From Independent to Institutionalized

David Hidajattoellah
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Dutch peer support education has changed dramatically over time since its inception. Five waves of development can be distinguished. Peer support education has evolved over time from empowered and independent peer support education to institutionalized peer support education.

1st Wave: Empowered and Independent

The first wave entails empowered and independent peer support education. A programme called GOAL was set up in 1996. This educational programme was based on the supported education principles (Unger, 1998). The primary focus of the educational programme was learning to learn. The first Dutch peer support educational programme was the TOED provided by IGPB. This was the first independent and empowered non-accredited educational programme for peer support workers.

After the TOED many more non-accredited educational programme were provided by independent peer run organization like GEO (IGPB and Anoiksis), Herstellen doe jezelf (in English: Recovery is done by you), Werken met eigen ervaring (in English: Using your own experience), BAED (Anoiksis) and many others. All the educational training programmes used an independent educational model. Lessons were predominantly taught by peer teaching staff.

2nd Wave: Upsurge of VET-programmes

The second wave development is the upsurge of accredited vocational educational training programmes (VET-programmes). The first VET-programme was offered by ROC Zadkine. This BGE (counsellor experiential psychiatric care) was a spin-off from the GOAL educational programme albeit without the aspect of learning to learn. The BGE was offered by a standard accredited vocational educational institute. The standard social work curriculum was marginally supplemented with parts of peer support work.

So in essence the BGE used a co-optational social work educational model. In the same vein many other social work vocational educational training programmes were set up by vocational educational training institutes. They were all based on a co-optational model and the education was delivered predominantly by non-peer teaching staff. The social work vocational educational training programmes were presented as peer support education but in actuality were merely a form of institutionalization of peer support work.

3rd Wave: Co-operation and Higher Education

Co-operation was set up between accredited social work vocational educational training programmes. The aim of the co-operation to align their curriculum and develop one basic curriculum for social work vocational educational training programmes. The curricula of the social work vocational educational training programmes were more or less aligned.

During this period accredited higher education initiatives for peer support education were set up. Social work tertiary professional educational had difficulties with their registration as a professional, the upsurge of interdisciplinary social work tertiary professional educational programmes and educational marketing.

Social work tertiary professional educational programmes were set up for peer support work on the basis of the co-optational educational model. These educational training programmes were taught predominantly by non-peer staff. Furthermore  the standard social work curriculum was marginally supplemented with parts of peer support work. The social work tertiary professional educational programmes were presented as peer support education but in actuality were merely a form of institutionalization of peer support work.

4th Wave: Independence and Institutionalization

EducationaI initiatives were set up by social work tertiary professional education institutes, mental health care organizations and independent peer run organization. An educational training programme was set up by the foundation Zelfregie centre. This independent peer run organization set up an accredited vocational educational peer support training programme for experts by experience. This educational programme is an one year training programme.

An educational peer support training programme called LEON was set up by three mental health organization, i.e. Mediant, Dimence and Tactus  and the social work department of the tertiary professional educational institute, Saxion. The one year educational training programme is not accredited.

The educational programme can be typified an example of instititutionalized peer support education because it is based on a co-optational educational model and developed by mental health institutes and the social work department of a tertiary professional educational institute. The programme promotes institutionalized peer support education and institutionalized recovery based care albeit endorsed by protoprofessionalized experts by experience.

The lessons are taught predominantly by non-peer staff. The programme promotes the acculturation by non-peer staff during the training period and before the future experts by experience actually enter into the workforce. The future experts by experience run the risk of entering into a professional moratorium. Hence the students have to make a forced and coerced choice before having the full information in regard to being a expert by experience in the mental health workforce.

5th Wave: Power Coalitions and Institutionalization

In the Netherlands an economic crisis has taken more hold on the Dutch economy. This led to more and more budget cuts by the Dutch goverment. The goverment enforced budget cuts in mental health care, social security and education amongst others. Moreover the unemployment rate rose dramatically.

The LDOO, National Think Tank for peer support education, was initially aimed at promotion and development of empowered and independent peer support education. During the 3rd and 4th wave of development the aims of the LDOO tacitly changed into the promotion and development of institutionalized peer support education. Factors that contributed to this tacit change were the involvement of Mental Health Netherlands, social work departments of tertiary professional educational programmes for peer support workers and social work vocational educational training programmes for experts by experience in the LDOO.

The Knowledge centre Phrenos and research institute Trimbos set up the project LIVE. One of the purposes of LIVE was to develop a competency framework for peer support workers. This resulted in the BCP-E. This was developed in co-operation with Mental Health Netherlands

The competency framework, BCP-E, is a product of  an institutionalized peer support project as all parties involved in the development of the BCP-E are examples of institutions promoting institutionalized peer support.

