Prue Anderson & Lachy Hartup
Prue Anderson and Lachy Hartup work together at
T & K Support Services, where Prue is part of the leadership team supporting complex mental health, disability and justice-related work, and Lachy works as a Peer Worker, using lived experience, music, creativity and connection to support others. Their working relationship today is built on mutual respect, shared values and two very different forms of expertise. But their story started in a very different place: years ago, Prue was a psychiatric nurse and Lachy was her patient. Today, they are colleagues - peer and mentor - working side by side to challenge the way people experiencing mental illness and neurodivergence are seen and supported.
Prue & Lachy bring two very different forms of expertise to the same conversation. Prue has a background in psychiatric nursing, therapeutic justice and community-based disability support. Across her career, she has worked alongside people experiencing significant mental health challenges, neurodivergence, justice involvement and complex life circumstances, and has become increasingly passionate about challenging systems that reduce people to diagnosis, risk or behaviour. Lachy brings lived experience of neurodivergence and the mental health system, alongside his work as a peer worker supporting others through connection, creativity, music, shared interests and genuine relationship. What makes their perspective particularly powerful is that they do not approach mental health from opposite sides of a debate. They bring professional expertise and lived experience together, allowing each to challenge, strengthen and deepen the other.
Their work is grounded in a simple idea: diagnosis can tell us something about a person, but it can never tell us who they are. Mental health systems are very good at gathering information. Diagnosis, risk, symptoms, medication, behaviour, insight, compliance and history can all matter, and at times they matter enormously. But there is another question that is not always asked with the same urgency: Who is the person underneath all of it?
This question sits at the heart of
Identity Before Diagnosis and has become central to the way both Prue and Lachy think about mental health, neurodivergence and support. Their perspectives are different. A clinician may notice presentation, risk, symptoms and treatment needs. A person with lived experience may notice what it actually feels like to be observed, assessed, discussed or supported. Neither perspective needs to cancel out the other. The opportunity lies in recognising that one lens is rarely enough.
Language plays an important role in this. Across mental health, disability and justice systems, terms such as non-compliant, difficult to engage, challenging, poor insight and behaviour of concern are familiar. Sometimes those terms have a legitimate professional purpose. The problem begins when a description becomes an explanation. A person described as difficult to engage can quickly become someone we expect not to engage. A person labelled non-compliant can become someone whose refusal is seen as a problem to overcome rather than communication to understand. A behaviour can become something to stop before anyone has asked what it might be telling us.
Words create lenses, and once a lens is in place it can shape what we notice next. Neuroaffirming practice asks us to become curious about those assumptions rather than simply replacing them with gentler terminology. It asks whether what looks like resistance might be overwhelm, whether apparent disengagement might reflect an inaccessible environment, or whether behaviour might be communicating sensory distress, uncertainty, a loss of autonomy or a need for safety. Neuroaffirming practice is not about finding nicer words for the same assumptions. It is about changing the assumptions.
This becomes particularly important when we think about environment. Mental health care understandably focuses on what is happening within a person. What symptoms are present? What has changed? How are they behaving? How are they responding to treatment? But especially when supporting neurodivergent people, another question is essential: What is happening around them?
Noise, lighting, unpredictability, changing staff, repeated questioning, unfamiliar communication styles, loss of privacy, demands and limited control over space and routine can all affect a person’s ability to regulate, communicate and engage. If we focus only on the person’s response, we may miss the role the environment is playing in creating or escalating distress. Rather than only asking, “Why can’t this person regulate?”, we might ask, “What is their nervous system responding to right now?” Instead of asking, “Why won’t they participate?”, we might ask, “What would make participation accessible?” Instead of asking, “How do we get them to comply?”, we might ask, “Do they understand what is happening? Do they feel safe? Do they genuinely have choice?” Prue and Lachy’s work together captures this shift clearly: before expecting somebody to engage, communicate, process information, make decisions or regulate, we should first consider whether they are regulated enough to do those things and, if not, what we can change.
Prue and Lachy also challenge the way we think about engagement. A person following instructions is not necessarily engaged. A person quietly sitting through an appointment is not necessarily feeling safe. A person attending a service does not necessarily feel connected to it. Likewise, someone who struggles to engage with traditional services is not necessarily incapable of engagement.
Lachy’s peer work offers a useful lens here. People who have been described across systems as difficult to engage have often connected through music, creativity, movement, shared interests, humour, community and time. When the relationship or activity feels meaningful, engagement can look very different. This raises an important question: perhaps the issue is not always, “Why won’t this person engage with what we are offering?” Perhaps the better question is, “Have we created something they can - and actually want to - engage with?”
This is where relational practice matters. Not every meaningful intervention looks clinical. Sometimes it looks like sitting beside someone, doing something together before asking them to talk, slowing down, sharing a laugh, listening without rushing to fix, or recognising the need underneath what is being communicated. Connection is not an optional extra added after the “real work” is complete. Often, connection is what makes the real work possible.
The same thinking applies to behaviour. When behaviour is distressing, risky or difficult for others to understand, the natural response can be to ask how to stop it. There are times when immediate safety must come first, but once safety is established, curiosity matters too. What happened beforehand? What is overwhelming? Has something changed? Is there a sensory need that is not being met? Does the person understand what is happening? Do they feel safe? Do they have meaningful choice? What is this behaviour communicating?
This shift sounds small, but it fundamentally changes the role of the person providing support. We move from trying to control the person to trying to understand the person. A person can require significant support and still have autonomy. A person can experience profound distress and still have knowledge about their own experience. A person can communicate differently and still have something important to say. A person can need co-regulation without being incapable. A person can need support without becoming a problem to solve.
None of this means diagnosis should be dismissed. Diagnosis can provide important information about a person’s experiences, treatment and support needs. Clinical knowledge matters. Treatment matters. Risk assessment matters. Identity Before Diagnosis is not an argument against any of those things. It is a reminder of their limits.
A diagnosis cannot tell us what music someone loves. It cannot tell us what makes them laugh, who makes them feel safe, how they communicate when overwhelmed, what environments work for them, what they are passionate about or what gives them a sense of purpose. It cannot tell us what someone may be capable of when the right people, relationships and opportunities surround them. For those things, we have to know the person.
That is where Prue and Lachy’s combined perspective becomes particularly valuable. Prue understands the systems: clinical practice, risk, mental health deterioration, advocacy, therapeutic intervention and the structural barriers that can shape care. Lachy understands what those systems can feel like from the other side, while also bringing the expertise he has developed as a peer worker - an ability to connect through music, creativity, shared interests and genuine human relationship. Neither perspective needs to be more important than the other. Their work shows what becomes possible when clinical knowledge and lived experience are allowed to sit beside each other, when professionals remain curious, lived experience is treated as expertise, and the person receiving support is recognised as an active participant rather than simply the subject of care.
One of Prue and Lachy’s greatest strengths is their ability to notice what can easily be missed when we focus only on what is visible: the need underneath the behaviour, the environment contributing to distress, the reason engagement has become difficult, or the strengths, interests and identity that have disappeared beneath clinical descriptions. They bring different skills to that work, but share the same instinct - look deeper, stay curious and know the person.
That is what makes their approach stand out. They are not interested in reducing people to diagnoses, risk profiles or service categories. They are interested in understanding what helps someone feel safe, what matters to them, what they are communicating and what support will actually work in their real life. They show that good mental health and neuroaffirming practice is not about choosing between clinical expertise and lived experience. It is about recognising how much more we can understand when we make room for both.
Diagnosis can provide information. Behaviour can provide information. Risk can provide information. But none of those things, alone, can tell us who somebody is. For that, we have to know the person.