Mental health has become a key concern within social discourse in recent years, and with it, the discussion about the lived experience of pain. In dealing with this experience there has been a shift away from merely relying on medical care towards more holistic approaches involving community support, public awareness, and social change. However, little if any attention has been paid in this context to the contribution of aesthetic experience engendered by art that expresses and publicly shares with others the lived experience of pain. With reference to Phantom Limb, an art exhibition curated by Euan Grey and held at the Victoria Galleries and Museum Liverpool in 2016, I argue that aesthetic experience plays a crucial role in making sense of pain and suffering, thus breaking new ground in the appreciation of the significance of art for public mental health and holistic approaches towards patients.

The medical and social model of disability is discussed and debated among researchers, scholars, activists, and people in general. It is common to hold a mixed view and believe that some disabled people suffer more from social obstacles and others more from medical problems inherent in their bodies or minds. Rachel Cooper discusses possible ‘test environments’, making explicit an idea which likely plays an implicit part in many disability discussions. We place or imagine placing the disabled person in a range of different environments. If there is a relevant test environment in which they do fine, their problem was societal/external; if there is not, it was medical/internal. Cooper admits that deciding on the appropriate range of test environments is an ethical and political question. In this chapter, I argue that we often ought to widen our scope when discussing psychiatric disabilities.

I suggest that the diagnosis that an individual self-diagnoses with can be influenced by levels of public awareness. Accurate diagnosis requires consideration of multiple diagnoses. Sometimes, different diagnoses can overlap with one another and can only be differentiated in subtle and nuanced ways, but particular diagnoses vary considerably in levels of public awareness. As such, an individual may meet the diagnostic criteria for one diagnosis but self-diagnoses with a different diagnosis because it is better known. I then outline a potential negative consequence of this. Psychiatric diagnoses can grant access to what I call social resources, namely, political advocacy, campaigning for support, participating in scientific research, building diagnostic cultures, and opportunity for social interactions with people who have the same diagnosis. The strength of the social resources for a particular diagnosis can be made stronger when more people have that diagnosis. As such, inaccurate self-diagnosis can result in the social resources for one diagnosis being strengthened whilst not being strengthened in relation to another diagnosis in comparison to accurate diagnosis. This shows how inaccurate self-diagnosis can alter the distribution of social resources. We need to consider whether this is unfair to people who are diagnosed with less well-known conditions.

Many worry about the over-medicalisation of mental illness, and some even argue that we should abandon the term mental illness altogether. Yet, this is a commonly used term in popular discourse, in policy making, and in research. In this paper I argue that if we distinguish between disease, illness, and sickness (where illness refers to the first-personal, subjective experience of the sufferer), then the concept of mental illness is a useful way of understanding a type of human experience, inasmuch as the term is (i) apt or accurate, (ii) a useful hermeneutical resource for interpreting and communicating experience, and (iii) can be a good way for at least some of us to establish a liveable personal identity within our culture.

‘The co-production of meaning’ is a phrase that has become entrenched in the field of public mental health, adopted almost as a slogan within the literature. But what does it actually mean? Current definitions gesture toward the very broad idea that co-production involves a collaboration between ‘service users’ and healthcare professionals, each contributing their knowledge to better understand and treat mental health problems. Yet, terms such as ‘equal’ ‘reciprocal’, and ‘partnership’ fail to clarify the nature of this ‘co-production’, and how it can be achieved.

To better understand the co-production of meaning, we shall attempt to develop an account of co-production through phenomenological psychopathology. Through Hans Georg Gadamer's remarks on ‘the hermeneutic problem of psychiatry’ two key obstacles to ‘co-production’ emerge: 1) contingent problems, and 2) intrinsic problems. In calling attention to these obstacles, we problematise the concept of ‘co-production’ in public mental health, revealing it to be more complex than originally thought. We conclude by arguing that new developments in phenomenological psychopathology can be used to overcome the limitations of ‘co-production’.

Co-production, in the field of mental health, aims to bring together academic and clinical researchers and those with lived experience. Often, research projects informed by this methodology involve the meeting of opposing attitudes, whether to the legitimacy of psychiatry, determinants of mental ill health, or the most appropriate interventions. This has meant that whilst some have reported positive experiences of co-production, many people with lived experience of mental ill health, sometimes referred to as ‘experts by experience’ (EbE), report harms which have taken place or been perpetuated during co-produced research projects. In the literature, nearly always, this is understood as a kind of epistemic injustice in Miranda Fricker's sense. In this paper, I argue that whilst Fricker's view does provide a plausible explanation of what's at play, we can gain more insight into the structural factors which exclude EbE by applying a framework of epistemic oppression. By highlighting the systemic and structural factors which work to keep certain knowers and their contributions out of our collective epistemic resources, we begin to understand the enormity of the task required to redress injustices in our knowledge production systems.

