STUDENT’S NAME:

INSTRUCTOR:

COURSE:

DATE:
 THE BENEFITS OF LIVED EXPERIENCE ROLES.

1.0: Abstract

The research was aimed at investigating the meaning of lived experience roles. How they are used as well

as their benefits. There was also a review of a collection of related information concerning the lived

experience. To achieve accurate and representative data secondary data collection was employed.

Secondary data collection entailed the use of relevant online scholarly documents such as books, journals,

and articles among others. Primary data collection procedures such as carrying out interviews, filling in

questionnaires would have been used but owing to the covid-19 pandemic this became quite impossible.

The researcher also identified some ethical issues considered while working with the affected. After a

comprehensive analysis, the significance and contributions of the findings were also identified.

1.1: Literature Review

Research by World Health Organisation shows that mental, neurological, and substance use disorders

have had a substantial impact on global health well-being. Disorders such as depression, alcohol abuse,

and schizophrenia constitute 13% of the total burden of diseases, Worldwide mental neural and substance

use disorder being the leading cause of disability, and the 10th leading cause of death (WHO 2008). The

research will provide more insight into the issue at hand especially, globally.

Mike Slade in his book; Personal Recovery and Mental Illness looks at the nature of a mental illness, the

clinical, disability and, diversity models, and their relationship with mental health. He also looks at the

development of a science of mental illness, the diversities of working with the affected, and their benefits

to society as an ethical rationale to dealing with mental issues. He argues that supporting personal

recovery requires a change in values. The new values involve being driven by the priorities and

aspirations of the individual rather than giving primacy to clinical preoccupations and imperatives. This

involves mental health professionals listening to and acting on what the individuals say (2009). His work

provides a good foundation in the field of mental health.

Marjorie Band in her book, Organisational and Community Responses to Domestic Abuse and

Homelessness, conceptualizes the issue of domestic abuse, victimization and, homelessness the
implications and ramifications. Marjorie, advices on the need to tell one’s lived experience story, as a

form of therapy. She samples out some real-life experiences by the victims as an intervention strategy in

inter-organizational crises. The social and political concerns and how they act as a hindrance to justice

and the need to come out and tell your story. She also addresses the need to start an organisation to

champion against the vice of violence, and homelessness (2016). The book provides an insight on

domestic violence especially against women the strategies to be employed to fight the same issue.

In their book Pathways of Addiction, the committee on opportunities in drug abuse research provided an

overview concerning the technology, prevention, consequences, treatment, management, and drug

control. They claim that the aim of the nation‘s investment in drug abuse research is to enable society to

take effective measures to prevent drug use, abuse, and dependence, and thereby reduce individual, and

social consequences and, associated costs. They state categorically that, health consequences of drug

abuse include increased rates of Human Immunodeficiency Virus transmission, increased spread of

tuberculosis: adverse developmental consequences to child-abusing parents, and increased violence. Their

research shows that the extent of drug use, abuse, and dependence on society is evidenced by its

enormous burden. It is estimated that the cost of illicit drug use, abuse, and dependence is tailed with that

of alcohol and nicotine, the collective costs of drug use, and abuse being approximately two fifty- seven

billion dollars exceeding the estimated annual one hundred and seventeen billion dollars of heart disease

and estimated annual one hundred and four billion dollars of cancer treatment (1996). Their research is

useful in providing much needed information on drug use especially in the United Kingdom, and how it

affects society. The figure of money used in drug use provides an insight into the worrying trend in drug,

and use.

Trachtenberg and Flaming (2004) look at problematic drug use as widely used in Literature. They quote

several definitions by scholars. The works include: Kaminski and Decorate (2004) in their report from

Belgium define problematic drug use as a pattern of use that is beyond one’s control. In other words, the

emphasis is on whether users find aspects of their drug use detrimental. Other publications have focused

more on dependency. In these cases, problematic drug use applies mainly to users of addictive drugs, like

heroin, crack, and cocaine.

The European Monitoring Centre for Drug and Drug Addiction defines problematic drug use ‘as injecting

drug use or long duration/ regular use of opiates, cocaine, and amphetamines. The simplest meaning of

problematic drug use is, to consider it as drug use that generates problems either to the user or the society.

Trevor and Katy (2016, p. 8). Relate problematic drug use to alcohol use. Usually defined as, alcohol use

that adversely affects the user or others. In practice, researchers have developed a wide range of

indicators of adverse effects of alcohol that might define problematic alcohol use. These include whether

the person uses alcohol to function properly, whether they regularly become intoxicated, whether they go

to work or drive a car while intoxicated, whether they have experienced any injuries as a result of being

intoxicated, whether the person feels that their life is affected adversely by alcohol, whether they want to

give up or cut down but cannot. Hence, a problematic drinker is anyone whose drinking causes a problem

to themselves or others. That research provides an insight into the concerns related to problematic drug

use and how people are trying to change the narrative of drug abuse.

In a UK study of 60 women using crack cocaine is 40% reported being physically assaulted by a current

or past partner as per the researcher. In a study of inner London treatment agencies in 2000, 30% of

women reported physical violence from their current partners although the figure was estimated to be

higher due to women‘s fear and, difficulty in reporting their experiences of abuse, and violence. For

women experiencing domestic violence, their physical safety, and emotional well-being must be

addressed first before there is any chance of reducing drug abuse. There are very few women-only

residential drug services in the UK and even fewer where children can accompany their mothers. Great

Britain, Parliament, House of Commons (2000, p. 197). The research provides an insight into the

worrying trend of silence among women who have faced domestic violence and the danger it poses to the

particular group.

Fitzpatrick and Jones (2005) suggest that casual mechanisms of homelessness occur at four levels.

Firstly, within economic structures, where poverty is the main driver: secondly, within housing structures

where inadequate housing supply and, affordability have an impact on homelessness and thirdly within

patriarchal and other dysfunctional family structures, where domestic violence, child abuse, weak social

support, and relationship breakdown contribute to a social situation where homelessness is a likely result.
Finally, individual attributes can contribute to the risk of homelessness. For example, if an individual‘s

resilience is undermined in some way including mental health problems, addiction, and substance abuse,

and lack of self-esteem. Notably, many homeless people especially women spend time living with friends

or relatives, often with periods of sleeping rough in between. Research shows that women do not appear

to access homeless services. This may either be due to a lack of awareness of the services available to

them or due to a lack of sustainable provision. Added to the problem of the lack of detailed, and realistic

information about the homeless in general across Europe, this problem is more acute in the case of

women homelessness because a very small proportion engages with street outreach teams many become

homeless to escape violence from a partner. Their work provides awareness of the contributing factors to

homelessness and, the remedy.

Slide (2009) Suggests that the issue of mental health may be looked at in three spectrums. Firstly, are the

people who benefit from mental health illness services. This group contains people who are progressing

well in life and, are then struck by mental illness. The application of effective treatment helps the person

to get back to normal to come to the view that mental illness experience as a bump in the road of their

life, which they get over, and move on from. For this group, mental health services as currently

configured promote recovery.

Secondly, are a group of people for whom mental health services promise much but do not fully deliver?

This group finds that the impact of the mental illness does lessen over time, but not clear how much this is

because of the treatment and how much because of other influences- the passing of time, learning to

reduce, and manage stress better, developing social roles such as worker and friend and partner, making

sense of their experience in a way that offers a hopeful or better future. For this group, mental health

services are configured as insufficient. They provide effective treatments though personal recovery

involves more than treatment.

Thirdly, are a group of people for whom the mental health system with its current preoccupations,

imperatives, and values is harmful. This group finds that the impact of mental illness increases over time,

to the point where their whole identity is enmeshed with the mental patient role. The more treatments and

interventions are provided, the further away a normal life becomes. The main aim of lived experience is

that mental illness treatment achieves the third spectrum. His work helps understand mental health better

which by understanding the problem then the solution can be arrived at.
1.3: The evolution of policy and services to help homeless people into employment

Many people especially women are rendered homeless as a result of drug abuse. Drugs may act as a

cause, response, moderator, or mediator of violent behaviour. Additionally, there is evidence of complex

linkage between violence, drug abuse and, co-occurring psychiatric disorder. Illicit drugs and alcohol

abuse are more significantly more prevalent among persons who suffer from psychotic disorders.

Housing support services have long recognised that housing in itself will not provide a complete answer

to the risks and consequences of homelessness. Homeless people can often lack self-esteem, a sense of

purpose and, a clear structure and goals in their lives Jones and Peace (2005).

Successive governments have taken the view that paid work is beneficial in many ways; it provides a

route out of poverty and it can address the sense of purposeless, lack of direction, and poor self-image

that may be present among people who have not worked for sustained periods. Alongside securing paid

work, activities that can lead to paid work, such as education, training and, volunteering, while not

delivering the same financial reward, can nevertheless help tackle some of the issues around having little

sense of purpose or self-worth that sustained lack of work may lead someone to experience. These ideas

are the keystone of a longstanding series of welfare-to-work reforms that in their most recent expression

in the planned restructuring of the entire welfare system with an emphasis on maximising the incentives

and opportunities for people on the benefit to enter paid work. However, some Organisations have

specialised in providing employment-related services to single homeless people, such worth noting

organisations are:

1.3.1: Shelter

The Shelter is a registered charity that campaigns to end homelessness and bad housing in Great Britain.

It gives advice, information and, advocacy to people in need, and tackles the root causes of bad housing

by lobbying government and local authorities for new laws and policies to improve the lives of homeless
and badly housed people. It works in partnership with Shelter Cymru in Wales and the Housing Rights

Service in Northern Ireland. The charity was founded in 1966. Shelter helps people with the need for

housing by providing advice and practical assistance; they also fight for better investment in housing and

for laws and policies to improve the lives of homeless and badly housed people.

