Written by Ailsa Rayner

 

A System Built on Unequal Terms

There is a fundamental dishonesty running through the Australian mental health system – and, by extension, through every forum, conference, roundtable and policy platform that claims to centre “lived experience.”  It is a dishonesty everyone inside the sector recognises and few are willing to acknowledge out loud:  some people get paid for their expertise, and others – often those who have been harmed, detained, silenced or stigmatized by the system – are expected to contribute for free.

This is the quiet economy beneath the glossy language of reform.

It is the reason change is so slow, why culture shifts stall, why “co-design” is repeatedly captured by professional interests, and why lived-experience leadership is tokenized more often than empowered.

In this political statement, I want to name the dynamics that many experience but almost no one in authority admits: the system exploits the vulnerability created by psychiatric history and institutional stigma; rewards insiders; and extracts unpaid labour from survivors under the guise of inclusion.  Until that inequity is dismantled, nothing approximating human rights-aligned reform can occur.

This is not an abstract debate.  It is a struggle over power, legitimacy and material resources – and over whose knowledge gets to shape the future of mental health.

 

1. The Currency of Credibility: How Psychiatric History is Weaponised

 

For those with psychiatric histories, society has constructed a permanent suspicion – a presumption that our testimony, our memory, our emotional responses, and our interpretations of events are inherently unreliable.  This manufactured doubt does not fade with time or recovery; it becomes a tool wielded by those who wish to maintain power.

This is the structural vulnerability that nefarious actors – individuals, institutions, bureaucracies – exploit.  Not a vulnerability of character, but a vulnerability imposed by decades of medicalised stigma and discriminatory laws.

When a person with lived experience challenges coercion, raises concerns about policy, or calls out injustice, organisations can retreat behind a familiar escape hatch:  dismiss them as “emotional”, “biased”, “unstable”, or “too close to the issue”.  Meanwhile, clinicians or consultants voicing identical criticisms are labelled “thought-leaders”, “innovators”, or “change agents”.

The double standard is not accidental.  It is a political tool – a method for controlling whose voices are taken seriously and whose are considered optional.

This is why payment becomes the fault line.

Those whose voices are devalued are the ones most often unpaid, or poorly paid.

 

2. The Unequal Economy of Mental Health Reform

 

Walk into any major conference in Australia – government branded “co-production” forums, “emerging priorities” meetings – and you will witness a caste system disguised as collaboration.

• Senior bureaucrats: salaried
• Consultants: billed at $2,000 a day
• Academics: funded through grants and institutional resources
• Clinical leaders: travelling on government budgets
• Lived-experience speakers: paid sometimes, partially, or not at all

 

Even when paid, the amounts are often symbolic – a fraction of what other experts receive for equivalent intellectual labour.  Many lived-experience contributors report being asked to waive fees to “support the sector,” while no such expectation is imposed on clinicians or executives.

This is not just unfair.

It is politically revealing.

It shows whose knowledge is treated as professional and whose is treated as voluntary confession.  It shows whose presence is considered necessary and whose is considered decorative.  It shows who is economically supported to remain in the conversations and who is financially worn down until they leave it.

And it raises a fundamental truth:

You cannot claim to value lived experience while excluding it from the funded economy of reform.

 

3. Diplomacy vs. Activism: The Movement’s Internal Tension

 

Within the lived-experience movement, two strategies have coexisted – sometimes collaboratively, sometimes in tension.

 

The Diplomatic Strategy

Calm voices in meeting rooms.

Incremental gains.

The slow work of persuasion and partnership.

Negotiating with government stakeholders.

Building relationships with clinical allies.

Producing frameworks, guidelines, and gentle invitations to rethink deeply embedded practices.

This strategy has its benefits.  It can open doors.  It can shift language.  It can create institutional pockets of progress.  But diplomacy is often hostage to respectability politics – to being “reasonable”, “constructive”, “manageable”, and “not too angry”.

Yet anger is not pathology.

It is evidence.

 

The Activist Strategy

Strident truth-telling.

Direct critique.

Naming abuses plainly.

Refusing to dilute the reality of coercion, harm, discrimination, and systemic violence.

Calling for abolition of forced treatment, not tinkering.

Aligning with global human rights movements, not clinical comfort.

Activists push the window open.

Diplomates stabilize it so more can climb through.

Both are necessary.

But institutions consistently reward the diplomatic style – because it is easier to control – while marginalising those who speak with urgency and political clarity.

And here again, payment reveals allegiance:

Activist voices are the least likely to be paid, because they challenge the terms of engagement itself.

 

4. The Human Right Frame: CRPD and OPCAT as Threats to the Status Quo

 

Australian mental health policy repeatedly references human rights while designing systems that violate them.  The CRPD (Convention on the Rights of Person with Disabilities) is clear:  involuntary treatment, substituted decision-making, and detention on the basis of disability are human rights violations.  OPCAT (the Optional Protocol to the Convention Against Torture) requires scrutiny of institutional environments where people are deprived of liberty or subjected to coercion.

These Conventions, taken seriously, would force a radical restructuring of mental health law and practice.  They would mover the sector from “risk management” to rights protections from clinical paternalism to supported decision-making, from locked wards to community-based alternatives, from “capacity” tests to underversal legal personhood.

The system knows this.

That is why human rights language is embraced rhetorically but resisted operationally.

