Peers betraying Peers, and Relapse
I am an extremely disillusioned peer. I have spoken up about issues in the peer community on this platform and face to face with other peers. Since I first began identifying as someone with lived experience, and learning about the peer movement, this aspect of living and working as a peer continues to complicate anyone claiming to be a peer worker with unassailable ethics.
The issue at hand is twofold: There is a lingering taboo question surrounding ‘relapse’ when living and practicing as a peer. How to best support a peer who is going through a crisis.
During my time practicing in the peer world, I have observed that when peers get sick or decompensate, peer support stops, almost in its tracks. When a peer relapses, other peers turn their back.
The second issue is that when there is suspicion or situation in which a peer may be relapsing, no protocols are put into place to ensure the intervention or investigation is completed without harming the peer further.
Further, like any claim or investigation, in the human services, and mental health, any investigation and intervention cannot be taken just in the grounds of good faith of the person claiming someone needs help. Unwarranted and false claims with children protective services are a punishable crime, in issues of neglect and maltreatment.
In the peer world, there is no such protections afforded to people corralling mutual peer support and interventions. Instead, people sometimes get harmed. In the case I will delve into later, I was personally harmed, and betrayed, by a false claim of relapse.
This twofold issue is extremely complex, with implications on both ends, as we cross walk and troubleshoot why this is such an important area requiring more looking into by the thought leaders of the peer profession.
Peers, by definition, have experienced the impact of a mental health ‘disorder’, and sometimes, severe ‘mental illness.’ While there is no rule written down by the Academy of Peer Services (APS) around how long a person should be in recovery or healed from their illness, there is a generally understood notion that this peer should be active in the recovery process, if not fully ‘recovered.’
If you are only just embarking on your recovery journey, you might experience a few more blips or issues while working as a peer than those who are fully recovered.
Think about it. If you are still experiencing some ‘symptoms’ of a ‘disorder’ or haven’t learned how to enact the best possible self-care, it’s more likely you may need more time off or might be triggered more. You might need additional time to heal and recover as you continue your healing journey.
More importantly, the concept of ‘peer support’ is a little unsettled when it comes to commonly accepted definitions when practicing in mental health. The definition of peer support even more than ‘relapse’ is what really belongs in the APS trainings. Here is the issue: peers carry their illness in their jobs and when they go home for the day. Now, when a hypothetical peer goes home after working in the agency, does the support he or she gives to her friends still considered ‘peer support’ because it is coming from a peer or just support because the peer is off duty? Since, at this point, the peer is no longer in his or her established role as a peer at an agency, and is in the community on his or her off time, what exactly is the protocol on how peers should help peers in crisis when there are so many boundaries and rules on how peers should do their jobs?
Cooptation complicates establishing a definition that is truly non monotonized and commodified, doesn’t it? Since peer work is now an established practice, monetized and a discrete thing, we should really know if peer support is still truly mutual, and person centered when peers are on their off time or socializing out of work. The problem is peers are even more lost when outside the gates of the agency especially if a peer is in trouble and needs support outside of their work environment. Why? Because as few protocols there are on how to support peers relapsing in the agency should help there is even less guidance on what to do when a peer is in need outside of work on their off time.
I suppose this shouldn’t be a shock I mean, other professions in mental health really aren’t given manuals on how to behave, in and out of the office. But peer work has a different caveat too it. Clinicians are not clinicians when they go home for the day. But, like I said earlier, peers always carry their diagnosis. So, should the fact that peers are still peers outside the office necessity them to provide their friends, or collogues in need support on their off time? I would hazard to say not required, and it certainly shouldn’t be encouraged for peers to work all the time. Self-care on a peer worker off time is critical to them continuing in their recovery.
However, we need clearly defined protocols in place on how to respond to this very specific set of incidents: peers relapsing in and out of the workplace and how the agency should respond at different levels to make sure safety, decency and respect are all in place for everyone in involved.
Either way, there is undoubtedly a vast spectrum to healing, recovery, and the level of rigor and performance of peers in the workplace. I’ll be brutally honest, when I first encountered another peer—introduced to her and a few others at my local mental health agency—my heart dropped, and I was highly concerned. I was concerned about myself, quite honestly, the status of the profession I was embarking on, and the quality of life and living and working as a peer in a mental health agency.
I was also worried because I was shaking hands with glassy-eyed people who looked highly medicated. In some cases, tired looking, again, perhaps because of medication, or overmedication, and a general attitude I picked up from them as being overly grateful and happy just to be working in the same environment as their ‘professional’ counterparts. Seeing this was difficult for me because I was one of them. I was a peer myself.
