From Representation to Integration: Lived Experience in Mental Health Teams: A Qualitative Descriptive Study

ABSTRACT

Lived experience workers are an integral part of mental health multidisciplinary teams, contributing unique insights and support grounded in personal experience and lived expertise. Despite their growing presence, challenges with the integration of lived experience workers into these teams persist. There is a gap in knowledge on lived experience workers' perspectives on their inclusion in multidisciplinary teams, as well as clinicians' views on the lived experience role. The aim for this qualitative descriptive study was to explore the experiences and perspectives of lived experience workers and clinicians regarding the integration of lived experience roles within multidisciplinary mental health teams, with a focus on identifying barriers, facilitators and impacts of role integration. Semi‐structured interviews were conducted with lived experience workers (n = 7) and mental health clinicians (n = 7). Framework Analysis of interviews resulted in four main themes: (1) Systemic barriers hinder integration; (2) Lack of lived experience workforce role clarity limits impact; (3) Discipline‐based defensiveness as a barrier to integration; and (4) Clinical and lived experience workforce perspectives clash. This study highlights that successful integration of the lived experience workforce in mental health care requires more than structural reform. Sustainable inclusion depends on role clarity, shared responsibility and accountability among multidisciplinary team members and relational trust. Without addressing differing attitudes and beliefs about authority and recovery, integration of lived experience into mental health risks being symbolic rather than transformative.

1. Introduction

There is global recognition that integrating lived experience workers into mental health service delivery is beneficial for effective recovery‐oriented mental healthcare (WHO ²⁰²⁵). The Lived Experience Workforce (LEW) is an integral component of mental health multidisciplinary teams, contributing unique insights and support grounded in personal experience and lived expertise. Despite their growing presence, challenges with the integration of lived experience workers into these teams persist.

The LEW comprises two distinct disciplines: consumer workers and family/carer workers. Consumer workers bring firsthand experience of mental illness and engagement with mental health services, while carer workers offer perspectives shaped by supporting a loved one through similar experiences. Both disciplines use their lived experience to advocate for and support consumers and carers, offering valuable perspectives on recovery and navigation of the mental health system (National Mental Health Commission ²⁰²³). Their contributions also extend to supported decision‐making, promoting autonomy and choice for individuals living with mental illness (Royal Commission into Victoria's Mental Health System ²⁰²¹).

In Australia, the LEW has grown significantly with an average annual increase of nearly 16% over the past decade (AIHW ²⁰²³). A recent Royal Commission into mental health in the state of Victoria has also seen significant recommendations regarding the integration, professionalisation and leadership development of the lived and living experience workforce across all levels of the mental health system (Royal Commission into Victoria's Mental Health System ²⁰²¹). However, effective integration into multidisciplinary teams remains an ongoing challenge. While the LEW primarily supports consumers, families and carers, successful collaboration with clinical disciplines is essential to achieving positive, sustainable outcomes. The contributions of clinical professionals, such as psychiatrists, psychologists, nurses, occupational therapists and social workers are equally important, bringing critical expertise in diagnosis, treatment and care coordination. A truly integrated team values and leverages the complementary strengths of both clinical and lived experience disciplines (Reeves et al. 2017). There is a notable gap in the evidence, however, on LEW perspectives on their inclusion in multidisciplinary teams, as well as clinicians' views on the LEW's role. Addressing these gaps is critical to understanding the barriers and enablers to role integration of LEW.

1.1. Background

International literature supports a balanced approach to mental health team integration of LEW. Reeves et al. (2024) identified key organisational actions such as education, structural support and leadership commitment that facilitate LEW integration, emphasising that collaboration between the multidisciplinary team must be mutual. Cooper et al. (2024) found that role clarity, supervision and workplace culture are essential for successful peer support implementation across global contexts. In Canada, Rebeiro Gruhl et al. (2023) highlighted systemic barriers such as stigma and lack of support for authentic peer practice, advocating for shared responsibility between disciplines. The World Health Organization (2025) similarly outlined a roadmap for embedding lived experience roles in European mental health systems, stressing co‐creation and mutual respect.

Research has also highlighted persistent issues for LEW such as role clarity, access to training, supervision and career development (Adams et al. 2023; Byrne et al. ²⁰²²; Gange et al. ²⁰¹⁸; Hurley et al. ²⁰¹⁸). These challenges are experienced not only by LEW members but also by clinical staff and executive leadership.

