Peer Specialists in the Mental Health Workforce: A Critical Reassessment

Darby PenneyPeter Stastny, MD
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Since its origins during the late 1980s, the use of peer specialists in traditional mental health agencies has grown tremendously. There are now an estimated 30,000 people with psychiatric histories employed in such positions across the country.1 The term “peer specialist” was coined nearly 30 years ago in a federally funded research and demonstration project in the Bronx, New York. 2 The position was created for workers with a psychiatric history who were trained to provide peer support and to assist people in developing self-help skills, support systems, and strategies to deal with emotional distress and extreme states.3 The goal of establishing this role was to bring genuine peer support to people receiving traditional community-based mental health services. “Peer support” was defined as a “reciprocal process through which people with shared experiences support each other’s healing and growth in the context of community.”4

The Bronx Peer Specialist Project came about at a time when the US federal government invested considerable funds to demonstrate that bringing “consumers” into the mental health workforce and supporting “consumer-operated projects” would have a transformative impact on the wider system and that service recipients would benefit from this type of engagement. While some of the projects showed that former psychiatric patients could provide support services like any other staff, the Bronx Peer Specialist program was first to demonstrate that peer workers’ personal experience directly correlated with certain improved outcomes for people receiving services.

Following this early enthusiasm,5 states began to implement a variety of programs for hiring peer specialists in various mental health settings. Based on our experience in the Bronx, New York became the first state in the nation to approve a non-competitive civil service position under the title “Peer Specialist” in 1993, based on an analogy with counselors who had relevant personal experience in the substance abuse field.

Over the intervening years, it became clear that being trained and hired as a peer support worker/peer specialist offers opportunities for people with psychiatric histories who might otherwise not have found their personal career path, as well as for those who benefit from participating in peer support. And yet, the inherent difficulties of working as a former patient in the system became apparent early on, but this did not result in serious consideration of how to address these issues. Recent research on peer workers suggests that these staff are often used to carry out paraprofessional and even menial tasks within traditional mental health programs, rather than provide genuine peer support. In most situations, relationships between peer staff and service users are construed hierarchically, in contradiction to the horizontal relationships of grassroots, user/survivor-developed peer support. Staff based in traditional mental health agencies are seldom exposed to the principles and practices of peer-developed peer support, nor do they usually receive supervision from seasoned peer experts. Cooptation of peer staff, where peer support values directly conflicted with the practice and beliefs espoused by the people in charge of those work settings, was frequently mentioned by peer workers, but never led to substantive changes in hiring and employment practices.6

One of the key concepts of peer support is that it must be voluntary, and such voluntariness is anathema to many, if not most, mental health services.7 There are indications that peer workers are increasingly being employed in situations where people are being coerced into “treatment,” secluded and restrained, and forcibly medicated. The original idea of peer workers was never meant for them to work under such conditions. For example, peer workers are frequently employed on Assertive Community Treatment (ACT) teams, which are coercive by definition. In addition, research found that peer staff are often required to perform tasks that conflict with peer support values, such as pressuring clients for medication compliance, reporting clients’ behavior to clinicians, and enforcing adherence to outpatient commitment orders.8 As a particularly notable example, Kings County Medical Center in Brooklyn, New York, one of the largest providers of emergency and inpatient psychiatric services in the country, hired many peer workers in a settlement with the US Department of Justice after the wrongful death of Esmin Green in their psychiatric emergency admission unit. While these peer workers may indeed facilitate the usually involuntary admission process, they are certainly not empowered to advocate for ethical and effective alternatives.

Recently, Resilience Inc., a “wellness” consulting firm run by Lori Ashcraft, the founder of Recovery Innovations and an early promoter of the expansion of peer specialists in crisis settings, announced that it is merging with Crestwood Behavioral Health of California. According to Ashcraft, “95% of people in their facilities are on involuntary holds.”9 Such a development epitomizes the ethical quandaries facing peer workers and will likely cause serious conflicts with respect to their commitment to the values of empowerment and rights preservation. It is apparent that, increasingly, traditional community mental health organizations and hospitals are using peer workers to create the appearance of a recovery orientation, human rights compliance, or community integration. This is an exploitative practice which will undermine peer workers’ ability to provide peer support and advocacy.