A report by Shelter dedicated to tackling homelessness and bad housing suggests that Depression is one

of the main problems affecting the health of people living in temporary accommodation.,

The report was based on a survey conducted by Shelter of 2000 homeless households (single people and

families). A total of 417 households, from nine local authorities in London, the South East, South West,

North, and Midlands, replied to the survey. Of the 375 households who responded to the specific section

on health 78% reported at least one specific health problem. 56% of the 375 respondents reported feeling

depressed. Around half of the parents with children and 71% of childless people reported feeling

depressed.

The Shelter was launched on 1 December 1966, evolving out of the work on behalf of homeless people

then being carried on in Notting Hill in London.

1.3.2: Back on Track Organisation

Back on Track is a Manchester charity that enables disadvantaged people to make lasting changes in their

lives. It supports adults who are going through a process of recovery or rehabilitation to build the skills

they need to lead independent and fulfilling lives. They offer support for ex-offenders and people who

have had problems with alcohol or drugs, accommodation, or mental health, working with them to build

their wellbeing, confidence, skills, and employability. Their centre in city Manchester provides training,

work experience, volunteering and mentoring. Overall the number of people supported each year has

increased from 600 to 1100 in the last five years. The organisation believes that developing partnerships

with local employers and agencies is the key to succeeding in our aim of supporting people into work or

further training. They have a range of ways that employers can get involved, from running a skills

workshop, working one to one with our service users, or holding a company challenge day.

1.3.3: Women Aid

The Women's Aid Federation of England, commonly called Women's Aid, within England is one of a

group of charities across the United Kingdom. There are four main Women's Aid Federations, one for
each of the countries of the United Kingdom. It aims to end domestic violence against women and

children. The charity works at both local and national levels to ensure women's safety from domestic

violence. It also promotes policies and practices to prevent domestic violence.

Women's Aid Federation of England is the sole national body for the England-wide network of over 370

local domestic violence organisations, providing over 500 refuges, outreach, advocacy, and children's

support services. Women's Aid campaigns for better legal protection and services and in partnership with

its national network runs public awareness and education campaigns. Any woman can stay at a refuge

(and take their children) and proof of abuse is not needed to stay at a refuge.

Women's Aid provides services through its publications and website and runs a Freephone 24-Hour

National Domestic Violence Helpline in partnership with Refuge.

Women's Aid was set up as a national United Kingdom federation to supervise almost 40 services that

had been established over the country. It was originally known as the National Women's Aid Federation,

before the launch of Scottish Women's Aid in 1976, and both Welsh Women's Aid and the Women's Aid

Federation Northern Ireland in 1978. The first Women's Aid Federation was set up in 1974, shortly after

the founding of the first refuge for women experiencing domestic violence. The organisation provided

practical and emotional support as part of a range of services to women and children experiencing

violence. The charity was instrumental in lobbying for the 1976 Domestic Violence and Matrimonial

Proceedings Act, and for having women and children at risk of domestic violence count as homeless

under the 1977 Housing Act.

During the 1980s, Women's Aid established the first-ever National Domestic Violence Helpline service to

meet the increasing number of calls to the Women's Aid national office. The Helpline not only provided

help and support for abused women and children, as well as agency professionals seeking advice, it also

became a national reference point for access to the national network of refuge and support services. The

charity continued to lobby for greater consideration and support for women and children experiencing

domestic violence. Through the 1990s, Women's Aid continued its lobbying work, as well as increasing

its public campaigning. In 1994, the charity released the first-ever domestic violence cinema

advertisement and supported the television soap opera Brookside in a long-running, high-profile storyline

on a family affected by domestic violence. In 1999, Women's Aid launched the first comprehensive

domestic violence website in the UK and The Gold Book, the first-ever UK-wide public directory of local

refuge and helpline services.

Since 2000, Women's Aid has run several high-profile campaigns, continued its work lobbying

government and launched some educational resources aimed at schools and teachers to encourage the

teaching of healthy relationships as a preventative measure against domestic violence. Katie Ghose was

the chief executive officer of Women's Aid, having started in July 2017. She took over the post from

Polly Neaten, and stepped down in February 2019, after complaints from several women groups after her

public praise of the United Kingdom Independent Party. In 1978, Women's Aid carried out a study of

1,000 women living in refuges, in light of statistics demonstrating that 1 in 4 crimes in Scotland was 'wife

assault.' This was the beginning of significant amounts of research performed by Women's Aid and many

partners into issues around domestic violence, which has developed into the release of Women's Aid's

'Annual Survey of Members', which gives details of the services in England working to support women

experiencing domestic violence, and the women who use them

Women's Aid states that:

Domestic violence against women is a violation of women and children's human rights, that it is the result

of an abuse of power and control, and that it is rooted in the historical status of women in the family and

society. Women and children have a right to live their lives free from all forms of violence and abuse, and

society has to recognise and defend this right.

Women's Aid advocates for abused women and children in three main ways. Firstly, they aim to affect

policy decisions and laws by working with the local and national governments. Secondly, they attempt to

raise awareness of the problem of domestic violence by campaigning and running websites such as The

Hideout. Thirdly, they provide services to abused women and children.

1.3.4: Women Matter

In 2015, the McKinsey Global Institute showed that narrowing the gender gap in the global labour market

would not only be equitable in the broadest sense but would also double women‘s contribution to global

gross domestic product (GDP) growth between 2014 and 2025. A best-in-region scenario, in which all

countries match the improvement rate of the fastest-improving country in their region, could add as much

as USD 12 trillion, or 11% to global 2025 GDP, and USD 2.1 trillion to Western Europe‘s GDP in 2025.

The additional USD 2.1 trillion in GDP comes from; the increase in hours worked by women; the higher
participation of women in the workforce; a greater representation of women in high productivity sectors.

Capturing these opportunities requires tackling the part-time and unpaid work gaps. This narrowing of the

gender gap would go beyond a mere GDP increase and improve the representation of women in

leadership positions. There is a correlation between the representation of women in leadership positions

and women‘s part-time employment rate on the one hand and hours of unpaid work on the other hand. In

addition, the management of government information established a clear link between gender equality in

society and gender equality in the workplace. In fact no country has achieved gender equality in the

workforce without first narrowing gender gaps in society. For the past 10 years, McKinsey & Company

has researched companies and managers for the Women Matter series, and in each year, has built a case

for higher representation of women in top management positions and explored concrete ways to change

corporate attitudes toward women in the workplace. In particular, research has consistently shown a

correlation between the proportion of women on executive committees and corporate performance. While

correlation does not prove causality, a diversity of leadership styles can contribute to more effective

decision-making, and that the leadership behaviours women typically display can have a positive impact

on many dimensions of an organization‘s performance and health. Our work has shown that, beyond

gender diversity, it is the diversity of leadership styles that improves an organization‘s performance, and

that companies that have been successful in retaining talented women are significantly better at retaining

talented men as well. Although the case for gender diversity is compelling, progress toward parity in most

Western European countries remains slow: only 17% of executive committee members are women and

women comprise only 32% of the corporate boards of companies listed in the major market indices in

Western Europe (+6 points since 2012 for executive committees and +10 points for corporate boards) and

17% of executive committees and 18.7% of boards in the US. A 2016 survey of 233 companies and 2,200

employees showed that while the vast majority of companies surveyed had introduced measures to

increase gender diversity at the top, many were struggling to achieve significant results. The measures

mentioned include setting quantitative targets and programs to increase the representation of women,

launching women’s development programs such as training, mentoring, and networking, establishing and

monitoring gender diversity indicators, as well as human resource processes and policies to attract,

develop and retain talent. Specifically: Increasing the number of gender diversity initiatives is not enough:

having a critical mass of diversity measures is important but the volume alone does not explain women‘s
representation in top management: In a survey, 52% of the companies sampled implemented more than

50% off The power of parity: How advancing women‘s equality could add $12 trillion to global growth.
A survey was conducted in 2016 in nine countries (Finland, France, Italy, the Netherlands, Norway,

Portugal, Spain, Turkey, and the UK). Executive summary Women Matter 2016; Reinventing the

workplace to unlock the potential of gender diversity measures, only 24% of them reported having more

than 20% of women in top management positions. Only 7% of the companies sampled ranked diversity

among the top three priorities on their strategic agenda. Of the 2,200 employees surveyed, over 88% said

they did not believe their company is doing what it takes to improve gender diversity, and 62% of them

did not know how to contribute to gender diversity. The effectiveness of gender diversity programs was

frequently raised, and only 40% of the respondents reported they were well implemented in their

companies that is, they had clear follow-up processes in place, were assessed regularly, and their

effectiveness was evaluated at various levels of the organization. The survey of 2,200 employees sought

to better understand the barriers that prevent women from being promoted to leadership positions. It was

noted that, once again, that the prevailing anytime performance model and leadership styles in the

corporate world were key roadblocks for women at all levels. In previous Women Matter reports, the

organisation identified a comprehensive gender-diversity ecosystem that companies can implement to

increase women‘s representation at each stage of the organization. Building on this ecosystem, the 2016

research showed that the following three game-changers distinguish best-in-class companies:

1. Persistence: best-in-class companies initiated diversity programs earlier (3 to 5 years ago vs. 1 to 3

years ago). This indicates it takes time to effect tangible, sustainable results.

2. CEO commitment: companies that have successfully engrained gender diversity at the leadership

level are twice as likely to place gender diversity among the top three priorities on their strategic agenda,

to have strong support from the CEO and management, and to integrate gender diversity at all levels of

the organization.