The world of mental health has become used to the notion of co-production as a good thing. While the paper is not a critical analysis of co-production, the authors make the case that while it is a good thing, it is not the only good thing; and it is neither sufficient, nor necessary for good things to happen in mental health services. Alternative concepts of progressive innovation in this field are introduced. Real world case studies (most of them previously unpublished) are then worked through to test which concept(s) – co-production, or the alternatives, or neither – are the better fit, bearing in mind the complex relationships to be negotiated, not just between service users and mental health professionals, but between service users and members of other professions, and of the general public. Finally, the question is raised as to whether there is anything (such as the flattening of hierarchies or stigma reduction) which all these innovations – co-production and the alternatives – have in common.

The focus of this paper is the moral and scientific value of ‘expertise by experience’, that is, knowledge based on personal experience of ill mental health as a form of expertise in mental health research. In contrast to individualistic theories of personal autonomy and the first-person in bioethics, my account of shared decision-making is focussed on how a relational approach to the ‘person’ and ‘patient values’ can throw new light on our understanding of ‘voice’ in mental health research. The mistake, I argue, is to think that a commitment to listening to the patient voice in the process of perspective taking implies a threat to ‘objectivity’ in clinical practice and the very concept of evidence in the philosophy of science more generally. Instead, I use Helen Longino's account of epistemic validity in philosophy of science to argue that narrative experience and ‘patient perspective’ should be understood as an ongoing dynamic partnership working between the different stakeholders’ knowledge perspectives. I also address the connection between expertise by experience and the psychiatric significance of the personal self for the entrenched topics of agency, self-hood, personal identity, and self-knowledge in psychiatric diagnosis. In contrast to identity politics, my model of shared decision-making preserves a critical distance between perspective-taking and value itself in self/other appraisal as the gold standard for good clinical practice.

Among the different approaches in mental health activism, there is an ongoing concern with the concepts and meanings that should be brought to bear upon mental health phenomena. Aspects of Mad Pride activism resist the medicalisation of madness, and seek to introduce new, non-pathologizing narratives of psychological, emotional, and experiential states. This essay proposes a view of Mad Pride activism as engaged in no less than the creation of a new culture of madness. The revisioning and revaluing of madness requires transformations in the basic concepts constitutive of current mental health narratives. This process is illustrated with the concept of self and its relation to passivity phenomena (thought insertion). The essay concludes with some of the challenges facing Mad Pride's ambition to enrich the cultural repertoire.

This chapter introduces values-based practice as a resource for working with individually diverse values in health and social care, and describes its origins in an on-going development through the resources of philosophy. The chapter is in two main sections. Section I, Values-Based Practice, builds on two brief interactive exercises to introduce and explain the key features of values-based practice. As a relatively recent addition to the range of resources for working with values in health and social care, values-based practice is distinctive in focussing on the diversity of values comprising individual lived experience. Like evidence-based practice, values-based practice is a process-driven rather than an outcome-driven methodology. That is to say, rather than offering prescribed answers, both approaches offer processes that support decision-makers in coming to answers for themselves based on the particular circumstances presented by the situation in question. Although entirely complementary, the processes involved are of course different. Where evidence-based practice relies on meta-analyses of the results of high-quality clinical trials to inform a consensual model of decision-making, values-based practice builds on learnable clinical skills and other process elements to inform a dissensual model of decision-making rather than seeking to overcome value-conflicts in reaching consensus. Working within a premise of mutual respect for differences of values, and guided by three key principles linking values and evidence, values-based practice, as described in the chapter, supports dissensual decision-making, balanced according to the circumstances presented by the decision in question, within frameworks of locally-set frameworks of shared values. Section II, The Theory-Practice Dynamic, then outlines the theory-practice dynamic on which values-based practice is based. The origins of values-based practice in mid-twentieth century ordinary language philosophy of the Oxford School are outlined. As the chapter illustrates, although a limited area of analytic philosophy, many aspects of values-based practice are informed by ordinary language philosophy, ranging from its premise, through the training exercises and other process elements described in Section I, to its role in hybrid empirical studies supporting its model of service delivery. The development of values-based practice, furthermore, as section II goes on to describe, is ongoing, with key initiatives drawing not only on both analytic and Continental traditions of European philosophy, but also on non-European philosophies such as those of Africa and the Caribbean.