Psychiatrists Discuss Concerns About Peer Support


Dr. Sunny Aslam writes a brief report in Psychiatric Services about working alongside mental health peer support employees, based on feedback he obtained from an American Association of Community Psychiatrists e-list. “Nonpeer staff have raised a number of concerns about working with peer staff who are currently receiving treatment from them,” writes Aslam.

Some of the concerns expressed, writes Aslam, include “discomfort in regard to treating fellow state employees; a sense that some peer workers take advantage of their status and do not show up for appointments because they have no fear of consequences; concern about peers sharing confidential information with others who are not authorized to receive such information; concern about not encouraging patients to move on to the ‘real world’ outside the clinic; and concern about a conflict of interest, such as a therapist’s being asked by a frequently suicidal peer worker to have his time sheet signed for hours he had not worked.”

On the topic of being the treating psychiatrist for a peer employee at the same agency, Aslam reports that one respondent said, “I cannot imagine this conversation occurring in any other area of medicine. A cardiologist not treating his partner? Until conversations like this end, the problem we have is stigma, pure and simple. Our own stigma toward the illnesses we treat.” However, Aslam quotes another respondent noting that, “There is much ethical commentary… about treating someone with whom you have another relationship… It can impair your objectivity, and if anything goes wrong, it can be emotionally devastating. This is not an issue of stigma, but one of setting up the best situation for competent care.”

Case Studies in Public-Sector Leadership: How to Help Peer Workers Succeed (Aslam, Sunny P. Psychiatric Services. August 1, 2014; doi: 10.1176/


  1. It seems like policies regarding this should apply across the board to all employees. There are a hell of a lot of people who work in the system that are in treatment. If peers can’t be treated at the same facility neither can social workers or psychiatrists. I can see why it makes sense for a therapist to not be supervising her patient’s employment, but the idea that peers should be encouraged to move on to the “real world” has me stumped. If that’s a concern why not quit and move on to the “real world” yourself? In the real world a job’s a job.

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  2. I haven’t read Aslam’s piece in Psych Services yet, but my initial reaction to this brief notice is that “peer” staff should absolutely not be receiving services from the same agency where they work. It’s completely unethical to put these staff members in that kind of a dual role. In fact, it’s amazing to me that the administration of the agency would allow such a thing.

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  3. Isn’t it stigmatizing and patronizing to deprive the individual – the peer – to make the choice? If the agency had a policy of not allowing people receiving services from the agency to seek employment there, this would deprive the individual of being able to make the choice that is best for him or her. In a small town, it could deprive a person of finding employment. Some may choose to work elsewhere, some may not.What is beneficial for one person may be harmful for another.
    Where I work, it has been so helpful and instructive to see people grow and development in their professional lives. Although I would never impose this on someone who did not want to do it – and choice is everything here- I am so happy to have our peers as colleagues.
    It is complicated – relationships evolve in ways that can not always be anticipated – and I am happy to see that Dr. Aslam is studying this.

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    • I am thinking that we need a definition of what is a peer support worker here. Is the peer support role coming from a mental health agency which takes its peer support workers from the client pool? Or is there a written in place position of peer support that reguires certification or some sort of specialized training or education? Is this a paid role or volunteer? This perception is crucial to any sort of ongoing dialogue. In the Developmentally Disabled community where I worked at a children’s camp we had junior counselors that we hand picked from the registered cmpers for that role.But we never ever had DD counselors. It would have been unthinkable at that time.We thought we were so ahead of the game to have even the role of junior counselor.I worked at another camp for children with Mental Health issues where some counselors had been treated in the same agency that ran the day camp. It was not above ground and created estrangement among those who were or who were not agency clients.I would have been fine with the truth and I would have trusted the administration much
      more if it was openly acknowledge . Awkward for everyone all around.

      In the old days everyone who was in the helping profession usually had some sort of personal experience or as they would say training in treatment. Until the playing field in cleared for all and stigma is truly reduced – I would think twice before agreeing to be a peer support worker with those on my treatment team.

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  4. This article shows that peers working in places where they also get “huelp”…….expose the mentalism inherent in a system that can’t or struggles to cope with the idea that someone could need help and at the same could have something to offer as a helper.

    I do feel that people should work in places that deem themselves suitable providers…. to deny them work doesn’t make any sense because otherwise you would have to sack/fire current workers who “get ill” and need help. Anyone can need help one day. MH services need to get used to this and peer workers can be part of cultural change inside the system.

    Obviously working as a peer comes at a personal cost as peer working is ultimately incompatible with working inside the system….. ironically exposing the reasons why this is true is part of the power of the role…. its a paradox and comes at a cost….. pure abolitionists will feel uneasy with the idea of peers working inside the system at all…… my own feeling is that change will come faster with survivors working inside the system as well as outside….

    Each to their own…. thier is no point trying to occupy the existential moral high ground as no such place exists…

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  5. The concerns listed in the article above just serve to demonstrate how mentalist all the concerned employees are….. all the so called concerns have to do with peers not meeting thier conditions of employment…. peers are no more likely to fail to meet the terms of thier employment contracts than anyone else. Its pure mentalism on the part of the “concerned” staff…..

    The concern about confidentiality is hilarious….. social workers and MH nurses are notorious blabber mouths…..

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  6. Interesting that this appears to be one sided (from the tone of the article). As a peer worker, who has some contact with the medical side of things, I have my own set of concerns….Ethically, I have found peer workers rising to much higher standard than psychiatrists (my first psychiatrist worked in the same hospital as my stepfather, with whom I had many issues. Not very much was kept confidential…they had a standing appointment after every session!). I have been repeatedly asked to ‘bend’ rules that are particular to my area by medical model personnel. Believe me when I day it is far more intimidating to be treated by someone you work with than to be treating someone you work with…..and confidentiality is something that is far more concerning to me than to the medical modelers – they haven’t experienced the adverse effects it has on one’s life when betrayed

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