3. Holistic transformation programs: best-in-class companies have initiated holistic change programs to

engrain gender diversity. Specifically, those companies are more likely to have change agents and role

models at all levels of the organization; they also have developed and communicated a compelling change

story to support the programs, policies, and processes they have put in place. We believe it will take

government and business-led interventions to create an environment that offers women better

opportunities, one that enables women to train for and work in skilled, better-paying sectors, occupations,

and roles; that reshapes social norms and attitudes, and that supports work-life balance. To achieve this,

companies need to embark on a broad transformational change journey that will entail re-evaluating their
traditional performance models and challenging the long-term viability of their prevailing leadership

styles.

1.3.5: The Changing Life Initiative

Changing Lives initiative believes that everyone deserves a safe home, a rewarding job, and a life free

from addiction or abuse. They also believe that, given the right support, anyone can change their life for

the better. By focusing on their strengths, potential, and opportunities, they help over 12,500 people

overcome their problems and live safe, successful, independent lives each year.

They have around 100 projects in England staffed by 600 dedicated staff. They help people experiencing

homelessness, domestic violence, addiction, long-term unemployment and more, to make positive change

for good.

1.4: Research Questions

1. What is the definition of lived experience roles?

2. Which are the lived experience roles?

3. What are the benefits of using people with life experiences as drivers of change?

4. How can hope be achieved for the lived experience cases?

1.5: Research Methodology

Owing to the effects and concerns of the world’s Covid-19 pandemic, the researcher opted to find

information and research evidence from secondary sources books, personal sources, journals, websites, as

well as government records.

1.6: Definition of Lived Experience Roles

The lived experience workforce refers to a range of roles that can be delineated based on direct service

provision, or peer support, with individuals and groups through to more indirect service provision within

leadership and management roles in mental health (Jacobson et al. 2012).

Lived experience is also defined as personal knowledge about the world gained through direct, first-hand

involvement in everyday events rather than through representations constructed by other people. It is also
defined as the experiences of people on whom a social issue or combination of issues has had a direct

impact (Sandu 2017).

Below is a diagrammed representation of lived experience.

Here are the well-elaborated lived experience positions that have evolved organically in services to suit

the skills of the people working in the roles that one has been assigned and the needs and expectations of

each service. As a result, there is no consistency of role functions across states. This has confused about

the purpose of lived experience roles, leading to difficulties in growing and supporting the workforce. In

2008, a consumer-led research project sponsored by the department resulted in the report, Real Lives,

Real Jobs Bennetts (2008).

1.6.1: Peer work, peer support, and lived experience

There continues to be confusion over the inconsistent use and understanding of the terms peer support‘,

peer work peer support work, and lived experience ‘work. The Mental Health Foundation (UK) defines

peers support as the help, and support that people with lived experience of a mental illness or a learning

disability can give to one another. It may be social, emotional, or practical support but importantly this

support is mutually offered and reciprocal, allowing peers to benefit from the support whether they are

giving or receiving it (2018).

. The term is often confused with, or used to describe peer support work; therefore the terms lived

experience work and lived experience workforce express the broad range of lived experience roles.

This diagram below shows that lived experience work is grounded in and draws on, lived experience and

informal peer support, which originated in the 1950s with grassroots mutual self-help organisations such

as Alcoholics Anonymous. The diagram also shows the relationship between the various roles lived

experience workers perform; the roles are not distinct, and while there is some overlap, there are skills

specific to each identified role Downes and Edan (2017).

The following is a diagrammed representation of the lived experience work Downes and Edan

(2017).

A large number of people have been newly introduced to lived experience work through their

involvement with the Expanding post-discharge support initiative. The rapid expansion of peer support

positions has created an urgent need to communicate and differentiate the variety of roles undertaken by

lived experience workers.

A common area of confusion relating to lived experience work is the difference between consumer

perspective work and family and carer perspective work, with some services employing one worker to

utilise both perspectives in their work. The following diagram illustrates the separation of consumer lived

experience perspective, and family/carer lived experience perspective roles.

Consumer and family and carer lived experience work (Downes and Edan 2017)

The diagrams illustrate the separate perspectives while acknowledging some people have an experience of

being both a mental health consumer and of being a family member or carer of someone with one or more

forms of mental illness. The focus of consumer workers is supporting and/or advocating for consumers,

and bringing consumer perspective and experiences to their work, while the focus of family/carer lived

workers is supporting and/or advocating for families and carers, and bringing family/carer perspective

and experiences to their work. This is true whether the role is focussed on supporting individuals (such as

individual advocacy, or peer support work), or focussed on broader systems (such as education and

training roles, or policy advice). There are times when there are differences or tensions between consumer

and family/carer perspectives, needs, and expectations, creating potential ethical issues if one person is

required to work from both perspectives within the same role. It is therefore important to distinguish

between and be clear about, the focus and perspective required for each role.
1.7: Describing Different Lived Experience Roles

1.7.1: Peer Support Work Roles

Consumer peer support workers

Consumer peer support workers use their personal lived experience of mental illness and recovery to

support other consumers.

Carer peer support workers

They use their experience of supporting a family member or friend who has experienced mental illness to

support family members and friends of consumers.

Peer support work focuses on building mutual and reciprocal relationships where understanding

emotional, social, spiritual, and physical wellbeing and recovery are possible. This is highly skilled and

specialised work that requires training and ongoing supervision from experienced peer support workers.

Peer support workers may work with individuals or groups.

Consultants

Consumer/ Carer consultants collect information and feedback from customers, families about their views

and experiences of the service and use the information to recommend the service improvement.

The focus of consultant work is service improvement and making it more proficient, with particular

attention to practices, policies, and procedures that affect access and equity. The work involves co-design,

community engagement, networking, planning, evaluation, and facilitation, and communication skills.

Managers

Lived experience managers are experienced consumer or family/carer workers who have responsibility

for the support and development of other lived experience workers. They may or may not line manage

staff or provide practice supervision for, or mentor other workers. Then making work run smoothly
Educators

Educators ensure consumer and family/carer perspectives; participation and involvement are included in

all aspects of education and training provided in services. They also facilitate or co-facilitate education

and training for staff, consumers, and carers.

Advocates

Advocates support consumers to have a voice and be a party to issues that affect them. It also supports

family/carers to be heard concerning issues that affect them.

Advocates support an individual or group to speak on their behalf and in their interests, or they may speak

for and/or on behalf of an individual or group under instruction. Advocacy usually occurs under

potentially difficult conditions when the individual is trying to achieve an outcome that may be at odds

with the stated and unstated outcomes desired by the organization and or its staff.

Policy advisors

The report; Real Lives, Real Jobs describes the consumer body of knowledge as being wider knowledge

of the kinds of experiences and everyday life issues that consumers face, their current and historical

situation collectively, as well as the nature of the service systems and discourses that affect consumers‖

Bennetts (2009, p. 7).

Consumer policy advisors draw on the considerable body of collective consumer knowledge and research

(both published and in grey literature) to inform systemic change and bring about change to laws, policy,

procedures, and bureaucracy which cause or perpetuate injustice or inequity.

Similarly, Carer policy advisors draw on the body of collective carer knowledge and research to inform

changes to those aspects of the mental health system that impact families and carers and to promote

family/carer sensitive practice.

Researchers

Consumer and career researchers draw on their lived experiences to promote and enable the engagement

of consumers and careers at all stages of research. Consumer and career researchers may be involved as
advisors in others ‘research, as partners in collaborative research, or as leaders - initiating, directing, and

driving research.

The following is a survey whereby mental health services were to provide a contact for ongoing liaison

around lived experience workforce and asked for the following information about each dedicated lived

experience position the service:

 Perspective (consumer or family/carer)

 Position title

 Type of service/organisation

 Functions (please briefly describe what do they do)

 Location (be specific)

 Is the position currently filled or vacant?

 Does the person in this role manage staff?

 Does the person in this role provide lived experience supervision to other lived experience

workers in the organisation? Lived experience supervision is discipline-specific supervision to

support practice development - the same as a nurse providing a nurse with practice supervision, it

is not the same as line management

Services were also asked to answer the following:

 This survey aims to determine the depth of experience that various health services have with

supporting lived experience workforce. Please describe the approximate number of years your

organisation has employed consumer lived experience workers in each service type/age program.

 Describe the approximate appropriate number of years your organisation has employed

family/carer lived experience workers in each service type/age program.

 Does your organisation provide lived experience perspective supervision for staff in lived

experience roles?

Lived experience workforce positions in Victoria

The census survey found:

 There are 341 reported positions

 The positions amount to 187 equivalent full-time positions

 20 positions are employed casually

 87 positions are employed at 4 days or more (0.8 - 1.0)

  20 positions are employed at 0.7

 203 positions are employed at 3 days or less (0.1 – 0.6)

There were 32 vacancies at the time of census reporting.

The census found that 69% (n=238) of lived experience workers are employed within clinical mental

health service settings, and 31% are employed within Mental Health Community Support Service settings

(n=103). The number of lived experience positions in clinical mental health services has increased

recently due to the Expanding post-discharge support initiative that sees peer support workers employed

at every adult area mental health service in Victoria.

Location

A significant part of the workforce is based within the metropolitan area (n=277). There are 70 positions

based in regional areas. This has implications for access to networks, training, and other supports such as

discipline-specific supervision for workers in regions. For example, in the Grampians area, there are only

eight reported lived experience positions, working across different positions (consultants, peer support

workers) and from different perspectives (consumer and carer) meaning there is a limited pool of relevant

peers/mentors for lived experience workers to draw from for support and practice development.

There are small regional services where there is only one or two lived experience workers. They may

work from different perspectives, meaning that they have no discipline-specific supports to draw on from

within their organisation at all.