Lived-experience researchers and survivor-led academics who invoke CRPD and OPCAT often find themselves excluded from working groups, deemed “too political” or “not aligned with service realities.”  Meanwhile, organisations adopt diluted “rights-based principles” that maintain biomedical dominance and coercive discretion.

Payment patterns follow these politics:

Projects aligned with mild reform attract funding;

Projects aligned with genuine rights-based transformation do not.

 

5. The Capture of “Lived Experience”: Professionalism Without Power

 

Over the last decade, Australia has witnessed rapid growth in lived experience positions:  consumer consultants, peer workers, co-design specialists, lived-experience academics.  On paper, this is progress.  In practice, many of these roles are tightly constrained, depoliticised, and expected to align with organisational interests rather than challenge them.

A peer worker who questions coercive practices risks being labelled “unprofessional”.

A consumer academic who highlights systemic abuse risks losing research opportunities.

A lived-experience adviser who critiques a policy direction risks not being invited back.

This conditional inclusion guarantees one thing:

Only the moderate voices get paid.

Meanwhile, those raising critical analysis – about forced medication, trauma from psychiatric detention, polypharmacy harms, racism in mental health responses, police involvement in crises, or the political economy of the sector – are treated as a risk to “sector cohesion”.

In other words, the system wants lived experience,

But only if it behaves.

 

6. The Global Movement: Why This Moment Matters

 

Internationally, lived-experience and survivor-led research is accelerating.

In the UK, New Zealand, Europe and North America, entire academic programmes are emerging led by people with lived experience.  Survivor research groups are producing work on medication withdrawal, coercion harms, alternative to emergency responses, and abolition of involuntary treatment.  These are recognised fields.

Australia is lagging – not due to lack of talent, but because the political and funding environment suppresses anything that threatens the biomedical status quo.

In global fora:

• Funding is available for rights aligned research;
• Survivor movements are linked to disability justice, abolition, queer liberation, and anti-carceral movements;
• The political tone is bolder, less apologetic;
• Lived-experience leaders are not asked to soften critiques.

 

Australia’s quiet, bureaucratic culture of reform cannot hold indefinitely.

International pressure – particularly through CRPD monitoring – is building.

And grassroots lived- experience networks are growing restless.

 

7. The Culture of “Invitation”: Inclusion on Their Terms

 

Perhaps the most politically revealing dynamic is the culture of invitation: the idea that survivors and lived-experience leaders should feel grateful to be included at all.  That an invitation to speak, consult or contribute is itself a form of compensation.

This dynamic is steeped in paternalism.

It reproduces the same power relations that shaped the psychiatric system itself.

The person who has been harmed is expected to be grateful.

The person who maintains the system is treated as generous.

This is not inclusion.

It is curated exposure – a performance of openness that leaves the core of the system untouched.

True inclusion is not based on selective invitations.

It is based on redistribution of power:

Resources, authority, paid roles, decision-making control.

Until then, participation remains conditional, not structural.

 

8. The Political Question at the Heart of It All

 

Here is the simplest, sharpest version:

• If lived experience is knowledge, it must be paid.
• If lived experience is leadership, it must be funded.
• If lived experience is expertise, it must be resourced.
• If it is none of these – if it is unpaid, infrequent, ornamental – then what the system wants is not knowledge, but compliance.

 

This is the truth governments avoid:

Paying lived-experience leadership equitably would rearrange the power map of the entire mental health sector.  It would shift research priorities.  Redirect funding.  Challenge clinical dominance.  Strengthen rights-based advocacy.  Empower resistance.  And accelerate demands for the end of coercion.

This is precisely why payment remains inconsistent.

 

9. The Call for Structural, Not Symbolic, Reform

 

Let’s be clear:

This is not a request for polite revisions or better etiquette at conferences.

This is a demand for structural change:

1. Equal remuneration for lived-experience expertise – benchmarked against clinical and academic rates, not arbitrary “honorariums”.
2. Funding for survivor-led organisations and research agendas independent of clinical control.
3. Universal adoption of CRPD-aligned principles including abolition of forced treatment and full supported decision-making.
4. OPCAT oversight across all mental health facilities, including community treatment orders, emergency responses, and mental health units.
5. Accountability for harm – not just incident reporting, but recognition of systemic violence.
6. Cultural shifts driven by survivors, not by public-relations departments.
7. A new economy of participation where lived experience is neither exploited not conditional.

 

This is not radical.

This is what human rights compliance looks like.

 

10. Conclusion: The System Cannot Continue as It Is

 

The gap between rhetoric and reality in Australian mental health is widening.  Every time lived-experience contributors are underpaid, unpaid, or selectively included, the system reveals its priorities.  Every time psychiatric history is weaponised to discount someone’s perspective, the system reinforces discrimination.  Every time human rights are referenced but not enacted, the system betrays its own stated values.

But here is the optimism – not sentimental, but strategic:

Movements grow not when institutions embrace them, but when institutions fail to silence them.

The lived-experience movement in Australia is at a turning point.

The days of grateful compliance are ending.

The quiet diplomacy is giving way to sharper truths.

The unpaid labour that propped up “co-design” for years is being recognised for what it is:  exploitation.

A new phase is emerging – one that refused the invitation-only economy of reform and demands structural transformation grounded in rights, dignity, justice, and equity.

And the message to the system is simple:

If you want our expertise, pay us.

If you want our leadership, support us.

If you want change, share power.

If not, we will build the future without your permission.

 

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