While organisational and structural barriers to LEW integration have been widely documented (Reeves et al. 2024; Mutschler et al. ²⁰²²; Opie et al. ²⁰²³), such as inadequate training, unclear role definitions and limited systemic support, there remains a significant gap in the literature regarding the interpersonal dynamics that influence integration within multidisciplinary teams. Much of the existing research (Reeves et al. 2024; Mutschler et al. ²⁰²²; Opie et al. ²⁰²³) focuses on what organisations must do to facilitate inclusion, yet it often overlooks the nuanced attitudes, behaviours and relational factors that shape everyday team interactions. These include how clinicians perceive and engage with LEWs and the extent to which LEWs feel respected and valued by their colleagues. Team culture, interpersonal trust and mutual understanding are critical to successful LEW integration, yet these elements are rarely explored in depth. For example, even when structural supports are in place, LEWs may feel their contributions are not genuinely acknowledged, they are excluded from decision‐making processes or find themselves frustrated by clinical processes. Similarly, clinicians may struggle with uncertainty and concern around the LEW role, or feel their decisions may be questioned, leading to hesitancy or resistance that undermines team cohesion (Chisholm and Petrakis 2022). These interpersonal and behavioural factors are often subtle but deeply influential and their general absence from the literature represents a critical blind spot in understanding why integration efforts may falter.

To address this gap in knowledge, the aim for this study was to explore the experiences and perspectives of both lived experience workers and clinicians regarding the integration of lived experience roles within multidisciplinary mental health teams, with a focus on identifying barriers, facilitators and impacts of role integration. By examining both perspectives, we sought to explore the relational and cultural enablers and barriers to LEW integration, insights that are essential for informing more holistic and sustainable approaches to workforce reform in mental health services.

2. Methods & Design

The study was conducted by a team comprising a senior consumer manager, a lived experience academic and experienced mental health researchers and clinicians. The integration of lived experience knowledge and methodological expertise reflected the co‐production approach in this study (Soklaridis et al. 2024), where diverse forms of expertise were valued equally in shaping and conducting the research. Lived experience workers were involved in all phases of the study: conception and design, data collection and analysis and writing of the manuscript, ensuring that the research was informed by both academic and experiential perspectives. This collaborative approach enhanced the credibility, relevance and translational potential of this co‐created research (Åkerblom and Ness 2023).

This study employed a qualitative descriptive design. This design was appropriate because it aims to describe the experiences of individuals who are experiencing a phenomenon which has not previously been well explored or is minimally theorised (Sandelowski 2000). The study is reported using the EQUATOR network recommendations for consolidated criteria for reporting qualitative research (COREQ) guidelines (Tong et al. 2007). Ethics approval was granted by the relevant hospital Human Research Ethics Committee (HREC/104738/2024) and reciprocal university ethics was also obtained (2024‐166).

2.1. Participants & Setting

Participants were recruited from mental health settings in a major metropolitan tertiary health service in Melbourne, Australia. This major health service employs over 1000 staff in their mental health division, servicing over 200 000 mental health related interactions per year. The service introduced lived experience roles in line with the rest of the sector, with the first peer support worker role being introduced approximately 10 years ago. Positions have increased since the introduction of the Royal Commission into Victoria's Mental Health System, seeing the LEW grow quickly. Characteristics of participants are described in Table 1. Purposive sampling was used to recruit participants (7 LEW and 7 clinicians), with emails sent from the research team to health service managers (who were not involved in the study) for distribution, with two rounds of follow‐up. Purposive sampling is a non‐probability technique which takes a deliberate approach to participant selection (Etikan et al. 2016) and enables researchers to ensure the correct demographic are targeted for participation. Snowball sampling was additionally used because participants who had completed interviews referred colleagues to the study.

TABLE 1.

Participant demographics.

Demographics	Mental health experience in years	N (%)
		N = 14
Lived experience worker	0–2 years	3 (21.42)
	3–5 years	1 (7.15)
	6+ years	3 (21.41)
Clinicians	0–5 years	1 (7.15)
	6–10 years	2 (14.29)
	11–15 years	2 (14.29)
	16+ years	2 (14.29)

2.2. Data Collection

Participants provided both written and verbal consent, with n = 14 participants (n = 7 LEW; 7 = clinicians) providing written consent for interviews. Semi‐structured interviews (see Tables 2 and 3 for interview guides) were conducted by three authors, two of whom have lived experience (O.H, S.B‐H) from August to December 2024. All participants who began an interview completed it, and there were no requests to withdraw consent. Interviews were conducted over Microsoft Teams at a mutually convenient time, audio‐recorded, transcribed and de‐identified. Participants were sent a de‐identified copy of their transcript for verification. No participants requested to make any changes to their transcript. The average interview length was 56 min 44 s, with a range of 28:40–91:31 min. While procedures to manage participant distress were outlined in the ethics protocol, these were not required during the study.

