Support for SB 614 with Amendment to Supervision Qualifications

I agree very much with a main point of this article: It would be better for people who supervise or direct managed peers’ involvement to be people with lived experience who have provided peer support themselves.

I have a different perspective on the possibilities for peer support: rather than be licensed, regulated parts of the existing mental health System, peer supporters can also operate on their own outside of a treatment team or hospital program and without supervision. For example, I am a psychiatric survivor who was previously hospitalized, being diagnosed with Borderline Personality Disorder and Major Depression. I have a long story involving years of severe physical abuse from my father, neglect by my mother, terror, rage, and suicidal thinking and actions throughout high school and college. But after going to psychotherapy for some years, I now got well and work productively, own a house, have friends, and can function ok most of the time. Of course, none of this was thanks to the mental health system and its mostly useless interventions of drugging, falsely telling me I had an illness, and short-term stabilization.

Anyway, I have my own website where I write about what it means to get better from trauma and how trauma should not be defined according to the medical model’s conceptualization of Borderline Personality Disorder (and it should be noted that, if peers operate within a hospital or managed care system, they would likely be pressured to speak to people they are trying to help as if Borderline Personality or Schizophrenia were valid, real things, simply by virtue of being in that disease-focused environment). Through this website I’ve talked to many people, some via email and some by phone, about what I’ve done and how they can find more resources that will be of help. I don’t frame myself as someone who is a licensed peer specialist, just someone with a lived experience that might relate to theirs.

I am currently starting a real-life peer support group in my city where people who’ve undergone trauma (which may or may not mean having gotten a diagnosis) can meet together and share their experience and hopefully form supportive relationships which will endure outside of the group. I’m in the beginning phases of starting this program, but again it’s something I am doing outside of the system, i.e. through meeting in public buildings without any license of supervision from existing mental health powers, because I have little trust in that system, nor do most others who have been involved with it. My meeting in its guidelines explicitly notes that one doesn’t have to see a psychiatrist or be part of a system-sponsored treatment program to get better after having received a “mental illness” diagnosis, as should be obvious, but it has to be said. In fact, I’m not ashamed to say that I’ve often recommended people who’ve been labeled borderline or depressed against seeing a psychiatrist or taking drugs, because in America psychiatrists with their drugging and diagnosing usually do more harm than good.

So my point is that another realm of possibility for peer action exists outside of this notion that peer specialists need to be licensed by the state, regulated by federal or state guidelines, supervised by others, etc. There’s a lot you can do on your own outside of the existing mental health system, and one should not feel that one has to be licensed or supervised by the state or existing mental health system to be able to provide effective emotional help to others who’ve gone through trauma.

Lastly, I wish to constructively criticize the notion (in the author’s bio description) of “Coming Out Proud about Mental Illness.” I reject this characterization, which is presumably that one should accept having had a mental illness which one is now managing or overcoming. Rather, I promote the idea that emotional suffering in all its forms, even including suicidality, delusions, hallucinations, etc. is not an illness. So when I meet people in real life that I have told about my past struggles, I don’t frame it as my having had a mental illness that I have overcome; rather, borderline and psychotic states of mind are usually normal understandable reactions to abnormal overwhelming stress and trauma. I think it is much more useful to frame experience in this way than to pander to the medical model and say one is “coming out about mental illness.” A lot of research, for example in the recent article on here by William Schultz, and in the many studies by John Read, is showing that identifying as having or having had a mental illness (with a presumed biological cause) is harmful in terms of increasing stigma and distancing, no matter how well intended. Of course, I could be misinterpreting the meaning of coming out about mental illness, although I somehow doubt it. I don’t know exactly how the author of others in the book framed or understood mental illness or recovery. But whenever I heard the invalid term mental illness, I have a negative reaction, so that’s what you’re getting here.

Anyway, I encourage others who want to help to consider that one does not have to become a licensed peer specialist to help others: you can form your own group, or help people 1 on 1, entirely outside of the existing system.

