On the conversation about peer support

Depending on who you talk to peer support is one of three things.  To be fair some people believe it is more than one of these things.  I suppose some people believe depending on the circumstances that it can be anyone of these three things.

1.  Some people believe in the final analysis peer support really doesn’t make much of a difference.  According to them it really doesn’t help the people it claims to help.

This belief comes in two forms: the benign and the malignant.

In the malignant form peer support doesn’t just not help people it harms them.  It takes authority away from “professionals.”  It teaches people to question rather than value the expertise of people who really have the training and skill to help.  It teaches people that what they learn from their experiences and the experiences of others is equal to or even better than “medical knowledge” and basically misleads the people it says it is trying to help.  People who believe this tend to really believe in the medical model and view peer support as a threat.  In its more extreme forms it views peer support and recovery as almost a boogeyman threatening to destabilize the entire system.

In the benign form peer support is basically harmless, but it just doesn’t do much.  It provides support but not really treatment.  In this view peer support might be nice to have if you can figure out a way to afford it but it is definitely not a core element of what you are doing.  It is nice but not necessary.  My personal experience is that this is the view  of far too many mental health professionals.

2.  The next view also sees peer support as a threat, but not so much in its content as it’s role.  People from this view see peer support specialists basically playing a token role in the system and being co-opted into the system and essentially acting to prevent real change rather than trigger it.  Many people who self identity as either  anti-psychiatry or psychiatric survivors see peer support in somewhat this manner.  They think peer support specialists as a role in the larger system act to prop up what they believe is a corrupt system rather than changing it.  In its most extreme form people with this view end up attacking those who believe in the importance of developing a professional role for peer support specialists as being the real enemy of change and sometimes as even lacking in character and personal integrity.

3.  The third view sees the notion of peer support and recovery as being the core notion of change in a system badly needing change.  They do not see peer support as being incidental to what the mental health system should be about but as being core element of a system based on treating people as people, actually helping the people involved and showing people that better life is possible and a realistic hope.  Regardless of the degree you believe professional knowledge is needed people who believe in peer support  would tell you that while professional knowledge may be necessary for many people it is not sufficient.

People who accept this view think the notion of peer support believe it is already starting to change the system but believe that if is going to continue to change the system those who practice it must have an integral and accepted role within the system.  They believe there must be a peer work force.

Maybe there is at least some truth to all of it.  I have seen situations in which peer support has not seemed very important.  I have seen situations in which peer support was a token role in a system or program determined not to change.  But I have also seen situations where the notion of peer support is fundamental to needed change.  Most importantly I have known people who have found a way to build a better life, to have some measure of recovery who identify their experience with a peer support specialist as being fundamental  to the changes they have made.

I think perhaps the notion of peer support and peer support specialists is to a degree dependent upon where you live. Tennessee is my frame of reference and in Tennessee I think there is little doubt about the important role peer support has played. Tennessee has a network of over 40 peer support centers and has for years. Tennessee has no AOT and much of that has to do with the influence of the notions of peer support and recovery. Tennessee has developed also the notion of crisis stabilization units as an alternative to hospitalization and peer support specialists play a key role in many of them. This past year as many people came to crisis stabilization units as were admitted to state hospitals.

Most important the Dept of Mental Health has entered into a contract with The Tennessee Mental Health Consumers Association this year to change the way Tennessee does psychiatric hospitals with the goal of trying to make sure that people who are admitted to hospitals don’t simply end up being admitted again. Patients will be tied to peer support specialists while in the hospital who will provide education, training and support as well as peer link services. In addition as part of this initiative every single staff member in the hospital system will be trained in trauma informed care. We will see what results the year brings but it is not business as usual. Peer support is part of the definition of new business.

In closing:

Sometimes it doesn’t matter as much as we would hope it does.

Sometimes it is used in a manipulative manner to obscure the need for real change.

But sometimes is is the best option we have for real change. I am 100% sure that has been true in Tennessee and probably in other places too.

I wish it was not nearly as much a source of division within the peer community as it is. Very things in this life are either/or. Most things are both /and. And I think peer support is the same.

I know it is not worth a war particularly if that battle makes it harder to win the war we all want to win.

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3 thoughts on “On the conversation about peer support”

  1. Hi Larry. I commend you for the guts to publish this. You’re a brave man. As you know, I am a peer specialist in two states in the US, both rurally placed and have participated in much mental health transformation, social justice and innovative/emergent analysis for Peer Services | Supports to be a massive supporter for the burgeoning US Peer Workforce, which I do believe in entirely, and intrinsically. The Certified Peer Specialist plays many intensive and important roles via crisis intervention, early intervention, prevention, post-crisis, case management (ugh), psychosocial rehabilitative supports within a clinical triage team (ugh) but most importantly, IF IT IS peer led and peer driven, we also support respite which works. We reduce ER numbers, reduce inpatient intensive psychiatric care, increase outpx numbers, saving millions upon millions of dollars. The Co-Location of BH and Primary Care utilizing the CPS and Community Health Worker Promotora will prove worthy. Watch. Wait. Thanks again for the blog. Good work, my friend.

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