Peer support, empowerment, and control

The most recent post on peer support brought many comments, virtually all of them well thought out and well articulated.  I was told by several people when I told them what I planned to say in this post to be careful.  People who think there is only one thing to say about peer support they told me will have my head.  Someone will be pissed off.  Perhaps they were.  I don’t know.  My head, upon last inspection, seems securely fashioned.  I am grateful for the grace of anyone I offended.

The comments on the blog, on Facebook, and sent personally to me were great.  It is a contentious issue with many strong opinions.  My biggest reason for the post was to simply say that it is okay.  We can tolerate disagreement and still tolerate each other.

A side comment…..The Murphy Bill is in a crucial time.  The likelihood of a governmental shutdown and the announcement of Speaker Boehner’s resignation tells me that chaos is coming soon to the House and everything I have heard tells me Rep Murphy will be trying really hard to get his Bill out of committee while action on anything is still possible.  It is so important, that regardless of disagreement on specific issues that a loud voice be heard on Murphy.  Plan to take part in the National Day of Action recently announced. http://realmhchange.org/dayofaction/

Several people asked me. “We have heard you talk about the different views people can take on the subject. Where exactly do you stand?”

As I have struggled how to put it into words the first thing that is clear to me is that there is no “exactly”, but let me explain.

The only criteria that makes any sense to me about any kind of program, intervention or service is a simple one. Does it help? Does it work? Does it help people in distress find a better, more productive, more satisfying and happy life? Nothing helps everybody and nothing helps all the time, but things generally fall into one of 3 categories: they have no effect at all, they make things worse, or they make things better. An honest system tries to make sure people have access to things that help and tries to make sure they are not the victim of things that make things worse. And an honest system learns from its mistakes. It is more process than product probably.

Some theoretical frameworks have considerable more appeal than others to me. Some ways of looking at ways just seem to make more sense than others. All of these things are nice. Perhaps they are even to a degree necessary but none of them are sufficient. In the end one thing counts. Does it help or not?

Some fair disclosure about me. I have seen both sides of the system, as a “professional ” and as a consumer (peer or whatever term that you find appropriate) In Tennessee consumer is the term most people use so as a matter of habit I probably use it more often than not. Apologies to anyone who finds it in anyway offensive. I have been part of efforts to protect the funding of peer support centers in Tennessee and spoken often about the notion of recovery I think that is implicit in the notion of peer support. I know people- a lot of people- who feel like their contact with someone in a peer support role was instrumental in their life changing for the better….

But

I have also worked in programs that had no appreciation or even tolerance for the notion of peer support. They viewed it as not very important and potentially dangerous even and saw what I did as a very narrow circumscribed role. I have also seen peer support programs which made the people in them more dependent rather than less.

Two notions seem key to me. When the primary concern in a program is about who is in control and who is not those programs in my experience do little lasting good for those they serve. When they are “successful ” more than anything else they teach dependence. I know a bright and intelligent lady who has been hospitalized 24 times in the last 4-5 years. She has been taught that when she gets too upset it is a sign she is getting ready to fall apart and she needs to go to the hospital before things get really bad.

If the peer support role is primarily or chronically about control then I wonder what good they ultimately serve.

The other notion that seems important to me is that of empowerment. When it works, when it matters this is what I see peer support being about. The people I know who report that peer support has played a major positive role in their live speak about empowerment. Many of them say they had never experienced empowerment until they met someone in a peer role. Empowerment, at least to me, means telling people life can be better, that they can make life better, they can learn what they need to know to make life better, that they will be supported and that it all matters and they matter.

I believe peer support matters but perhaps a better question is to what degree the reality of peer support matches the promise of peer support. What keeps peer support from about being about empowerment? Some people may argue that in the real world peer support can never be about empowerment. I just don’t believe that. I have seen with my own 2 eyes when it is.

For me it comes down to is this:

To assume peer support is the answer to the problems of the mental health system is wrong. It is clear to me that sometimes it is part of the problem. Mental health is like any other system. It is about power and sometimes the people in power act to subvert things that would threaten their power.

To assume that peer support can never be part of the solution is equally wrong. My personal experience is that it can and often does make a difference. In Tennessee I am convinced it has made a difference. It’s reality may not match its promise too much of the time but the opportunity of peer support is real.

The real concern for me is not a black or white verdict. Few things are that simple. I think it can make a difference but too often it doesn’t, What gets in the way?

I know people who believe it can never be part of the system. They believe that it must operate outside to maintain its integrity. My biggest problem with that is that because of the tremendous amount of people in need and the inevitable costs of meeting those needs does that not mean that peer support will be basically unavailable for many who might need it and who could profit from it. And my other question is whether or not that means abandoning a system badly needing change to those less likely to change it.

Some other people I know strongly believe in increasing the peer work force in the system and feel like that is the greatest force for change. I tend to think that more people do have greater impact, but also believe if what it means to be a peer specialist is not clearly addressed and the roadblocks to that identified and addressed then it may not be what people hope. Bigger and better are not necessarily the same thing.

There are real problems with an either/or view regardless of what end of the pole you defend. I go back to the original point. Does it help and under what conditions and how can we make those conditions more likely? If it doesn’t help it shouldn’t be. If it can we should try to make it more likely it will and make it more accessible to those who need it.

Some will read this and write it all off as hopeless. Nothing can or will change. Some people will read this and see peer support as the hope of a better system.

I just don’t see anything as being that simple. If I look at it honestly I just don’t.

In the end my answer probably just begs the question.

What do I think of the value and ultimate significance of the notion of peer support?

It depends….

On us….

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One thought on “Peer support, empowerment, and control”

  1. I am a big believer in peer support. Properly run by trained leaders it can be a great help for those struggling with the despair of a mental illness. I, too, have run into those who think it is a dangerous thing — they usually fear that we are going to talk people into getting off their meds. I have found that when people come home to their families and say that the group told them to stop taking their meds, they are usually lying. So it is not the support group that is at fault, but the person.

    Like psychiatrists, psychologists, and others who work with people like us, peer support groups are fallible. But they fill in a gap that people who don’t live with the mental illness cannot fill, one that must be filled and that is the sense that they are not alone in their struggles.

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