Multiple hats, one truth: Lived experience as knowledge

The global mental health field increasingly recognizes the importance of involving people with lived experience of mental ill-health in research, policy, services, and systems. However, recognition and representation have not consistently translated into meaningful authority. The current essay examines the conceptual and structural questions underlying this gap: what constitutes experiential knowledge; how lived experience is transformed into expertise; how experiential, clinical, academic, and policy knowledge interact; and how institutions can distinguish genuine co-production from symbolic participation or incognito tokenism. Drawing on participatory traditions within and beyond mental health and community-led practice, the essay argues that experiential knowledge is neither a substitute for professional expertise nor subordinate to it. Instead, these forms of knowledge should operate reciprocally, with epistemic authority shifting according to whose knowledge is most relevant to the question at hand. At the same time, the authors distinguish this fluid exchange of epistemic authority from the more entrenched institutional power governing resources, leadership, and decision-making. The essay examines how power, institutional readiness, context, crisis, and intersectional diversity shape whether participation becomes structural or merely symbolic. A case study from Nunavut, Canada, illustrates both the consequences of externally imposed systems and the possibilities created when Indigenous knowledge and authority determine terms of engagement. Practical recommendations for moving from consultation toward co-governance are put forward to support decision-makers within global mental health seeking to operationalize meaningful lived-experience engagement rather than simply endorse it.