This week, Mad in America explores three new articles around peer support work. The first essay argues that peer support is crucial to mental health recovery and that lived experience of mental health struggles should be acknowledged as expertise on par with medical and psychiatric training. The second study finds that peer support workers often face stigma from their colleagues. The third study finds that systemic barriers, lack of role clarity, and undervaluing lived experience are persistent problems for peer support workers and lived experience experts.
Lived Experience and Peer Support as Foundations of Recovery
A new essay published in the Irish Journal of Psychological Medicine outlines the value of lived experience and peer support in recovery from mental health struggles. The author, Mike Watts from the Royal College of Surgeons in Ireland, argues that peer support work can be important in recovery from both mild distress and more severe conditions such as psychosis.
In this reflective essay, Mike Watts details his own lived experience of psychosis and his shared recovery journey with his life-partner, Fran, made possible by peer support and recovery-oriented approaches to mental health. In his youth, the author had an unhelpful encounter with psychiatric care where he was diagnosed with “pathological shyness.” Years later, his life-partner experienced psychosis after childbirth. Over the next three years, Fran was hospitalized, diagnosed with multiple mental health conditions, prescribed huge amounts of drugs (18 pills per day at one point), and exposed to ECT and periods of solitary confinement with little emphasis on recovery or psychosocial support.
They both eventually found hope through Grow, a mutual peer support organization. Watts describes how this organization, through an emphasis on peer support, meaningful social roles, spirituality, and community involvement, enabled both he and his life-partner to pursue long-term recovery. Watts would go on to become the National Programme Coordinator for Grow. He writes:
“The main theme to emerge was that recovery from mental illness through Grow was experienced as ‘a re-enchantment with life’ countering the observation by Max Weber that when science is applied directly to the human condition it tends to rob life of enchantment. It also countered the experience of many for whom seeking help and receiving a diagnosis of psychosis had represented the start of a life of disability, dependency and social discrimination.”
The author believes lived experience and mutual peer support are fundamental components for mental health recovery. He advocates for a view of recovery that goes beyond the clinical emphasis on symptom reduction. This includes personal, social, and experiential recovery across both mild and more severe mental health struggles.
Lived experience of mental health struggles is a kind of expertise that traditional medical and psychiatric training cannot replicate. These experts can empathize with mental health struggles in ways that clinical experts without lived experience simply cannot. This can foster hope, a more authentic connection, and less judgment than clinical and medical approaches to mental health recovery. Peer support work can also dismantle the power imbalance between service users/patients and clinical providers. The relationship between peer support worker and service user is one of reciprocity in which both parties are empowered and supported in their recovery rather than an expert attempting to cure a struggling patient.
The author outlines the main differences between the medical and recovery-oriented paradigms in psychiatry. The clinical approach focuses on symptom reduction and stabilization, measures recovery using clinical metrics, and is primarily led by clinical professionals. The recovery-oriented approach focuses on meaning, self-determination, and hope, defines recovery subjectively based on individual goals and needs, and is led by the patient/service user with support from peers and the community.
In order for peer support to be effective, mental healthcare systems must value lived experience to the same degree as medical and clinical knowledge, provide adequate organizational structure for peer support workers, and foster respect for peer support roles as equals alongside other mental healthcare workers.
Peer Support Workers Face Stigma From Colleagues
A new article published in the International Journal of Mental Health Systems finds that mental health peer support workers (PSWs) often face stigma from their colleagues. This study, authored by Trishna Chauhan from the University of Lancashire in the UK, reports that PSWs respond to this stigma by trying to demonstrate the legitimacy and value of their roles to their peers.
PSWs’ roles are often misunderstood and undervalued by other healthcare professionals. The aim of this study was to examine how PSWs working in the UK National Health Service experienced and responded to stigma from their colleagues. To achieve this goal, the author conducted semi-structured interviews with 70 PSWs and their colleagues.
The interviews lasted between 20 minutes and two hours and focused on experiences working as a PSW, workplace relationships, perceptions and experiences of stigma, and strategies use to cope with stigma. The author analyzed interviews and identified common themes from 36 PSWs and 34 other healthcare staff that worked alongside PSWs.
PSWs reported experiencing both subtle and explicit stigma. Subtle forms of stigma included PSW experiential knowledge being devalued, dismissive and patronizing treatment, and being viewed as less professional by other healthcare staff. One PSW said “There have been a few times where my supervisor has tried to protect me from things and not told me about patients struggling and stuff like that… which I felt a little bit patronised”
More explicit forms of stigma included colleagues openly questioning PSWs’ competence, exclusion from staff meetings and clinical decision making, and assumptions that their mental health history made them unsuitable for working in mental health. One PSW reported that their concerns were often dismissed as them being too unwell to do the job: “Every time I did try and say I’m not happy with this, or can you give me some advice, it was ‘well maybe you’re not well enough to this job.’”
