In April of this year, Sera Davidow authored a blog on Mad in America titled “The Downfall of Peer Support: MHA & National Certification.” I’ve read several pieces written by Ms. Davidow and had the opportunity to watch a couple of videos she was featured in, and I have to admit that she is very sharp and that there are some areas where we probably agree. When she talks about reactions to trauma and what I would call the “cheapening” of the experience by breaking it down to a series of symptoms, which supposedly can best be dealt with by traditional treatment and medications, I believe I’m with her. Powerful emotional and physical changes due to trauma are natural reactions to intense negative experiences.
There is no doubt in my mind that much of what is called mental illness is in reality a reaction to the way we are treated once we are labeled with a diagnosis. I’m sure that there are a number of other areas where she and I could come to some manner of agreement, such as involuntary outpatient treatment, forced medication, social rejection and exclusion, and enforced poverty among others.
The Bell of Hope
With that said, is she serious when she equates MHA’s certification to the downfall of peer support? Does anyone believe that a single certification process that is totally voluntary and conceived of and implemented by people with lived experience could actually diminish the power of peer support? I do not agree with much of what she says and the conclusions she arrives at in her blog, and as the vice president of Peer Advocacy, Supports and Services at Mental Health America I’d like to respond.
Completely setting aside her issues with our CEO, Paul Gionfriddo (Paul is completely capable of addressing them himself if he thinks it is worthwhile), I first want to address the MHA Bell of Hope. The message of the bell is far more than her interpretation of the inscription “Cast from the shackles which bound them, this bell shall ring out hope for the mentally ill and victory over mental illness.” As Ms. Davidow points out, the bell was cast in the 1950’s, a time when terms like “for the mentally ill” were far more acceptable. In my opinion, though, the real meaning of the bell is captured in the first part of that sentence, “Cast from the shackles which bound them.”
Mental Health America, in all of its iterations, has stood against the barbaric use of seclusion and restraints. The first sentence of our Position Statement #24, Seclusion and Restraints, states: “Seclusion and restraints have no therapeutic value, cause human suffering, and frequently result in severe emotional and physical harm, and even death.” It is neither presumptuous, paternalistic nor condescending to be against brutal treatment and to be in favor of instilling hope and seeking victory over what has traditionally been thought of under the single classification of an illness. I do not find creating a symbol which encourages hope from fear and brutality to be “tone deaf and gross.” Every day the MHA bell reminds us of the inhumanity that took place in the past, the tendrils of which reach even into the present. It is a symbol of the overwhelming need to end it.
MHA & the Peer Community
Throughout the years of the existence of MHA, the national office has periodically been peer-run — that is to say that it has had over 50% of the board and the staff, along with the CEO, be self-disclosed individuals living with significant mental health challenges. Currently about 25% of our board, and more than 50% of our staff meet this criteria. Many of our largest affiliates do meet the SAMHSA standard of being a peer-run organization, and several of them are larger than our national office. In my department, Peer Advocacy, Supports, & Services, all of my staff are self-disclosed peers with direct experience with a less than adequate mental health system.
For 13 years MHA ran one of the national SAMHSA TA Centers assisting states to develop independent peer-run organizations. Over the years, we have supported the creation of numerous peer-run networks through financial and technical assistance. We firmly believe that peers should be involved at all levels of the healthcare system, and we have fought for that right throughout our history.
I agree that the term “peer” can be problematic but it seems to be the one most widely used currently. When Ms. Davidow states that “when one carefully considers the peer role — and how ‘being with’ and ‘connecting with’ are at its very core — a costly online exam is precisely what comes to mind,” I get the sarcasm, but she seems to imply that the cost of the examination somehow affects the core values of the peer to peer relationship. Maybe not: anyway, we will get into more detail about the cost later in this post.
“Subject Matter Experts” Advisory Committee
The fact that one writer in an independent publication referred to the individuals with lived experience that we chose as our subject matter experts as “something of a who’s who of peer support” is not a negative about our certification. It simply shows that an accomplished writer feels that we made very good choices in choosing our advisors. We feel that we have been able to work with some incredible people who have been involved in all of the aspects of peer support for many years and who bring a wealth of wisdom and insight to the task.
The individual who “confessed” to feeling beholden to their employer was not referring to us since they are not an employee of our office. As far as I’m concerned, I welcome new and different ideas from all of the participants. I firmly believe that when people stay true to their principles the outcomes are better for all.
In our group we had nine self-disclosed individuals including a primary care physician who lives with a mental health diagnosis and who has participated in peer support. The three other clinical professionals were there to provide insight into the cultures of private clinical environments where peer support could prove to be very beneficial and still stay true to its standards. They were not there to impose any clinical standards or ideology on our work. I feel safe in saying that our peer subject matter experts are confident in their knowledge and their abilities to share it.
For development of our domains and core competencies we relied on the SAMHSA national core competencies list and the iNAPS national standards as our starting place. We examined certification standards from a number of states and studied their planning processes.
I, personally, would like to see peer support become available throughout healthcare as a supplement and alternative to traditional care. One of our goals has been to work with private health insurance companies to help them recognize its value and to understand the core principles and standards of peer support so that it can become insurance reimbursable as a non-clinical service. Such recognition will create many new opportunities for individuals to work in peer support for a livable wage and with the potential for career growth.
What the Heck is this Thing?
Ms. Davidow is concerned that our certification does not include training. Many states that provide certification do not have proprietary trainings. They often accept training from a list of approved trainers or they contract with a single one to do all of the state’s peer support training. It is interesting to note that, according to their website, the much admired Canadian Peer Support Certification group, PSACC, does not offer peer support training.
Our certification has been designed to meet the development standards of the Institute for Credentialing Excellence. In order to achieve accreditation standards we have partnered with the Florida Certification Board, a fully accredited professional credentialing agency that provides certification in four states. Interestingly, their Director of Certification is a self-disclosed peer. They have provided the system for developing the credential and we have provided all of the expert information on peer support. MHA maintains an advisory council for effective management of the credential and to function as the ethics committee, and we will continue to market peer support and the certification.
The full cost of the certification is $425. $225 for the application and certification and $200 to take the national online examination. MHA makes a total of $162.50 per certification. The additional $262.50 goes to the Florida Certification Board, the proctored testing sites, and the company that provides the online examination. Developing the certification has taken three years and approximately 3500 hours of intense work. It will take several years to bring in an amount equal to the costs, but that is okay because “profit” is not the point.
In state certifications, the cost of certification and testing is frequently covered by the state or county. To mitigate the costs of our credential we initially offered 110 scholarships worth $225 each and are now offering a limited number of scholarships for testing. We intend to provide additional scholarships in subsequent years.
The MHA National Certified Peer Specialist (NCPS) credential is not training based, it is examination and qualification based. It is not our intention to make state qualified peer specialists go through another full training. If you are a state certified peer specialist with a minimum of 40 hours of training you are eligible to apply for our certification. It is important to recognize, though, that 40 hours of training alone is not sufficient to pass the examination. The credential also requires 3000 hours of peer support experience. The primary qualifications for certification the hours of experience and passing our rigorous 125 question examination.
We refer to our certification as an advanced level credential. This is because we require additional knowledge in comparison to existing certifications. The expanded knowledge base includes the areas of adult learning and mentoring, trauma-informed care, activation and self-management, and the foundations of healthcare systems. Individuals with the NCPS credential will be prepared to work in a rapidly changing and diverse work environment.
For many people,the additional knowledge learned on the job will be sufficient to pass the examination. The best way to know if you are sufficiently prepared to take the examination is to download the “MHA NCPS Training and Test Self-Assessment” at www.nationalpeerspecialist.org. This will walk you through what core competencies and skill sets are necessary to pass the examination. Additional training needs can often be met by participating in webinars and conference workshops to supplement your knowledge. It is this experiential and additional formal training that we refer to when we talk about enhanced training. Perhaps a better term would be enhanced knowledge and skill sets.