Oh and one more thing – I have to criticize this phrase, “As with all interventions, it (self-disclosure by a peer specialist) must be used carefully, under the supervision of qualified individuals with experience using the intervention.”

This is totally false! Supervision of qualified individuals is not required for me or anyone else to be helpful to others with similar lived experience. This is paternalism writ large. In my case, I’ve spent years studying psychodynamic and psychoanalytical approaches to psychotic and borderline states alone, and also, have spent several years working on my problems in intensive psychotherapy. From these experiences I have what I need to be able to effectively listen and help other people who’ve undergone trauma and been (mis)labeled borderline, schizophrenic, or whatever. I don’t have to be supervised by some person with a title, although, if I choose to, I might find supervision or consultation useful.

So again, I want to challenge the idea that psychiatric survivors cannot do things on their own or without the supervision of people within the existing mental health system: They can, as I am going to demonstrate.

I’ve worked as a peer specialist (certified by my state) for several years. Per the standards here, my direct supervisor must be also be a certified peer specialist with supervisor training (which in my state amount to two days,) but his/her supervisor is a LCSW. Other states have more strict, less strict, or no formalized criteria The primary reason I needed a supervisor was not for how to work alongside an individual (you either know how to do that or you don’t) but how to navigate the ungodly amount of paperwork. Some organizations in my area are free standing and are entirely peer run and operated. BUT in order to be reimbursed by Medicaid, the ENDLESS documentation has to have certain key words all over it…lots of recovery language, tons of stuff about WRAP (which I think is a poorly evidenced waste of time…could be a whole other post) and the like and has to be signed off by someone with initials other than CPS after their name.

But that’s just billing and whatnot. The actual connection with another individual who is trying to navigate life’s challenges has value. The bulk of the interactions I have with other individuals are geared toward connecting them with services like housing, vocational support, social opportunities and less to do with diagnosis, doctors, etc… Of course, that assumes the person cares to discuss any of these things and wants them. Coercion is still coercion, even if it doesn’t involve medication or hospitalization so forcing goals that “I” think are best is still manipulative. Meeting them where they are at is the best start.

I went through a CPS class, but was dismayed to learn that they are still allowing the “chemical imbalance” theory of mental illnesses to be propagated in those training sessions. I agree with others above that if peers are required to tout the unscientific theories of the psychiatric field, including belief in the “chemical imbalance” theory and the DSM disorders, those pessimistic “lifelong, incurable, genetic” theories of “mental illness” will result in hindered recovery and a sense of hopelessness.

I, for one, decided working in such a disingenuous field was not the proper route for me to take, since I do not believe the DSM disorders are scientifically valid disease entities, I believe the psychiatric treatments today are “torture” drugs, and I believe the drugs create “chemical imbalances,” rather than cure them.

I agree peers should not be required to be supervised by those who still harbor belief in psychiatry’s spurious DSM disorders and their “chemical imbalance” theory.

“Professional peers”? You’ve got to be kidding! If ever there was a profession that nobody needs it has got to be that of professional mental patient. I have a lot of trepidation, to say the least, about mental health treatment becoming the gateway into a career in mental health treatment, paraprofessional or with a university degree. I know ‘the real world’ is out there somewhere, you’re just going to have to push a lot harder than that to get there.

I realize that it can be very difficult to get people decent jobs outside of the mental health system, once they’ve been introduced to that system, but I can’t see the virtue in expanding it. I can, on the other hand, see a lot of vice in doing so.

Really? We can allow more ‘adult babies’ into the ‘adult baby sitting business’. Whoopee! It must make the ‘adult baby sitters’ that be, envisioning it, proud.

I am not a “consumer” of “mental health” “services”. I am a survivor of psychiatric (mis)treatment. This makes the choice much easier for me than might be for others I suppose, I’m not going to be selling “mental health” “services” either.

Excuse me, I know I qualify as a radical because I can live without the mental health system. Would that there were more of us.