PSWs adopted three main strategies to manage the experience of stigma. (1) Demonstrating commitment to their role included presenting themselves as professionals and adhering to organizational rules and expectations. Some PSWs reported overworking in an effort to demonstrate their value to colleagues. One PSW reported that they “haven’t had one day off for five years.” Another PSW said “I felt that I had to work even harder than if I’d just been a normal support worker because I felt I had something to prove.”
(2) Leveraging experiential knowledge as expertise included positioning PSW lived experience as valuable knowledge that other mental health staff did not possess. PSWs also commonly framed their lived experience expertise as complimentary to the clinical and medical expertise of their colleagues.
(3) Using the role for reciprocal benefits included PSWs using their experience to aid in their own recoveries. One PSW said “using your experience definitely helps you in your own recovery.” Another commented that “I can use my experiences to help other people. And it makes me feel a little bit less shit frankly.”
This study had two main limitations. Participant accounts could be biased by misremembering or reporting what is socially acceptable rather than what is true. Participants were all working in the UK National Health Service, limiting generalizability to other populations.
Systemic Barriers, Lack of Role Clarity, and Undervaluing lived Experience Expertise Create Challenges for Lived Experience Workers on Multidisciplinary Mental Health Teams
A new study published in the International Journal of Mental Health Nursing reports that systemic barriers, lack of role clarity, and undervaluing lived experience expertise complicate the integration of lived experience workers (LEWs) within multidisciplinary mental health teams. The authors, led by Olivia Hatchman from the Lively Collective in Australia, believe sustainable inclusion would require role clarity, shared responsibility, and addressing different perspectives around recovery. Without shifting the current practices and perceptions around LEWs, “integration of lived experience into mental health risks being symbolic rather than transformative.”
The goal of this research was to explore the perspectives of mental health workers around integrating lived experience roles within multidisciplinary mental health teams. The authors conducted semi-structured interviews with seven LEWs and seven mental health clinicians from Melbourne, Australia. They then coded the interview data for recurring themes related to integrating lived experience into current mental health systems.
The authors identified four main themes in the interview data. (1) Systemic barriers hinder integration. This included having LEWs’ offices being located separately from other mental health workers, having few LEW team members which made influencing the team difficult, lack of adequate onboarding for LEW roles, lack of mentorship, high turn-over rate for LEWs, and a dominant biomedical framework.
(2) Lack of role clarity limits LEW impact. The lack of clarity for LEW roles often created tension. LEWs reported having to explain their roles to colleagues repeatedly and overlapping roles with social workers leading to social workers feeling threatened by LEWs. Clinicians reported being unclear on LEWs roles and boundaries in clinical settings. Some clinicians also believed that recovery-oriented approaches used by LEWs needed to be balanced with clinical concerns due to possible legal repercussions borne exclusively by clinicians.
(3) Discipline-based defensiveness acted as a barrier to integration. This included tension around beliefs about recovery, authority, treatment, and approaches to risk and autonomy. LEWs often felt that their input was ignored, their experience was undervalued, and priority was given to clinical and medical voices despite being assured that a multidisciplinary approach would be used. Some LEWs reported being scared to speak in clinical meetings and not even being able to finish sentences without being interrupted.
(4) Clinical and LEW perspectives often clashed. This included different backgrounds, communication styles, and past experiences. As a result of these clashes, some LEWs reported having to “mask” their behaviors by being especially careful with language so as not to be labeled overly aggressive or emotional. One LEW reported being encouraged to speak up in clinical meetings only to be reprimanded afterwards: “I’ve been pulled aside (and told my opinion) is not valued…be a little bit quieter.” LEWs also reported feeling inferior due to a lack of a formal degree.
“I always say that when you’re a peer worker you have to work twice as hard. To be accepted right, because we don’t have that degree that title to say I’m a social worker. I’m an OT, or I’m a nurse. We don’t have that. Yeah. So to me, you need to work really hard. You need to not rock the boat. I try very hard not to rock the boat because for me to be accepted.”
This research had three main limitations. The interview data could have been biased by participants reporting what was most socially acceptable rather than what was accurate. The small sample size, while common in qualitative research, limits generalizability. All participants were from a single health service in Melbourne, Australia, further limiting generalizability.
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Chauhan, T. (2026). Experiencing and navigating occupational stigma as a peer support worker in mental health services: A qualitative exploration. International Journal of Mental Health Systems, 20(1). (Link)
Hatchman, O., Buchanan‐Hagan, S., Foster, K., Pemo, K., & Alexander, L. (2026). From representation to integration: Lived experience in Mental Health Teams: A qualitative descriptive study. International Journal of Mental Health Nursing, 35(1). (Link)
Watts, M. (2025). Reflections on the value of lived experience and mutual peer support in recovery from all forms of mental illness, including psychosis. Irish Journal of Psychological Medicine, 43(1), 29–34. (Link)
What my group does is called “twinning.”
Two students are paired up and go through the training and therapy they need by doing it on each other. They are assisted by a course supervisor and a case supervisor.
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