If you are not state certified (a number of states currently do not have certification) you are required to take an MHA approved training course. Currently we have five trainings on our approved list, but if you have taken a different training please submit it to us and we will examine the training to see if it qualifies. We hope to approve as many trainings as possible. Qualification for approved trainings is based on:
1. Does the training cover the substance of our 6 domains of practice:
- Foundations of Peer Support
- Foundations of Healthcare Systems
- Mentoring, Shared Learning, and Relationship Building
- Activation and Self-Management
- Professional and Ethical Responsibilities
2. Was the training developed by peers?
3. Are the majority of trainers peers?
4. Is it a minimum of 40 hours?
5. Is the training well documented and presented?
We took on this project as a peer-conceived, peer-designed, and peer-implemented endeavor. All of the work to bring the certification to fruition has been done by my staff, our subject matter experts, and a peer who is the Director of Certifications for the Florida Certification Board. MHA has over 100 years of experience in peer support and engagement.
No doubt someone else will create a national credential, perhaps even an advanced one similar to ours. We are not in this to monopolize the market, rather, we are dedicated to furthering the provision of peer support throughout healthcare and to helping peer supporters earn a living wage and to gain opportunities for career advancement.
During the process of developing our core competencies we sent a link to our document to over 10,000 peers through our own mailing lists, TA Centers, other organizations and our affiliates. Over 1500 people logged on and we used their feedback to modify the original concepts. We then sent out a role validation study to the same audience plus additional people we identified through our website. Each one of our 55 core competencies were scored for importance and frequency of use. This information was interpreted by a psychometrician to create the blueprint for our examination.
On a side note, I have no qualms about saying that all of the peers, including me, involved directly in the creation of this credential have just as much right to claim membership in the peer community as anyone else. When other people, particularly those with large audiences, try to disparage our “peerness” I have visions of a so-called recovery center I once visited which required proof of diagnosis before people were allowed access to the facility. It makes the hair on the back of my neck stand up.
To continue, peer support is growing rapidly but one essential area that has shown very little advancement is the private health sector. MHA has worked on peer workforce development for several years and we recognize that expansion into the private sector will open up many thousands of new opportunities for peer employment. According to a recent survey, peers working in healthcare provider organizations and health plan/managed care organizations make on average 16% higher wages for the same or similar work than do individuals working in the public sector.
In our discussions with private health insurers and large healthcare organizations about what would be necessary for them to fund and offer peer support services, we heard repeatedly that the primary barrier was the lack of a uniform high national standard. Under the state and county certification system standards vary significantly. Some states have developed high standards while others may require as little preparation as taking a 30 hour training and having 100 hours of peer support experience.
Like most certifications we do not promise individuals employment, but we do think that providing employers with highly experienced candidates with advanced knowledge and skill sets will help peers find better paying, more career-oriented positions. In our private sector pilot programs involving peers who meet our certification standards, pay scales have equaled or surpassed a 16% increase over average wages for the region.
Clinical: I Don’t Think So
I stand by my statements made in an open letter to the peer community and in the numerous workshops I have conducted at Alternatives, the iNAPS conference, the NYAPRS conference and in multiple webinars: “We have never intended to move peers towards doing clinical work in any way. Our efforts are to give peers every tool they need to perform as true peer supporters in a wide variety of settings. Peers are never expected to cross the line into a clinical role or to promote any clinical practice.”
Ms. Davidow cites a quote of a statement made by me in an interview to substantiate her belief that we are crossing that line. As written, the quote is pretty accurate. What is not said, through no fault of Ms. Davidow, is that in the initial interview I accentuated that individuals choosing to participate in DBT do so voluntarily and arrive at treatment goals and methods in concert with their therapist. In my work as a peer supporter I have witnessed on more than one occasion peers in a support role who have interpreted an individual’s interaction, or lack of interaction, with their therapist as a threat to the wellbeing of the person receiving support and have encouraged the individual to seek a new therapist or file a grievance. Most of the time the individual will let the peer supporter know that the nature of the relationship with the therapist has been arrived at mutually, but on occasion either the individual is influenced by the support worker and the relationship with the therapist is adversely affected, or the person becomes conflicted because they are caught between two people that they trust. In either case it is the individual being served who loses. I don’t suggest that the peer participate in the therapy in any way, but I do feel that it is important to understand DBT if only to know what questions to ask.
In any case, the only relationship this discussion has with the MHA certification is that our core competencies include having a general understanding of treatment modalities so that peers can support people in their chosen treatment. This strengthens the values of peer support by supporting self-determination, voice, and choice. Neither the peer supporter nor the therapist determine an individual’s goals and direction. This can only be effectively done by the individual with any assistance they choose to accept.
And Let’s Not Forget to Mention: Ethics
Ms. Davidow’s comments on the Code of Ethics are her opinion. They are the same as the majority of codes of ethical behavior that any certified professionals agree to. I thank her for pointing out an error in the code that says people agree to a “random criminal history check to ensure compliance.” That was a holdover from a state certification where the state required that language in order to use state funds for peer support services. We have amended it to say:
“When creating their online certification system account, all applicants must complete a section agreeing to allow the FCB (Florida Certification Board) to conduct a criminal history check in response to an ethical allegation of non-compliance with the FCB Code of Ethical and Professional Conduct standards related to criminal activity.”
It is clearly stated that we do not conduct a criminal history background check unless an allegation of criminal activity is filed against a certified individual.
On the issue of not performing services outside the individual’s training, expertise, competence, or scope of practice, the discussion of the rule states:
- When a consumer’s therapeutic issues are outside their level of professional functioning or scope of practice, the certified professional must refer the consumer to another professional who will provide the appropriate therapeutic approach for the consumer
This is a self-regulated rule unless a formal grievance is filed. As to who decides what constitutes a violation of any of the code, we have an Ethical and Professional Conduct Advisory Committee made up of peers who will rule on a complaint or grievance.
On the item that refers to putting their credential on inactive status for any mental, physical, or behavioral related adversity that interferes with their professional functioning, that last part is the key. Again Ms. Davidow has left out the discussion of that rule.
- The private life of an applicant or certified professional remains a personal matter to the same degree as any other person. However, when a personal issue begins to adversely affect professional performance, affecting the quality of service delivered and thus putting the consumer at risk, the applicant or certified professional must take sufficient and timely action to resolve any adversity that interferes with their professional functioning.
Closing with a Poisonous Kiss
Like my earlier comment about questioning someone’s “peerness” this last section is offensive. By including her thoughts on “so-called peers” and people who act a certain way because they have a job they can’t afford to lose so they follow the “party lines,” she is being personally insulting. Ms. Davidow is writing this in a blog about Mental Health America, so the clear implication is that MHA is shrouding itself in “so-called peers” and “party liners.” The comments about not being able to see through their own medicated haze and tokenism are even more revolting.
If you want to critique MHA’s certification just do that. Don’t try to trivialize or put down the peers who have worked on bringing it to fruition. These tactics are an insidious type of journalism, casting aspersions on the validity of people’s experience and motivations without anything to back it up. To me that is the same kind of thinking that equates MHA’s credential with the “Downfall of Peer Support.” Ridiculous.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
my best peer support was a group of depressed persons and all the persons were helping each other…we were all equal as human beings…and no money was involved…i am interested in helping without hurting…
I don’t have time to respond to this right now (but, boy is there a lot to respond to)! However, I just wanted to say thank you! I’ve been cited in blogs and articles before, and even been the focus of an article outside of the Mad in America world.. But this is totally my first Sera-focused Mad in America blog written by another party. 🙂 It’s kind of like when I got my first ever hate mail following a letter to the editor that got published in the New York Times. Pretty exciting stuff.
I look forward to having the time to respond.
I completely understand your objections to certification – it is simply an invitation to co-optation and control by the system. I would also be very interested in hearing if there are some areas where the two of you agree. Maybe there isn’t anything, but it’s hard to build a movement with so much fragmentation! I guess that’s the point of co-optation, isn’t it?
Looking forward to your response!
Anyone out there interested in talking on this topic I’m having a radio show this evening starting at 6:30 going for ONE HOUR ONLY. Topic: Leadership and the Psychiatric Survivor Movement: Where do we go from here?
Here is the blurb:
Call in to speak with the host
This is a ONE HOUR call-in show. Who shall lead us now that the Movement has gotten so large? Who is best qualified? Why is it important not to rely on “providers” to take up these roles any longer? Who shall speak out as authority? Who shall be the decision-makers? Where shall the hub of our leadership be located? These and other questions will be explored tonight.
Feel free to call in!