I wondered, do other folks see me in this light? Do others see me as healed or still ‘disordered? The answer to this question preoccupied me because if people still saw me as disordered, even just a little, I know they would be more likely to turn their back on me when they thought I was relapsing.
It has happened to me. I have been marked as relapsing, even when I was quite well.
I wasn’t even in distress.
In this case, a colleague competing for the same position wanted me to resign and walk away from a promotion in our department in fear I would be promoted over her. This colleague went as far to suggest I was behaving out of my usual character and maligned me with a series of microaggressions when I was quite well.
I sent her an email, but I inadvertently had a typo, or God forbid, two of them. When my coworker’s email responded with: “Max, are you OK??” my heart dropped. Because at that point, I knew this coworker wanted to mobilize her knowledge of my lived experience to make a case I was unwell or unfit and therefore not a good candidate for this position we were both competing.
That is exactly what she did. I walked down to her office and started to apologetically explain away my typos, trying to make a joke about the email and how I could understand how it must have been extremely troubling and distressing to read an email with typos. That was when she said: “Max, I don’t like your tone. It is alarming…. please calm down!”. It seemed I was calmer than she was, and my interns surrounding me looked extremely puzzled at the interaction that just took place.
I wasn’t puzzled or confused. The word ‘alarming’, just like ‘problematic’ and ‘distressing’ are often used to describe other folks when they are perceived as threatening. Since these words have so little clinical value, or much inherent meaning, I can understand why she used it. Words like ‘alarming’, ‘problematic’, ‘troubling’, are often used when no real language with real meaning or clinical value can be offered to describe a person’s behaviors. In this case, these behaviors were later the grounds used to make a negative false claim about my mental status.
This was disturbing for me on several levels. When I first had my break due to schizophrenia, I did not know I was sick, a feature of the illness called anosognosia. Now, here I am, far into my recovery, ten years later, working in the field, and a coworker makes a false claim that I was sick when I wasn’t. This was also sad for my interns, who witnessed first-hand the type of heinous and deplorable behaviors people in their field are capable of enacting publicly.
After the office incident, no one, not one other collogues at the agency or administrator stepped in to say this sort of transgressive way of handling inter office communication was frowned upon. Moreover, the void in the office left room left a gaping vacuum where other peers could have been supportive and intervened making it clear I had behaved appropriately and my collogues response was unwarranted. There was none of that, so, I left the agency shortly after. I am writing this so other peers aren’t left in the same shifty and lonely void I was left in where peer support would have been truly welcome and needed.
My first peer supervisor, years before this betrayal, taught me how I was more powerful than lousy peers at our agency. My lived experience could one day be a model to others to be agents of change and a testament to the upper limits of success and career growth that a peer was truly capable of during their career. My supervisor also reminded me how important it was that I came out and stayed out as a peer and someone with lived experience. She also told me that my resolve and health would be under scrutiny from everyone around me in the agency. As I discussed earlier, and would sadly find out, again and again, this would be the case in the future too.
I fully believe that in a profession based on living out and healing from a disorder, we should not just expect but be prepared for our fellow peers to relapse. There should be active protocols in place in every agency when this happens. From HR to agency-wide discussions and conversations around this very natural part of living with a mental health disorder.
This can be handled several ways. I am recommending one possible approach given the issues I circled in the article. HR sets the agency tone of what is expected and frowned upon in terms of behavior. HR usually has books associated with the agency it is attached to and working for and can insert a working guidance on how agency members can handle a peer crisis or relapse both inside and outside of the agency. This can be reviewed during orientation to the agency and refreshers throughout the year at HR events. The direct service programs can trouble shoot these directives and reinsert new guidance into the HR books when there are substantive updates.
Most importantly, if we are to gleam and further learning from my story, if an internal claim is made against another peer at an agency, there must be some sort of third-party review. All peers have the potential for relapse. We all can’t go around speculating on each other’s health during a time for promotions to knock another candidate back into the unemployment line.
To be even more precise, we need to radically transform the way mental health agencies handle relapse. When I finally walked away and resigned from the situation I described above, I had a to send out emails to my interns, apologizing for the agency, and for the difficult interactions they observed. I can only imagine how difficult it must be for peers who really do relapse and and are too sick to follow up with the fall out within their agency. People struggling with relapse really shouldn’t have to hand hold their agency or coach them through this process. It needs to be manualized, and talked about at meetings, and embedded into the very culture of the agency,
In my book, the most important item here is that we begin to fully prepare the ongoing conversation in agencies and the larger peer community around relapse and what it might mean for a program or a community of peers. I have often seen the taboo treatment of ‘relapse’ mean withdrawal or removal of support between the person relapsing and their fellow peers. This phenomenon is the very converse of what should happen between peers. We need to augment support in a crisis, not remove it, folks.