Thanks to commenters for critical responses. I’m trying to educate my kids; to keep them unmedicated; and to keep them far from the psychiatry industry. Your perspectives are hugely educational. Your critical voices here in MIA teach me more in the service of keeping my kids healthy than you can know.

Liz Sydney

Yes, if you have peer professionals they should have supervisors who also have lived experience. Thanks for the article!

I worked as a ‘peer specialist’ for a couple of years in San Francisco, as part of an ‘anti-stigma’ public speaking program, and indeed, it was a valuable step in my process of moving forward because it allowed me to process my extremely challenging and eye-opening experience of going through the system, where for the first time ever I experienced professional discrimination to the point of having to involve an attorney.

I also got a film out of it, which has done well, where a few of us share our journeys of healing, and thanks to that, I was catapulted out of the mental health world in order to get back to a more integral and well-balanced sense of myself, outside of all that. That was the biggest relief of my life, to finally be done with all that. So it was definitely a very valuable and vital experience for me, and served as a bridge from the system and disability, back to my well-grounded real life.

The only problem was that I discovered that this ‘anti-stigma’ program was, in reality, just one more cog in the wheel of the mental health industrial complex, and once again, the discrimination based on the very same stigmatizing and discriminating attitudes and actions continued without apology. They called it ‘advocacy,’ but I would beg to differ. I felt that word is a terrible misrepresentation of the actual work done in these agencies. I don’t see “advocacy” as much as I see corporate-like run agencies perpetuating the same old stigma and discrimination as is found in the system itself, and supporting merely self-interests.

I like the idea of supporting others who have been through this, but at the same time, the politics and social programming of the system runs very deep, and can repeat as generational oppression and inherent discrimination, as we learn from the example of others. Somehow, it also seems to be a survival tactic, to pay forward the stigma, as this is inherent in the spirit of these agencies, that same dualistic perception of people and what mental illness is and is not.

These are well-funded programs which, to my mind, are questionable in terms of allowing people to really find their own voice, path, and freedom. I think a lot of it is political smoke and mirrors, so I found it very difficult to trust what I was being told. In fact, deceit and avoidance was not uncommon in this environment, just as I had experienced in the heart of the system.

At least this was my experience in the ‘peer’ world.

Thanks for this post Malia and welcome to MIA. My difficulty with your overall point has to do with Prof’s “not traditionally including the disclosure of personal lived experience as a tool”. This is a tradition that ought to be changed (and many professionals that I know do self-disclose about various kinds of struggles and distress). So I’m not sure about the whole “unique scopes of practice” thing – Peers can provide what prof’s offer (often more effectively) – and prof’s should be encouraged to selectively self-disclose. Thanks again for adding your voice.

Malia,

I appreciate the intent of your first article here, but also take several issues here, some of which are similar to other posters above and some of which are different.

First, I can start by saying that I *agree* with you that if we’re going to have formalized peer roles within the system, that those roles should be supervised by individuals who also identify as having experienced psychiatric diagnosis, hospitalization, trauma, or some other aspect of the system and life-interrupting emotional distress themselves.

I agree that to suggest otherwise not only diminishes the overall respect for this type of work simply by the inequality of practice (most people working in highly respected professions can generally anticipate at least some supervision and support from others who are closely familiar with their work), but brings about a bit of a set-up and barrier to do the job being done well at all. That funders and policymakers often do not understand any of this does not bode well.

Perhaps a first difference between you and I, though, is that I don’t think it’s just about the supervisor having some sort of ‘lived experience’, but also that they’ve been exposed to similar trainings, concepts and values, are extremely familiar and invested in peer-to-peer approaches, and have ideally worked in such a role themselves. Simply having had some sort of ‘lived experience’ doesn’t really say much about how that experience has impacted that person, or what they understand it to mean at this point in their life.

Some other differences/concerns:

I think there’s much graver concerns than the supervision issue. First of all, I personally recommend highly that people working in peer roles *NOT* be employed directly by conventional mental health organizations. Given that part of their charge *should* be to be a change agent within that organization, and to (in the vast majority of situations) hold to very different values and priorities… It’s just a bit of a (huge) set up.