Pretty big compliment, Sera. Patrick wouldn’t bother publishing here if his affiliate group didn’t view you (and probably MIA) as a threat! You go, girl!
I hope you find the time to reply as I would enjoy reading it
I’m not avoiding answering you and the other comments. I live in South Florida right where the hurricane came through and we had to evacuate. This is the first access I’ve had to my computer since last week. I’ll catch up on all the comments and reply in the next few days.
Patrick, my daughter was involuntarily committed for nearly eight years and forcibly medicated with every drug imaginable. For eight years she was a human guinea pig enduring the most horrific adverse drug reactions and withdrawal symptoms that one can imagine.The loss of her personal agency when she needed it the most was deeply traumatizing and harmful. When our family needed hope and leadership at the national level, we looked to organizations like yours to take a clear moral stand on the issue of assisted outpatient treatment, telling the world the truth about force and coersion and how harmful it is to individuals recovering from trauma, your organization, abandoned our family. Your organization, with NAMI, supported the Murphy Bill which morphed into the Cures Act.How can you purport to represent human rights?
There is certainly a lot of information here, and I won’t pretend that I can comprehend all of it. However, there are certain things that I would like to state in going forward, and to which I hope both of you can reply.
1.) there is the sincere acknowledgment that both of you are very sincere in your efforts, and that I hope everyone realizes that.
2.) although I am not aware of the origin of your disagreement, I will have to state, going from what I have read, that I am completely opposed to any sort of institutionalization of peer support, whether paid or not.
One of the simplest ways that any professional organization (like psychiatry) can destroy the opposition of a grass roots organization is to buy it. Yes, that’s right: by deciding to “certify” (according to exactly whose expertise?) and then to pay for the work of peer specialists (who chooses them? to what authority, like an institutionalized psychiatrist, or another mental health agency, do they answer?), we turn over our authority to an outside agency. And the psychiatric profession can buy our peers, take control of their training, then control who manages them and what they are allowed to say. And what this means is: certification by ANYONE as some kind of authority is a way to take over and control and then destroy our movement.
If you want to work in peer support, good for you. But if you want to work for an agency, or a department of something-something-something (the bullshit department), you are not working in peer support. You are working in a system that is about psychiatry and you are supporting psychiatry’s control, because that is who is at the top of your food chain. And if you tell yourself anything different, you are lying to yourself.
And once they get you on their payroll? Once they have silenced you, as you answer to their managers and their system? Then they cut your funding, and you are back out on the street again. This is how social movements too numerous to mention have been coopted and destroyed: by accepting a paycheck, and being silenced by it, and then not seeing what was really coming.
Please don’t sell us out. That’s what the whole alliance between the deadly mental-illness system and the mentally ill is really all about. Don’t let this happen.
And I hope that you two have a lovely debate.
A “pe-ah” bureaucracy is still a bureaucracy, but to get to the point, dance, dance, dance. Dance until Nijinsky comes back into fashion.
I’m thinking about becoming a grief coach to those who have had their lives all but ruined by the mental illness system. I don’t think they give out peer certification for that; certainly nothing the National Alliance promoting Mental Illness would approve.
I used to belong to NAMI till I started losing friends to psychiatry. Yes, psychiatry does kill people! NAMI did nothing to stop this criminal negligence. As long as they died “meds compliant” everything was peachy keen.
Thank God they died WITH THEIR RIGHTS OFF! Because no one should die with their rights on after all. 😛
It interests me, as a peer worker, about all this business with the DBT and peers being detrimental in the therapeutic process.
As a peer worker I better never be caught telling the person that I am working for and with what to do. If I get caught telling anyone what to do then I will be fired. Peers are available to people to support them in their choices that they themselves want to make. I am not there to coerce them towards any one choice. I am there to support them in their freedom of choice.
I will listen to people if they want to share something with me, and I will help them to wade through things to see the pros and cons of situations; but in the end my job is to walk with them in ways that lead to them making choices on their own. I do not tell people to do anything; I share with them what worked for me in my own life but always point out that they can pick and choose from what I’ve shared with them. They are never obligated to accept anything that I share.
My job is to walk with them in their journey in a way that allows them to discover that they have the ability to empower themselves to do the things that they want to achieve. I cannot empower anyone other than myself, but I can point out things in their own life that may lead to them discovering how to empower themselves.
I am curious about your reaction to someone who is expressing thoughts of suicide or refusing medications even when it is what “everyone” wants.
Two difficult questions.
By law, I am mandated to report anyone who says that they want to kill themselves. I believe that people have the right to take their own lives. But I would never tell anyone to do so. This is a very personal view that I hold for myself.
My ultimate goal is to attempt to walk with people in their journeys so that they can build better and more fulfilling lives for themselves. Stating that they want to kill themselves alerts me to the fact that things have gone awry and it is important to investigate to see what is going on. If someone tells me that they want to kill themselves my first response is to sit and listen to them to see why they feel that they want to die. Unless a person has a gun or knife or has taken bottles full of pills you have all the time in the world to explore what is going on in their lives. It is often in that exploration that people find that perhaps killing themselves is not exactly what they want to do. It is often in the listening to people that they realize that someone is willing to take the time to care and for me, this made all the difference in the world when I tried to kill myself. I also know that, if a person truly does want to end their lives there is really nothing that anyone can do to stop them.
This is not the best of answers but it’s all I have to offer. Part of my job is to not only support people in their choices but to help people search for better answers that may work for them in building something for themselves. It’s is an intricate process and I am not always as good at it as I would like to be for the people I work with and for.
And now to the question about the dreaded drugs. To be very honest, I run into very few people who do not want to take the drugs. the system has convinced most of the people I work for in the state “hospital” that the drugs are the answer to all their problems. I often wonder if they aren’t just saying this to me because they think it is the wise thing to do so that I will report to the authorities and they will be allowed to go free from the “hospital”. I don’t know. But many people state the party line. And I must support them in this if this is what they say they believe and choose.
As to those few individuals who don’t want to take the drugs I will sit with them when they tell this to their psychiatrist. I will physically and verbally support them in their choice. But I will tell you that we are never successful. The “patient” and I are always overruled and I am treated in a condescending manner by the clinicians. It is as if I never said anything at all during the meeting.
There is also another problem with the drugs. In the state where I live people can be mandated by law to take the drugs. You can be taken to court and the judge will mandate that you have no choice and you will take the drugs. What they usually do is get the psychiatrist to arrange it so that you will be given one of the long lasting shots of one of the “antipsychotic” drugs. You are mandated to appear at the community mental health clinic once a month for the shot and if you don’t show up they issue a bench warrant for you to be picked up and taken to court. Then you are brought right on over to the state “hospital” where I work and you will be admitted. It’s disgusting to say the least.
Peers have great difficulty doing what they are supposed to so in traditional institutions. It’s like beating your head against the brick wall. I think that most peers work in other places where they have more success in walking with people in order to find a better life.
“By law, I am mandated to report anyone who says that they want to kill themselves. I believe that people have the right to take their own lives. But I would never tell anyone to do so. This is a very personal view that I hold for myself.“
I hold the same view and behave the same. The responsibility when it comes to suicide lies with the person themselves. However, if someone is committing suicide, leaving behind small kids to fend for themselves etc., then it becomes an issue. But, like you, I would never tell a person to kill themselves for obvious reasons.
“Unless a person has a gun or knife or has taken bottles full of pills you have all the time in the world to explore what is going on in their lives. It is often in that exploration that people find that perhaps killing themselves is not exactly what they want to do. It is often in the listening to people that they realize that someone is willing to take the time to care and for me, this made all the difference in the world when I tried to kill myself. I also know that, if a person truly does want to end their lives there is really nothing that anyone can do to stop them.“
What do you do practically to help them except “showing them that someone cares” and listening and talking? Listening and talking won’t do anything practical for them.
“The “patient” and I are always overruled and I am treated in a condescending manner by the clinicians. It is as if I never said anything at all during the meeting.“
“There is also another problem with the drugs. In the state where I live people can be mandated by law to take the drugs. You can be taken to court and the judge will mandate that you have no choice and you will take the drugs. What they usually do is get the psychiatrist to arrange it so that you will be given one of the long lasting shots of one of the “antipsychotic” drugs. You are mandated to appear at the community mental health clinic once a month for the shot and if you don’t show up they issue a bench warrant for you to be picked up and taken to court. Then you are brought right on over to the state “hospital” where I work and you will be admitted. It’s disgusting to say the least.”
