Sharing Experience Learned Firsthand (SELF): Self-Disclosure in Mental Health Services

Background/Purpose: Peer delivered services have been increasing at a significant rate in community mental health. The active ingredients of the programs include sharing lived experience of mental distress and role modeling recovery. Limited attention has been given to the topic of disclosure of lived experience despite issues of stigma present in mental health service systems and society in general. The purpose of the Sharing Experience Learned Firsthand (SELF) investigation was to gain an appreciation of the role of lived experience of mental health challenges in professional training and work experience. The investigators were individuals with lived experience of mental health challenges concurrently engaged in consumer advocacy and graduate training. Methods: A mixed methods design approach was used in a sequential exploratory manner. A purposive sample of 35 individuals participated in interviews and focus groups.  Based on their reports and a literature review, an anonymous online survey (N=117) was developed and distributed through consumer networks and SAMHSA funded Technical Assistance Centers. The qualitative data was subjected to thematic analysis. The survey data was statistically analyzed for differences in levels of disclosure and factors regarding risks, benefits, and guidance regarding engaging in self-disclosure. Results: Participants spoke to how they valued their lived experiences as resources. They found that they could form connections and communicate hope for others on recovery journeys.  Sharing experiences was noted to be healing. However, some individuals chose not to disclose in situations that featured imbalances of privilege and power. Disclosure was dependent on social context and perceptions of safety. Individuals recognized that disclosure could address stigma, yet advised thoughtfulness about engaging in a disclosure process. SELF participants emphasized that individuals should carefully consider their reasons for disclosure, weigh the benefits and risks, and exercise self-determination. They recognized that disclosure would not be right for everyone given the existence of discrimination. However, some stated that despite the risk involved, it was only through disclosing that they were able to let go of shame. Conclusion and Implications: Self-disclosure has become recognized as a strategy for supporting recovery. Results of the SELF project were consistent with studies that have found self-disclosure to be a complex process invested in power. Individuals expressed concerns regarding exclusion and discrimination. Peers maintain that the sharing of lived experience is essential to the very approach of consumer delivered services. Project participants highly valued what they could offer others based on their own experiences of mental health challenges and recovery. Their experiences were their greatest strengths in helping others.  Decisions on self-disclosure were dependent on workplace culture, power dynamics, and type of role occupied. Recommendations for organizations included recognizing the strengths that peers bring to the work, providing training on mental diversity and the use of self-disclosure, and creating disclosure policies that apply to everyone regardless of particular role occupied. Future projects are needed to develop a better understanding of how identity, power, and status factor into self-disclosure.  Sharing lived experience is central to peer-delivered services and further exploration will be required to support service development.