduate nurses. Insufficient mental health content and clinical placement experience in undergraduate nursing courses have been central to this criticism. The study aim was to identify the areas and modalities of capability development of graduate mental health nurses, from the perspectives of end point users. In order to meet the aim, a four-item cross-sectional online survey with three additional and open-ended questions was developed. The questions were co-designed with consumer academics and reviewed by consumer and carer organizations. The survey was widely distributed across Australian consumer and carer organizations, with 95 useable responses. Findings indicated strong support for lived experience being integrated into teaching teams for nurses, as well as support for undergraduate direct entry for mental health nursing. Themed content from open-ended responses reflected the survey outcomes as well as prioritizing skill development to support better therapeutic relating and nurse self-care. Key findings included strong support for greater lived experience input into mental health nurse education, specialist undergraduate preparation and a focus on developing relational capabilities in the mental health nurse workforce.

This article explores how employees with mental illness perceive HRM and its impact, drawing on consumer-centred perspectives. Using the case of consumer-workers employed for their lived experience of mental illness in mental health care services, we investigate the degree to which they feel included or marginalised by HR systems, processes and practices. Through a mixed method study designed along co-production principles, we found consumer-workers faced different but interrelated problems stemming from their status: a general lack of understanding of the role and its purpose; inequity in pay rates, workplace conditions, and training and development; as well as employment precarity and difficulties around disclosure, stigmatisation and discrimination. Overall, organisational support for these unique roles seemed to be lacking despite the clear business need for these positions. We make several contributions: firstly, we show how employees in a unique role that requires experience of mental illness are impacted by the interaction between HR systems, processes and practices; secondly, we illustrate why HR scholars need to engage with varied paradigms of knowledge about mental illness beyond the dominant medical/psychiatric one; and thirdly, we demonstrate a methodology that not only explores employee perspectives, but includes employees in the research design and process.

Purpose To explore the views and opinions of nonconsumer researchers to the concept of an Expert Consumer Researcher Group. Design and Methods Qualitative exploratory involving individual interviews with nonconsumer mental health researchers experienced in working collaboratively with consumer researchers. Data were analyzed thematically. Findings Participants viewed the concept positively, albeit with caution. Perceived advantages included: greater visibility and enhanced access; collegiality; sharing and creating expertise; broader acceptance; making it mandatory; and structure and location. Participants were concerned about potential tokenism and implementation barriers. Practice Implications Consumer involvement enhances the quality and relevance of research, potentially impacting clinical practice.

Increasing efforts are being made to prevent and/or eliminate the use of seclusion and restraint in mental health facilities. Recent literature recognises the importance of the physical environment in supporting better outcomes in mental health services. This rapid review scoped the existing literature studying what physical design features of mental health facilities can reduce the use of seclusion and physical restraint.DESIGN:A rapid review of peer-reviewed literature.METHODS:Peer-reviewed literature was searched for studies on architectural design and the use of restraint and seclusion in mental health facilities. The following academic databases were searched: Cochrane Library, Medline, PsycINFO, Scopus and Avery for English language literature published between January 2010 and August 2019. The Joanna Briggs Institute's critical appraisal tool was used to assess the quality of included studies.RESULTS:We identified 35 peer-reviewed studies. The findings revealed several overarching themes in design efforts to reduce the use of seclusion and restraint: a beneficial physical environment (eg, access to gardens or recreational facilities); sensory or comfort rooms; and private, uncrowded and calm spaces. The critical appraisal indicated that the overall quality of studies was low, as such the findings should be interpreted with caution.CONCLUSION:This study found preliminary evidence that the physical environment has a role in supporting the reduction in the use of seclusion and restraint. This is likely to be achieved through a multilayered approach, founded on good design features and building towards specific design features which may reduce occurrences of seclusion and restraint. Future designs should include consumers in a codesign process to maximise the potential for change and innovation that is genuinely guided by the insights of lived experience expertise.

This review examined research on physical design features in mental health facilities that reduce the use of seclusion and restraint. Overall, the review found evidence that the physical environment can have a role in supporting better outcomes for consumers of inpatient mental health services, including reduction in the use of seclusion and restraint. Improvements to the physical environment are likely to be achieved through good design features; these include adequate space and privacy, no overcrowding, exposure to daylight and other appropriate lighting, reduced levels of unpleasant noise, access to gardens and a home-like environment.

This article discusses initiatives aimed at preventing and reducing 'coercive practices' in mental health and community settings worldwide, including in hospitals in high-income countries, and in family homes and rural communities in low- and middle-income countries. The article provides a scoping review of the current state of English-language empirical research. It identifies several promising opportunities for improving responses that promote support based on individuals' rights, will and preferences. It also points out several gaps in research and practice (including, importantly, a gap in reviews of non-English-language studies). Overall, many studies suggest that efforts to prevent and reduce coercion appear to be effective. However, no jurisdiction appears to have combined the full suite of laws, policies and practices which are available, and which taken together might further the goal of eliminating coercion.