Yeah, this is the thing. In cases where you are re-abusing an already abused person with “compassionate coercion”, they will try and strike back.
Recently, a person told me that people in the antipsychiatry movement best not align themselves with organisations like NARPA because they have become violent. How can you blame them for becoming violent when something unjust has gone on for far too long?
A day will come when a “patient” will seriously hurt or kill a “doctor” or a judge as vengeance for ruining their lives.
Of course, they will conveniently blame it on the person’s “mental illness” or “antipsychiatry activism/activists”. The public will also eat these words up. Violent organisations will be labelled as “terrorists”. It’s an uphill battle.
What indeed can be done about these people Mr. Gilbert? Large demonstrations in front of a hospital to get a person out? Violenc
Huh? Who has become violent?
Read again. Thoroughly and carefully.
No need to be rude. You wrote this:
“Recently, a person told me that people in the antipsychiatry movement best not align themselves with organisations like NARPA because they have become violent.”
I am asking who has supposedly become violent.
Sorry. My intention wasn’t to be rude. The answer to your question was already in what I had written and I thought you missed it.
Also, the answer to your question is yet again in the text you have quoted.
This like someone writing “My name is Jack” and you asking “What is your name?” after they have explicitly mentioned it.
Okay. So how has NARPA supposedly become violent? Are they advocating and/or committing violence collectively, according to your friend, or have some individual members become violent? I was just wondering about the details.
Not sure why someone would want to quote their “friend’s” stupidest and most slanderously ignorant statements as the starting point for a serious discussion.
I have no idea TBH. It is hearsay. I was not told about the details, and it was a passing remark made to me by someone (someone that I am not even in touch with anymore).
However, even if they (whether it is individuals or collectively) have become violent, I don’t see that as a bad thing, which is what I was trying to get across.
I haven’t come up with a good answer to your last question as to what is to be done. I go to bed almost every night asking myself that very question. All of the cards seem to be stacked against us. Large demonstrations in front of “hospitals” like where I work might just be a beginning.
Thanks for responding.
Actually, my experience is that good, active listening does, in fact, provide something practical – it removes the barriers of confusion and overwhelming emotional intensity and helps the person involved get to a place of doing their own practical problem-solving process. I’ve done this with dozens and dozens of suicidal people, and had excellent success in helping them achieve some sense of greater control over their lives, and sometimes even a plan for moving to a better way of surviving and thriving in their lives. I could share a story or two. The truth is, no one can really develop a practical plan for someone else – they can only help that person develop perspectives that enable the person him/herself to come up with such a practical plan. At least, that’s my experience.
Thank you for sharing your perspective Stephen. Everything you described is accurate based on my observations when my daughter was locked up in the state hospital. Although the peer worker assigned to her treatment team was very sympathetic and comforting, even admitting privately that patients must ‘play the game’s to get discharged, there was very little the peer worker could do to obtain choices and non drug alternatives for a client.
I could write a treatise on why MHA (which is now indistinguishable in its philosophy from the Treatment Advocacy Center) taking it upon themselves to create a national certification contributes to the on-going downfall of peer support, which has been happening for 20+ years, but I’m going to save that for my own article on the subject. Very briefly, the main problems is that for more than 20 years, people in power – mostly people who have not experienced the mental health system first-hand – have conflated the practice of peer support (or what those of us in the ex-patients movement used to call self-help back in the 80s and early 90s) with a job title called “peer specialist,” in which people with psychiatric histories are hired to work within the system, often to do tasks that support the system in oppressing other people with diagnoses, rather than in providing genuine peer support based on mutuality. I know – I was in the thick of this 25 years ago, helping to create the first Peer Specialist civil service title in the nation in NY. I naively thought this was a way to bring genuine peer support to people trapped in the system. What I saw instead was people hired in those roles browbeat and demeaned by professionals into doing things like pressuring people to take drugs against their will, reporting on people to professionals, and also being treated like dirt by their co-workers. I’m sorry I was involved in this fiasco – it was a serious mistake. What I learned from that experience was that so-called “peer staff” should never be hired by traditional agencies, that the only way to bring genuine peer support to people involved in the mental health system is through independent, free-standing peer-run organizations that are dedicated to mutuality. Anything else is harmful. What is happening now with “peer specialists” working in mainstream organizations makes me despair.
Our state DHS has “peer specialist” who receive the best training from the state that can be had. The fault in that is so glaring even a blind person could see it (no offense).
Squash, I have no clue what your comment means.
“the only way to bring genuine peer support to people involved in the mental health system is through independent, free-standing peer-run organizations that are dedicated to mutuality.”
Thank you for sharing your thoughts, Darby. Do you know of or can you recommend any organizations or individuals doing the kind of peer support you mentioned above?
I believe Darby would agree that the organization to which I am connected (correct me if I’m wrong, Darby!) is one: the Western Mass Recovery Learning Community. http://Www.westernmassrlc.org
I agree with you 100% Klortch. The organizations must be free standing, run by peers, and based on mutuality.
Oh, boy, a knock down drag out! This should be fun! I can’t wait for Sera’s response, but I’m sure it will be a humdinger.
I don’t think graduating from mental patient to peer support paraprofessional represents much of a progression. Next question, how do you then graduate from peer support specialism?
I have a friend who relocated to the Philippines and has nothing but praise for the place because people are not always talking mental health and mental illness there they way they seem to be doing everywhere and all the time in the USA.
Peer support seems a maze to me. The question is, how do you get out, and with finality, from the mental patient system once you’ve been introduced (i.e. subject to intervention) to it. I never thought the betrayal idea (from inmate to warder) such a good thing.
I’m not fond of the mental patients’ (i.e. peer) movement. I’m more partial to the mental patients’ liberation (i.e. psychiatric survivor) movement. I’ve been liberated, I’m not “sick”. I don’t know that you and yours can, or would, make the same claim.
“Peers” are just like “non-peers” (i.e. everybody else). Why do we even use that term? Oh, yeah, because we’re addicted to mental health treatment, some of us anyway.
Actually, being around before the preschool idea got off the ground, I went to kindergarten. I had enough of this kind of thing in kindergarten. Kindergarten for adults, no thank you. Repeating kindergarten, and potentially lifelong, is not my idea of a good time. Wanna try again?
I’m currently involved, in a small way, with helping to revise the peer support certification process for the State of Kansas, and I have been involved with training peer specialists in the past–and I probably will be in the future as well.
The question of whether or not one can get paid and stay peer is one I contend with literally every day. Rather than getting defensive about it, I chose to address it directly in the training, for a couple of reasons: first, as an educator I believe in an open and transparent pedagogy, and second, our trainings were also attended by those who work and volunteer in our state’s independent consumer-run organizations (CROs), and I beleive it is right to honor their experience.
And I can certainly understand Mr. Hendry’s taking offense at having one’s “peerness” questioned. I went through the same thing when I started doing capacity-building work with CROs. But these folks had a point. I’m a middle-class, middle-aged, white male with a good education, entirely unlike most members of our state’s CROs. But I discovered something: peerness cannot be asserted; it must be established. So I acknowledged my privilege, and then I told my story. And then I shut up and listened to the stories of those I was serving. Peerness is relational. It’s about doing the work to create a space you can share.
As far as the assertion that a national certification is necessary because that’s how we get taken seriously by insurance companies and professional organizations goes, that’s a textbook case of cooptation by (not exactly) subtle coercion, and it helps make Ms. Davidow’s case. Rather than bowing to this pressure, we must create a set of values and principles truly our own, rooted in lived experience, and honoring what we know to be right. And we must live by those principles and values to the best of our abilities.
For me, that means having some uncomfortable and possibly career-limiting conversations with clinicians and administrators, and coworkers and advocates as well. I know I won’t always win their hearts and minds, but I feel I’ve got a duty to try.
I wish people would recognize that in this context, “peer” is not a noun but a descriptor. As we all know, “peer” simply means “an equal.” It has come to be used as a euphemism for “mental patient.” It’s fine to talk about “peer support,” which means “support among equals.” It is not OK to refer to a person as “peer” when what you really mean is they work in a peer role.”
Finally, someone gets it!