We believe that the time has come for a comprehensive reassessment of the practice of hiring peer specialists in traditional mental health programs, and for a moratorium on hiring people with psychiatric histories in coercive environments. This should include inpatient units and psychiatric emergency rooms, as well as mobile crisis and ACT teams, and other programs that do not have the capacity or dedication to provide alternatives to involuntary interventions. Such a moratorium would be an opportunity to reconsider and articulate the most ethical and mutually beneficial role for peer workers.

Rethinking the role of peer specialists would also be an opportunity to establish a dedicated funding stream for independent peer advocacy, provided by peer-run programs or other non-clinical organizations. A peer advocate is a person with a psychiatric history trained in mental health law and policy whose role is to represent the interests and desires of a mental health services recipient who voluntarily requests his or her services.10 Peer advocates can actively support people who want to reject coercive interventions and help them identify alternatives of their choice. They can also assist people working on crisis plans and advance directives. Peer advocacy has been part of some peer-run programs for over two decades, but its impact on mental health services remains largely unknown.11 Looking at the research on peer support, it is clear that not only have researchers failed to define peer support in a way that is consistent with the definition of genuine peer support, they routinely conflate peer support with peer advocacy. Thus, there is not a reliable body of research on the outcomes of peer advocacy.

There is a history of peer advocacy from which we can take inspiration, a legacy of the early consumer/survivor ex-patient movement. Probably one of the stronger peer advocacy projects of the time was the Oakland Independent Support Center, run by Howie the Harp, who subsequently came to New York where he began to put together an autonomous peer specialist training program, the development of which was curtailed by his early death. In New York State, other local groups, including the Mental Patients Liberation Alliance, came together in the 1980s and 90s to provide advocacy services for people faced with involuntary commitment. The New York State Office of Mental Health implemented a policy in 1995 requiring all state-run psychiatric facilities to allow such advocates access to inpatients. In addition, New York funded peer advocates who were incorporated into federally funded Independent Living Centers for people with disabilities. It is time to seriously consider re-focusing our energy and resources away from placing peer staff in roles where they support the mental health system’s status quo, and toward the goal of making high-quality peer advocacy available to people faced with coercion by the mental health system.

