Written by Michael Elwan – Lived Experience Solutions (LEXs)

This new series is written from lived experience. It includes personal reflections on illness, loss, and caregiving. Please read Michael Elwan’s writer-in-residence series with awareness and care.

Alexandria, 2002.

The rain was steady that evening, tapping against the window of a small psychiatrist’s private clinic. I was sixteen, trying to explain my mother’s confusion and fear. The psychiatrist listened, cigarette balanced between his fingers, and finally said that what I described had no cure. She would need medication every day for the rest of her life, or lifelong admission to hospital. Then he added, almost gently, that hospitals could be dangerous places.

His words landed with the weight of a sentence. I imagined the scenes I knew from films (patients restrained, humiliated, forgotten) and felt the narrowness of my choices. Hospitalisation felt cruel; daily medication felt impossible. I walked home through rain-slick streets, defeated and unsure how to proceed. Yet I already knew what I would do. She was my mother. Obligation and love were the same word.

The long work of secrecy

When I told our remaining relatives, they nodded gravely and agreed she should stay home. Sympathy filled the room for a few hours, then thinned into absence. No one lived close enough to help. The responsibility became domestic routine: measuring medication, managing voices, hiding the truth.

I built walls that looked like discretion. Neighbours offered polite questions but rarely eye contact. At university, I avoided conversations that risked disclosure. Friends spoke about weekend plans; I learned how to keep mine private. Each year the silence grew thicker until it felt almost natural.

In Egypt, mental health challenges existed outside social vocabulary. Distress was spoken about through faith or morality, never through psychology. Hospitals were feared institutions, symbols of shame. My father’s stroke years earlier had drawn community support; my mother’s mental health challenges drew distance. Both were challenging, yet only one could be discussed.

Carrying silence across borders

A decade later, after my mother’s death by suicide, I migrated to Australia. The silence travelled with me. It shaped how I entered the mental health sector; first as a support worker, then as a practitioner.

In Australia, I found systems fluent in the language of recovery, risk management, and person-centred care, yet families often described feeling invisible. The paperwork was meticulous; the human connection less certain. Clinicians hesitated to cross professional lines, managers worried about liability, and the space between them filled with procedure.

It took years to recognise that the silence I had known in Alexandria and the one I met here were connected. One grew from stigma, the other from structure, yet both left people unseen.

Two systems, one pattern

Egypt taught me that fear can keep families from seeking help. Australia taught me that even when help is available, systems can make it hard to feel helped. In both places, mental health care tends to separate the person from their relationships and the challenges from its social world.

In Egypt, treatment centred on medication; in Australia, on individual recovery plans. Neither approach gave much room for culture, family, or belonging. When those dimensions disappear, people experience care as something done to them rather than with them.

Families shoulder this gap. They become interpreters, advocates, and unpaid clinicians. Yet policy still treats them as background actors in someone else’s story. That omission has consequences – emotional, financial, and intergenerational.

Learning through practice

Working within the system, I began to understand that silence isn’t simply absence; it’s data. It tells us where trust has been broken. Each time a person lowers their voice to describe distress, or a family hesitates to ask for help, the system has already failed to make them feel safe.

The lessons from Alexandria began to merge with my Australian experience. I saw how compassion loses power when it is filtered through forms. I saw clinicians who cared deeply but were bound by time and targets. I saw families who wanted to help but were never asked to speak. The details differed from Alexandria’s hospital corridors, yet the outcome (a sense of distance) remained familiar.

Over time, my practice shifted from treating silence as resistance to seeing it as a signal. Behind every pause lies a reason: fear of judgement, exhaustion, or a history of being unheard. Listening for what is not said often reveals the truth.

Re-imagining what help can mean

When I founded Lived Experience Solutions (LEXs), it was partly an attempt to build the kind of space that had been missing all along. Through counselling, peer and social work supervision, and consultancy, I work with individuals and organisations to create relationships that hold both culture and care. Each session begins with listening for what systems overlook; the stories families carry in private, the meanings attached to suffering, the resilience that goes unrecorded.

These practices might sound small, but they are the architecture of trust. If a model like this had existed when I was sixteen, my mother might have spoken more freely, and I might have felt less alone in supporting her.

Reflections for systems and policy

The story doesn’t end in memory; it continues in the systems we build. Each silence I’ve encountered (whether shaped by stigma or by structure) points to the same need: relationships that last, conversations that matter, and communities that can carry both pain and hope. From this, several lessons emerge.

• Keep connection at the heart of care. Mental health outcomes depend on relationships that endure beyond crises. Continuity deserves the same attention as clinical outcomes.
• Include families early and with respect. When carers are recognised as collaborators rather than afterthoughts, trust deepens and recovery stabilises.
• Rethink what safety means. Real safety grows through understanding and consistency. It relies on cultural humility more than compliance.
• Build community literacy. Sustainable change will come from everyday places (e.g. schools, workplaces, and faith communities) where language and belonging already exist.

Closing reflection

The psychiatrist in Alexandria told me there was no cure. Years later, I still think about what he left unsaid: that care itself can be healing when it is shared. My mother needed that circle of care; so did I.

Across countries and decades, the challenge remains the same; to build systems that can hold silence gently enough for it to turn into speech.

Click here to see our Writer-In-Residence guidelines and all of our previous Writer-In-Residence posts.

About the writer

Michael Elwan is an award-winning social worker, lived experience advocate, and founder of Lived Experience Solutions (LEXs) – a values-led social enterprise advancing lived experience leadership and culturally responsive practice across Australia’s mental health and social sectors. Through LEXs, he offers counselling, coaching, supervision, and consultancy that bridge the personal and the systemic, translating human stories into policy transformation.

Born and raised in Egypt, Michael became a young carer at fourteen when his father’s sudden stroke left him blind, and later faced the profound grief of suicide bereavement after his mother’s death. Those experiences shaped his lifelong commitment to building systems that hold people, not harm them. After migrating to Australia in his late twenties, alone, he rebuilt his life from the ground up-rising from frontline roles in youth and peer work to senior leadership and national advisory positions shaping mental health policy and reform.

Now a PhD candidate researching lived experience leadership in mental health, Michael brings an intersectional lens as a CaLD man, suicide-bereaved son, carer, clinician, and enterprise founder. His writing explores the emotional and structural layers of care, culture, masculinity, and justice.

In 2025, he was honoured with the WA Mental Health Award – Lived Experience Impact & Inspiration, recognising his contribution to expanding culturally responsive, lived-experience-led practice and policy. Through this 16-week residency, Michael invites readers to journey with him through what the mental health system didn’t see-and what it could become when rebuilt with lived experience at its heart.