TABLE 2.

Semi structured interview guide questions: Clinicians.

Topic	Interview question
Experience of working with LEWs	What has been your overall experience working with lived experience workers (LEWs) within the multidisciplinary team (MDT)?
Impact of LEWs on team dynamics	How does the presence of a LEW influence the dynamics within the MDT, and what kinds of feelings or responses does this evoke for you?
Challenges and tensions in collaboration	Have you experienced or observed any tension, division or challenges in the working relationship between LEWs and clinicians?
Systemic influence & reform	What impact do you think the Royal Commission's push to centre lived experience in mental health reform has had on collaboration between clinicians and LEWs?

TABLE 3.

Semi structured interview guide questions: LEWs.

Topic	Interview question
Role expectations and reality	Thinking back to why you became a lived experience worker (LEW), do you feel that your current role aligns with what you hoped it would be, and what factors have made it harder or easier to do the work you envisioned?
Presence & perception in the MDT	How would you describe your experience of being part of the multidisciplinary team, and what do you think contributes to how you feel in that space?
Influence of lived experience on professional relationships	In what ways has your personal experience of engaging with clinicians in the past shaped how you interact with them now as a colleague, and do your fellow LEWs' experiences influence this as well?
Equality, integration & team relationships	What helps you feel like an equal and integrated member of the multidisciplinary team, and have there been times when you've felt excluded or that a divide existed between clinicians and LEWs?

2.3. Data Analysis

Gale et al.'s (2013) Framework Methodology was used to analyse interview data. This systematic approach to analysing qualitative data is particularly suited to multi‐disciplinary health research. The method supports both inductive and deductive thematic analysis and is appropriate for use with semi‐structured interviews with more than one participant cohort. Data analysis was undertaken by all members of the research team, including researchers with lived experience as well as health professionals. Data sufficiency (i.e., where the range of data provided adequate information power to address the study aim) (LaDonna et al. ²⁰²¹) was reached with both groups interviewed (LEW and clinicians). We implemented the Framework Method (Gale et al. 2013) by first transcribing the data and thoroughly familiarising ourselves with the content. Transcripts for each cohort were initially analysed independently. We collaboratively developed and applied a coding structure, which informed the creation of a working analytic framework. This framework was systematically applied to each dataset, with data charted into a matrix to support comparison across cohorts and themes. In the next phase, emergent themes from each dataset were subjected to data triangulation, where they were compared and contrasted in an iterative process, and then integrated (Schlunegger et al. 2024). In the final phase, we reviewed the emergent integrated themes through team discussions until consensus was reached. This structured process supported trustworthiness, transparency, consistency and rigour throughout the collaborative analysis.

To evaluate integration of the lived experience workforce across multiple levels (systems, team, person), we adopted the Consolidated Framework for Implementation Research (CFIR), which is widely used to explore outer setting (system), inner setting (team/organisational), individuals (person) and process domains in implementation studies (Reardon et al. 2025). This framework has been updated recently and remains one of the most robust tools for operationalising and comparing implementation determinants across levels. Utilising this framework assisted in conceptualising theme across various levels, resulting in system, team and person levels, which incorporated the barriers and enablers to lived experience role integration. This multilevel framework was useful because it helped identify governance issues at the systemic level; issues with multidisciplinary team functioning; and communication factors at the individual level.

During analysis, where disagreements arose, we applied Hemmler et al.'s (2020) justification method to guide thematic decisions before proceeding to subsequent stages of analysis. Hemmler et al.'s (2020) justification method enhances transparency and rigour by clearly documenting and rationalising key methodological decisions throughout the research process and was employed in this study to ensure accurate representation of participant accounts and minimise potential bias.

3. Results

The analytical framework (Gale et al. 2013) of a systems, teams and person approach incorporated understanding the barriers and enablers to lived experience integration. This multilevel framework was useful because it helped identify governance issues at the systemic level; issues with multidisciplinary team functioning; and communication factors at the individual level.

For the purpose of these results, we use the term ‘clinician’ to describe participants other than a lived experience worker. Following the analytic process, four themes were identified: (1) Systemic barriers hinder integration; (2) Lack of LEW role clarity limits impact; (3) Discipline‐based defensiveness as a barrier to integration; (4) Clinical and LEW perspectives clash. Participants are referred to by role and interview number in the findings.