Number of lived experience positions by region Number of lived experience positions

Region

Barwon South West 17

Gippsland 14

Hume 14

Loddon Mallee 11

Grampians 8

Eastern Metropolitan 66

North West Metropolitan 145

Southern Metropolitan 66
Less than one-third (n=102) of the lived experience workforce in Victoria work from a family carer

perspective, with more than two-thirds (n=239) working from a consumers perspective. A significant

proportion of both consumer and family/carer perspective workers are peer support workers (n=211), a

lower proportion of family/carer workers (n=52) are providing peer support when compared with the

number of consumers peer support workers (n=159). There is a relatively even number of both consumer

and carer consultant roles across the state, with 38 consumer consultants and 36 carer consultant

positions. Other positions identified were described as advisory roles, group facilitation, and NDIS

transition roles.

The number of lived experience workers in each type of role can be seen in Table 2. And Figure 5.

Table 2. Roles and Family and carer Consumer perspective

perspectives Role perspective

Consultant 36 38

Coordinator 1 6

Educator or trainer 2 16

Manager 2 4

Peer support worker 52 159

Other 11 15

Roles and settings

There are considerably more consultant positions within clinical services (n=66) compared with Mental

Health Community Support Service (MHCSS) organisations (n=8). There are 75 peer support positions

reported in MHCSS settings, and 136 in clinical mental health service settings.

The number of lived experience workers in each type of role at clinical services and MHCSS can be seen

in Table 3.

Table 3. Roles and settings Role Clinical services MHCSS

Consultant 66 8

Coordinator 6 1

Educator or trainer 12 6
Manager 5 1

Peer support worker 134 77

Other 15 10

There is a growing recognition that peers (people with their own experience) can directly contribute to the

recovery of others. Meaningful peer recovery involvement is associated with innovative services

internationally.

In recent years, the notion of consumer involvement has gained considerable currency in the areas of

mental health and, to a lesser extent, addiction policy throughout the world. Consumer/peer involvement

is a broad, umbrella term that describes a range of approaches that engage members of a particular target

group in delivering health promotion initiatives to their peers Mason (2007, p. 4).

It has been recognized as a potentially important contribution to all areas of mental health and addiction

policy and practice, including research and policy development, Service delivery, Social support,

evaluation, and review. The fundamental significance of those individuals who self-identify as peers

consumers Research suggests that how these terms are used and defined will raise social implications in

terms of issues of stigma, power-sharing, and boundaries, among others Mason (2007, p 6). Furthermore,

the evidence base asserts the inherent values that come with these best practices, including the evident

benefits of collaboration with institutional partners in the mental health and addictions systems.

The evidence base for consumer involvement in mental health has had a longer period of development.

Systematic reviews by Simpson & House (2002) and Doughty & Tse (2005) summarize the conclusions

from the literature:

• Users can be involved as employees, trainers, or researchers without detrimental effect. Simpson &

House (2002)

• Involving users with severe mental disorders in the delivery and evaluation of services is feasible.

Simpson & House (2002)

There is a wealth of both peer-reviewed and grey literature that suggests why collaborative partnerships

between consumers and service providers are worth pursuing. The evidence base surrounding the

question of peer support and peer-reviewed services has received an exhaustive analysis by Solomon

(2004, p 23
1.8: Peer Organisations

Peer support is a system of giving and receiving help founded on key principles of respect, shared

responsibility, and mutual agreement of what is helpful. Peer support can take many different forms,

including self-help groups, internet support groups, and warm lines. Peer run or operated services:

(consumers plan, operate, administer, and evaluate them) and which value freedom of choice and peer

control; small staff and a larger number of volunteers (examples include drop-ins, clubhouses, crisis

services, vocational services, psychosocial educational services, and peer-to-peer support programs).

They include:

1.8.1: The Crack Users’ Project (CUP), Street Health, Toronto

This is an on-going peer-driven capacity-building project established by Street Health, community-based

health care and harm reduction organization situated in east-central downtown Toronto, an area generally

acknowledged as the epicentre of the city‘s urban core crack cocaine communities. Motivated by the goal

of reducing the harms associated with the use of crack cocaine among users in the service area, the

objectives of the CUP project were to increase communication with and among marginalized crack users;

build capacity among crack users to develop and implement peer-led, crack-specific harm reduction

strategies; and to improve access to physical and mental health services for this group Street Health

(2007, p. 2). Crack smokers have been acknowledged as a particularly marginalized and hard-to-reach

substance use community, and crack users are at increased risk for a host of health and social problems,

including violence, diseases like Hepatitis C and HIV, malnutrition, social isolation, and mental health

problems. The CUP project consisted of two main components, including:

(1) Scheduled drop-ins specifically for crack users.

(2) A series of harm reduction training sessions for more involved CUP participants. Seamlessly

integrated and interwoven into these two main components was the provision of a full range of services

and supports designed to address the health needs of participants holistically and comprehensively. This

included providing primary health care, peer support, individual counselling, housing advocacy, and

healthy food onsite, thus complementing core programming activities. The drop-in component of the CUP

project is peer-led, and facilitated by a member of Street Health staff with direct lived experience of

homelessness and crack use. During regular project evaluations, participants have clearly and repeatedly
shared how much they value having a stable peer attached to the project who can provide advice and

information from a perspective of shared and similar experience.

Drop-ins are held at a local community health centre, provide harm reduction equipment, and participants

are issued membership cards that serve to remind participants of the drop-in schedule, and help create a

sense of belonging (ibid.). Additionally, the program allocated resources for one women-only drop-in

each week, given the fact that women are disproportionately affected by the harms associated with crack

use and poverty. The harm reduction training component of the CUP program is similarly peer-focused

and peer-driven, involving specific activities oriented towards training relevant to peer outreach work,

including an introduction to harm reduction, communication skills, sex work, HIV and Hepatitis C basics.

Overall, the success of the CUP project was attributed to the crack specific, non-judgmental, welcoming

space that has been created for users, and the supportive environment that has been created around the

project through the provision of services and supports, which address and improve all aspects of 27

participant health in an integrated, comprehensive and holistic way (Street Health, 2007: 9)

1.8.2: The Vancouver Area Network of Drug Users (VANDU),

Vancouver Established in 1997, VANDU is the oldest, largest, and most well-known advocacy and

activism organization for people with lived experience of substance use in Canada. One of the most

significant strengths of VANDU is the organization‘s broad involvement across the policy landscape,

spanning from advocacy, activism, and public education to community care and support activities.

Several prominent principles guide VANDU. They include:

I. Inclusivity of all current and former drug users.

ii. A militantly user-driven orientation

iii. The maintenance of a peer mentorship policy involves pairing someone who has skills in a particular

area with someone interested in acquiring those skills (Kerr et al., 2006: 63). The experience of VANDU

has demonstrated the unique and vital contribution that can be made by engaging and involving people

with lived experiences of substance use. Here, the fundamental impact of user-run organizations in

preventing the spread of blood-borne infections, in particular HIV, and in advancing the rights of people

who use drugs had been distinctly highlighted Canadian HIV/AIDS Legal Network (2005, p. 6). Founded
at the height of a public health crisis among injection drug users (IDU) in Vancouver‘s Downtown

Eastside, as overdose and HIV/HCV infection rates soared, VANDU‘s early work focused on political

activism, advocacy, and awareness-raising. With a mission statement to improve the lives of people who

use illicit drugs through user-based peer support and education, VANDU‘s activities grew more diverse

as its capacity increased, encompassing public education efforts, participation in governmental and

community research projects, and the establishment of support groups for various sub-populations of

people with lived experience of substance use, including persons with hepatitis C, women with HIV, and

methadone users Health Canada ( 2001). VANDU maintains a militant stance on drug user inclusion in

every aspect of the service, policy, and research initiatives that are ostensibly conducted in their interests.

Additionally, all published research relating to the organization must conform to VANDU‘s philosophy

and members demands that all projects directly involve them‖, again reinforcing the notion of

collaborative autonomy, popularly understood by the Canadian HIV/AIDS Legal Network‘s (2005)

mantra nothing about us without us Kerr (2006, p. 62). The notions of indigenous inclusivity and

collaborative autonomy are raised again later on in the matter of peer mental health organizations. The

fully realized state of membership within VANDU attests to their outsized impact on public policy

discussion in western Canada. Persistent stigma and a lack of core funding/support for initiatives and

organizations of substance use have prevented similar voices from emerging in Ontario.

1.8.3: Engaging the 12-Step Movement.

On Powerlessness, Autonomy, and Positive Identity Transformation Established, driven, and operated

solely by people with lived experience of alcoholism and substance use, Alcoholics Anonymous (AA)

and other programs based on the 12-step model such as Narcotics Anonymous (NA) were initially

founded in the United States during the early 1930s, and have evolved and expanded to become the

largest and most widespread self-help group in the world Peterson (1992); Robinson (1983). The rapid

proliferation of AA during the post-depression era is instrumental: the three founding chapters that

existed in 1939 grew to 40 chapters scattered throughout major US cities by 1940, and by 1946 this

number grew to 86 listed chapters holding regular meetings Robinson (1983). The first record of AA

activity outside the context of the US can be traced back to 1941 when Montreal, Toronto, and Vancouver

started holding regular meetings, and by 1977, the General Service Board of the organization estimated

that there were more than one million members worldwide Robinson (1983).
Given the core principles and values that drive the 12-step movement, both in terms of organizational

structure, and in terms of the practical, day-to-day philosophy and lived reality of the movement (i.e.

meeting attendance), concrete outcome measurements relating to the overall success of AA and NA are

difficult to assess Chi et al. (2009). The 12-step movement‘s central philosophy of anonymity among its

members, as well as its overall reluctance and refusal to engage in broader political, or social issues, are

two factors that have effectively served to frustrate research efforts Robinson (1983); Thomassen,

(2002b); Valverde & White-Mair, (1999). The 12-step movement‘s wariness to embrace and engage with

researchers is additionally compounded by the fundamental conviction that only an alcoholic can truly

understand and empathize with the experience of alcoholism, leading to suspicion of the traditional

scientific and medical communities; here, researchers are seen to represent ―an orientation towards the

problem that is directly antithetical to the group‘s understanding of the problem. Thomassen (2002b:

181).