Thank you, Darby!
The term “peer” as used by “Mental Health” Inc. is typical of its Orwellian distortion of language and has nothing to do with the term’s real meaning. If you consider the term as used and its implications, doesn’t “peer” signify that there is a caste system in place? Or imply that there is a level “greater than peer”? From what I can see “peers” are used as snitches and overseers, and are decommissioned if they refuse to roll over.
Some people would consider “certified peer specialists” as sell outs. I almost became one, but stuff happened. Looking back, I believe it was providential.
Lael, I appreciate your heartfelt perspective and I honor you for your work with clinicians to support those who are stuck in the system. No doubt you have to work with some very unpleasant people who abuse their power at times, or take their privilege for granted. Your comment makes me wonder if we are dying on the wrong hill. Rather than focus on national certification for the purpose of reimbursement and job creation, perhaps we should be focusing on how to get more choices and power to the client such as putting each client in charge of his/her own treatment fund and employ a brokerage system? In other words, work with the repugnant Republicans who are always looking to cut back Medicaid in order to deploy innovative treatment/reimbursement models not dependent on the medical model, DSM, etc
The “Cures Act’ was bipartisan. Both parties couldn’t wait to throw us under the bus for bribe money disguised as “campaign contributions” from Big Pharma. Frankly, more money would just mean more money for Big Pharma, detainment centers (“hospitals”) and electroshock. Julie Greene chooses to go uninsured because no insurance/Medicaid takes away the incentive to “treat” you. Makes a lot of sense, when you think about it. I got released after 4 days during my final psych ward stay because they couldn’t bill Medicaid. Ha ha.
I hope you will see my full response to Patrick below. I did not question anyone’s ‘peerness’…. not in the way he suggests anyone. I do however question the way that word gets thrown around, and the hiring practices and intent of many orgs hiring up people into peer roles.
I still haven’t heard any reasoning why obtaining the NCPS from the Florida Certification Board costs more than a Mental Health Counselor’s license from the Florida Board of Mental Health Professions.
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Equal certainly doesn’t describe hiring practices. It would be interested to see a study done matching certified peer specialists with their diagnoses, and see who it was who got the jobs. I would imagine that some labels end up being much more employable than others.
Not to be put off though, I feel I’ve beaten them to the punch not wanting to be a mental health worker of any sort.
End “mental illness”! Boycott the mental health system!
What about the “Hearing Voices” Peer Support Groups. I was talking to a person last year at a British Psychological Society function who had joined this group and said it had “cured” them.
I attended a peer support in Ireland that was not pro medication and had had evidenced success within its members at Full Recovery from the so called Severe Mental Illnesses.
I attend peer group meetings in the UK but not specifically for “mental illness”. All groups are expected to be self supporting, and have a good success rate at helping any “insane members”.
It would be interesting to see a study like that. From what I observed, it had a lot to do with how “high functioning” and compliant a “consumer” was from adhering to principles and “treatments” within the system. Compliance and “high functioning” would then “qualify” the person to coach others into going along with these same “treatments”. However, the whole concept of “consumers” working within a mental health system seems to be a little outdated now, so many people are on psych meds, including all kinds of staff (mental health worker, nurses, psychiatrists, etc); psychiatric drugging being so common and the go-to, it seems strange to me that the a “peer support” person is still differentiated, and somehow within the system they are thought to be on the bottom of the pecking order amongst staff.
Also something else I noticed, and not sure if there are studies on this because I haven’t looked into it too much, just a personal observation. But substance abuse is also *huge* amongst mental health staff. And I don’t just mean a drink with a coworker after work, but that heavy partying stuff. Kind of tough to be turning to people for help and wanting non drug options, when the people you are turning to are not only indoctrinated with the DSM/ Pharma business, but are also coping with life by drugging themselves.
Very true. Having overheard conversations… and talked to some of them, both who work at such places, and those who formerly worked there. Drugs, both justified via “Oh I get it from a doctor!” and totally off the street…” are partaken by staff at all levels. They get around the drug testing. They know how, for chrissake. I doubt any study is going to show this with any accuracy.
Definitely. Even the psychiatrists and APRNs participated in this kind of thing, as did mental health/ social worker staff who were working with not only people diagnosed with various “mental illnesses”, but also with substance abusers. Talk about the blind leading the blind :/
Lenora you figure this out after decades in the system. I even had a staff ask me out.. Outside of the institution. We ran into each other in town and that’s when it occurred. I was still a brainwashee to an extent and I was clueless as to what to do so I made a quick exit.
Eeek Julie, that too! Staff getting involved with/ sleeping with the people that are supposed to be “treating” and helping. Seen that too. Thank the universe you had good instincts and made an escape.
Lenora back in the 1990’s we had an incident of staff and patient marrying. OH no, they claimed it never happened. Hah! The two announced their plans to marry to the entire program, then, quit, then, married that I know of. This and other gross violations (there were many) led to a friend feeling violated and confused. She suicided.
That is very sad 🙁
For readers more on centric side google search Steve Harrington’s “organizational culture change can help mental health centers thrive” article. When talking about this topic, Steve’s work matters.
It’s signifiant to me for when I read a few of his articles several years ago I reached out to him to get more involve (inter) nationally. I like his style and appreciated his uncanny way of involving all stakeholders and listening. Anyhow his article provides outstanding ways people in recovery can make change happen when employed by an agency. Not everybody in the USA creates change like the east coast advocates. In general the east coast is the scourge of planet Earth.
I find myself continuously surprised at the animosity of your comments, Pat, particularly since your misunderstanding of our work seems to run deep.
This guy is making Sera seem like a radical in comparison.
Seriously though folks, unless one is doing research on the nature of opportunism and cooptation, do we really need to waste time on all the fine print here? Glancing through the above comments I think Julie & I are simpatico on this; the tone of the article speaks for itself. Is an impassioned rebuttal really necessary?
And hey, is anyone else sick of the term “people with lived experience” as a euphemism for “mental patient”? Who the fuck is living on earth without lived experience?
Oldhead, I couldn’t get a job as peer because I told the agency I refused to coerce or use force. Never mind my eyesight is damaged so badly by psych drugs I cant pass the driver’s license eye test.
And the ilk (authors/commenters) here lash out at powers that be in Manhattan . Your movement may have a lot of people and a mixture of cultures, but 95% white people write here because they feel comfortable doing that. Authors here are white privilege turned on it’s head and then heels again.
The rest of us know better and cow tow and some bow down as well. Actually we realize its better to pick and choose our battles, speak clearly & calmly, provide genuine knowledge and give hope that one day powers that be will make changes that will benefit us.
Patrick, I think you’re missing part of the reason why Mad people object to the (over) credentializing of our health supports. Pay-to-play peer work would be hurt many of us, no matter what its context. Even if these “exams” were free and not graded, even if the “hours of intense work” were highly paid, and even if some Mad people “chose” to standardize these hoops, they would still face a backlash from many Mad people. Most of what’s taught about Madness is #fakescholarship and #fakescience. That BS “education” will certainly attempt to place harmful on restrictions the scope of peer work. You call it a “supplement” to “medical care”, but many people can and DO need peers to *replace* clinicians. Some of them will die, if their peers are barred from working in the health care system. And it’s quite ominous to “extreme vet” people who want to and *should be* working ENTIRELY for – and under the direction of – the people they’re caring for. I’m fine with a “qualifying” process to become a peer worker, but that process must be set up by the service users – their REAL employers.
Only mentioned Steve Harrington because I don’t want this east coast newspaper leading this movement.
I need the medication I take to survive and take care of my family. I’ll keep commenting here until I’m censored. I was ridiculed on here for saying that a few months ago so I’m certain I don’t need you being in the forefront leading our movement.
You have 3 comments on this site. All on this article. Where was the ridiculing done?
You are free to take whatever drugs you want and bear the consequences (positive or negative) of said drug use. Even Szasz wrote about “Our Right To Drugs”.
I can love it away with family and friends/peers.
I can use therapy from an array of mental health professionals (peer run programs, peers, psychologist, social workers).
If needed I can try medication.
There is help available. That’s the way I see it and that’s what I did in my life.
“There is help available. That’s the way I see it and that’s what I did in my life.”
Good for you. The rest of us wish that we knew what “help” would mean when we got into it.
