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Paper short abstract

Drawing on action-research in Northern Italy, this paper analyses the introduction of experts by experience in mental health services. Exposing polarisation around authority, care and legitimacy, the paper shows how transformation can be supported through tensions rather than shared agreements.

Paper long abstract

The role of peer support workers and people with lived experience (PLEs) has gained increasing recognition within mental health services. This has led many systems to actively implement PLEs as part of recovery-oriented initiatives. However, this has been accompanied by critical concerns regarding the co-optation of experiential knowledge towards biomedical and managerial logics.

This paper draws on an action-research project that aimed to support the implementation of PLE roles within public mental health services in Udine, Italy. Established through a robust partnership between health authorities, service users and associations, the project sought to initiate a novel role and service model, whilst examining the epistemic and cultural practices of mental health services.

Rather than glossing over frictions as “implementation problems”, this paper focuses on the most challenging issues that arose: uncertain role boundaries and remuneration, disputes over legitimacy and accountability, concerns about tokenisation, and shifting alliances. We highlight how the project navigated these tensions by starting with the creation of dedicated, separate spaces where service users and family members could develop a shared language and political consciousness that transcended individualised recovery narratives, and where professionals express their doubts and limitations. Through facilitated moments of exchange between these spaces, tensions became apparent, enabling provisional 'fits' to be negotiated between competing moral economies of care, authority and knowledge. By addressing these fractures, the project highlights the ethical responsibility of researchers and practitioners to recognise conflict as an integral part of transforming care.