So, for example, a local hospital where I live sub-contracts to the Western Mass Recovery Learning Community to hire, train and supervise people working in peer roles who then spend the bulk of their time working in the hospital. Although this brings its own set of challenges, it’s been hugely important to supporting people working in that role to hold to the integrity of peer-to-peer support and feel confident that someone has their back when they challenge the systems there.

Then there’s the training. Like some of the commenters above, I think most of the certification trainings available out there are *terrible*. They use ‘mental illness’ language, teach psychiatric diagnosis, and (as noted above) sometimes even teach pharmacology. Virtually all of them (of which I am aware) promote referring to people as ‘clients’ and ‘consumers’ and rarely do they do anywhere near enough to challenge conventional perspectives.

That said, unlike some commenters above, I *do* support the idea of training. I am a part of the Massachusetts Certification program (which I sometimes feel better about than others, admittedly) and I can offer that we *never* teach diagnoses. We also introduce critical resources like Mad in America and texts like Anatomy of an Epidemic, directly challenge the chemical imbalance theory and the idea that psychiatric drugs are the answer to all (or that there shouldn’t be support to people who want to get off them), and really push the idea of *not* indoctrinating people into system language. Additionally, we screen ‘Beyond the Medical Model’ and encourage conversation about completely non-medicalized ways of making meaning of our experiences. Overall, we spend a lot of time emphasizing the idea that it’s *essential* to the peer role that people be given the information and support they need to come to their own understandings and make their own choices (and that we have a responsibility to make sure they know what those choices are, to the very best of our abilities), and so on.

So, I guess that brings me to my next point which is I *do* think training is important. Sometimes, I think that people who push that there should be *no* formalized training for peer supporters are missing the fact that *so many* people who’ve been hospitalized, etc. have internalized oppressive ideas. I see some *really* terrible stuff (actions, ideas, etc.) from people who’ve ‘been there’ almost as frequently as I do from people who haven’t…

It’s not just the supervision that needs to come from people who’ve ‘been there’… It’s also the training. *AND*, the people who develop and offer the trainings need to not just have ‘been there’, but also have already been supported to understand not just their personal experience but the oppressive nature of the system before they’re in any way qualified to do that sort of work.

One final note: I also find it troubling when peer roles are boiled down into ‘those who share their stories’ verses ‘those who don’t’. While there’s a certain reality to that right now, I do think it’s best when individuals in traditional roles are willing to ‘get human’ and share of themselves, too. So, if the story-sharing bit is all that separates us, then we’re in trouble… And, ultimately not doing our roles justice.

There’s so much more then becoming walking, talking storybooks to all this work we’re doing. Far more of it is about not having to be immersed in the power systems (writing notes, giving psych drugs, assessing, goal planning, etc. etc.) to which the rest are so beholden. So much of it is about not being a part of someone’s ‘team’ (who is never really able to be legitimately on that person’s ‘side’, per sey), and really being there – unconstrained by all the other crap – to make sure that person knows their choices and rights and that they are getting their voice heard.

Honestly, the ‘sharing your own experiences’ part is important in certain contexts, but – in some ways – it’s really not the most important at all.

I wonder why you’re not replying to commenters? It would be good to hear your further thoughts.

Thanks,

Sera

Hi. It seems like the eternal dilemma — does one become a prison guard to make things better for prisoners by being there to make things a little easier, or work to end prisons altogether? It’s the slipperiest slope imaginable. If I were locked up I’d probably be glad to have access to someone trained by you. But realistically, in the end the roles are contradictory if the “supporter” does anything other than fight like hell to stop his/her contacts from being forcibly incarcerated or drugged, being diagnosed, etc., as you ultimately can’t support the oppressor AND the oppressed at the same time. So if one sees an inherent contradiction between psychiatrist and psychiatrized the notion of “peer support” is in the end untenable, wouldn’t you agree?