Who ridiculed you, Pat? As I recall, you were ridiculing others and that’s what got you into trouble. You want others to respect your choices. Why don’t you respect the choices of others, including their choice to take a position you don’t agree with?
The eagle has landed.I repeat the eagle has landed. Boogie on out of there commodore Pat. ( I aint in the navy….just lightening the mood)
You have not answered neither Steve nor me. You have just written balderdash to “lighten the mood”.
With all due respect to Pat, he still belongs to the Church of Psychiatry. Replying to him is like trying to converse to someone in a language I’ve never studied. Even when I believed in psychiatry I was open to other ideas. When I ran across the concept of Glassner’s Choice Theory/Reality Therapy I was ready to think outside the box the System had told me was the universe.
He doesn’t even seem to realize how restricted his rights as a “mental health consumer” are. At least he must be deriving a placebo effect from the drugs he takes.
Across the pond we did ‘peer support’ (we didn’t choose the name peer) without any training or qualifications that’s what mad people/loonies/survivors do. The problem with peer support is that the moment it gets monetized or embedded in statutory services it immediately becomes the services bitch.
Within alternative movements it can also become bastardised if it comes a part of a neorecovery approach.
i have a major depression disorder….i want help from others who have the same problem..
i don’t want help from someone who is getting paid to help me…i want someone who knows what it is like…and i don’t want money $$$$ involved at all..i don’t like what is happening everywhere where $$$$$$$$$$$$ is being made…i want someone who is motivated by love alone..
They’re not getting paid to “help” anyone do anything but remain slaves to the system, even when they believe otherwise.
Soon we won’t be able to have best friends unless they pass state-certified exams officially qualifying them as such.
Well, those of us who choose to remain “consumers” and stay in the system won’t!
I’m finally back. I hope you’ll bear with me in my more detailed response to your piece. It’s going to be long, although it’s late and so I’m afraid it won’t be quite as thorough or well thought out as I would have liked.
First of all, let me begin by saying (once again) thank you. In order to respond to your blog, I needed to go back and read my own. I forgot how much I liked that particularly blog, so thanks for making me take another look! 🙂
Okay, but, let’s get down to business. For starters, no, I am totally not kidding you. Do I mean to suggest that this certification has taken a completely healthy ‘peer support’ industry and knocked it off its perch onto the ground? No. ‘Peer support’ was suffering for being an ‘industry’ at all, and it was already deeply in trouble. But, Mental Health America certainly ain’t helping the situation.
My complaints about Mental Health America (MHA) date back well before this last blog. In fact, the very first blog I ever wrote for Mad in America (back in December of 2012) was about MHA’s disappointing connection to mental health screening tools. See here, for more: https://www.madinamerica.com/2012/12/i-am-the-number-60/
I followed that up with others, including ‘Dear NAMI: My apologies. I’ve been unfair’ (https://www.madinamerica.com/2014/03/dear-nami-apologies-ive-unfair/) in 2014 (in which I detail MHA and a few other organization’s heavy connections to the pharmaceutical industry), and ‘Do NAMI and MHA suffer from Anosognosia’ (https://www.madinamerica.com/2015/09/do-nami-and-mha-suffer-from-anosognosia/) back in 2015, where I discuss (among other things) Gionfriddo’s testimony in support of the Murphy Bill. So, you see, the problematic roots of MHA run deep.
But, that aside, let’s look at what you wrote.
So, the bell. I think you missed quoting what the bell *actually* said, or accurately representing my concerns with it at all. It’s not the ‘mental illness’ language. As harsh as that is on my ears, I understand the language of the era and all that. It’s the actual message. A refresher: Here’s what the bell’s inscription says in full:
“Cast from shackles which bound them, this bell shall ring out hope for the mentally ill and victory over mental illness.”
It doesn’t say that the bell shall ring out hope for the ‘mentally ill’ and victory over the system, the abuses they have suffered, the discrimination, the maltreatment, or whatever words might have been most commonly used to describe these phenomenon in that year. No, it suggests the bell ‘ring out hope’ for ‘victory over mental illness.’ That’s a *completely* different message, isn’t it? In fact, it sounds exactly like NAMI’s message, and every other organization that seeks to increase treatment to ward off and conquer these destructive ‘diseases’ without any real critical eye on the system itself (except perhaps to say it doesn’t offer enough beds or access for the “seriously mentally ill”). So, either you have re-interpreted what was written to what you wish it said (or what serves you in this moment), or the author(s) was a really poor writer. Either way, I’m sticking with my assertion that it is tone deaf and gross.
You continue with several other points (I particularly appreciate the details on who makes what per each certification, so thank you for that), but also misrepresent another point I made here:
“On a side note, I have no qualms about saying that all of the peers, including me, involved directly in the creation of this credential have just as much right to claim membership in the peer community as anyone else. When other people, particularly those with large audiences, try to disparage our “peerness” I have visions of a so-called recovery center I once visited which required proof of diagnosis before people were allowed access to the facility. It makes the hair on the back of my neck stand up.”
Not a single time did I question anybody’s ‘peerness.’ Anyone who knows me or has read much of what I written will know that anything that links me to any place that would ask people for their diagnosis (or any other such thing) isn’t taking the time to understand what I’m saying at all.
This is what is called a straw man argument, Patrick. You are responding to an argument I never made in order to (intentionally or not) distract from the points I actually made. I have *never* questioned the experiences of anyone who claims to have a psychiatric history or to have faced enough life-interrupting challenges to work in a peer role. What I *actually* said was that many organizations eat up the people who have internalized oppression, or who are prone to be silenced and changed when their paycheck comes from those they’ve previously sought to change.
This is an important argument. It does not seek to diminish one’s experience or identity (and certainly doesn’t seek to ‘prove’ whether or not they qualify for membership to the ‘club’), but rather it questions whether or not they have had or currently have the support to not be swallowed up whole, co-opted and used by the system. And, it further questions the nature of a system that would prefer to hire people in this position than those who have gone through a fuller process of self and system realization.
Based on what you say here, I’d also go several steps further and question your use of the word ‘peer’ in at least two other ways. First, you seem to be using it to mean an identity. Thus, right from the start, you are using the word in a co-opted manner. ‘Peer’ is not an identity you get to claim because you have some particular life experience. ‘Peer’ is a way of relating to other people. It’s an approach. A way of being. You serve to do the work of co-optation of the role simply by changing it to mean something else. (See my blog, ‘Cheers for Peers’ for more on this: https://www.madinamerica.com/2013/07/cheers-for-peers/)
Meanwhile, by claiming doctors and licensors and all that can be ‘peers’ you also go a step or two deeper into dangerous territory by not only claiming ‘peer’ as a singular identity, but by also ignoring that peer supports and peer-to-peer relationships are fundamentally built on minimizing power imbalances. So, while doctors, licensors, and all sorts of other people may have psychiatric histories and legitimate wisdom to share from those experiences, they are full of power.
Is this what you mean when I say I’m questioning people’s ‘peerness,’ Patrick? Because, if so, then I guess you’re right on. I do not question anyone’s right to claim a psychiatric history, or to choose to work in peer support. I do not think someone needs to share a diagnosis, take a qualifying test, prove they’ve been hospitalized, or anything else in order to play this game. But, yes, I sure as hell reject that I am a ‘peer’ (I am a human) or that doctors who have psychiatric histories are able to participate in offering peer support for all the power they hold.
On to the clinical dance: You say, ” What is not said, through no fault of Ms. Davidow, is that in the initial interview I accentuated that individuals choosing to participate in DBT do so voluntarily and arrive at treatment goals and methods in concert with their therapist.”
Now it’s my turn to say, ‘Are you kidding me!?’ Hundreds of thousands of people have been forced into DBT-inspired programs. If they’re given a choice at all, sometimes it goes something like this, “So, you could live in this here DBT-based residential program, or… you could be homeless. What do you choose?”
Additionally, some people who ‘choose’ DBT do so under coercion or misinformation. And, once they’ve ‘chosen,’ and they realize it’s not working for them, they can’t easily or immediately undo their ‘choice.’ So, yeah, what you offer here changes nothing, and simply re-enforces my impression that you’re not paying attention to what’s actually happening to so many people in the mental health system.