1.9: The Benefits Of Using Self-Help Groups For Life Experiences Include:

- Personal Stories and Community Narratives are Told

Personal stories are told, often repeatedly within setting which shape understanding and identity. These

normative narrative communities promote recovery by helping participants make sense of their

experiences in less stigmatising ways. Telling one’s story is cathartic, promotes reflection in reciprocal

and for some people may be possible peer to peer (Slade 2009)

- Role models

Leaders within self-help groups are visible role models. Hearing the experience of others struggling with

similar issues is normalising and can be inspiring and also promotes hope. (Slade 2009)

- Opportunity role structures

The core belief is about all participants having value and something to offer translations into an

assumption that all members can give and receive help.

- Social support, sense of belonging, and connection

Self-help groups stress both the role of taking personal responsibility and the need for support.

Consequently, they emphasize social support, belonging, connection and community. Supporting access

to an external mutual self-group can be important recovery support by a clinician for an individual

consumer. However the external positioning of mutual self- help groups reduces their direct impact on the
mental health system since it can be challenging for clinicians to work in recovery-focused way.Slade

(2009).

- Therapy

People who employ the services talk about the importance of the lived experience shared by other

individuals in a therapeutic context. It may be useful to how a practitioner coped with anxiety. However,

in this case, sharing lived experiences is helpful when the relationship has developed than others. People

want to know that the practitioner they are working with is competent and well trained and stable (Lewis-

Holmes, 2016). Alongside particular experiences, it may be helpful to share that you are well supported

and have supervision and they need not worry about you.

2.0: The Benefits of Using Peer Groups for Life Experiences Include:

- Value

For the peer support specialist, it is a job with all benefits that follow from this. Their own lived

experience is valued, which can be a transformative reframing of an illness. They give to others, which is

an important component of healing. Self-management and work-related skills are consolidated.

Increased awareness of personal values

For the staff, their presence leads to increased awareness of personal values. Since very few mental

workers disclose the history of mental illness to their co-workers, there is no challenge to them and our

beliefs about fundamental otherness held by many mental health professionals. Interacting with peer

colleagues challenges these beliefs in a natural rather than forced way. It is a common experience of staff

to initially feel they can‘t talk freely when a peer joins them, but over time the raised self-awareness

becomes a means of identifying and addressing the unhelpful values and beliefs.

A reduction of harm

Reducing the harms associated with drug use, including the transmission of blood-borne viruses such as

HIV, represents perhaps the most considerable area where peer/consumer involvement has had

significant, objectively measurable positive benefits among communities of people with lived experience

of substance use. Directly supporting this finding, a review of published outcome data regarding peer

outreach–based interventions in HIV risk behaviour demonstrated that peer-led community outreach
efforts resulted in significant follow-up reductions in drug injection, multi-person reuse of syringes and

needles, multi person reuse of other injection equipment (cookers, cotton, rinse water), and crack use.

This report revealed that the vast majority of published literature strongly indicates that outreach-based

interventions have been effective in reaching out-of-treatment, providing the means for behavioural

change. Coyle (1998, p. 20). Similarly, other researchers have documented significant reductions in HIV

prevalence rates among communities following peer-based interventions, thus suggesting the importance

of creating and propagating peer-based models to be used in regional contexts, where such programs

remain underrepresented and underfunded, at best Friedman et al., (2004).

Role models

For other consumers, exposure to peer support specialists provides visible role models of recovery- a

powerful creator of hope. This type of benefit is increasingly being recognised in other areas of medicine,

such as the importance of patient contact with survivors of cancer. There is also less social distance than

with professionals, leading to more willingness to engage with services. For example, clients of an

assertive outreach team who were allocated to receive input from peer support in addition to standard case

management had a greater level of engagement and little need. Peers tend to focus on practical support

needs. For the mental health system, peer support specialists can be carriers of culture. Their peers often

need to train and maintain pro-recovery orientation I recovered consumers, because of their own lived

experience. They promote these values in their interaction with other workers and with the system as a

whole.

Case study; sharing your recovery story

The sharing your recovery story training helps people in recovery from mental illness to discover their

story in a new want and begin to develop a simple structure for their story. The training focuses on

helping people identify the recovery portion of their story, what they did to get from a hard time to the

place they are in now.

The training uses techniques drawn from the storytelling of story listening and appreciation as a way to

help people begin to develop their stories in new ways. It is based on the belief that we are all born

storytellers; we just lose touch with our story along the way. People express appreciation at the end of the

training and often make new peer-to-peer connections, providing extra avenues of support.
Lived experience positions in clinical mental health services

Whilst this graph shows the number of lived experience positions within each Area Mental Health Service

it does not compare positions or equivalent full time (EFT) positions with population or service size.

NorthWestern Mental Health positions are located across six mental health services including Orygen

Youth Health.

The number of lived experience positons at each Area Mental Health Service can be seen in Table 4 and

Table 4. Number of lived experience positions in clinical services Number of lived experience

Service positions

Albury Wodonga Health 4

Alfred Health 19

Austin Health 16

Barwon Health 8

Bendigo Health Psychiatric Services 6

Ballarat Health Service 5

Eastern Health 36

Goulburn Valley Area Mental Health Service 7

La Trobe Regional Hospital 10

Mercy Hospitals Victoria 13

Monash Health 18

Northern Mallee Mental Health Service - Mildura Base Hospital 3

NorthWest Mental Health (6 services including Orygen youth Health 54

Peninsula Health 19

South West Healthcare 9

St Vincent's Hospital 11
Leadership Roles in Life Experience

Line managers

Of the 341 reported positions, 26 positions provided lived experience supervision to other lived

experienced workers, and 11 were managers. This means that the vast majority of lived experience

workers are being line managed by someone that does not work from a lived experience perspective.

Whilst that is not necessarily an issue, line managers of lived experience staff must understand role

functions to provide adequate support and line management to lived experience workers.

Lived experience specific supervision

The census survey reports that there are 26 positions attached to public mental health services in Victoria

providing lived experience supervision. Lived experience-specific supervision supports lived experience

workers with the development of their practice. For many disciplines (for example, psychology, and

nursing), this type of supervision is mandatory as it is essential to further development and support for

workers. These figures highlight a significant gap in the availability of discipline-specific supervisors to

support Victoria‘s 341 lived experience positions.

2.1: Homelessness and Violence

People experiencing homelessness or who have been vulnerably housed often experience income

insecurity, exposure to violence, substance use, and a high incidence of physical and mental health

conditions. Paradoxically, they are less likely to have access to a dedicated family physician or a patient‘s

Medical Home. At least 235 000 Canadians experience homelessness each year, and 35 000 people are

homeless on any given night. Furthermore, it is estimated that many more people use couch surfing or

other approaches to avoid staying in shelters or living on the street particularly women, youth, elderly

persons, or people living in remote and rural areas. People in these situations are under-reported by

conventional point-in-time homeless counts and often are referred to as provisionally accommodate or

hidden homeless According to the 2016 census, approximately 2.3 million Canadians aged 15 years and

older experienced hidden homelessness in their lifetimes. Beyond those experiencing homelessness, there

is an even larger segment of the population who are vulnerably housed and at risk of homelessness certain
population subgroups overrepresented among those vulnerably housed and experiencing homelessness

include

refugees, people living with disabilities, members of lesbian, gay, bisexual, trans, queer, intersex, asexual,

and 2-spirit (LGBTQIA2) communities, people with mental health and substance use problems, and

people exiting institutionalized settings such as foster care or the correctional system. Indigenous peoples

are particularly overrepresented, as they are affected by colonization, on-going structural racism, and

jurisdictional ambiguity in access to services. Understanding homelessness and the housing continuum

Homelessness is ―the situation of an individual, family or community without stable, permanent,

appropriate housing, or the immediate prospect, means, and ability to acquire it.

There are several types of homelessness:

Unsheltered: A person who is homeless and living on the streets or in places not intended for human

habitation (e.g., cars, makeshift shacks)

 Emergency shelter: A person staying in overnight shelters for people who are homeless, shelters

for women and children affected by family violence, and emergency shelters for people affected

by natural disasters (e.g., flooding, forest fires)

 Provisionally accommodated: A person who is homeless and without permanent shelter who

accesses temporary accommodation, including people who are hidden homeless or couch surfers

staying with friends or family, institutionalized persons who might transition into homelessness

after their release in the absence of sufficient discharge planning, recently arrived immigrants and

refugees in temporary settlement housing.

 Precariously housed and at risk of homelessness: A person or family whose current housing is in

core housing need, which can lead to an imminent risk of homelessness in the event of a crisis or

worsening of one or more underlying risk factors (eg, job loss, eviction notice, exacerbation of

addiction or mental illness, marital separation, escalating violence)

 Adequate housing does not require major repairs for poor heating, unclean water, defective

plumbing or electrical wiring, structural repairs, mould decontamination.