Show 11 footnotes

  1. Peer Workforce (n.d.). Mental Health America. https://www.mhanational.org/peer-workforce
  2. Felton, C. J., Stastny, P., Shern, D. L., Blanch, A., Donahue, S. A., Knight, E., & Brown, C. (1995). Consumers as peer specialists on intensive case management teams: Impact on client outcomes. Psychiatric Services, 46(10), 1037-1044.
  3. Felton et al (1995). Op.cit.
  4. Mead, S. (2003). Defining peer support. http://www.nhcornerbridge.org/Articles/DefiningPeerSupport_Mead.pdf
  5. Mowbray, C., Moxley, D., Thrasher, S., Bybee, D., McCrohan, N., Harris, S., & Clover, G. (1996). Consumers as community support providers: Issues created by role innovation. Community Mental Health Journal, 32(1), 47-67.
  6. Alberta, A., & Ploski, R. (2014). Cooptation of peer support staff: Quantitative evidence. Rehabilitation Process and Outcome, 2014(3), 25-29.
  7. Tingleff, E., Bradley S. , Gildberg F., Munksgaard G. & Hounsgaard, L. (2017). “Treat me with respect”: A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion. Journal of Psychiatric Mental Health Nursing,24 (9-10),681-698. doi: 10.1111/jpm.12410.
  8. Walker, G., & Bryant, W. (2013). Peer support in adult mental health services: A metasynthesis of qualitative findings. Psychiatric Rehabilitation Journal, 36(1), 28.
  9. Resilience Inc. newsletter, August 31, 2019 (47).
  10. New York State Office of Mental Health (2005). OMH Official Policy Manual, Section PC-1500, Peer Advocacy.
  11. Ostrow, L. & Hayes, S. (2015). Leadership and characteristics of nonprofit mental health peer-run organizations nationwide. Psychiatric Services, 66(4), 421-5. doi: 10.1176/appi.ps.201400080.
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Darby Penney
Darby Penney is a longtime activist in the human rights movement for people with psychiatric histories. A senior research associate at Advocates for Human Potential, Inc., she is principal investigator of a federally funded study of the effect of Intentional Peer Support on community integration, and co-author of Engaging Women in Trauma-Informed Peer Support: A Guidebook. Darby serves on the boards of the National Association for Rights Protection and Advocacy and the Campaign for Trauma-Informed Policy and Practice.
Peter Stastny, MD
Peter Stastny is a psychiatrist and documentary filmmaker who has been involved in international advocacy, community organizing and services research for many years. He is a co-founder of the International Network toward Alternatives (INTAR) and was one of the initiators of the New York City Parachute Project. Peter has frequently collaborated with psychiatric survivors, for example by spearheading peer specialist services and peer-run businesses.

68 COMMENTS

    • As the son of Shoah survivors I do not welcome this analogy. The comparison between institutional psychiatry and concentration camps is facile, polemic and inaccurate. While coercion, exclusion, overmedication and iatrogenic morbidity are rampant in mental health care, the systematic mass murder of innocent people remains in a category of its own.

      • While the comparison between institutional psychiatry and death camps might be inaccurate, I think a comparison with concentration camps apt. The link between genocide and eugenics is there for anybody to explore if they choose to do so. Franco Basaglia compared the mental institution to a concentration camp following his experience inside one during WW II.

        • It’s more than a “comparison”; psychiatrists actively collaborated in the creation the death camps and devising extermination methods. Breggin has thoroughly documented this.

          Some prominent American psychiatrists at the time also supported “euthanasia” for psychiatric inmates, as documented in the American Journal of Psychiatry.

          • I happen to know all about the pivotal role of psychiatrists in T4 and in devising concentration and extermination camps. But to compare peer specialists with Kapos seems like taking it to another level. The ethical quandaries faced by peer workers are of a different order than the outright collaboration practiced by Kapos.

          • Boans was talking about psychiatry, period, not “peer workers” specifically, though the latter is certainly a slippery slope.

            However “peer workers” in 99% of the cases (there are exceptions) promote the psychiatric agenda and encourage compliance. Kudos to the 1% who attempt the impossible!

          • I dunno about that either Doc.

            Seems to me that part of being human is to do the best you can with what your given. Take for example Viktor Frankl. Was he a Kapo?

            My point though was that if this type of system is to be used, lets be sure it is for the right purposes and not done as a means to futher brutalise people who are already in need of assistance. I know my personal experiences with these so called peer workers has been both positive and negative.

            On the points made by Nijinsky its said a lot better than i’ll ever say it. I can’t even explain in plain English to the authorities that I was not a “patient” and therefore I was kidnapped and tortured not referred and detained. More false narratives from the people who brought you such products as ECT and brain damaging drugs as medicine. Or maybe the kangaroo courts set up to give the appearance of fairness prefer a certain type of false narrative. The Jack Boot is just so effective in silencing complaints. Ask the hospital Manager who investigated my complaint and told me they would “fuking destroy” me if I spoke anymore about their vile conduct. Getting them all a good name, as people who terrorize their victims.

            Is it the case for psychiatry (and the drug companies) that like the American military involvement in Iraq that “we don’t do body counts”?

