Since their development in the 1990s, consumer/survivor-led organizations have provided crucial peer support and mutual aid alternatives within the mainstream mental health service delivery system. Over time, however, few have been able to sustain their organizational independence and autonomy originally encoded in the legislation that legitimized them as government-funded programs within Ontario’s mental health system. Engaging Fricker’s (Epistemic injustice: Power and the ethics of knowing. Oxford University Press, 2007) theory of epistemic justice/injustice, this chapter explores how the subjugation of consumer/survivor knowledge and peer-run practice perpetuates epistemological injustice, positioning the direct knowledge of mental health problems at the bottom of the epistemological hierarchy within the mainstream mental health system. It examines the challenges these organizations face in maintaining the values and principles rooted in the liberatory psychiatric/ex-patient movement that forms their foundation, raising ethical concerns about the role and relationship of peer-run organizations and peer support within the contemporary mental health system.