From Patienthood to Active Collaboration: Advancing Lived Experience Expertise in Addressing the Economic Determinants of Mental Health.

Abstract

Economic hardship-including poverty, housing insecurity, unemployment, food insecurity, and debt-is among the most consistently documented determinants of mental health. Extensive epidemiologic and social science research shows that adverse economic conditions increase the risk, severity, and persistence of depression, anxiety, suicidality, and severe mental illness. Although social policies can improve mental health outcomes, relatively few interventions within mental health systems target economic determinants. Those that do are often professionally designed and limited in scope. In this perspective article, we argue that advancing effective and equitable interventions that address economic determinants of mental health requires meaningful participation of people with lived experiences of economic hardship and mental health challenges. Drawing on epistemological and empirical literatures, we conceptualize lived experience as a form of expertise and contend that its systematic exclusion constitutes epistemic injustice and a barrier to intervention relevance and effectiveness. Using the International Association for Public Participation's Spectrum of Public Participation, we propose a framework for integrating lived experience expertise across the intervention cycle (i.e., needs assessment, design, implementation, and evaluation). Emphasizing collaboration and empowerment, we illustrate this framework with examples from the literature and highlight both its promise and limitations. We then identify systemic factors underlying these challenges-such as funding structures, governance, regulatory constraints, and capacity gaps-and offer practice-informed recommendations to address them. We conclude with a call to psychiatry and clinical professions to act as allies in redistributing epistemic and decision-making authority, positioning lived expertise as essential to interventions addressing economic determinants of mental health.