Peer Work and Stigma Reduction in Australian Mental Health Policy: Tackling Sanism or Reinforcing the Status Quo?

Abstract

Peer workers are increasingly included as part of mental health policy approaches to stigma, reflecting ongoing imperatives to include lived experience within mental health policy and practice. Using a post-structural analysis of Australian mental health policy, we critically examine the effects of such inclusion on dominant enactments of peer work and stigma. We find that mental health policy predominantly produces stigma as a problem of individual lack of capacity and responsibility, reinforcing neoliberal and psychiatric logic that locate individuals as the site for intervention and mental health practitioners as the experts to undertake such interventions. The inclusion of peer workers, predominantly enacted as role models, promotes the appearance of progressive governance whilst distracting from the socio-material conditions and processes that mark individuals as other, and leads to significant harm when individuals seek support. Dominant enactments of stigma thus remain undisturbed by the inclusion of peer work within mental health policy. Our findings challenge the notion of inclusion of lived experience via the peer workforce as universally progressive, calling for a more nuanced examination of the effects of inclusion. We propose sanism as an alternative problematisation that aligns more closely with peer work and social justice. We conclude with practice and research recommendations