What is Peer Support Really?

Some confusing stuff is happening around peer support. Although not a new development, it seems to have morphed into a different concept without us really noticing that we have been conned, laypersons and well-meaning professionals alike. By now the new meaning of “peer support” is so intrenched in publications and conversations that there is no way back.

Before, stopping reading this article, bear with me: I do value peer support, just not in the way it has infiltrated our society and taken over by governmentally funded large institutions. I will attempt to explain this.

It seems that current peer support is a profession, a career option that requires prior screening of suitable candidates and formal training that comes with a hefty price tag resulting in certification on different levels. Only “approved providers” can offer this certification training to the aspiring peer supporter. So, peer support as it is currently, is a specialist profession and therefore (should be) a paid position.

That is a contradictory in terms: Peer support has become a career choice?

Let us go back to the roots of peer support and what it used to be.

A peer is an equal. It means that a peer is on your level and peers support each other. To support is to be there for each other, and to advocate for each other. There is no hierarchy and no power differential, and none is in a position of authority. It means that when you support a peer you listen, you make them feel comfortable, and offer reassurance. You share your experiences, and you normalize feelings. Talking about your shared lived experience helps people to connect with each other as they feel understood and respected.

A peer can be someone in your own class at school, a person you work with at the same company, or a person who has the same or similar profession as you. New parents may seek out peers, to support each other, exchange ideas and to encourage each other. A peer can be someone you meet in the hospital in a waiting room, at an agency where people seek services, and of course, like minded people with a shared experience, can find each other on social media.

You might share jokes about your situation, or you may complain a bit about how you and others are treated. You feel a solidarity for others who go through the same stuff as you. Your interactions maybe a fleeting smile of recognition, or a conversation and from that, people may re-connect to talk about the issues in more detail.

We do not forget these people. I still think with fondness of a woman I met in hospital when both of us had given birth to our first child. We both cried and laughed and normalized the less picture-perfect process and consequences of giving birth.

Although we all are peers, not all of us make good peer supporters as it requires a person to care about others and to feel empathy. Having peers who you can call upon when you need support and validation, when you need to vent or just hang out in peace, is invaluable. Therefore, the hurdle to seek support from a peer is small. You do not need to censure yourself. You can just blurt it out and they will get it and forgive you for your use of less than eloquent expressions and phrases and your lack of a filter, as they listen to you without judgment. You need to be able to trust them, that they have your back and that they keep your personal stuff confidential.

Most of us need this, when we go through turmoil and trauma, we often feel isolated, and the suffering is worse when you feel alone. Humans have that special ability and drive, to reach out to others who understand them. When injustices have been done, and others have similar experiences and start to share this, a group is formed that has the potential to make changes in our society. Parents of children with disabilities often bond over shared experiences. There are many examples of these wonderful and valuable human connections.

Before all became “formal and official”, this level of helping each other as equals was referred to as “self-help”. It originated from people who shared experiences and they were willing to share as it could lead to positive change and helping others. Grassroot groups start like that, people come together to share experiences, the good ones, and the negative ones. They advocate for and promote positive changes regarding equal rights or better access to services. There are many examples in our history of peers supporting each other and we might know most about the groups that became active in 1960s and 1970s.

The term peer-support, in current times has a different meaning. The “new” peer support of the 80s and early 90s, and beyond, no longer has direct and clear connections with the grassroot advocacy of community-based groups.

 Old fashioned peer support is dead!

When you Google peer support…you get 240,000.000+ results and I have been scrolling through these and it required me to scroll down to page 22, before I finally came across an article that addressed the conflicting perspectives on peer support. So, just when I was about to discard this article and abandon the topic, I found helpful articles of which one by Darby Penney a senior research associate at Advocates for Human Potential, Inc.

Relevant to the field of mental health, Penney created two categories to differentiate the terms that were conflated in the research literature:  Peer-developed peer support, and the other the Peer staff model.

Peer-developed peer support “is a non-hierarchical approach with origins in informal self-help and consciousness-raising groups organized in the 1970s by people in the ex-patients’ movement. It arose in reaction to negative experiences with mental health treatment and dissatisfaction with the limits of the mental patient role.”

What I found was scaringly similar to what Penney found when she was searching for information on peer-developed peer support (old fashioned peer support) for her literature review. Almost all! references made on the Internet are about the peer staff model and this type of peer support is not clearly defined. The peer-supporter of-current times is some sort of specialist, mentor, coach, or officer.

This new type of peer specialist is no longer an equal, as the only part that remains is that they share background experience with the people they “support”. They are trained, guided and supervised by non-peer mental health professionals. Although being part of the staff does not imply that peer support workers are also presented with clear job descriptions and equal pay and benefits. Hereby a warning to all well-meaning people with lived experience….be aware of the interest in you and your experience, as you may be used as you are valuable, but you will never be given the status of the staff members who gain from your knowledge.

There are ample examples of these specialist’s peer supporters. They receive training in models, and they adopt the language and status quo of the current health and mental health system in place. They are briefed on what is available and they share this knowledge during presentations. They are familiar with the guidelines written by policy writers, or they receive training in how to teach others about the guidelines. An example of the latter can be found in the numerous publications regarding the Mental Health First Aid (MHFA) program that originated in Australia in 2001, which became popular in Canada in 2013 and is currently spread over 20 countries worldwide. In Canada, the MHFA movement is monopolized by the Mental Health Commission of Canada.

I used the word “conned”, and I stated that lay people interested in helping others as well as professionals who advocated for better and equal access to mental health services have been misled. For those interested in reading more, Jan Nadine Defehr, Studies in Social Justice at the University of Winnipeg has written an excellent article about MHFA.   

Of course, it can be helpful to have many trained people talking about mental health with new recruits in the first responder’s profession, but do not call them equals or peers, as these people are trained and supervised by those who are not your peers and the training material might not be consistent with the current philosophy of diverting the blame of illness and mental illness from the individual to the deficits in our society.

After all this, nothing stops you from helping others in an informal way from one human being to another and that is enough. As the term Peer Support is hijacked, maybe we have to come up with a new name!

But also, nothing stops you from learning more about mental health issues and helping others and becoming organized in a group.

Nothing stops you from getting informed about the existence of diverse approaches and service providers that provide people with choices and options.

And finally, nothing stops you from being critical of any authority and to question their motivation to develop training programs for peer supporters and promoting these as the only approved program. Although benevolent on the surface, the underlying message, no matter how carefully hidden, remains putting the blame of mental health problems on the individual rather than looking at discourse and culture.

Elisabeth

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