3.1. Theme 1 Systemic Barriers Hinder Integration

This theme describes the systemic barriers to LEW integration that emerged when health systems were structured in ways that made it difficult to align the roles, values and needs of both clinicians and LEWs. Systemic challenges included unclear role expectations, limited resources, structural stigma and differing work policies and practices, which created tension and reduced the effectiveness of team collaboration.

Participants described infrastructure and space issues that saw some LEW separated from the multidisciplinary team by having their office physically located elsewhere. This distance exacerbated their feeling of being ‘other’: “I feel a little bit isolated to be perfectly honest. …The isolation is real… I'm on my own…” (LEW3). This isolation was also linked to small team sizes and the part‐time nature of many lived experience roles. Having no, or very few, other lived experience colleagues made it difficult for them to feel supported and limited their ability to influence the work of the multidisciplinary team:

We are a very small staff in a very big system and sometimes sheer amount of numbers is impactful if you're trying to be a voice of about 3 people… that's really hard to be a solo voice that you're meant to all of a sudden be the entire voice of a lived experience which obviously isn't really, you know, possible. (LEW3)

Despite many LEW noting that they were frustrated by providing role clarity to the MDT, many of the clinicians interviewed did not see it as the sole responsibility of the LEW and acknowledged that the rollout of the lived experience workforce lacked a “role clarity framework” (CLIN9) from the very beginning. Another noted that psychiatry should not be rigid in how roles are established because that makes healthcare inflexible and noted that “having a fluid approach to working with consumers” (CLIN14) was much more appropriate. Additionally, several participants noted the cyclic nature of medicine, resulting in continuous rotations where new doctors needed to be trained again in understanding the role and responsibility of LEW. One participant believed it was the responsibility of senior medical staff to educate new arrivals on the role of the peer workforce:

…it is actually the responsibility of those that have been around or been enrolled longer…to actually explain that and create that meshing of the MDT so that we're cohesive. (CLIN10)

The recruitment and retention of LEW was described frequently as challenging: “I've hired 5 peer workers in 2 years and lost all of them” (LEW4). These experiences also informed and shaped the ways in which members of the current LEW understood and navigated their roles: “I haven't had anyone to work under that, you know, that can help guide me or anything like that…” (LEW3). Participants described an overwhelming lack of training about how to undertake their role, which impacted on retention and job satisfaction:

I was definitely just thrown in the deep end…I have no support whatsoever…I wasn't taught anything, nothing. And that's ok cause I've got some maturity on my side, but if you're a young lived experience worker…some mentorship would be invaluable and at the moment it's lacking. (LEW7)

Participants also noted the appropriateness of a person to work in the LEW role. This was seen as important when working in an acute context where psychosis and other serious mental illness were experienced by consumers. Not having the maturity, robustness or clinical understanding of what these conditions are, was seen as a barrier:

Not everyone with a lived experience of mental illness can do this work. I think it is a grave injustice to our workforce because we're failing, because we're putting people in that may have a lived experience, but they don't have the maturity, the communication skills to handle this environment, so they burn out and leave (LEW7)

In an area where position clarity was unclear, this lack of appropriate role models was felt by most participants:

Our (LEW) coordinator/supervisor was a nurse and my first ever ‘this is what peer support is’ was her doing a nursing assessment 'cause that was her background… I just remember sitting there going ‘I don't think I'm in the right place. Are they aware of this? Because this feels strange’. So, I felt like I had to do a lot of self‐learning, which was quite challenging. (LEW1)

While the issue of retention and support of LEW was seen as layered, both LEW and clinicians identified that one of the major contributing factors for this was the biomedical model of care present in psychiatry which was frequently described as “too medical (and) too clinical” (LEW4). These experiences were in direct contrast to LEW's perceived role in supporting recovery, where they knew what they needed to do to achieve this, “but they can't implement it. They don't have the time. There's not enough of them to kind of make those little changes (to the system)” (LEW5).

3.2. Theme 2: Lack of LEW Role Clarity Limits Impact

This theme identifies that when the roles of LEWs lack clear definition within clinical systems, confusion arises for both LEWs and clinicians, leading to role overlap, miscommunication and missed opportunities for meaningful contribution. Clinicians were often unsure how to engage with or appropriately refer to LEWs, while LEWs felt unprepared, uncertain about their scope, or pressured to explain or defend their role within the team.

