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History suggests that assimilation and co-option happen when a social justice movement becomes popular enough to present a threat to established power structures. Thus, some survivors avoid too much cooperation with formal services:

Assimilation and co-option These terms refer to a process whereby service-user groups become incorporated within professional organisations and their oppositional voice can therefore be neutralised.

Once a social justice movement becomes co-opted, it has in turn been immobilized as it is swept up into becoming a part or extension of the larger group or system(s) it initially sought to dismantle and transform. Both co-option and oppression are insidious and sneaky processes: the path to co-option is often paved with the very best of intentions and the oppressed are often at first unaware of their own oppression.

(Feldman, 2018)

Despite these anxieties, several features of service-user activism have been professionalised and are now integrated within the mental health system (Voronka, 2019). ‘Peer support’, for example, originated within the survivor movement – people have always found ways to support one another within mental health institutions, so it became an integral part of early activism. Due to the grassroots and context-dependent nature of peer support, there is no single definition, though there are common themes:

Peer support occurs between people who share similar life experiences and as a result can provide each other with reciprocal support, advice, empathy, validation and sense of belonging and community which professionals and/or others who have not endured the same difficult situations may not be able to.

(Murphy and Higgins, 2018, p. 441)

Grassroots peer support can subvert the power dynamics within the mental health system by providing support mechanisms for patients who are defined by the users themselves. Nowadays, mental health peer support exists in many forms, such as one-to-one (Gillard and Holley, 2014), group (Castelein et al., 2008), and online, which is becoming increasingly popular (Barak et al., 2008). Since 2009, various forms of peer support have been formalised within the UK mental health system (Munn-Giddings et al., 2009). The introduction of the peer support worker role within statutory services has generated employment for thousands of people who have experienced mental health problems and used services. However, the lack of agreed definitions of peer support has opened the term up to be co-opted into ways of working that re-enact the problematic power differentials that it originally began to counteract (Faulkner, 2013). A clear tension exists between formalised peer support and ‘grassroots’ peer support, with the former predominantly focusing on service-provider outcomes (e.g. standardised depression scores) rather than service-user led priorities (e.g. support for accessing benefits or stable housing).

In addition to problems of assimilation, there are many structural and attitudinal barriers that peer support workers must endure once they are employed. Overt discrimination and microaggressions from other, non-service-user staff are common (Sinclair, 2018), and I am aware from my own experience and observations that there is no career progression.

Despite the problems associated with formalised peer support roles, many service users really value the opportunity to use their lived experience in a paid, professional capacity (Basset et al., 2010).

Lived experience The value given to those who have experience of difficulties or mental health services and the expert knowledge this gives them.