Living in Two Worlds: Conflict and Stigma

Living in Two Worlds: Conflict and Stigma

For most of us served by its auspices, we call it the system. There are many ‘systems of care’ serving consumers with services and their people with “benefits” (e.g. social security, social services). Some of these systems are more archaic, coercive, and outmoded then others. No system is as complex, repressive, isolative, feared, and misunderstood as the mental health system. I fully intend to explore the aspects of the mental health system at the local/community that can benefit from reform. I write from the perspective of a clinician who continues to work within the aging and fallen community mental health model. This is a model that continues to evidence serious delinquencies. These delinquencies are rooted in its failure to provide adequate person-centered care, and even fewer opportunities to move forward and escape its revolving door.


As a mental health provider and peer in the mental health system, I have witnessed various attitudes towards consumers, most of which were not person-centered. I define person-centered here as a holding a stance towards consumers that allies with their recovery and creates a culture and environment of recovery. This culture is rich with their voice in whatever treatment pathway they choose, feeling supported, and made aware of their rights.


I have worked at various levels of the mental health system in my locality. Working in an Article 31 clinic, community centers, schools, and conducting home visits providing in-home therapy. These experiences have provided me with an opportunity to work with various systems that intersect the mental health system to connect consumers with other services and benefits.


Remarkably, the most person-centered attitudes I have traversed while working were by both peers and professionals in other systems (e.g. D.S.S & Social Security, Schools & other community organizations ). Processing this out was sobering. Our systems so-called person-centered care is as rife with inequity as it with racism, bias, and stigma. As s community practitioner and peer, I like to think we have the most advanced person-centered perspective. I would hazard to say we have not yet reached the limits applying our theories to our practices.


The most egregious flaw I’ve identified in today’s community mental health system is the utterly difficult struggle to leave the system in an “improved” position without relapsing. This mental heatlh recidvisim happens all too often as a result of not connecting to other services promptly given insurance/Medicaid or working disabled issues, and conversely, giving up disability status, and being left to one’s own devices to succeed without any support.


These two stories have been told a million times by consumers that I know and by practitioners and peers that have witnessed and worked with people that encounter the systems forked road: 1) the path of living as “working disabled” with its many restrictions in insurance coverage and assistance and/ or 2) no system support in which it is all too easy to rebound back into the system.


Is anyone shocked people are rebounding into the system? After years of support suddenly people carrying a mental health diagnosis improve in their condition and are dropped from services to survive without support and years of conditioning, in some cases, hand-holding, and in others, benefits and services.

No question being a peer and mental health professional has its challenges with negotiating boundaries with co-workers, friends, allies, and consumers.

Where does disclosure become overexposure and unprofessional in the clinical realm? Yet, living as a peer, practice as a professional means mutuality and disclosing your life in the most open manner which may require peers to discuss their lived experience which complicates and conflicts with boundaries that set the standard for clinical practice in mental health. 

This struggle sets the stage for today’s dilemma in mental health, how to be transparent, authentic, and real for the best interest of the consumer’s care, treatment, dignity, and right to the best practice and options for their health and wellness. So, how do peers and professionals handle this complexity?

Being a social worker and peer means building empathic connections with clients and colleagues. We know what it’s like to be sick. We know what it’s like to treat that sickness. Bridging this gap is fundamental in provoking the best possible care available in mental health.

We all have our histories, but authentic peers are comfortable with their journey and the journey of clients in the most intimate and supportive relationship in a system that is centered around suffering and deep pain. 

Fundamentally, it’s about restoring the human aspect of care in the human services. Well, it’s about time. But we aren’t there yet. To get there, the relationship between peer professionals needs to shift. 

We need supervisors, clinicians, and administrators who understand this duality and nurture its delicate and complex layers. 

Ultimately, support and openness, holding space, and challenging the fear of the unknown, the gap becomes a bridge to the best possible care in mental health.

Where do you draw the line between your history and clients’ suffering? 

There is no choice except for people to choose which world they want to be apart of as a mental health professional: 1) become a social worker that discredits and places sanctions on uses of self-disclosure, or 2) practice mutuality that can create conflict when the peer enters the real world and find that there are regulations and rules that complicate pure equality and freedom of choice.

This means as a social worker, support and consultation will look and feel different than the counsel I get from a peer practicing mutual support. This seems odd when we are all doing the same thing. Call it ‘Treatment, Case Management, Peer Support’, we are all looking to resolve the mental health issues of our clients and patients.

Should the treatment pathways or peer support connection we make when we engage with clients make a difference in how we understand our roles in the profession?

Labels will make us realize that how we see each other and how we understand our role differently because of stigma and the evolution of the mental health system. The system will create identities for people enrolled in its institution and label us as something less than or other than a professional.

This is why until the stigma is dislodged from the mental health paradigm we cannot expect to see outcomes that reflect on the importance of peer work or mutuality as an intervention that creates a lasting space for change and results in resolving mental health issues.



Guttman, Maxwell. (2018). Mental health diagnosis: Axioms, continuum, and future directions. http://doi.org/10.5281/zenodo.1256934

Sabrina Johnson, LMSW

Sabrina Johnson, LMSW

Licensed Social Worker & Peer Advocate
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