A lack of role clarity was a strong theme that emerged during interviews with all participants, but particularly among LEW. The requirement to continuously explain their role to the team led to a sense of despair:

I'm out of energy for it. I've had to have the same conversation a million times about what it is that we do, how we do that. You know, we've had training packages that we've done, you know, at home base here for new people to come in. We had to scream and yell, just to be a part of the, you know, the induction packages. (LEW4)

Despite this, one LEW identified that understanding the mechanics of the team including the need to be cognisant of clinical processes, medications and mental illness was the responsibility of LEW too because to place them into an environment where this was common language without understanding, made it harder:

…they're coming into the clinical spaces. They're coming into medical reviews. They're coming into clinical reviews. They're coming into new patient assessments. They're coming in with consultants, head of consultants like, if you've not been in that space before that's an intense space to be in that can be really intimidating. If you're not equipped to deal with that. So, let's equip them! (LEW7)

These tensions were also experienced by clinicians, with one describing a situation with a consumer where they had agreed to an approach, and then the LEW changed tactics during the meeting: “…this was really undermining in a really unhelpful way” (CLIN9). Some clinicians noted that while LEW may be passionate about enforcing recovery‐oriented practices within the team, this needed to be balanced because the legal consequences of any harm incurred was not their responsibility, but that of clinicians: “there has to be defined scope of practice and they (need to) work within their scope of practice” (CLIN13).

All clinicians described the positive influence and role that the LE workforce had for consumer outcomes and within the team, and most described themselves as allies. Interestingly, social workers strongly aligned themselves closest to LEW, describing an allyship borne out of shared roles. This contrasted, however, with observations from some LEWs, who described experiencing tension when working alongside social workers. They attributed this conflict to overlapping role boundaries and a perceived sense that social workers, in particular, felt threatened by the emerging lived experience workforce.

Yes, there was a bit of argy, bargy. There was a bit of head butting in the beginning, where I had a few heightened conversations with some of the key clinicians where they felt I was doing their job because there's quite a crossover between social workers and lived experience. We both try to build hope we both to a certain extent, have a referral processing pathway that we encourage our clients to go down and there was some confusion around. ‘Well, that's what I'm here for. So, what are you doing here? What's your purpose?’…like back off sort of thing. (LEW7)

This lack of role clarity was perceived to impact LEWs' sense of belonging and their perceived integration within the team. Many LEW described frustration at having to orient the team to their role:

There's a point that in clinical review I was kept on asking to write notes, like an 8‐week review note, like 4‐week review note, like things that I've not had training in. In fact, like it should be done by registrar, and I don't also have that lens, that clinical lens all the time like to write a note. So being asked to be put in a completely different position, or like do something completely different because they don't understand that a lived experience carer peer support worker isn't going to, doesn't write these full notes about people and their plan and their diagnosis. (LEW2)

This lack of LEW role clarity was also identified by clinicians: “I'll be honest and say it took me quite some time to understand their role. How they would add value, what the boundaries were” (CLIN9).

3.3. Theme 3: Discipline‐Based Defensiveness as a Barrier to Integration

This theme describes how effective collaboration between clinicians and LEWs required navigating role‐related tensions and differences and recognising that both clinical knowledge and lived expertise offer unique and complementary value to mental health care. Differences in views on treatment, recovery, communication styles and approaches to risk and autonomy created tension, particularly when LEWs felt their input was not fully considered and clinicians felt uncertain or challenged in their roles.

Lived experience participants described challenges with a sense of belonging within the team, particularly in relation to feeling valued, complicated by a perception that lived experience work was “… not seen as a discipline that is taught” (Clinician 14), which is challenging within the medical model. The challenges of integration are echoed by other clinicians:

…the main challenge is we are working very hard to put consumer perspective into our practice, but it is very important to put clinical or clinician perspective into practice as well…we cannot just work within a recovery model. We all wonder that consumer safety is very important, but clinician safety is getting forgotten. (CLIN13)

These issues of approaching interactions and care within one model was highlighted by this clinician: “…we (medical team) are looking at risk, pros and cons of treatment and all that. Whereas a peer support worker is mainly focusing on the person's recovery journey…we (medical team) are looking at both” (CLIN11).

Several participants noted that despite being assured that there was a multidisciplinary approach to how the team dynamic was structured in their health service, this was not consistent with their experience: “You have the issue of not being taken seriously” (LEW4), and “you have to prove yourself more because your title declares you as something else” (LEW1) and “…I'm at the bottom of the list…” (LEW2).

