1. As services become more truly focused on service users needs and accept the value of lived experience, so there are obvious implications for the composition of the workforce … (Sainsbury Centre for Mental Health, Implementing Recovery. A framework for organisational change, 2010) How Many Mental Health Professionals Do You Need to Run a Mental Health Service? Rachel Perkins Director of Quality Assurance and User Experience South West London and St Georges Mental Health NHS Trust

2. Them and us – experts and patients Traditionally it is assumed that mental health services must be run by expert mental health professionals Assumed that the expert professional has access to a body of knowledge that cannot be understood by non-experts Therefore it is mental health workers to fix people - tell people what they should do and get them to comply with their expert advice

3. But recovery is not about being fixed by and expert – like a refrigerator or a car Recovery is about rebuilding your life. Finding meaning in your distress. Discovering and using your own resources and resourcefulness. Finding a new sense of self, meaning and purpose - growing within and beyond what has happened to you. This requires not just the expertise of traditional mental health experts The expertise of lived experience is critical. Recovery is not a professional intervention nor do professionals hold the key

4. Technical treatment may be one thing that people may find helpful in their journey of recovery – but only one thing among many To me recovery means being in the driving seat of my life. I dont let my illness run me. Over the years I have learned different ways of helping myself. Sometimes I use medications, therapy, self-help, mutual support groups, friends, my relationship with God, work, exercise, spending time in nature – all of these measures help me remain whole and healthy even though I have mental health problems. (Deegan, 1993)

5. Expertise of lived experience is central to recovery... Valuing the experience gained from living with mental health problems – using your experience to help others Reciprocity - moving beyond them and us Feeling less alone The gift of hope that people can give each other - images of possibility Sharing experiences and different ways of understanding what has happened Sharing experience of different treatments and support Working out ways of dealing with problems Support from someone who understands what you are going through Therefore we need to include the expertise of lived experience in our workforce

6. Including the expertise of lived experience in the mental health workforce Employing people with mental health problems in existing positions in the workforce … important, but not enough … A nurse (or a psychologist, or a social worker or a doctor, or an occupational therapist) with mental health problems is still a nurse (or a psychologist, or a social worker or a doctor, or an occupational therapist) Traditional power, hierarchy, claims to special knowledge about others etc. remain … and get in the way of people working together and caring for themselves and each other

7. Including the expertise of lived experience in the mental health workforce Creating new roles and relationships - employing Peer Support Workers to provide services A relationship based on mutuality and a shared journey Creating relationships where people can learn and grow as equals drawing on each others expertise and experience –A way of sharing our personal story – A way of being in a relationship that empowers people to recover – A way of offering help and support as an equal – A way of teaching, learning and growing together – An attitude that values each persons experience Peer support is about being an expert at not being an expert and that takes expertise. A win-win arrangement promoting the recovery of those employed (by enabling them to use their experience to help others) … promoting the recovery of those using services (by enabling them to access the expertise of lived experience)

8. The dangers of professionalising distress: deskilling individuals … deskilling communities … stopping people from discovering and using their own resourcefulness Mental health services – whether they be statutory or non-statutory - and the mental health professionals who inhabit them can, albeit often unwittingly, serve to perpetuate exclusion and marginalisation in a kind of vicious cycle. People with mental health problems believe that experts hold the key to all of our problems Our nearest and dearest believe we are unsafe in their untrained hands. And we all become less and less used to finding our own solutions and, embracing distress and human problems as a part of ordinary everyday life (OHagan, 2007)

9. The challenge Handing over control to service users and communities by fostering service user leadership, integrating with other sectors and fostering community development and inclusion... re-creating communities that can accommodate human distress and human problems. People with mental health problems, as well as communities, need to start believing they hold most of the solutions to human problems. (OHagan, 2007)

10. But what about traditional mental health workers? Professionals will remain important, but they will have to recognise that their contribution needs to be made in a different way, acknowledging service users self-defined priorities. (Sainsbury Centre for Mental Health, Implementing Recovery. A framework for organisational change, 2010) on tap not on top putting our expertise at the disposal of those who be able to make use of it... we need to see ourselves as carriers of technologies that we may want to use at times, just like architects, plumbers and hairdressers. (OHagan, 2007)

11. So how many mental health professionals do you need to run a mental health service? … we expect to see a greatly expanded role for peer professionals in the mental health service workforce of the future. We recommend that organisations should consider a radical transformation of the workforce, aiming for perhaps 50% of care delivery by appropriately trained and supported peer professionals … (Sainsbury Centre for Mental Health, Implementing Recovery. A framework for organisational change, 2010)