Written by Dr Rachel Tindall (PhD) – Barwon Health

As a mental health nurse, a co-designer of public mental health services and a person who identifies as having lived experience of mental ill-health, I have eagerly anticipated the growth of the lived experience workforce in mental health services. However, whilst my role enables me to be a key actor in facilitating this growth, I am also a witness to the challenges that surround the implementation of this vision. Recently, I have spent time reflecting on this challenge using an adaptive leadership framework (Heifetz 1994). Whilst the outcome of this reflection is that I have greatly underestimated the type and extent of leadership work required, I believe that analysing the challenges through this lens provides strategies for moving this change forward toward implementation.

The context

For decades, the mental health system has been designed and implemented by politicians, public servants, and healthcare professionals – that is, people with medical, nursing, social work, occupational therapy or psychology qualifications and clinical experience. However, there is an increasingly urgent need to listen and learn from mental health consumers and their carers, integrating their experiences, skills, and expertise as the “lived experience discipline” (Bassett et al. 2010; Gilbert & Stickley 2012). There are many roles within this discipline, ranging from “peer workers” (working alongside people experiencing mental ill-health, sharing insights and stories on recovery and wellbeing) to “lived experience policy officers” (using experiences to inform policies at government, hospital, and community levels). Roles have been further cemented and elaborated on in Victoria with the recent Royal Commission into Victoria’s Mental Health System (State of Victoria 2021) and the Productivity Commission Report (2020).

Adaptive leadership

Adaptive leadership, as described by Heifetz (1994), is the work of bridging the gap between the values people stand for and the reality they face, which may pose conflicts to existing value systems. Interaction of different value systems is important for society, as it enables people to see challenges from different vantage points and shifts away from risks such as ‘group think’. This type of leadership is required when problems extend beyond requiring only technical expertise, instead encompassing areas such as ‘reform’ or ‘cultural change’. It requires leaders to induce learning by asking hard questions, in suitable timeframes, whilst maintaining a safe, holding environments for learning to occur within. For success, there needs to be a level of tension and urgency that mobilises people, whilst not causing any feelings of being overwhelmed. Issues are framed so that people can explore opportunities, challenges and tensions, and people work together towards agreeable outcomes. As such, outcomes and actions are owned by all who participate in the process.

What does this mean for Victoria’s Mental Health System?

The need for, and value in growing the lived experience discipline has been recognised for years, with many inspirational leaders working in this space. However, whilst there is an authorising environment from the Victorian State Government and other States and Territories are making headway to facilitate substantial growth, from my observations, there are difficulties in both recruiting and retaining people into this workforce, especially within the public mental health system. The reasons for this are multifaceted and include a narrow focus on achieving the technical requirements for change whilst simultaneously overlooking the cultural complexities. For example, mental health professionals have historically “othered” those with mental ill-health, working in a well-unwell dichotomy. Consumers and carers of services also report varying levels of helpful-unhelpful interactions, with many reporting instances of iatrogenic harm (Katterl & Maylea 2021). Trying to move forward with the technical aspects of implementation without addressing these factors will not result in any enduring success.

Highlighting and focusing attention on the adaptative work required is essential to facilitate the cultural change required. Some examples of the technical and adaptive work needed are:

I see many places pushing ahead, in good faith, to meet the technical components of the change required without adequately paying attention to the adaptive components. This could be due to a lack of awareness, or understanding of, the amount of leadership work required to implement this type of change well.

In this reflection, I have only been able to describe the ‘tip of the iceberg’, and it is written only from one perspective. However, it is informed by my discussions with colleagues, my experiences, and I hope it opens a space for further conversations to happen. To end, I would like to pose three questions:

• How can we better enable this adaptive change to happen?

There are many leaders in this space who have fought hard for these changes. Additionally, the Royal Commission and other National Strategies, Plans and Frameworks have reinvigorated this conversation, and adaptive conversations are happening across Victoria. However, for many health and lived experience professionals, the space for adaptive conversations is limited. How can we ensure more consistent attention to this across the entire workforce?

• How can we value and promote the adaptive change required?

There is a specific focus from industry experts, health unions, and the Government to meet technical tasks in a timely manner. How can we equally embrace key performance indicators that measure for adaptive change, for example, staff surveys, assessments of culture or retention of lived experience staff?

• What can you do today to support the leadership of adaptive change in this area?

We would love to hear you share your thoughts here https://livedexperience.alivenetwork.com.au/discussion-topics/what-can-you-do-today-to-support-the-leadership-of-adaptive-change/

References

Basset, T. Faulkner, A, Repper, J. & Stamou, E. 2010. Lived experience leading the way: Peer support in mental health. London, United Kingdom: Together UK.

Gilbert, P. & Stickley, T. 2012. “Wounded Healers”: the role of lived‐experience in mental health education and practice. The Journal of Mental Health Training, Education and Practice, 7(1), pp. 33-41.

Heifetz, R.A 1994, Leadership without easy answers. Cambridge, America: Harvard University Press.

Katterl, S. & Maylea, C. 2021. Keeping human rights in mind: embedding the Victorian Charter of Human Rights into the public mental health system. Australian Journal of Human Rights, 27(1), pp.58-77.

Productivity Commission 2021, Annual Report 2020-21, Annual Report Series, Canberra.

State of Victoria 2021, Royal Commission into Victoria’s Mental Health System, Final report, Summary and recommendations, Parliamentary Paper No. 2020, Session 2018-21.

About the writer

Rachel is a mental health nurse employed as the Program Implementation Manager at Barwon Health Mental Health Drugs and Alcohol Services. She has clinical, research, project management and senior management expertise and is a strong advocate for lived experience participation at all levels of mental health service reform, design and delivery.