— Discussion and Analysis

The importance of GPs was evident, given their key role in providing mental healthcare, especially to those referred to as “the missing middle”—consumers with mental health issues who fall through the gaps in care in other parts of the healthcare system. The study found that many respondents chose to engage with mental healthcare providers primarily due to accessibility and affordability, but also because of the relational qualities that they displayed as part of delivering care. These qualities fostered consumers’ sense of trust, feeling listened to, and not being stigmatized as part of help seeking and having their mental health needs met. Implications for education and practice are offered.

We were similarly gratified to read an Editorial in The Lancet Psychiatry arguing for pressure from service users to more actively shift societal discourse. And yet, as welcome as these statements are, we worry that the primary problem we are all up against is not a paucity of articulated support for service-user involvement but rather the gap between rhetoric and reality.

Drawing on theoretical ideas of participation, recovery and social citizenship, the study aim and objective was to identify and analyse the knowledge, attitudes, and practices of mental health managers in relation to consumer and carer participation. A qualitative research design using an interpretative approach was applied. The researcher adopted an insider/outsider/in-betweener researcher position based on her lived experience as a carer, a social work mental health advocate and a manager in a public mental health service. Twenty-three executive level mental health managers across nine public mental health services were interviewed. The study findings showed that numerous participation challenges exist for mental health managers including, working within a neo-liberal context of cost efficiency and effectiveness, competing work priorities, staff negative attitudes towards participation, tensions among stakeholders with different ideas about participation and, managing a growing consumer and carer workforce. Despite these challenges, managers in this study were committed to participation. Managers considered that growth in the consumer and carer workforce was evidence of national participation standards being met but that participation is a complex space that is ‘easier said than done’. Findings highlighted the need to strengthen participation through building human connections and relationships among consumers, carers, and mental health professionals and, by fostering mutual respect for lived experience and professional expertise. Findings also highlighted the need to increase support for the consumer and carer workforce and, that while the emphasis has been on growing consumer participation, there is a need to foster and grow family and carer participation.

About a decade ago, the Hogg Foundation hired its first two consumer and family liaisons, Stephany Bryan and Tammy Heinz. As program officers, their passion and perspective has proved invaluable to making the foundation bolder and more inclusive in its grant making strategy. To celebrate their ten-year anniversary with the foundation, this episode of our Into the Fold podcast explores the consumer movement from the ground up—with Bryan and Heinz as our guides.