Some participants also described a lack of collegiality experienced within the team, where their voice was dismissed: “You're being shut down…your sentence isn't even being valued or allowed to be finished…it's quite awful” (LEW7). This LEW described fear experienced during clinical meetings where the medical voice was consistently prioritised: “…(I'm) very scared to speak up, waiting for a still, firm rebuttal of a medical angle” (LEW4).

Despite this, clinicians described the value that they saw in the LE workforce, the contribution they made, and the mutual role of supporting consumers: “our job is to get them from clinically unwell to well enough to discharge, (while) the peer support workers are there to support them during that journey” (CLIN 10). Additionally, there were moments where participants had clinical experiences with LEW that changed their perspective, as explained by this clinician:

And you know I saw and heard that flash up in my mind and went ‘hang on a sec. What about the hard‐won practice, wisdom and lived experience, wisdom of managing every day for X amount of years with a mental illness that we now have the enormous benefit of, and potential access to’. And, as I said, I'll be honest. I had to really check… (CLIN9)

3.4. Theme 4: Clinical and LEW Perspectives Clash

This theme identifies that tensions arise when LEWs and clinicians approach their roles with attitudes shaped by personal history and professional training, which influenced their confidence, ability to emotionally self‐regulate and resilience. LEWs often felt pressure to prove their value while managing the emotional complexities of their role, while clinicians found it challenging to fully appreciate the nuances of lived experience or alternative views on mental health recovery. At times, negative personal experiences brought by LEWs resulted in unhelpful and unwarranted attitudes toward clinicians, leading to misunderstandings, unproductivity and a sense of division within the team.

Some LEW had to become more aware of the way they interacted with the team and that this resulted in ‘masking’: “…(you have) to try harder. Be mindful of language, because otherwise, you know, you don't want to be labelled like ‘aggressive’ or ‘emotional’ or you know those sorts of things” (LEW1). One LEW described needing to be ‘assertive’ because of the power imbalance within the team resulting in a “clash” between members. Another described experiences where they were encouraged to speak up in clinical review meetings, and then when they did, they were ‘told off’: “I've been pulled aside (and told my opinion) is not valued…be a little bit quieter” (LEW2).

All participants identified the impact to self for LEW in their role, particularly in relation to their mental health and wellbeing “…there's been a few teething problems and I've just had to cope with it. I've got to work…I have a mood disorder and I've struggled with work” (LEW3). For some LEW this impact to their wellbeing came from having to navigate their interactions with the team:

…you have to be mindful of what you say…you have to overcompensate a lot, because otherwise they've (MDT) already got a negative view of you, even just subconscious bias…especially when you exert power over people all day, every day in your job…you (LEW) have to engage more to break down those barriers. (LEW1)

Clinicians were more likely to describe concern about boundaries that they thought LEW had crossed on occasions and the possible impact this had on their wellbeing: “I think it can be really challenging creating the kind of separation” (CLIN12) and “they're not disclosing for themselves, they're disclosing in order to be able to be authentic and genuinely supportive to other consumers” (CLIN8). Despite this, one clinician noted that with the inclusion of the LE workforce into mental health, they felt that there had been a shift in confiding about personal mental health struggles in general:

at a personal level, professional level, if I had to speak to my colleagues and say ‘I'm not travelling well or I have family violence’ I actually feel much more free now to disclose that…I don't feel like I've got to make up a lie. (CLIN9)

While most participants acknowledged that the LEW have a ‘degree’ in lived experience, several LEW identified that the lack of a formal qualification made them feel inferior to other members of the MDT, particularly in relation to being accepted:

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. (LEW5)

Despite some of these tensions, many participants were able to identify the positive impacts to consumers, families, the service and their own clinical practice that the LE workforce had. One clinician noted that their respect for LEW had grown over her period of time at the service and was able to identify that without LE input, “we probably wouldn't have achieved the level of success in our projects…I've found the input extremely helpful” (CLIN8).

4. Discussion

This study explored the experiences of the integration of the Lived Experience Workforce (LEW) into multidisciplinary mental health teams from the perspectives of both LEW and clinicians, revealing a complex interplay between structural, relational and cultural factors. While LEWs are increasingly recognised as essential contributors to recovery‐oriented care, their integration remains fraught with challenges. The four themes: systemic barriers, role clarity, defensiveness and differences and conflicting attitudes and beliefs highlight how both organisational structure and interpersonal dynamics shape the success or failure of integration efforts.

