Peer Support in Mental Health

Emma Watson, Sara Meddings, Emma Watson, Sara Meddings

• Publisher: Bloomsbury Academic
• Year: 2019
• ISBN:
  9781350313149
• Edition: 1
• Topic: Scienze sociali
• Subtopic: Lavoro in ambito sociale

In recent years, the concepts of peer support, self-help and self-management have moved from the periphery of mental health care toward the centre, and have fast become mainstream approaches to supporting well-being. Peer Support in Mental Health provides an overview of the core concepts and an appreciation of the complexities, controversies and applications of each concept. This innovative textbook will support not only mental health professionals and trainees, but also peers, people who use services and their carers. The authors...
- Track the development of peer support approaches and provide an overview of their current uses and applications.
- Use case examples to support the application of theory to practice.
- Draw on lived experience to demonstrate the diff erent approaches to peer support.

1

Introduction

Emma Watson and Sara Meddings

Have you ever felt as if no one in the world could possibly understand how you’re feeling or what you are living through? Have you ever felt so alone that even to be in the presence of other people is a painful reminder of the uniqueness of your own internal world? Maybe you have found yourself opposite a person who is trying to help you, maybe even paid to help you, and wondered how they could possibly understand. Worse still, have you ever sat opposite somebody who is telling you they know how you feel when they clearly don’t?

We have both experienced this sense of isolation when life has brought us to particularly challenging places. My (Emma) experiences of mental distress have often been lonely and frightening. These experiences coloured my world and made it feel as if it was slightly (or sometimes wildly) different from the world that people around me lived in. My experiences of trying to explain my world to others have been, at times, incredibly shaming, reminding me of my difference; my inferiority even.

Throughout history people have found solace in meeting others who have had similar experiences to them, whether this be of parenthood, culture, education, grief, profession, emotional or physical pain. This has come to be known as peer support and many have described the profound impact that this has on their sense of self. In her book Madness Made Me, Mary O’Hagan describes the experience that meeting other ‘peers’ had on her:

Over the years I met many good people who were mad like me. Their madness had taken them to a foreign land where only mad people could go to … Mental health professionals stood at the border trying to pull people out of the mad land, even the ones who wanted to stay. They knew the mad land as a bad place where people get lost, sometimes forever. But most of them had never been there. My peers showed me that the mad land, for all its perils, had some of the most enchanted scenery in the world. Like a land that has mountains and ravines, rivers and caves, blinding sun and swirling storms, the mad land could be a place of beauty as well as danger. My peers helped me to understand that I was not alone in the mad land, that there was a whole tribe of us who had been there and seen many of the same things. Things that other people did not easily understand. Things they feared and denigrated. (O’Hagan, 2014, p. 111)

At its most simple, peer support is the coming together of two people who have walked along a similar path and who find comfort in each other’s journey. But peer support is far more than that. Peer support rests on the assumption that a person’s own experiences are a source of strength and the means to build connection with others. As such, it flips the narrative about where expertise lies on its head. It implies that we ourselves have the power to understand our experiences and are best positioned to direct our own path to well-being.

This is a powerful philosophical standpoint with far-reaching implications in terms of mental health service delivery and human rights. Traditionally we have seen people who experience distress as in need of professional, mostly medical, intervention. To locate expertise within the person, to name lived experience as a source of expertise, is disruptive.

In this way, peer support, which has at its heart a simple sharing relationship, is incredibly complex. Peer support is not an uncomplicated solution to the loneliness of mental distress. In fact, it seems that peer support in mental health is growing more complicated by the day. In recent decades, peer support has become more prominent in mental health policy and practice throughout the western world. More and more paid roles are being created within mental health services, as well as in community initiatives. Training courses in peer support are becoming more widespread and in the UK and Ireland the introduction of peer workers is understood to drive forward culture change within mental health services. The growth of peer support has taken place in decades that have been defined by austerity and often division, but this has not seemed to slow its growth in popularity in mental health. Perhaps there is something refreshing about the peer support standpoint that values the voice of the non-expert and locates strength within individuals and communities, that explores experience rather than seeking to ‘fix’ it.

It is with this standpoint that we have written this book, capturing a snapshot of the landscape of peer support in the UK and Ireland, with the understanding that it is ever expanding, distorting and evolving. Given the breadth of offerings, both formal and informal, that fall under the umbrella of peer support, we have chosen to focus on intentional peer support in mental health, but not solely in mental health services. Intentional peer support involves deliberately offering support based on shared experience, most often where one person is working (either paid or voluntarily) within a peer role. This focus has enabled us to consider several forms of peer support in greater detail. Given the diversity that exists within peer support, it is not possible to explore every context in which it takes place, such as online, parenting groups, or in offending, prison or homeless populations. Nonetheless, we hope that the content of the book is helpful in understanding peer support as a concept and offering guidance, challenge and ideas which go beyond specific contexts.

We bring to this book a number of different identities and both of us have been defined, or have chosen to define ourselves, differently in our working lives. I (Emma) was employed and trained as a peer support worker in 2010, at a time when I was still very much swimming in my own experiences of distress, and using mental health services. Like so many other peer workers, the role helped transform my sense of self and I began to understand that I needn’t see my experiences as failure or weakness. The role also brought my lived experience into the foreground; it was (and perhaps still is) what defined me and how others understood me.

