If You’re Not at the Table, You’re on the Menu
Why Lived Experience Leadership in Mental Health Must Take Centre Stage
3-minute read
I was reminded of the phrase “If you’re not at the table, you’re on the menu” this week at the WHO’s consultation event on building ‘a roadmap for lived experience integration into mental health systems’ and it was a helpful reminder of the consequences if we continue to exclude. This phrase is a call to action, a demand for agency. Nowhere is this more urgent than in mental health, where decisions about policies, funding, and services often shape the lives of those with lived experience—yet they remain absent from the decision-making tables.
For too long, lived experience in mental health has been seen as something to be consulted rather than something that drives leadership. Co-production models have been a step forward, but they often stop short of real power-sharing. The future of mental health advocacy, peer support, and service design lies not just in co-production but in lived experience leadership.
Moving Beyond Tokenism
Too often, people with lived experience of mental health challenges are brought into discussions as a tick-box exercise—invited to share their perspectives without being given real decision-making power. But lived experience leadership (or ‘Peer Leadership’) is about more than consultation; it’s about shifting power structures. When those directly impacted by mental health systems lead the way, the outcomes are more relevant, effective, and sustainable.
The Case for Leadership, Not Just Representation
Representation matters, but leadership is the real goal. Lived experience leaders in mental health bring a depth of understanding that no academic qualification or professional expertise can replace. They challenge assumptions, drive innovation, and hold systems accountable. When people with lived experience are at the table—not just as guests, but as decision-makers—they ensure that mental health policies and programmes work for the people they are meant to serve, rather than simply serving the interests of institutions.
The Risk of Staying on the Menu
When lived experience is sidelined, mental health systems continue to be designed by those with little to no direct understanding of their real-world impact. This leads to ineffective interventions, wasted resources, and harm. If those with lived experience aren’t at the table, the policies and funding structures that dictate their lives will be shaped without them—and often against them. The result? Further marginalisation, missed opportunities for meaningful change, and systems that fail to address the complexities of real-life mental health struggles.
Building a Future of Lived Experience Leadership in Mental Health
The shift to lived experience leadership in mental health requires more than good intentions. It demands structural change:
Redefining expertise: Valuing lived experience as equally—if not more—important than professional expertise.
Investing in leadership development: Providing funding, training, and mentorship to lived experience leaders.
Embedding lived experience at all levels: From frontline mental health services to executive boards and policy-making spaces.
Challenging gatekeeping: Removing the barriers that keep lived experience leaders from accessing power, whether that’s rigid hiring criteria, exclusionary board structures, or tokenistic engagement practices.
A Seat at the Table Isn’t Enough—We Need Ownership
Community engagement should always involve community organisations and partners who may be able to bring people together. Identifying and tapping into existing networks is essential in ensuring that people from a range of communities are included in your projects and programmes.
Communities often have answers to the problems they face, therefore going back to these communities to validate findings or solutions is important.
At Habitus, we always embed a feedback loop where we meet with people – be it in person, online or through sharing materials – as a way of giving back to the community and empowering them by sharing our findings.
Securing a seat at the table is a start, but real progress comes when lived experience leaders own the table—setting the agenda, shaping the conversations, and leading the way. The future of mental health peer support and advocacy isn’t about being invited into existing systems; it’s about transforming those systems so that lived experience is at their core.
If lived experience leadership in mental health isn’t centred, then it’s being exploited. And if it’s not at the table, then it remains on the menu. The time for change is now – check out the ‘Heiloo Declaration’ that we were part of co-creating alongside a group of peer and lived experience leaders from across the globe in 2024 in The Netherlands.
If you would like to build your own lived experience or peer leadership, come join our monthly international community of practice or keep an eye on when our peer leadership incubator programme opens.
At Habitus, we have developed and designed successful community programmes for various charities, health organisations and businesses both in the UK and internationally.
We are accomplished in peer research, co-production, action-based and anti-oppressive research and evaluation. We are experts in helping organisations to engage wider community participation in their projects so that their work is more inclusive and impactful. Through this approach we are dedicated to increasing lived experience leadership.
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