A key finding was the persistent ambiguity surrounding the LEW role. This lack of practical clarity and expectations contributed to a dynamic that could be described as “all care, no responsibility” tension, where LEWs were expected to provide emotional support and advocate for recovery, while clinicians retained decision‐making authority and accountability, thus creating a divide in influence and responsibility that neither group felt was fully equitable or sustainable. Moreover, our study found that integration is not solely a structural issue; it is deeply relational (Kessing 2022; Reeves et al. ²⁰²⁴). Both LEWs and clinicians brought personal histories, professional identities and emotional responses into the team environment. These shaped how they perceived one another, navigated conflict and interpreted their roles. Without space for reflective dialogue, shared accountability and mutual understanding, these differences often led to defensiveness, projection, miscommunication and siloed practice. In contrast, Ehrlich et al. (2020) found that clinical teams adapted peer support worker roles to individual skill sets, enabling peer workers to contribute to team practices and foreground service user perspectives within clinical decision‐making. The study noted that successful integration depended on clinicians' attention to the unique strengths peer support workers brought to the team.

To sustain successful integration, LEW roles must be clearly defined and adapted to suit clinical environments. A principle‐based approach alone is insufficient; practical expectations and some clinical understanding and responsibility must be co‐designed and context‐specific, with calls for standardisation of LEW roles (Robinson and Isaacs 2024). Clarity about expectations, supervision, training and organisational readiness are crucial to keep peer worker roles from being diluted (Gillard et al. 2024). Facilitating factors for integration include structural adjustments, training, organisational readiness and support; however, (Reeves et al. 2024).

Our findings align with existing literature that identifies organisational barriers to LEW integration, such as role ambiguity, lack of supervision and stigma (Reeves et al. 2024; Shalaby and Agyapong ²⁰²⁰). Furthermore, as highlighted by Berry et al. (2011), other factors that may influence the perception of LEW include LEW challenging clinical practice and decision making, as well as developing mutual connections with consumers which could contribute to mixed perceptions of the relationships they form with consumers and boundaries of professional practice. Furthermore, Una Foye et al. (2025) recently highlighted additional contributing factors such as: leaders who support and value LEW, the complexity of working where there are tensions between the flexibility of LEW and the structures of existing healthcare systems and pay and progression for LEW compared to other disciplines. However, our study extends the conversation by foregrounding interpersonal tensions, attitudes and emotional labour; areas often underexplored in peer workforce research. Chinman et al. (2016) and Cooper et al. (2024) note the importance of role clarity and team culture; however, our study adds nuance by showing how conflicting beliefs about legitimacy, authority and responsibility play out in practice. The concept of “all care, no responsibility” resonates with critiques of tokenism in peer work (Ocloo and Matthews 2016), where LEWs are celebrated for their empathy but excluded from influence in clinical care. This study illustrates how such dynamics can erode trust and reinforce “wanting to be right”, even in teams committed to recovery‐oriented care.

These findings further reflect critiques within lived experience scholarship that question whether integration into clinically dominated systems can occur without constraining the distinct values, practices and epistemic authority of lived experience work. Both clinicians and LEWs highlighted the personal toll associated with drawing on one's lived experience in practice, expressing concern about the emotional strain of repeatedly revisiting personal experiences in a professional context. Despite this, most of the LEWs in our study did not identify sharing their LE as emotionally taxing, but rather that it was the team's dynamics and the overly medical nature of mental healthcare that took a toll. This finding is unsurprising, given that existing research highlights the persistence of stigma associated with disclosing personal distress within mental health settings (King et al. 2020). Moreover, many clinicians have been professionally socialised and trained to maintain strict boundaries by avoiding personal self‐disclosure (Arroll and Allen 2015). This dynamic generates a tension between clinicians' perceptions of professional risk and one of the foundational principles underpinning the inclusion of lived experience perspectives in healthcare practice. Hierarchy within healthcare is a longstanding phenomenon. Health organisations commonly structure their workforce according to levels of authority, with further standing often influenced by professional role, sex and ethnicity (Essex et al. 2023). As such, LEWs are positioned within a healthcare system characterised by longstanding hierarchical structures, thus highlighting the need for teams to prioritise building mutual respect and understanding in order to work and thrive optimally within a hierarchical system. The concept of “integration” itself has been critically examined within Australian lived experience scholarship. Sinclair et al. (2025) argue that integration is often enacted as inclusion within dominant biomedical systems, which can function as assimilation rather than genuine transformation of power and knowledge relations. From this perspective, difficulties with integration may reflect deeper cultural and epistemic tensions, rather than solely problems of role implementation. These concerns align with evidence from organisational research showing that integration requires sustained cultural, relational and structural change, rather than the addition of roles alone (Reeves et al. 2024).