 Suitable housing has enough bedrooms for the size and composition of the household, according

to National Occupancy Standard requirements

  Affordable housing costs less than 30% of the total before-tax household income the terms

precariously housed and vulnerably housed are often used interchangeably. While the former is

the more accurate term, the latter is preferred in this article to reduce jargon and be more readily

understood by a wider readership. However, the term vulnerable populations are increasingly

replaced by underserved populations to highlight the resilience of people with lived experience

and the need for structural and societal changes to redress what are primarily structural and

societal problems. Relatively few family physicians work in shelter-based specialty clinics,

community-based outreach models, or primary care clinics targeting underserved populations.

Even fewer on-boarding models exist to assist people experiencing homelessness to access

comprehensive, team-based care in clinics serving the general population.

In 1996 in its resolution, World Health Assembly called on the World Health Organisation to develop a

type of violence that characterised the different types of violence and the links between them. They

include:

- Self-directed violence includes suicidal behaviour and self-abuse. Attempted suicide or deliberate self-

injury

- Interpersonal violence is divided into two categories

i) Family and intimate partner violence that is violence largely between family members and intimate

family members

ii) Community violence that is between unrelated individuals.

- Collective violence is subdivided into social, political, and economic violence committed by larger

groups of individuals or by states. World Report on Violence and Health (2002).

Lived experience is mainly concerned with interpersonal violence which contributes largely to

homelessness.

Types of homelessness prevention intervention Evaluations of preventative interventions in England and

Scotland Pawson (2006); Pawson (2007) have found that the main types of prevention interventions have

included:

• Housing advice;
• rent deposit and related schemes;

• Family mediation;

• Domestic violence support (including refuges and Sanctuary Schemes7)

; • assistance for (ex)-offenders;

• Tenancy sustainment/loading support.

2.3: Drug abuse and Violence

The National Institute on drug abuse (2009) calls drug addiction and abuse a complex illness

characterised by intense and at times uncontrollable cravings along with compulsive drug seeking and use

that are persistent even in the face of devastating consequences. They argue that Many people don‘t

realize that addiction is a bargain disease while the path to drug addiction begins with the act of taking

drugs over time a person‘s ability to choose to do so becomes compromised and seeking and consuming

the drug becomes compulsive. This behaviour results from the effects of prolonged drug exposure on

brain functioning. Addiction affects multiple bring circuits including those involved in reward and

motivation, learning and memory, and inhibitory control over behaviour.

Addiction is often more than just compulsive drug taking-it can have far-reaching results for example the

use of drugs and addiction increases a person’s risk for a variety of other mental and physical illnesses

related to a drug-abusing lifestyle and toxic effects drugs themselves. Additional a wide range of

dysfunctional behaviours can result from drug abuse and interfere with normal functioning in the family,

workplace, and the broader community.

Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an

individual’s life, treatment is not simple. Effective treatment programs typically incorporate many

components and each directed to a particular aspect of the illness and its consequences. Addiction

treatment must help an individual stop taking drugs, maintain drug-free lifestyle, and achieve productive

functioning in the family, at work, and in society. The came up with principles of effective treatment

which include:

1. Addiction is a complex but treatable disease that affects brain function and behaviour.
Drugs abuse alters the brain, structure, and function resulting in changes that persist long after drug use

has ceased.

2. No single treatment is appropriate for everyone

Matching treatment settings, interventions, and services to an individual‘s particular problems and needs

are critical to his or her ultimate success in returning to productive functioning in the family work place

and society.

3. Treatment needs to be readily available

Because drug-trained individuals may be uncertain about entering treatment, taking advantage of

available services the moment people are ready for treatment is critical. Potential patients can be lost if

treatment is not readily available

4. Effective treatment attends to multiple needs of the individual not just his or her drug abuse

To be effective treatment must address the individual drug abuse and any associated medical

psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to

the individual age, gender, ethnicity, and culture.

5. Remaining treatment for an adequate period of time is crucial.

The appropriate duration for an individual depends on the type and degree of his or her problems and

needs the most addicted individuals need at least 3 months in treatment to significantly reduce or stop

their use.

6. Counselling an individual or group and other behavioural therapies are the most commonly used forms

of drug abuse treatment.

Behavioural therapies vary in their focus and may involve addressing a patient‘s motivation to change.,

proving incentives for abstinence, building skills to resist drug use, replacing drug-using activities with

constructive ad rewarding activities, improving problem-solving skills, and facilitate better interpersonal

relationships. Also, participation in group therapy and other peer support programmes during and

following treatment can help maintain abstinence.

7. Medications are an important element of treatment for many patients, especially when combined with

counselling and other behavioural therapies.

8. An individual‘s treatment and services plan must be assessed continually and modified as necessary to

ensure that it meets his or her changing needs.

A patient may require varying combinations of services and treatment components during treatment and

recovery. In addition to counselling or psychotherapy, a patient may require medication, medical services,

family therapy, parenting instruction, vocational rehabilitation, and legal services.

9. Many drug-addicted individuals also have other mental disorders. Because drug abuse and addiction

often occur with other mental illnesses patients presenting with one condition should be assessed for the

others.

10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little

to change long term drug abuse although medically assisted detoxification can safely manage the acute

physical symptoms of withdrawal and for some can pave the way for effective long term addiction

treatment detoxification alone is rarely sufficient to help addicted individuals achieve long term

abstinence. Thus, patients should be encouraged to continue drug treatment following detox. Motivational

enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement.

11. A patient may require varying combinations of services and treatment components during the Couse

of treatment and recovery.

The United States of health department and human services has come up with principles for prevention

planning for drug users. These principles include:

- Prevention programmes should address all forms of drug abuse, alone or in combination, and the

appropriate use of legacy obtained substances for example inhalants, prescription medications, or over the

counter drugs.

- Prevention programmes should address the type of drug problem in the local community, target

modifiable risk factors and strengthen identified protective factors.

- Prevention programs should be tailored to address risks specific to population or audience

characteristics such as gender, age, and ethnicity to improve programme awareness

- Prevention programmes aimed at the general population to key transition points can produce beneficial

effects even among high-risk families and children. Such interventions do not single out risk population

and hence reduce labelling and promote bonding to the community.

- Community prevention programmes that combine two or more effective programs such as family-based

can be more effective than a single programme alone.

- Community prevention programs reaching populations in multiple settings for example faith-based

organisations are most effective when they present consistent community-wide messages in each setting.

- Prevention programmes can be designed to intervene as early as possible to address risk factors for drug

use such as aggressive behaviour and poor social skills.

2.4: Providing Hope to the affected

Hope is an inner strength that gives the inspiration to go forward and keep going in traumatic situations,

but it can be influenced by family and others. Secondly, hope is related to aspirations for something and

someone and it means different things at different times. If whatever is hoped is not achieved or doesn‘t

turn out for the best then hope must be turned into something else. The lived experience of hope is

persevering with enlivening fortitude amid adversity with the persuasion of close alliances while yearning

for the cherished emerges in diversity with immersion in confidence anticipating.

Betty’s story

Betty describes her struggles with alcohol and drug addiction. She is enrolled on-site substance recovery

program at the emergency shelter. She speaks tearfully about the losses she suffered while using drugs,

stating, I had hope before my getting into alcohol and drugs, but then after experiencing drugs and alcohol

in my life I lost hope- hope of believing in whom I am, the hope of spirituality, the hope of life itself.‘ But

she states repeatedly that, hope is a beautiful thing and describes the new hope for the future she is

experiencing in the substance abuse recovery program and the hope of regaining a relationship with her

family ‗ she says that, hope is a success; it‘s the hope of progress; it‘s the hope things are getting better

… hope is wide raged different things. She says, that recovery is important to her and it does give her

hope.

- When Betty was lost in drugs and alcohol she completely lost hope. But she believes that in recovery

life is beautiful and hope is believing in oneself, her spirituality, and tomorrow
- She believes that taking suggestions and progressing towards something better will lead to regaining a

relationship with family and having what she knows she can have.

Joan’s story

Joan describes living with addiction and links her hopes to staying clean and sober‘‘ she speaks of her

memories of molestations at an early age when she started drinking to change my feelings about me,‘ and

she continues to hope for feeling good about myself.‘‘ She says that hope is having my family close to me

again… because I made everybody mad at me. She looks forward to getting my kids back having a big

house and living with God on my side and hopefully being successful eventually. For Joan hope means

staying sober, getting an education and a job being successful, getting her children back having the family

close again,, and having those things she and her children never had. Rozzo.R. & Hope (1999)

Marjorie argues that there are many ways of expressing needs, hopes, and fears. One very common way is

through the process of narration. The study of narrating, narrators, and narratives has been of great

importance. Having spent 18 years interviewing affected especially women. Employing the technique of

vacuum cleaner she gets everything she can from the field informants and sorting it out later. She is a

victim of abuse and homelessness with no one to share her anguish had no insights as to the psychological

and physical trauma involved in crises situations. She did not know how to deal with the problems

described over and over again by the victims. She claims that one is literary alone. When people ask you,

How are you doing? They don‘t want to hear the truth about personal dilemmas. She claims:

‘‘I know-and I know–it myself. I can recall every exquisite detail of victimization by an abusive

husband and the insensitive and often outright corruptive behaviour of attorney’s, agency

members, and public officials in Baltimore, Maryland who contributed to the creation of a

homeless person in me. I suspect that I may be the only woman who survived psychological and

physical torture, overt neglect and malfeasance by attorneys; lies by the state, county, and court

officials; denial of access to the judicial system and my divorce trial; and enforced indigence and

homelessness to keep her sanity and sense of humour.’’

This announcement appeared in the 28th October issue of the South Carolina Gazette:

Lydia, the wife of John Wilson, having eloped from her husband; hereby forbids all persons to

give her any credit to his name, is determined not to pay any dent contracting…He likewise

forbids the harbouring or entertaining his said wife, on pain of prosecution.