Hi Malia, You do a truly nice job picking through the details you chose to focus on, as in keeping your reactions to the multitude of implications brief and on track–with your involvement with the issue at a personal level allowed to show up very obviously. I will save this page to read it over again. Thanks for the concision and neat succession of facts, all very logical and informatively presented. I respect your coherent approach to recommending one clear line of conclusions that strike the pragmatic note, overall. I wouldn’t want to nitpick over any of it. Definitely, you avoid prophesying about how to settle all bets and you have good ideas about how to avoid business as usual very clearly understood, here. Also, we all certainly have to recognize that things are too bad as they stand–both in life and with the behavioral healthcare system–than to prove some point by engaging in “exceptionalism rhetoric” about each and every hiring and firing and certification issue… which are not all equally skin deep.

My alternative in support of your conception for good navigation of all these dilemmae would just be to keep as many sorts of facilities as can handle the work totally peer run/lived experienced staffed, with working professionals scheduled in by these authentic peers to the milieus for any regular 100% voluntary care needs. Potentially, soome invited on-site staff could serve, in the vein of the average dormitory front desk personnel, merely standing by until called in when upset or nervous or paranoical folks or peers with lived experience like. Or else they respond in limited verbal fashion according to specific demands for “expert opinions” off of them for some set period of time, and so on. But they should have to enter through the rear of the building when reporting to work and keep their offices there, without control over the workings of the facility and staff. This keeps them out of presuming to impose automatically on other visitors, compeers, clients, janitors, or psychiatric technicians who invite messages from the milieu that clients want directed To Those Professionals who cannot secure their egress themselves. Lived experience folks should handle all word coming the other way form them and likewise serve as escorts and observers of these helping professionals, since medical needs should be sorted out completely and not bear on the facts of behavioral theory for mental problems, under observation, in situ. Otherwise, these usual well-meaning academic types will just be around trying to do psychology to justify their own existence and supporting no one but the testing agencies and the lousy likes of the AMA/APA1/APA2, the war on drugs idiots, and the phony judgeships and socialist bureacracies, and all the bad researches and foolish wealth tranfer schemes of the racist establishment that goes with it. Just look at it now in the guise of the nanny state. Maybe some of them can change their personalities and do better for us, but not most. For instance, they haven’t even done the hard work needed of them on appreciating the meaning of comprehending and relating to altered states of perception.

In addition, evidence is lacking that they actually esteem the perfection of existential feelings of comity and reciprocity available to everyone alike in hard won moments of rational enlightenment. These can come spontaneously with capable guidance during creative and authoritative interventions, and represent signal achievements for recovery of emotional stability and normal perceptual reasoning. They don’t take the right view of others’ achievements in attaining clear insights once they “get identified as mentally ill”. They ignore issues in respect to reaching higher consciousness free of illusory thinking, or the sense of oneness that results in the total dissipation of narcissistic and histrionic processes hidden deep within most people’s familiar ruminations. So far, as a class of human relations investigators, they are unreliable in ridiculous measure when it comes to popularizing important linguistic distinctions: what especially comes to mind is the dleiberately suppressed fact of the necessity for having every paternalistic practitioner’s policies of non-patient advocacy kept totally explicit.

Such “caregivers” should not get legal authority or permission to contribute to case histories or trade publications regarding their work in connection with mental health goals, except as our own anti-psychiatry representatives release them from force majeur clauses, formally. Since these middle class types, logically speaking, are just the same kind of front for internal fraud as purveyors of selective enforcement of laws and entrapment of otherwise innocent of legitimate accusations for alleged wrongdoings, that is the minimum appropriate to the honest category for their IDs to represent. Anyway, how I come across the ideological divide to meet your proposal in likemindedness is simple to work out for me, in that your appeal is to conscientiousness at the same time as it is made in the name of good conscience! Fantastic work–and an approach I wouldn’t have had confidence to try. Please give us more of your recommendations again, soon.