On the basis of the BCP-E the basic curriculum for peer support was developed. This was developed by the same parties as the BCP-E albeit that it was endorsed by protoprofessionalized peer support workers. It was and is heavily criticized during its development and when it was presented in 2015 however all criticism was ignored by the developing parties. Both the BCP-E and the basic curriculum for peer support workers promote institutionalized peer support education and further institutionalized peer support work.

Social work tertiary professional educational had difficulties with their registration as a professional, the upsurge of interdisciplinary social work tertiary professional educational programmes and educational marketing.  Within this growing educational free economy market determined by competition the social work departments of tertiary professional education developed minor programmes on peer support. These peer support minors are based on the co-optational educational model as they merely marginally supplemented the standard social work curriculum.

In a time of a Dutch economic crisis, budgets cuts and high unemployment rate more and more future peer support workers choose the accredited peer support social work training programmes at vocational educational training level and tertiary professional educational training level.  The reason for such a choice lies in the economic urge of peer support workers and securing financial means of income in dire times.

The LDOO has proposed to compose three power coalitions on the basis of the type of education for peer support. This implied three power clusters, i.e. independent education, vocational educational training programmes, tertiary professional training programmes. The latter power cluster called HOED has developed a basic curriculum for peer support at tertiary professional education level.

The cluster for peer support education at vocational educational training level has not yet developed such a curriculum however the curriculum of the vocational education training institutes has become more aligned over time since the inception of the educational training programme provided by ROC Zadkine.

Future

There is a high likelihood that due to socio-economic political pressures the three power coalitions have to voice one policy voice. This complete alignment in effect implies that the institutionalization of peer support education and peer support work can be finalized. Two of the three power coalitions, i.e. tertiary professional education and vocational education training, are likely to align first.

The third power coalition, i.e. independent education, is most likely to be the most important coalition in preventing the complete institutionalization of peer support education and loss of empowered independent peer support education.

Conclusion

Since the 1st wave, peer support education has evolved from independent empowered education to institutionalized peer support education based on a co-optational model, for the purpose of promoting the institutionalization of peer support work and of peer support education. This implies that the (future) peer support workers are highly likely to fall victim to acculturation when working with non-peer staff, and during education. Acculturation is a major threat to independent professionalization of peer support workers and there is high likelihood of protoprofessionalization of peer support workers  (Alberta & Ploski, 2014). In effect the (future) peer support workers in the Netherlands could become clinician-friendly peer support workers who merely represent peer support work in name but not in practice.

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References:

Alberta, A.J. & Ploski, R.R. (2014). Cooptation of peer support staff: quantitative evidence.

Rehabilitation Process and Outcome, 3, 25–29.

Unger, K.V., (1998). Handbook on supported education: providing Services for Students with Psychiatric Disabilities. Baltimore: Paul. H. Brookes Publishing Co.

BCP-E retrieved on April 1, 2015

Basic curriculum retrieved on April 1, 2015

Vocational educational training programme for peer support workers by Foundation Zelfregie centre retrieved on April 1, 2015

LEON: peer support educational programme retrieved on April 1, 2015

LIVE retrieved on April 1, 2015

 

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David Hidajattoellah
David Hidajattoellah is an English/maths teacher, educational scientist, statistician and philologist in Amsterdam, The Netherlands. I work as maths/statistics teacher, peer support teacher and senior researcher at Anoiksis. He has done research into the intersection of education, law and organization/management in regard to peer support since 2003, as well as studies into competencies, stigma, programme evaluations, learning and professionalization. He has developed (online) educational training programmes for peer support workers, taught peer support workers and founded an online peer support learning network, and a peer support academy.

8 COMMENTS

  1. David, thank you for addressing this important issue. The same thing has been happening in the US for years,as these roles have been re-defined by professionals not as “peer support” roles, but as low-paying paraprofessional roles that don’t really require experiential knowledge as an ex-patient, but are just a cheap labor force . As Alberta & Ploski note in the article you cited, the entire enterprise has been co-opted. Also I wanted to say as a non-Dutch person, I had some trouble understanding the acronyms you used. But that did not detract from the importance of your message. Thanks for putting this out there!

  2. Financial “independence” is considered by the neurotypical master class to be the most important, if not the only, barometer of recovery from mental illness. Without jobs and independence from public assistance, Mad people are forced to gain societal acceptance based primarily on who we are rather than on what we can do. Such faith in the tolerance and empathy of our fellow citizens would be a good thing for everybody if we lived in a world that could measure the worth of Mad lives by the quality of our companionship, the style of our creativity, or on our unique ability to live in contradiction to the individualistic, materialistic status quo. These scab jobs in the mental health field will be a persistent and pernicious temptation for Mad people who don’t want to or can’t afford to keep their eyes on the prize and work on building that tolerant, empathetic world.