John Wilson has simply stated that he will not be responsible for any debts incurred by his wife- who has

abandoned him. His last sentence provides insight into the social-economic and political life of women.

Lydia once evicted from her home could not act freely within her community and in the political life of

women or indeed, in any other community unless she was an exceptional and economically independent

woman. Lydia was a victim of marital incidence.

In the South Carolina American Gazette Sarah Cantwell states categorically:

John Cantwell has the imprudent to advertise me in the papers, cautioning all persons against

crediting me; he never had any credit till he married me: as for his bed and board he mentioned, he

had neither bed nor board when he married me. I never eloped; I went away before his face when

he beat me.

It is assumed that Sarah Cantwell was not alone in the quest for justice and there must have been

numerous other women who were forced out of their homes and faced with insurmountable problems

related to companionship, housing, economics, and politics. Marjolie 2016, p. 4).

2.5: Ethical issues in lived experience

2.5.1: Informed consent

Informed consent is the major ethical issue in conducting research. According to Armiger: "it means that

a person knowingly, voluntarily and intelligently, clearly and manifestly way, gives his consent".

Informed consent is one of how a patient's right to autonomy is protected. Beauchamp and Childress

define autonomy as the ability for self-determination in action according to a personal plan. Informed

consent seeks to incorporate the rights of autonomous individuals through self-determination. It also

seeks to prevent assaults on the integrity of the patient and protect personal liberty and veracity.
Of course, individuals can make informed decisions to participate in research voluntarily only if they

have information on the possible risks and benefits of the research. Free and informed consent needs to

incorporate an introduction to the study and its purpose as well as an explanation about the selection of

the research subjects and the procedures that will be followed. It is essential to describe any physical

harm or discomfort, any invasion of privacy, and any threat to dignity as well as how the subjects will be

compensated in that case. In addition, the subjects need to know any expected benefits either to the

subject or to science by gaining new knowledge. The researcher must inform the subjects about the

methods which will be used to protect anonymity and confidentiality and indicate a person with whom

they can discuss the study. He must also provide a "Noncorrosive Disclaimer" which states that

participation is voluntary and no penalties are involved in refusal to participate.

Moreover, the subject must be told that some information has been deliberately withheld to avoid altered

behaviours. The researcher must also take into account that persons with physical, cultural, and emotional

barriers may require a very simple language to understand them. Finally, the freedom to withdraw must

be explained. This is very important but raises the issue of how difficult the Subjects can withdraw after

developing a personal and sometimes friendly relationship with the researcher. About withdrawal, a

researcher may be in a dilemma in case many subjects choose to withdraw at an advanced stage of the

study because this can affect the validity of the results. The Declaration of Helsinki provides some help as

it declares that the interest of the subject must always prevail over the interests of society and science.

According to this, the will of the subject must be respected at any cost for the research. Beneficence- Do

not harm the ethical principle of beneficence refers to the Hippocratic "be of benefit, do no harm".

Beauchamp and Childress, suggest that "the principle of beneficence includes the professional mandate to

do effective and significant research to better serve and promote the welfare of our constituents" (2001).

Beneficence is sometimes difficult to predict when creating a hypothesis, especially in qualitative

research. Carr says that if the research findings prove that it was not as beneficial as it’s expected, this can

raise immense ethical considerations. Ford and Reutter (1990) say that "beneficence relates to the benefits

of the research, while non-maleficence relates to the potential risks of participation". No maleficence
requires a high level of sensitivity from the researcher about what constitutes "harm". According to Burns

and Grove (2003), discomfort and harm can be physiological, emotional, social, and economic. When a

researcher tries to learn intimate details of the participant’s lives he has to deal with opening old wounds.

No maleficence dictates both preventing intentional harm and minimising potential harm. A researcher

must consider all possible consequences of the research and balance the risks with proportionate benefits.

The type, degree, and a number of potential risks must be assessed as well as the patient’s value system

which ranks various harms. The risk-benefit ratio can only be achieved by identifying these factors. If the

risks outweigh the benefits, the study should be revised.

Last, debriefing at the end of a study, should be mentioned. Treece and Treece say that debriefing refers

to explaining the exact aim of the study and why the disclosure was not full. Treece and Treece suggest

that subjects should feel as much at ease as possible and express their feelings. In addition, Burns and

Grove suggest that if the subjects experienced a high level of discomfort, they should be debriefed or

referred to appropriate professional intervention as necessary.

2.5.2: Respect for Anonymity and Confidentiality

The issue of confidentiality and anonymity is closely connected with the rights of beneficence, respect for

dignity, and fidelity. Anonymity is protected when the subject's identity cannot be linked with personal

responses. If the researcher is not able to promise anonymity he has to address confidentiality, which is

the management of private information by the researcher to protect the subject's identity. Levine (2010)

advocates that confidentiality means that individuals are free to give and withhold as much information as

they wish to the person they choose. The researcher is responsible to "maintain the confidentiality that

goes beyond ordinary loyalty". Clarke addresses the ethical dilemma of the researcher when

confidentiality must be broken because of the moral duty to protect society.

According to the utilitarian theory, which focuses on the best interest of all involved, the happiness of

society is of greater importance. On the other hand, the deontological theory which ignores the result

implies that moral duty is what matters. If a researcher, though, acts deontological he may feel that he has

not protected society. Another issue is that the researcher may have to report confidential information to

courts which can also cause

Moral dilemma can be argued that moral duty and personal ethos can be stronger than legal requirements.

Even if there are no duty conflicts, the researcher faces several problems to maintaining confidentiality
especially in qualitative research where conduct is personal, the sample is smaller and the reports display

quotations of interviews. Ford and Reutter suggest using pseudonyms and distorting identifying details of

interviews when transcribing the tapes used.

In situations that are particularly complex, sensitive, and in which the participants are extremely

vulnerable, a Certificate of Confidentiality which may be useful to help ensure the privacy of research

participants especially in studies in which participants and researchers may be exposed to compelled legal

disclosure of research data.

The researchers must always bear in mind all psychological and social implications that a breach of

confidentiality may have on subjects. To protect participants, they have to inform them of their rights and

use all possible coding systems that they regard appropriate in each case.

2.5.3: Respect for privacy

The fifth principle of the entitled, "A Patient's Bill of rights" document published in 1975 by, the

American Hospital Association (AHA), affirms the patient's right to privacy. According to Levine :

"privacy is the freedom an individual has to determine the time, extent, and general circumstances under

which private information will be shared with or withheld from others Kelman believes that an invasion

of privacy happens when private information such as beliefs, attitudes, opinions, and records, is shared

with others, without the patient’s knowledge or consent. However, different persons may hold different

opinions about when privacy is invaded. A researcher cannot decide on behalf of other persons on those

delicate issues. All aims, instruments, and methodology must be discussed with the prospective subject

and the research workers before the investigation.

Treece and Treece suggest that whenever subjects refuse to report personal information as they regard it

as an invasion of privacy, the researcher ought to respect their views. This may even apply to report of

age, income, marital status, and other details that the subject may regard as intimate. They also imply that

privacy can be invaded when researchers study certain groups without their knowledge and without

identifying themselves. Practitioners need to be aware that "an invasion of privacy may cause loss of

dignity, friendship or employment, or create feelings of anxiety, guilt, embarrassment or shame". In

conclusion, all possible measures have to be taken to protect subjects from potential physical,

psychological or social damage during the research or after the circulation of the results.
2.5.4: Vulnerable groups of people

Nowadays, there is an increased concern about vulnerable groups and whether it is ethical or not for them

to be used as research subjects." Fisher classifies vulnerability as one characteristic of people unable to

protect their rights and welfare". So, vulnerable groups include: captive populations (prisoners,

institutionalised, students, mentally ill persons, and aged people, children, critically ill or dying, poor,

with learning disabilities, sedated or unconscious.

The different opinions about their participation in research can be attributed to their inability to give

informed consent and also to their need for further protection and sensitivity from the researcher as they

are at a greater risk of being deceived, threatened, or forced to participate. Many are in favour of the use

of such subjects in research whilst others would argue strongly against it. Most condition their responses

according to the seriousness of the research, the level of potential risk, and the availability of alternatives.

According to Burns and Grove vulnerability increases the need for justification for the use of such

subjects.

Intense analysis of potential risks and benefits should be the first step of starting such research and a

careful approach should exist both in acquiring consent and during the research procedure itself. Persons

with diminished autonomy are also more vulnerable to the invasion of privacy since their right to privacy

is limited in contrast to others’ right to know. In the case of the mentally ill, families, as well as

employers and colleagues have the right to know while patients may not be able to see the testimony of

others in their record. In the case of mentally ill patients, it is important to measure comprehension and

develop valid tools for it, before obtaining informed consent to participate in a research study. In a

descriptive study of Beebe and Smith the Evaluation to Sign Consent (ESC) form was used to document

comprehension in 29 schizophrenia outpatients. Participants living in supervised housing were

significantly more likely to require prompts than those living alone. Participants prescribed two

antipsychotic medications were significantly more likely to require a prompt than those prescribed only

one antipsychotic.

According to Lasagna there are strong feelings among professionals who disagree with experimentation

on vulnerable groups. However, the potential improvement of their nursing care raises the issue of careful

consideration before rejecting or accepting this kind of research.

2.5.5: Skills of the Researcher

Jameton declares that in research the three more important elements are the competency of the researcher,

the careful design, and worthwhile expected outcomes. The Royal College of Nurses declares that nurse

researchers should have the necessary skills and knowledge for the specific investigation to be carried out

and be aware of the limits of personal competence in research. Any lack of knowledge in the area under

research must be clearly stated. Inexperienced researchers should work under qualified supervision which

has to be reviewed by an ethics committee.

