The Peer Support System Within Mental Health Is Broken and We Need to Fix It
I am a consumer of mental health services, I am also a professional licensed social worker. I’ve done supervisory, engagement, and worked as a mental health therapist. I was also apart of the peer movement in mental health from its inception. I was out there, advocating, protesting, and blocking admissions to psychiatric facilities. As a result of my work for the county government, many of the ‘peer’ programmes which exist in Westchester county today have come into being under my watch. I have indeed seen fruits of our tabor in the movement birth services which have helped countless people.
I have also seen the movement change stall, and so many of us co-opted by the medical and psychiatric industry, and people in the state government who were more interested in social control than healing. In this state, having peers with so-called lived experience is the new ‘in’, and where the money stream is funnelling its support from the state and its benefactors. But the truth is as with all movements which take money from the government, and become part of a standing reserve, co-opted, we lose our voice and our power.
I ran a peer programme in a large mental health agency. In the beginning, we had loose regulations, and the money allotted for our programme was generally decided among the peers at meetings. Slowly, as the peer gained more visibility and worth to the agencies, the government stepped in. The government pushed peers to be credentialed. So, in order to be reimbursable as a Medicaid service, we needed to become peer specialists.This meant we peers had to go through a training, set up in many ways under a medical model and informed by the systems that oppressed us for so long to get Medicaid funds.
Since the driving force in so many agencies like mine and for so many people with severe mental health issues have Medicaid, this was a must, and new standard for peers to practice. This is the moment our situation as peers went from bad, to worse. Now, in order to practice, we had to conform to a way of doing things that not only once oppressed us, but also now defined our roles moving forward, limiting our potential to be true advocates providing mutual support.
Mutual support, is what it was all about. There is something we call Intentional Peer Support. This is a way of thinking about purposeful relationships. A process where both people (or a group of people) use the relationship to look at things from new angles, develop greater awareness of personal and relational patterns, and to support and challenge each other as we try new things. IPS has been used in crisis respite (alternatives to psychiatric hospitalisation), by peers, mental health professionals, families, friends and community-based organisations.
So, instead of assuming there is a ‘problem’, peers practising this from of intervention teach others they work with to make sense of our experiences, and then use the relationship to create new ways of seeing, thinking, and doing. In New York State, practising IPS is not a requirement. In fact, in most agencies in New York, its not even practised. This is where the problem takes on a whole new dimension and density. Every discipline intersecting the mental health system, whether it is social work, or psychiatry, has a code of ethics, a way of practising that sets it apart from other disciplines, in role, and in the way interventions are carried out in the field and in the therapy office.
Without including IPS, or similar interventions as a standard of practice for the peer, what really are we doing differently as peer specialists? In the end, I’ve seen peers doing the jobs of case managers, therapists, and filling in other treatment gaps in the system, getting paid less, and doing more. Until peers adopt a code of ethics, and have a way of practising that sets them apart from others, it will always be more of the same, undercutting the consumer, and benefiting the agency pocketing surplus money without providing authentic peer services.
As peers, without authentic voices, no matter how loud we chant, or how many people we advocate for, we are not real peers in the sense of the word. And without practising true mutual support, and having the backing of our government to do so, our voices and ability to shape change will be lost forever. So, no matter what you think a peer is, whether that be having lived experience or just be discriminated against because of a stigmatised illness, remember, this battle for equal partnership in the system isn’t over yet.