Beyond Gatekeeping: Building Foundations for Lived Experience Recovery
Author : JH
The following article is written by JH, a mental health consumer who has navigated the hospital and outpatient systems since 2021. At Making Rights Real, we invite every ally in partnership—whether you are a service provider, clinical staff member, or family member—to use the Blueprint for Partnership to shift your engagement.
This reflection explores the move away from the role of the Gatekeeper (someone who manages and restricts) toward the role of the Foundation Builder (someone who builds the supports necessary for a consumer to lead their own life).
I am an outpatient at Fremantle Hospital’s mental health ward, and have been since 2021. In that time as an outpatient, I have had two different case managers. The main reason why I have had two case managers was because I had to “break up” with my first case manager, as she was causing me more distress than help, even though she was trying her best. As a result, I went for about three years as an outpatient without a case manager at all, until finally, around 2024, I was assigned a new one. We will call my first case manager Y and my second case manager M.
I was warded in the psychiatric ward of the hospital back in 2021. When I was released from the ward after about one and a half months, I was still considered an “inpatient” but being treated in my own home (Hospital in the Home), and that was when Y was assigned to me. I was not in a good state at the time, especially because my medications were extremely sedating and I was sleeping up to 20 hours a day. One of the most distressing things that Y did was to drop in on my house without forewarning—that is, without a text or phone call to let me know she was coming. I found this to be a huge invasion of privacy and also very embarrassing, as I was having trouble keeping my house presentable at the time.
| Blueprint for Partnership: Identifying Roles The Role: The Expert vs. The Collaborator The Blueprint for Partnership helps allies identify when they are operating as an “expert” prescribing solution rather than a “collaborator” facilitating documented preferences. By entering a home unannounced, Y prioritised institutional monitoring over JH’s right to privacy and self-direction—a practice that blocks the path to a Good Life. |
She also seemed very focused on “checking boxes” when it came to getting me into programs, such as a CCI (Centre for Clinical Interventions) group. She also had a way of lecturing me about getting a job when I was truly in no state to even contemplate it, and it was very distressing to hear her “common-sense” ideas about what I should or should not do. It seemed that she was not very well-informed about disability or how to handle someone who had just been discharged from the hospital. I think she saw her role as a case manager to check off her list of tasks to do, such as checking off that she had visited all her clients within a set period of time, even though the way she was doing this was causing me more distress than help.
She did put me into a CCI bipolar group which I found helpful when I attended it, which is to her credit, but again I felt like she was checking off a box when she enrolled me in it. Eventually, I had to stand up for myself and tell her that I did not wish to work with her anymore because she was causing me to feel worse about myself and causing me more anxiety with her practice of turning up at my house uninvited and lecturing me in a “toxically positive” way that was also culturally inappropriate. As a result, I did not have a case manager for three years.
| Blueprint for Partnership: Dismantling Barriers The Practice: Dismantling Systemic Aggression When rigid “standard procedures” and box-ticking override human dignity, they become a form of systemic aggression. The Blueprint for Partnership provides a way for allies to identify these practices and replace them with ones that align with our good life vision—where autonomy is the baseline. |
I limped along in the hospital system without a case manager for three years after “sacking” my case manager Y. It put me off seeking other help in case I got someone like Y again, intruding into my life and making it worse. The experience of having Y as my case manager has also put me off applying for the NDIS just in case any social workers I encounter through that program may turn out to be like her.
Finally, in 2024, I was assigned M by the hospital, as the hospital sought to get me to have a case manager again as is the norm. I was shocked at the difference between how M acted and how Y acted. M realised that I was in a better place physically and mentally now than I had been before but gently asked me about what therapies may help me to improve.
With M’s help, I got into an exercise physiology program as the winter months came around, as I tend to get depressed when there is less sunlight. The exercise program lasted for about three months and helped me to sustain exercise, which was helpful to combat depression, during the winter of 2025. I also received transformative PTSD EMDR (Eye Movement Desensitisation and Reprocessing) help from a clinical psychologist after I was helped by M to get on the waitlist with the hospital. This therapy lasted for most of 2024 and was critical in helping me get over a debilitating driving phobia that was getting in the way of me finding more meaningful work and social activities.
M also understands my cultural background better as she shares some of it, as a fellow Chinese person, and actually listens to me rather than lecturing me. She has definitely felt more like a “scaffold” rather than a “cage” compared with my relationship with Y.
| Blueprint for Partnership: Aligning with the Good Life The Role: The Foundation Builder M’s approach aligns with the Blueprint for Partnership’s definition of a “Foundation Builder”—someone who builds the supports necessary for a consumer to lead their own life. By listening to JH’s goals and facilitating access to specific therapies, M dismantled the barrier of dependency. |
I sometimes wonder if I would be further along on the way to recovering more autonomy and agency if only I had had M assigned to me at the start in 2021 rather than Y. I am still proud of the way I stood up for myself, even in the depths of my illness, when I told Y I could not work with her any longer. In this way, social workers can sometimes be a hindrance rather than a help if not properly trained or not sensitive to the actual needs of the client they are serving. As a mental health consumer, I had to learn to advocate for myself in order to get a social worker who actually met me where I was in order to help me, rather than just checking off a box to say they have done their job.
Call to Action: From Reflection to Operation
JH’s story is a call to move beyond the barriers of our current systems. We invite our allies in partnership (service providers, policymakers, family/carers/kin and community organisations) to explore our operational tools to embed these human-rights based practices.
- Operationalise the “Blueprint for Partnership“ – Use this framework to identify the roles and practices in your workplace that currently align with the “Gatekeeper” role rather than the “Foundation Builder” role.
- Identify one “standard procedure” (like unannounced visits) that limits autonomy.
- Use the Blueprint to design a collaborative alternative that aligns with our Good Life Vision.
- Adopt “The Warm Entry” Guide – Prioritise a “Soft Space” where a consumer’s humanity is greeted before their case file is opened.
- Implement “The Relational Standard Checklist” – Use this checklist to ensure your daily interactions move from clinical compliance to relational safety.
[Download the Warm Entry, Relational Standard & Blueprint Tools Here]