What is more, careful choice of method for data collection, to ensure validity and reliability, are two main

requirements that must be met in all kinds of research? The choice depends on the object of the study.

When human beings are involved, all the ethical issues, discussed above, must be taken into account.

2.6: Significance of the study

It is hoped that the study will provide an insight into the meaning of lived experience roles and how they

are used. It is also hoped that the research will provide clarity on the benefits of using people with life

experience as drivers of change. Moreover, it is hoped that the research provides insight on how the lives

of those affected can be changed.

2.7: Contribution to the study

Some notable bodies have had recommendations to lived experience and violence against gender, the

parliament of Great Britain, House of Commons (pg. 195) proposes:

- Adoption of the United Nations definition of violence against women by all government departments

- A focus on preventing violence against women before rather than after in occurrence

- Inclusion of tackling violence against women in government‘s public service agreements

- The development and implementation of a strategic plan cross-departmental approach to tackling

violence against women in England, Wales Northern Ireland, and the extension of the strategy as reserved

matters to Scotland.

- Provision of long term secure funding to support joined-up services for vulnerable women and girls

- Closure of service provision gap experienced by certain groups including women on a low income,

trafficked children, disabled women who live in rural areas and trans-people

- Use gender equality Duty to tackle violence against women.

- Raise awareness amongst employers of the impact of violence against women in work –lace and

encouraging the provision of appropriate supporting consultation with trade unions.

Other suggestions to dealing with homelessness in the article: The Plan to End Homelessness are that:

 no one sleeps rough: whether they are in tents, cars, or at worst, on the streets

 everyone has a safe, stable place to live: so that nobody is in emergency

accommodation like a hostel or night shelter without a plan to quickly move into

housing

 Where we can predict homelessness, we can prevent it: so that no one leaves their

home or is forced to leave a state institution like a prison with nowhere to go.

Ending rough sleeping

Rough sleeping is the most dangerous form of homelessness, yet there has never been more evidence of

how to end it. We should not accept anybody sleeping on the streets. All people experiencing

homelessness should be entitled to support, whatever their background. We need to quickly identify

everyone sleeping rough and help them for as long as it takes to find and keep a home. Those who just

need some short-term help, like assistance with a deposit, should be helped into secure, decent housing

rather than a temporary solution. For those who need a lot of support, Housing First is a proven approach.

The plan includes a full list of policy recommendations needed in England, Scotland, and Wales to end

homelessness.

Solutions in this area include:

 Ensuring emergency accommodation is always available for those in immediate need

 Funding for robust, personalised support for all rough sleepers, focussed on moving

them into permanent accommodation

 Making Housing First the default option for anyone homeless with complex needs.

 Getting everyone housed

The vast majority of homeless people in Britain are in temporary accommodation like hostels and night

shelters or sleeping on people‘s sofa and kitchen floors. In situations when someone‘s homelessness

cannot be prevented, there needs to be a rapid response that ensures they are supported into mainstream

accommodation in ordinary communities.

While there will always be a need for some form of emergency accommodation for those in immediate

need, a housing-led approach accompanied by the right support for each individual can ensure we

minimise the amount of time people are homeless.

Emergency accommodation should only ever be a temporary solution – people instead need greater

entitlement to a home, giving them the best chance of being healthy, having a job, and feeling part of

society. To do this, we‘ll need enough housing available that homeless people can truly afford.

Solutions in this area include:

 Time limiting the use of unsuitable temporary accommodation

 100,500 new social homes each year for the next 15 years to meet the needs of

homeless people and people on low incomes – including those at risk of homelessness

 Funding of Critical Time Interventions, an evidence-based approach that helps people

move quickly into their homes.

Preventing homelessness

The best way to tackle homelessness is to stop it from happening in the first place. Where there are

predictable routes into homelessness, like leaving the care system or prison, we should do everything we

can to help people find and keep a home. Preventing homelessness is cost-effective – but more

importantly, it is the right thing to do.

The idea of focussing on preventing homelessness is well developed across Britain but gaps still exist that

stop some people from getting the help they need when they need it most. Everybody at immediate risk of

homelessness must be able to access support – which means that governments need to provide enough

funding for councils and other relevant organisations to step in when they need to. We also need to

address the on-going failure of state institutions to prevent people from falling into homelessness when

leaving their care.

Solutions in this area include:

 A duty on local authorities in Scotland to prevent homelessness

 A wider duty on other public bodies across Great Britain to prevent homelessness

 Funding for local authorities to provide a mandatory set of activities to help prevent homelessness,

including family mediation and supporting people to keep their tenancies.

 2.7: Conclusion

The evidence base reviewed in this paper strongly asserts the overwhelming value and benefits of

engaging people with lived experience and the potential for further integration and application of

peer/consumer involvement when conducted in innovative, respectful, equitable, collaborative

partnerships with service providers and the larger health care system. While in other parts of the world,

mental health and addiction policy has adopted bold and innovative new paradigms and approaches with

an explicit focus on the direct involvement of people with lived experience, the unfortunate reality is that

peer/consumer involvement has been highly limited, due to continuing stigma, a lack of core funding and

support, and systemic social inequities. It is hoped that with time lived experience and its contributions

will be wholly appreciated.

2.8: Future Developments

- In the Western world, rapid growth in lived experience roles has led to an urgent need for training and

workforce development. However, research indicates the roles risk being co-opted without clear lived

experience leadership, which is often not occurring.

- In developing countries and many Western contexts, the lived experience role has not yet been accepted

within the mental health workforce. There is a need to appreciate its role for better living standards.

- There is need for lived experience leadership to guide these issues is highlighted. A window of

opportunity currently exists to maximize lived experience leadership, and that window may be closing

fast if broad-based actions are not initiated now (Byrne, L., Stratford, A., & Davidson, L. (2018).
Bibliography

a. Bennetts, W. (2009). Real Lives, Real Jobs. Melbourne: Psychosocial Research Centre.

b. Coyle SL, Needle RH, Normand J. (1998) Outreach-based HIV prevention for injecting drug

users: A review of published outcome data. Public Health Reports 113: 19-30.

c. Downes, L., and Edan, V. (2017). Relationship between peers, peer workforce and peer workforce

specialists. Melbourne: unpublished paper.

d. Byrne, L., Stratford, A., & Davidson, L. (2018). The global need for lived experience

leadership. Psychiatric Rehabilitation Journal, 41(1), 76–79. 

e. Epstein, M., and Wadsworth, Y. (1994). Understanding and Involvement (UandI) –Consumer

Evaluation of Acute Psychiatric Hospital Practice: A Project’s Beginning...’, (Vol.1),. Melbourne:

VMIAC.

f. Friedman, Samuel R., Aslow, Carey, Bolyard, Melissa, Sandoval, Milagros, Mateu-Gelabert,

Pedro, Neraigue, Alan (2004) urging others to be healthy: ‘Intravention’ by injection drug users as

a community prevention goal. AIDS Education and Prevention 16(3): 250-263

g. Foundation, M. H. (2018). Peer Support. Retrieved January 4, 2018, from Mental Health

Foundation: https://www.mentalhealth.org.uk/a-to-z/p/peer-support

h. Johnstone M. Bioethics. A Nursing Perspective. 5th edition Churchil Livingstone Elsevier, 2009.

i. Kilpi H., Tuomaala U. Research Ethics and Nursing Science: an empirical example. Journal of

Advanced Nursing, 1989;14: 451-458.

j. Rozzo.R., Hope (1999): An International Human becoming perspective: Jones and Bartlett

Publisers Interntional, London UK

k. Sandu, B. (2017, July). The value of lived experience in social change: The need for leadership

and organisational development in the social sector. Retrieved from the lived experience.or

Southern Health (2010). Instilling Hope: a five-year plan for the Consumer and Carer Relations

Directorate. Southern Health Consumer and Family / Carer Relations Directorate.

l. Fitzpatrick, S. (2005) ‘Explaining homelessness: a critical realist perspective’, Housing, Theory

and Society, 22, 1, pp. 1-17.

m. Robinson, D. (1983) The Growth of Alcoholics Anonymous. Alcohol & Alcoholism, 18(2): 167-

172
n. Rozzo.R., Hope (1999): An International Human becoming perspective: Jones and Bartlett

PUblisers interntional, London UK

o. Thomassen, L. (2002) AA Utilization After Introduction in Outpatient Treatment. Substance Use

& Misuse, 37(2): 239-253

p. Valverde, M. & White-Mair, K. (1999) ‘One Day at a time’ and Other Slogans for Everyday Life:

The Ethical Practices of Alcoholics Anonymous. Sociology, 33(2): 393

q. Mason, Kate (2006) Best Practices in Harm Reduction Peer Projects. Toronto: Street Health.

Beauchamp T. L. & Childres, J. F (2001) Principles of Biomedical ethics, 5th ed, Oxford

University Press, Oxford.

r. Ford L., Reutter L. (1990;15, 187-)191.Ethical dilemmas associated with small samples. Journal

of Advanced Nursing

s. Jameton A. (1984) Nursing Practice. The ethical issues. Prentice Hall, New Jersey.

t. D.H.S.S Ceri Davies (1983) Report Under-used and surplus property in the National Health

Service: report of an Enquiry into ways of identifying surplus land and property in the National

Health Serice. London,.

u. Robinson K. (1992; 88: 44) .Research module: R4 the real world of research. Part II = Research

Ethics. Nursing Times,

v. Carr L. (1994;20: 716-721) The strengths & weaknesses of quantitative and qualitative research.

What method for Nursing? Journal of Advanced Nursing,.