    • On the Dutch wards peers are incorporated into the system. They are often expected to promote psychiatric drugs and work in the system using the same principles. They are allowed to apply their experiential knowledge under the guise of the financial registration system. This system dictates that only if and when you use the terminology of the DSM and work in accordance with the regular mental health principles then and only then you are allowed by god’s grace to even work in the system. So they cannot really use their experiential knowledge. Moreover the wards most often only employ peer workers who have not had any training and are not very critical of the system. They have already fallen victim to opting for being one of the regular mental health care workers, being accepted by their non peer colleagues. The financial status improvement is more important than being critical. If they do become critical of the system their contract is cut under the guise of the financial registration system will not allow us to have you work for us. If a peer worker is critical and does have a paid job then they are taught this attitude should be relinquished. In most cases the positions peer workers have are not paid jobs and constitutes nothing more than being the gofer of the non peer staff. They often expected to reel in the clients and then let the clients be abused by the system. The current economic crisis and budget cuts on social benefits and welfare as well as the deplorable state of the welfare state implies that peer workers feel compelled to opt for the financial status and working in accordance with the system rather than opting for a more independent position. In a way the peer workers have opted for acculturation and assimilation rather then changing the system and being critical. This effect is even more enhanced as many employers assess whether the peer worker has progressed sufficiently in recovery. If the mental health organizations and its workers find that the peer worker has progressed enough then he is allowed to work as a peer workers. Hence the state of recovery is assessed by the mental health professionals. As you can imagine only peers who are not critical are employed. Such hautain and arrogance is commonplace when peer workers apply for the job as peer workers. I fear the Dutch situation is not much different from many other countries.

      • Sounds exactly like what is happening here in the United States, at least in my experience. If you work in alternative settings you can function as peer workers are supposed to function.

        However, if you work in traditional settings or organizations, such as state hospitals, the expectations for what peers should be like and what they should do completely go against the training and ideals that we embrace in order to walk with other people in their Journeys. Many traditional institutions want peer workers simply because it makes them look good on paper; they can say that they really are promoting recovery and healing. The actual truth however is a very different thing. Most traditional institutions don’t even know what peers are trained to do, and what we cannot do, which is to support choice for the people on the units and to walk with them in whatever ways encourage and support what they want for their own lives. Obviously, this is exactly contrary to what the institution promotes so you can see the dilemmas that arise for those of us who attempt to remain true to our calling as people who support and walk with people as they strive to put their lives back together and make their own personal choices about what they want to do and who they want to be. The moment that you raise your voice in dissent about what’s done to people in the name of treatment you’re accused of “staff splitting”, which is just about the worst thing you can be accused of. Once you’re been accused of this the psychiatrists on units can ban you from working in their areas. It’s an impossible task but I still have some hope that something actually good and worthwhile can be accomplished for the so-called “patients” on the units, perhaps not right now but in the very near future. But, I’ve also been accused of being over-optimistic.

  3. I live in the US, and took the accredited “peer training” program in my current state. It was actually fun, and I met a lot of nice people. But within the training, the “chemical imbalance” theory of “mental illness” was allowed to be espoused as valid.

    I knew personally I could not work within a “system” which allowed this to happen, so did not personally persue a job based upon that training. My college degrees are in different fields, so I was not forced into doing so.

    But I do see the problem inherent with the fraudulent institution of psychiatry forcing those who do not have other options into so called “peer” positions for a paying job, and co-opting them into a system that perpetuates forced and coerced drugging. It was those “peers” who “bought into the system” who did end up becoming “peers” for a profession.”

    • It is always amazing to me how many peer workers want to believe in their labels and their supposed “illness” and who take the drugs themselves. I won’t accept those things for myself.

      However, my peer training was based on the idea that peers are not allowed to support and hold up a particular “treatment” and promote it, we are not to proselytize and coerce anyone into seeing anything in a particular way. What we are to do is support the people we’re walking with in what they believe in and want, even if we don’t necessarily believe in it ourselves. We exist to work for and promote personal choice for all people. This is exactly why we have a very difficult time working in traditional settings where everything is decided by the system for everyone under their control and power. We are not supposed to chart on the people we work with because this gives us power and privilege over them and doesn’t promote the mutual relationship that we’re called to create with the people we walk with.

      Unfortunately, what poses as peer work in so many states and institutions and organizations is not peer work at all. Far too many of us have gone over to the Dark Side.

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