Employed but not included: the case of consumer-workers in mental health care services

Abstract

This article explores how employees with mental illness perceive HRM and its impact, drawing on consumer-centred perspectives. Using the case of consumer-workers employed for their lived experience of mental illness in mental health care services, we investigate the degree to which they feel included or marginalised by HR systems, processes and practices. Through a mixed method study designed along co-production principles, we found consumer-workers faced different but interrelated problems stemming from their status: a general lack of understanding of the role and its purpose; inequity in pay rates, workplace conditions, and training and development; as well as employment precarity and difficulties around disclosure, stigmatisation and discrimination. Overall, organisational support for these unique roles seemed to be lacking despite the clear business need for these positions. We make several contributions: firstly, we show how employees in a unique role that requires experience of mental illness are impacted by the interaction between HR systems, processes and practices; secondly, we illustrate why HR scholars need to engage with varied paradigms of knowledge about mental illness beyond the dominant medical/psychiatric one; and thirdly, we demonstrate a methodology that not only explores employee perspectives, but includes employees in the research design and process.

Keywords:

• Mental health services
• human resource management
• consumer perspective
• qualitative research
• co-production

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Due to the nature of this research, the data are not publicly available due to their containing information that could compromise the privacy of research participants.

Notes

1 Following Roper et al. (2018), we use the term mental illness in single quotation marks to signal this labelling reflects the dominance of the medical paradigm and that there are other ways of understanding such phenomena. For example, lived experience of mental illness gives rise to a different form of knowledge, the value of which is increasingly recognised and is one of the reasons for establishing consumer-worker roles in mental health services. In addition, individuals may experience symptoms but not be formally ‘diagnosed’ or be subject to changing diagnoses over time. They may also not identify with, or accept, their medical ‘diagnosis’ nor consider their experience to be an ‘illness’ but rather a form of neurodiversity or a natural reaction to the experience of trauma.

2 We acknowledge there are many ways of referring to people who have the experience of a diagnosis of mental illness. The preferred language is person first, i.e. a person with a lived experience of [a specific condition]. Following a worldwide movement in the 1980s, in Australia, the term ‘consumer’ has been used by advocates, community groups, services and policymakers to refer to people who use mental health services. In other countries terms such as service user, patient or survivor may be used. For the purpose of this paper, the language most common in Australia has been adopted.

3 Consumer workers is the term commonly used in Australia to identify people using their lived experience of mental illness in their work. In other countries terms such as ‘service user’ or ‘peer worker’ may be used. See p. 4 Lived experience roles in mental health services: Consumer-workers for an explanation of this specialist workforce.

Additional information

Funding

This work was supported by Melbourne Social Equity Institute, The University of Melbourne.