By insisting that peer supporters deviate from listening to the person they’re supporting over all other influences, you are diminishing the most very basic point of this all. At the very least, if a person participating in DBT chose it voluntarily, then surely THEY know that. If, knowing that, they still choose to reach out to a peer supporter and ask them to advocate or help with something that clinicians may seen as ‘interfering,’ they do so also knowing that. Are you suggesting that the peer supporter nonetheless treat that person as a child who can’t knowingly decide to act outside of the DBT framework, and that the peer supporter needs to take on that responsibility?
In my world of peer support, we practice responsibility *to* one another, not for. The system has already done far too much harm being responsible ‘for.’ If a peer supporter has a question (so much of our work is about questions and curiosity), then they can *ask* the person with whom they’re connecting. After all, this is all so much more about understanding THAT person’s worldview and NOT someone else’s (and certainly not Marsha Linehan’s). I reject this idea entirely, and continue to assert that such beliefs will contribute to further destruction of whatever good and potential may be left. So, yes, ‘clinical, I do think so.’
You go on to offer that, “Ms. Davidow’s comments on the Code of Ethics are her opinion… They are the same as the majority of codes of ethical behavior that any certified professionals agree to.”
Well, okay, but this isn’t the “majority” of work. It’s an employment structure for people who have faced silencing and discrimination. It’s already been severely co-opted and misunderstood. While I don’t agree with everyone here who says its pointless altogether, I do seriously question whether there’s any way to have it exist and hold it on track as anything else than what people here accuse it of being. Peer support is also already something that people like Tim Murphy, Susan Inman, Elinore McCance-Katz, E Fuller Torrey, and DJ Jaffe have sought to control or destroy. The language of not practicing beyond one’s expertise is precisely what was put into the Murphy Bill in an effort to control peer roles in really limiting ways.
Saying this is all ‘just the same’ as any other license is just silliness as far as I can tell. Don’t you at least think the level of potential for discrimination is worth considering before people start signing off on this thing? Has it not occurred to you that various Anosognosia disciples might lodge complaints simply to push these issues? Are you ignoring national news of the Murphy Bill passing under the 21st Century Cures Act or McCance-Katz making her way into SAMHSA with destroying peer support on her mind? Might you not be handing them just the tools they need?
I just recently received an e-mail from someone wishing we’d get ‘shut down’ simply for hosting a Coming Off Psych Drugs event. You seem to be very naïve about the potential dangers here, and that is terrifying given you are constructing a framework in which so many other people may get caught.
You close with this: “Ms. Davidow is writing this in a blog about Mental Health America, so the clear implication is that MHA is shrouding itself in “so-called peers” and “party liners.” The comments about not being able to see through their own medicated haze and tokenism are even more revolting.”
Are you denying that organizations across the country are hiring up “party liners” and people who haven’t made their way out from under the weight of over prescriptions and other varieties of disabling treatments enough to think about their role? If you’re truly suggesting that’s not a thing, then you’re not paying any attention at all. None of that is meant to disparage the people working in peer support who get caught up in that trend, as it’s usually not really their fault. But, to ignore the phenomenon is just as dangerous as everything else you suggest.
But you seem really wed to ignoring all this. For example, when you say “The individual who “confessed” to feeling beholden to their employer was not referring to us since they are not an employee of our office,” you’re missing the point entirely. Is it intentional?
It doesn’t matter if they were talking about Mental Health America when they told me how silenced they felt at times. They were saying it in regard to a presentation they were offering, and in general. They were explaining how they felt that – whenever they acted in a professional capacity relating to their role in any way – they felt they needed to watch what they say, and tow at least some part of the party line. Your unwillingness to understand how that connects to MHA’s work is baffling to me.
Patrick, this national certification is not a good thing. (And neither, I suspect, is Canada’s, though I know much less about it.) None of this is news to you. People have spoken up at your presentation at iNaps, at Alternatives, and more. Your blog really doesn’t present a convincing argument otherwise. I hope you’ll consider this further, but it seems clear you won’t.
We need to tear down the “professional mystique”.
The only reason we “license” people is to “protect the public”. Pretty much every board of licensure (including the FCB) has as it’s mission protecting the public from people capable of great harm.
Doctors, nurses, lawyers, electricians all have a degree of threat based on their relation to the persons they serve.
A peer support should never be placed into such a compromising position where they are capable of causing that degree of harm.
A peer support, by design, should NOT have that kind of power over the health and well-being of another. Once that power differential manifests, they are no longer a peer support.
They are a case managers.
And we DON’T require case managers to be licensed.
People call this “professionalization”. It’s not. It’s stigma dressed in a tie and offering reassurance to potential employers that you are “one of the good ones.”
That you, the person with a mental health history, are not a danger to the public.
They have a term for this: “respectability politics.”
Sera, did you this this know this blog was coming, or were you blindsided when you discovered it was directed at you? Some of us are curious about its timing and significance.
I did receive a head’s up both that an article was coming, and a notification when it actually went up. I didn’t get to see it in advance or anything, but I knew it was on its way.
You probably won’t see this as the thread is getting old, but I wanted to comment on something you said:
“Based on what you say here, I’d also go several steps further and question your use of the word ‘peer’ in at least two other ways. First, you seem to be using it to mean an identity. Thus, right from the start, you are using the word in a co-opted manner. ‘Peer’ is not an identity you get to claim because you have some particular life experience. ‘Peer’ is a way of relating to other people. It’s an approach. A way of being. You serve to do the work of co-optation of the role simply by changing it to mean something else.”
I hope some day this view is embraced more. I see myself as my wife’s peer. She and I are in this healing journey together. I view her d.i.d. as the ‘enemy’ and not her. We are ‘fox hole buddies’ when she was going thru all the PTSD crap in the beginning. I NEVER let her go thru it alone, so I could be her ‘safe haven’ and once she realized she wasn’t alone…that’s when she began to heal. When I make suggestions, she/they are free to accept or reject and I always make clear the rejection of my suggestions will NEVER affect the status of our relationship.
I have to remind myself when reading about ‘peer’ support, they really don’t mean me, even though by your definition, I ought to be welcome. Maybe some day.
Amazing clarity as usual, Sera. Power dynamics lie at the center of why there is an antipsychiatry movement. Embedding “peers” in the system and then taking away their ability to proceed from an empowering viewpoint is cooptation at its most pernicious. I would ask Patrick to look at some of the comments of Stephen Gilbert, a peer worker of great integrity, who is constantly barraged with complaints and threats and disrespect when he stands up for his peers in a truly peer-like way. Certification per se is not the problem – the problem is that the professional “mental health” workers don’t want to give up their power over their clients. A true peer-to-peer model means clients get to make their own decisions and have those decisions respected, even if if those decisions are now what the peer would decide for him/herself. Those currently in charge of the mental health system will never stand for it, and that’s why certification is popular amongst the professionals – it enables them to disempower the peer movement and make it the handmaiden of their own need for control.
Thanks for your courageous response!
See my comment on your first comment. I will get back to you soon.
I appreciate your taking the time to provide a very thoughtful reply to my Op-Ed. I think that by and large there are so many fundamental differences in our beliefs and philosophies that it makes it impossible to arrive at anything other than clarifications of our points. But that is fine with me. I did not write about your blog with the hope that I would change your point of view but rather to distinguish more clearly mine from yours.
I personally enjoy and benefit from much of MIA’s content. A lot of it is very much in keeping with my own opinions. I too, like so many others, have experienced involuntary confinement and treatment along with restraints and seclusion. I rebel against the pretense that medication and clinical treatment is the answer to all of our problems. I think that the system is very quick to take away someone’s rights and excruciatingly slow to restore them.
I do know that my ideas about peer support are quite different than yours and many of the people who have commented on our blogs. I’m not against you having your point of view, but I would say that while many people are in agreement with the ideas you have set forth there are many more who believe that peer support only gets better with increased knowledge and experience and that setting standards elevates the field. I think that the people who choose to work in this area are entitled to be paid a living wage with opportunities for career advancement. For a number of years I provided peer support as a volunteer and felt strongly that the support and strength that I got from helping to provide support to others was of great value. I also saw that many of the people who were really great at providing support eventually moved on because as their personal recovery increased they wanted to have full or part time jobs that allowed them to climb out of poverty.