I (Sara) am employed and trained as a clinical psychologist. However, my first experience of mental health services was of being sent to see a psychiatrist in my adolescence. The kind of psychologist I am is influenced by my life experiences, including of traumas, distress and disability, of using mental health services and of having close relatives use mental health services. Working alongside other recovery-oriented practitioners and professionals and peers who used their lived experience helped me integrate these two forms of learning. Working with the peers at the Recovery College, and in writing this book, has profoundly inspired me, helping me to see my lived experience as an asset and to bring my dual identities more into the foreground.

There are both positive and negative consequences to the foregrounding of different expertise and experiences. Both of us have lived experience, and academic backgrounds, but the way the world sees us, and the way we experience the world, is very different. Within this book we draw on our experiences, lived and professional, academic and lay, and take every opportunity to invite the experiences of others. We are sharply aware of the privileges we have enjoyed as well as the challenges, and that as white, educated women, with our unique experiences of the world of mental health, we can only know so much.

This book is a coming together of people with diverse lived and life experience to explore the concept of peer support from different angles, to present the debates that exist in the literature, as well as those that they personally have experienced. The first part of the book introduces the concept of peer support; we go on to explore some of the specific settings where peer support occurs; and then the practicalities of providing peer support. We have learned much from developments in peer support in the USA, New Zealand, Canada and around the world. We hope that this book provides opportunities to learn from experience in the UK.

Chapter 2 provides an introduction to peer support, beginning with its history which is rooted in a civil rights movement, among other things. It also describes the evidence and values that underpin peer support, so that readers can hold on to these as they read later chapters, using them to develop their own perspectives on some of the debates that exist within peer support.

Chapter 3 places these debates under the microscope, in particular exploring the tensions that exist when peer workers are introduced into statutory mental health services, which use approaches that are often at odds with the philosophy of peer support. This chapter is by no means the only place where debates are explored. In each chapter the authors provide critical thinking points in relation to the subject at hand. Chapter 4 broadens the focus once more, beyond mental health services to describe and unpack some of the many ways that peer support is formally offered in the UK, including in group settings and within charities. Recovery Colleges are becoming more popular across the UK and we have dedicated Chapter 5 to these, to allow space to fully explore the peer support that is offered and received by students, tutors and staff in these settings.

Equally important and distinct in identity is the peer support that is offered between carers, family and friends, and peer support in communities that have traditionally been marginalised. Chapters 6 and 7 provide space for the uniqueness of peer support in different communities to be considered, and to explore who is a peer to whom. Debates surrounding identity and stigma are well articulated here, and the distance that peer support must still travel in order to appreciate the many different lived experiences which people define themselves by is clear.

Chapter 8 provides an overview of the learning that has emerged around peer support training. This includes a consideration of the values which must underpin training, and some of the common components of training courses, both in the UK and across the western world. Training, unsurprisingly, places emphasis on the use of lived experience, how a peer might go about this, and the boundaries which accompany peer support relationships. This is well positioned alongside Chapter 9, written by mental health professionals who consider how they and other professionals might use and share lived experience in their work. It includes a weighing up of the benefits and challenges that come with sharing personal experiences, especially when this is not expected within professional identities. This consideration draws attention to the huge amount of lived experience which exists within the mental health workforce, raising the questions of what support is consistently offered for mental health workers, and what additional support might be helpful in relation to lived experience?

Chapter 10 goes some way towards answering these questions as the authors describe best practice approaches to employing peer workers, and the support structures which are needed within organisations to offer these. The authors draw on the available evidence as well as their own experiences of employing peer workers and of working with organisations where the peer support role has presented a challenge to existing employment structures. Finally, Chapter 11 describes a world where the balance of peer workers and ­professional is tipped the other way. In ‘peer-led’ organisations, rather than having a seat at the table, people with lived experience have control over the design, delivery and evaluation of services. We end the book with the peer-led message as a means of inviting the reader to think radically about the way in which mental health support is currently offered, and what it could become if lived experience was as valued as professional expertise.

We have thought carefully about the language choices we make within this book, particularly the language we use to describe people and their experiences. Language is incredibly important; it demonstrates the value and meaning we place on ideas. We have strived to use language that represents the philosophy of peer support, that values whole people (not patients) and human experience (not illness). Given the history of peer support, rooted in campaigns against the medicalisation of madness, we have particularly avoided using the language of illness or medicine. This is not language which fits with our personal understanding of these experiences and does not fit with the philosophy of peer support.

It is unlikely that agreement will ever be reached on the most helpful language to use in the context of mental health. While some prefer the term madness, having reclaimed it within the Mad Pride movement, others find it offensive. While some prefer mental health problems, others believe this still implies illness and biomedical approaches. As much as possible we have chosen to use the terms ‘lived experience’, ‘mental distress’ and ‘mental health challenges’ to describe these experiences. We believe these are most in keeping with the philosophy of peer support (and our own personal values). They honour the very human nature of these experiences and encompass the broad spectrum on which they exist.

For similar reasons we have shied away from describing people as patients or service users, instead choosing terms such as people receiving peer support and people who use services, as this is less reductive. There may be points within the book where authors make other language choices based on their own perspectives and experiences or the literature and people they are citing, and we have not policed this too heavily; everybody has the right to choose how they describe themselves and how they understand their own experiences.

REFERENCES

O’Hagan, M. (2014). Madness Made Me. Wellington: Open Box.

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What Is Peer Support? History, Evidence and Values

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