Peer Support in Mental Health Recovery

“To understand”peer support,” it’s important to look at the meaning of the word “peer.” “Peer” is a relational term that indicates a connection or relationship amongst two or more people based on similar attributes, characteristics or experiences. We often speak of “peer pressure” to describe experiences within groups of young adults, or “peer reviewed” when professional articles are read and approved by others in our same professional area. “Peerless” links people through commonalities and similar experiences.

“Peer Support,” then, is when people who share these comparable experiences offer each other encouragement, empathy, hope, consideration, respect and empowerment from the vantage point of experiential understanding. The “been there, done that” connection creates a unique understanding and eliminates the power and authority typically associate with helper roles.

It is worth noting here that sometimes systems have a tendency to get too literal and too lax about what constitutes a commonality relevant enough to consider two or more people “peers.” It is equal parts mistake to assume that people need to, for example, have the same diagnosis or same type of distress to offer one another peer-to-peer support, as it is a mistake to assume that all people who have been diagnosed or received mental health services will fit for one  another. Sometimes, simply being human with one another is enough. Other times, the commonality may be more specific like both having heard voices, both having been dependent on Social Security Disability Income, both having experienced involuntary hospitalization, and so on.

Peer Support is not a new phenomenon-it has existed in some way since the dawn of human beings. It is a natural tendency for us to seek out those who have walked similar paths and can truly understand us.

Within the Mental Health Recovery frame work, peer support grew out of a human rights movement, as well. In the 1970’s people who saw themselves as having survived the hospital experience were connecting with each other, offering support and validation that they were recovering (despite what they had been told was possible or not), and uniting in the righteous indignation at the abuses they had endured as part of what they told was treatment. People bonded together to not only provide mutual support, but to change the way things were done so that others wouldn’t have to endure the same abuse they had experienced. Unlike others areas of peer support, mental health has always included a segment of people who have taken on the mission of speaking out about conditions within mental health services and exposing it to the public to advocate for change. This dates back to 1800’s with the written works of such people as Katherine Packard, John Percival and Clifford Beers, the founder of Mental Health America.

Out of the falling call against hoe things were came the mission of having an active role in facilitating the change process. “Nothing about us without us ” became a familiar mantra borrowed from the disability rights community at large), and writings like “On our own” by Judy Chamberlin were published to offer guidance for peer-run supports as a more humane alternative to traditional systems of care.

Peer Support took their place as stand-alone, peer-run organizations separated from mainstream services. Some people were paid and others were volunteers, but either way, supports were provided by individuals who were themselves in recovery. Some organizations functioned as drop-in centers: others had a more educational approach, while others played more of an advocacy/activism role.

Over time, partnerships between public behavioral health professionals and people with persona experience developed, and more representatives were invited to participate in planning, developing, delivering and evaluating mental health services. Pioneering agencies created roles for people in recovery,and state agencies began to create liaison roles, often called “Office for Consumer Affairs.” For the most part,however, peer supports were in the community, trying to influence change from the outside, strategizing for ways to be invited to the tables and trying to get the message of recovery to people in any way possible. Peer Support was offered within these community settings in a variety of ways, from 1:1 support and encouragement, educational classes like Wellness Recovery Action Planning (WRAP), empowerment and leadership forums, etc.

While many agencies were developing a desire to incorporate more peer roles, the lack of funding streams was a primary barrier. In 1999, Georgia was successful in getting approval for a dedicated “Certified Peer Specialist” role in their state Medicaid. This became the catalyst needed for a ground swell of change in peer support within traditional mental health systems. What started out as peer support groups and “consumer-run” organizations has now evolved to include formal peer supportive behavioral health agencies, complete with a training curriculum to ensure that people working in peer roles meet predetermined competency criteria before engaging in support roles. Both informal and formal organizations have valuable roles in the overall system and enhance the spectrum of recovery support options.

It’s also worth noting that-concurrent to the development of peer roles-many organizations have also re-visited the idea of supporting all of their employees to have more latitude to self-disclose about personal experiences. Although, disclosing as a clinician does not make the relationship peer-to-peer, many are now finding value in sharing experiences across many borders that were previously considered uncrossable.

One group that has done some intentional work on the exploration of self-disclosure in clinician environments is the Transformation Committee in Massachusetts. In 2007, they produced a document called,”Promoting a Culture of Respect: Transcom’s Position Statement on Employee Self Disclosure in Mental Health Service Workplaces.”

For those interested in reviewing the statement, it can be found at:
http://transformation-center.org/wp-content/uploads/2012/02/Culture-of-Respect-Disclosure-Endorsed Feb 23 2007.pdf

Reference: National Council For Behavioral Health- The Providers Handbook on Developing & Implementing Peer Roles By Lynn Legere of Lynn Legere Consulting

With contributions from the Western Mass Peer Network & Sera Davidow of the Western Mass Recovery Learning Community

Recovery is possible for every individual

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