Peer Providers of Mental Health Services Use Personal Narratives to Help

A new paper, published in Qualitative Health Research, investigated the success behind peer providers in the mental health field. Through qualitative interviews conducted by researcher Michael Mancini, the study found that peer providers reflexively and strategically draw from their personal illness and recovery experiences to help others in their recovery.

“In this article,” Mancini writes, “I explored how peer providers of mental health services utilized their personal recovery narratives in their work with other mental health service users to better understand the specific mechanisms underlying this core element of peer practice.”

Peer providers take on various roles across a wide range of mental health settings and contexts. Although there is evidence demonstrating that peer providers are effective, there is little research that has examined the specific strategies and approaches they tend to implement. Further, not all work environments are optimal for peer providers.

In more traditional treatment settings, it is common for peer providers to report experiencing “role confusion, stigma, isolation, low pay, and a lack of opportunities for professional development and advancement,” writes Mancini. This puts them at risk for burnout, relapse, and work-related stress.

Therefore, there are two primary aims of this study: (1) to provide clarity on the successful strategies employed by peer providers, and (2) to use this understanding to develop better work environments for peers.

Mancini conducted semi-structured interviews with 23 certified peer specialists. Thematic analysis was performed to identify themes across the peer accounts. Three overarching themes were identified:

1. “Peers reported that they used strategic storytelling practices to help others develop a sense of understanding and meaning for their experiences and to chart a way forward in their recoveries.”

The word “strategic” is used here to honor how peers practiced reflexivity, choosing to use their stories to maximize benefits and minimize harm to both service-users and self. As one peer provider put it:

“. . . only certain parts of your story may pertain to certain people. You don’t tell them your life from the time that you sit down at the table with some drugs or the time that you started hearing voices. You don’t tell them all that, because they really don’t want to hear it. They want to hear ‘how can you help me?’ ‘Do you understand what I’m saying about this situation right here?’ And then that’s what you deal with. You deal with each individual’s situation with each individual person. . . You have to go back and find that one thing that pertains. . . But you best believe that there’s something in your story that’s going to help that person or start them thinking because you want them to start thinking.”

2. “Peers discussed several microlevel practices they relied upon in their day-to-day work of using their stories to help others.”

The micro-level practices used by peers resembled commonly-used strategies from dominant theoretical orientations in psychotherapy including motivational, solution-focused, and cognitive-behavioral approaches. In one interview, a peer discussed utilizing a skill referred to as “radical acceptance.” This skill is commonly used in counseling and social work settings, Mancini explains, but is a Buddhist concept.

“… See, [non-peer] professionals might have been manipulated and lied to and confused by so many clients that they put a guard up. See, we have that guard but we’re so used to it from being out on the street with other people manipulating us that we know that it’s not always a manipulation. Sometimes people just don’t know. And then you can’t hold it against them because that’s the way they survived on the street and this might be all that they know. They may not know how to talk to you any better than that, or create another situation. That’s just the way they are, and first thing you have to accept people for who and what they are and then you can work with them.”

3. “Peers reported that their lived experiences made them credible and authentic embodiments of a recovery process focused on self-discovery and personal growth.”

The credibility conferred to peers enabled them to embody a recovery philosophy centered around “hope, meaning, self-discovery, and personal growth.” The following peer account demonstrates this concept of credibility conferred to peer providers:

“I know when I was going through recovery [non-peer professionals] couldn’t really tell me anything. ‘What do you know? You haven’t lived on the street for 15 years. You haven’t been used and abused. You haven’t gotten to the point where you just want to jump off the roof. So what can you tell me?’ [Non-peer] Professionals can’t say ‘I.’ They can’t say ‘I did this and that’s what happened.’”

Mancini concludes with the following:

“Peers identified their superior ability to use their own authentic lived experiences of illness and recovery to engage, inspire, and mentor other service users and advocate on their behalf as their most important professional attributes.”

In addition to this, he includes discussion about how these findings might inform the development of better work environments by contributing to increased peer role clarity, supportive work culture, and a greater valuing of peer work. Mancini calls for narrative research to explore further how peer practices are influenced by intersecting social identities.

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Mancini, M. A. (2019). Strategic Storytelling: An Exploration of the Professional Practices of Mental Health Peer Providers. Qualitative health research, 1049732318821689. (Link)