This study has several notable strengths. First, two members of the research team hold lived experience positions, and the study was codesigned from inception through to manuscript development ensuring authenticity, relevance and alignment with contemporary principles of consumer‐led research. The methodological approach was further strengthened by a rigorous and transparent analytic process, enhancing the credibility and trustworthiness of the findings. Additionally, the interview guide was developed in direct response to current mental health policy priorities, ensuring strong policy alignment and enhancing the study's applicability to contemporary service contexts. Data saturation was achieved across the major thematic areas, supporting the adequacy of the sample and the robustness of the conclusions drawn.

However, several limitations should be acknowledged. The diversity of participants, while enriching the dataset, resulted in smaller subsamples across some clinical specialties. In particular, the clinician cohort was modest (n = 7), which may have limited the breadth of clinical perspectives represented. This likely reflects both the sensitive nature of the topic, integrating the lived‐experience workforce into multidisciplinary teams, and the well‐recognised challenges of recruiting busy healthcare professionals who face significant workload and time constraints. Such barriers to clinician participation in qualitative research are well documented in the literature (see Williams et al. ²⁰²⁰). Consequently, the findings may reflect the views of those clinicians most motivated or able to engage, introducing the possibility of selection bias. Further targeted recruitment strategies may help strengthen future studies.

5. Conclusion

This study highlights the complexity of integrating the LEW within multidisciplinary mental health teams, revealing that successful inclusion relies as much on interpersonal and cultural dynamics as on organisational structure. Persistent ambiguity surrounding LEW roles contributes to a divide in responsibility and influence, creating tensions that challenge the equity and sustainability of recovery‐oriented care. While LEWs bring unique insights grounded in personal experience, their roles are often constrained by misunderstanding, limited support and unclear role expectations.

Effective LEW integration requires more than a principle‐based commitment to lived experience; it demands practical clarity, co‐designed role definitions and contextually responsive approaches that balance professional responsibility with lived expertise. It is important to recognise that though each perspective—whether it is nursing, occupational therapy, psychiatry, LEW, etc., offers a different lens of support to individuals experiencing mental distress, all are valuable and all are vital. Integration of these different perspectives not only requires respect and clear communication between the professions but recognition that each profession is grounded in its distinct framework and perspective, and this is required to ensure support is truly holistic and person‐centred. This study underscores that integration is a relational process shaped by trust, dialogue and mutual respect. Without addressing the underlying attitudes and emotional dynamics of teamwork, efforts to embed lived experience risk becoming symbolic rather than transformative.

5.1. Relevance to Clinical Practice

For multidisciplinary mental health teams, including nurses, allied health clinicians, medical staff and members of the LEW, these findings highlight the need for deliberate and evidence‐informed strategies that bridge the relational, cultural and professional divides that can hinder meaningful integration. While nurses often sit at the centre of team coordination, all disciplines have a responsibility to model inclusive practices that value both professional expertise and experiential knowledge. This includes fostering open dialogue across roles and disciplines; supporting reflective practice that builds mutual respect and shared understanding of responsibilities, emotional labour and differing beliefs regarding recovery, risk and safety; and encouraging collective accountability rather than defensiveness when tensions arise.

Leadership across the MDT (clinical, managerial and lived‐experience) has a pivotal role in reducing friction, strengthening team cohesion and supporting the development of LEW‐led supervision, governance and practice frameworks that promote equity and authentic collaboration. Integrated training programs co‐designed and co‐delivered by LEWs and clinicians should extend beyond profession‐specific competencies to prioritise core interpersonal skills such as resilience, assertiveness and emotional regulation. Equally, LEWs benefit from structured opportunities to learn about clinical roles, risk assessment expectations and decision‐making processes, helping prepare them for areas where tensions commonly emerge.

Finally, mental health teams must remain attentive to the socio‐political, cultural and identity‐based factors that shape workplace interactions and influence perceptions of harm, autonomy and care. Acknowledging and understanding these influences, across both LEW and clinician groups, will be critical to fostering respectful, collaborative and enduring integration within contemporary mental health services.

Author Contributions

Each author certifies that their contribution to this work meets the standards of the International Committee of Medical Journal Editors.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Hatchman, O. , Buchanan‐Hagan S., Foster K., Pemo K., and Alexander L.. 2026. “From Representation to Integration: Lived Experience in Mental Health Teams: A Qualitative Descriptive Study.” International Journal of Mental Health Nursing 35, no. 1: e70230. 10.1111/inm.70230.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.