I believe that the way to keep many of our best supporters from leaving is to create increasing employment opportunities with the potential for growth in positions and income. Expanding the peer workforce moves many people from disability to ability. Growing the peer workforce is the only way we will ever achieve the goal I believe in, which is that peer support should be available to anyone who wants it. As it is, even with over 25,000 certified peer specialists and thousands more who have been through training without certification, peer support is difficult to access.
The belief that peer support should be, as some would say, voluntary without compensation or the benefits of employment is fine for people who choose that route but it, in my opinion, would create a serious shortage of peer supporters and would be an unintended message to providers that peer support is less valuable than traditional treatment. Many believe that it should only be available through peer-run organizations. I happen to believe that it is the most powerful model but I also believe that the thousands of peers working to provide true peer support from within the system have a powerful influence in creating a better, more effective, more humanistic and recovery oriented system of care for those who choose it.
As to the meaning of the bell, I still believe that its’ strongest message is an end to the brutality of restraints. The very fact that it is cast from them is powerful to me. That is the part that speaks to a system that has abused and discarded countless souls. Yes the rest of the message says an end to mental illness. That it is not a message of increased treatment, rather it is one that allows for any kind of approach that ends peoples pain.
About the idea of questioning “peerness” I, as before, quote you: “These organizations sometimes shroud themselves in so-called ‘peers’, but often only those who don’t flinch at having their identities boiled down in such a way. That is not to say that they aren’t still good people with voices as potentially valid as the next, but all too often they’re also the ones who have a job they can’t afford to lose and so feel constrained within their organization’s ‘party lines’. Sometimes they’re the people wrapped up in so much internalized oppression they can’t see through their own medicated haze. Or, they’re the tokenized one committed to “creating change from within” that started out with such a clear vision, but have fallen so far in that they can’t quite see they’ve lost their center. To me “so called peers” definitely questions an individual’s right to call themselves a peer, and “can’t see through their own medicated haze” is actually very insulting and demeaning to people who choose to use meds. You may say you didn’t refer to us directly, but putting this in a blog aimed at MHA seems to make your intentions very clear.
You question whether or not individuals have had or currently have the support to not be swallowed up whole, co-opted and used by the system. You also question the nature of a system that would prefer to hire people in this position than those who have gone through a fuller process of self and system realization. So do I, and I believe it is essential that individuals working within the system have a strong support system of their peers and a strong sense of self and awareness. I also believe that those same individuals and the ones who have gone before them are the ones to set the standards that can change systems to prevent co-optation and to provide peer support based on equality and mutuality, respect, and shared learning. The people working within the system and creating change are the pioneers who are making it possible for the true power of “support” to be available throughout healthcare.
Since you state in your reply that you don’t believe that MHA has taken a completely healthy peer support industry and knocked it off the perch, and you further state that it was already suffering and that “Mental Health America ain’t helping the situation” it seems that perhaps the headline doesn’t match the intent. Those statements are a far cry from the title of your blog which is The Downfall of Peer Support: MHA & National Certification. To me it sounds like you are now saying that MHA is just not helping the situation while your title sounds a lot like you are saying that the MHA certification is causing the downfall of peer support.
As to the word peer, I believe that saying that I am a peer means that I share some set of circumstances and/or experiences with another person, and that this person accepts me as a peer in that context. Is it silly to use a word that can apply to people in all walks of life, yes, just like the word consumer was. I think it is so popular because there are a very large number of people who want to be part of a community of people with similar experiences. So, while it is not a very accurate phrase it does not inherently demean anyone. The word itself is neutral. I did not say that doctors and licensors are necessarily peers, although they certainly can be. An excellent example of that is Dan Fisher M.D., Ph.D. To be clear we had 9 self-disclosed peer subject matter experts including a primary care physician who has worked in peer support and understands and has worked hard to overcome the innate power differential of a title. We also had 3 other, non-peer experts who were there for the specific reasons I wrote about in my Op-Ed. Anyway why are we discussing this, it is not a claim I made.
As to DBT, I am not saying that peer supporters should treat people they serve like children. What I am saying is that it takes some knowledge to ask the right questions of the person they are supporting. I realize that there are many examples of people being forced into DBT, but it is supposed to be voluntary, so when it isn’t it is being done incorrectly. I ascribe to the belief that “If it isn’t voluntary, it isn’t treatment”.
We could of course rehash every line in each blog but I don’t think it will make much difference. The bottom line is that I believe that organized peer support with certification is not inherently wrong, rather it is a positive development. I believe that peer support and the knowledge that backs it up is expanding and it is moving towards a time when it will be available to all of us. The purpose of our certification is so that the individual who has earned it can demonstrate to employers (peer or not) that they are highly skilled and experienced in their chosen field and can continue to grow in their skills and provide the best possible support.
Well said, Sera Davidow (at September 10, 2017 at 8:48 pm ).
Is a bit amazing that in the days between the Patrick Hendry original post and your post… despiste all the nonsenses he wrote… MIA has not been able to dissecate the many lies. And you Sera were well at that.
Patrick Hendry, i am amazed that that your original post fits MIA standards.
Most people that did passed the disgrace that is the peer fakes, dont know. Those that were inside, know you full of…
Sera, I am glad you mentioned the MHA screening tools. They recently posted under MH screening tools – “tests” — one of them is a “youth test.” I assumed it is to be filled out by a young person. Here’s the heading, “Pediatric Symptom Checklist – Youth Report.” The child is then supposed to rate how often they have these “symptoms.” One of them is DAYDREAMING. Others are sad, angry, etc. When did normal childhood experiences become SYMPTOMS? This is so incredibly sad! Children’s normal behaviors continue to be pathologized. Sickening.
I have been employed as a peer worker for the last decade. I consider myself fortunate to have developed my ideas of what peer support is thanks to people like Shery Mead and organizations such as The National Empowerment Center. I have constantly pushed back and have tried very hard to be “in the system and not of it” but I am realizing more and more every day how impossible this is with the way things are going in regard to attempts to “legitimize” or “credentialize” peer support. MHA’s NCPS certification strikes me as nothing more than their attempt to be *the* national organization that monetizes the certification process. This need to “prove” what peer support is and make it “more professional” is happening at the state level as well. For example, the Washington state peer program–which refers to their state certified peers as Certified Peer Counselors–has an ongoing effort called OPS (Operationalizing Peer Support) which teaches organizations how to hire, train and supervise peers. When you read about these efforts words like recovery, empowerment and choice are tossed about but in practice many employed peers are treated like low-level case managers who are expected to do everything but peer support while encouraging things like medication adherence and how to be a good, compliant patient. For me this is all very discouraging, but I have to believe there is hope for “peer-run organizations that are dedicated to mutuality” as Darby Penny mentioned above. Who or where are the organizations, people and trainings willing to help take back and define what peer support is really about?
Patrick: Here is my two cents worth: Peer certification is not the answer. Certification of peer run organizations is the answer. My guess is that the organization that you represent would not pass a basis litmus test of an authentic peer run organization. The inclusion (51% or higher within leadership and management) of the voices of psychiatric survivors-especially those who identify with having been harmed by the mental health system either through involuntary commitment (loss of personal liberties) or by the lack of access to alternatives and choices —must be a basic criteria for distinguishing a peer run organization from other pseudo consumer advocacy organizations such as NAMI. What is needed is to offer more technical assistance, training, and seed money to peer run organizations and a way of standardizing not individual peer specialists, but standardizing organizations so that an authentic peer run organization can be distinguished from pseudo consumer advocacy organizations which take money from big Pharma. Let the authentic peer run organizations within each state set certification standards for the peer specialists within that state. No need to have national certification standards, too sweeping and too vulnerable to the obvious corruptive influences of government/big Pharma funding.
“Let the authentic peer run organizations within each state set certification standards for the peer specialists within that state.”
That’s what we did in AZ.
The state should have no role in these matters and the only response it should receive when it presumes to do so should be MYOB.
Peers and Peer Support: He who pays the piper plays the tune.
Or to put it less cryptically: peer support, trained or untrained, run by psychiatric survivors and their allies and from an anti-psychiatry ideology is what I want to see. Most of the rest is co-opted nonsense which at it’s best gives service users a much needed step back into paid employment.
There are of course a few exceptions, such as peer supported Open Dialogue in the UK, but they are rare.