          • If one is going to talk about taking things to another level, then you might mention how the death toll from coercive, forced or fraudulently advertised treatment in psychiatry perhaps far exceeds what one is discouraged from comparing it to, as well as the length of its “rein.” That also involves ethical quandaries on all sides, including the people who then are told not to compare it.

          • I recall hearing a guy talking about terrorism and making the claim that it needs to be defined in a specific way so that when “they” do it it is terrorism, but when “we” do it it’s not. Setting up of double standards.
            And then I look at the wording of the “Assisted Dying Bill” before our Parliament at present. Of course we are not allowed to call it a Euthanasia Bill because of the negative associations with the thing we are not allowed to compare it to. And the propaganda machine (I mean free press) are complying with that request.

            Mind you, when they tried to include the forced sterilization of children without parental consent in our Mental Health Act it did get published. Mainly overseas though and it was outside pressure that had it removed (Thanks to whoever it was that helped) It was fairly obvious that this was to be done on ‘racial’ lines, or would it just be a coincidence that it was indigenous people?

      • And those who fail to learn from history are destined to repeat it I think I heard some smart guy say sometime.

        “Facile, polemic and inaccurate” Perhaps, but I was given a diagnosis for being “verbose”, and really don’t understand your terms. What I do understand is that in this system you describe as a bit of a mess, they are certainly looking for ways to save money and have they not in some ways adopted a system which looks awfully like the one used by the National Socialists?
        And while I don’t expect anyone to believe me Doc, one of your colleagues did try to knock me in an emergency department. I realise its not on a massive scale but I kinda liked my life the way it was before I was kidnapped, tortured and then they tried to knock me for complaining. Paranoid? You might want to check before slapping a slanderous label on me and drugging me to oblivion. Because once they did look it wasn’t just me who had been lined up for some unintended negative outcoming’. Lets start the count 1, 2, 3, 4, ….. Oh a ‘Bad Apple” an “isolated Incident”. Can’t blame the Doctor, his wife didn’t want to go to prison and ….. what would you do?
        That type of total disregard for the sanctity of life should be dealt with in my Book, not covered up by a Governement that has virtually no control over this industry out of control. And yeah, i’ve heard the excuses that i’m not a doctor and wouldn’t understand. Understand what? Those words that were delivered to Moses, thou shalt not kill? But we’ve found a loophole, were going to call it Voluntary Assisted Dying and make it sound humane. A slippery slope indeed especially with a Chief Psychiatrist who doesn’t even recognise the protections of the Mental Health Act
        From little things big things grow huh?

      • Just a little history lesson.

        There was a movement in Germany to make sure that the volk, remained pure. Volk is a difficult term for me to explain since I don’t speak German nor do I completely understand the philosophical background. In essence I think that it means that they wanted Germany to be totally Aryan(sp ?) in makeup. They didn’t want any “bad blood” nor did they want any weaknesses as they perceived things. Anyone who didn’t find themselves in this special group began finding themselves referred to as useless eaters and troublemakers. There was also a eugenics movement afoot, which was also afoot here in the United States. Germany praised us because of our sterilization of certain groups, particularly the “mentally ill”. There was a campaign carried out against “useless eaters” with posters and all kinds of other propaganda. The “mentally ill”, the Jewish people, gay people, Roma people, Russians etc. were all included in this group.

        But the group that they began killing off with impunity were the “mentally ill”. Everyone in an asylum had to have their cases reviewed by two psychiatrists. If you got one negative vote you were loaded up and taken to one of six cities in Germany. In each of these six cities the psychiatric community built gas chambers and crematoriums. The “mentally ill” were shoved into the gas chambers and murdered by exposing them to the exhaust from diesel engines. Later on they converted over to the zyklon (sp) gas that because the norm. When everyone was finally dead they’d drag the dead bodies of to the ovens for burning. Thousands of the so-called “mentally ill” met their untimely deaths like this. Later, the Nazis decided to use what the psychiatrists created to carry out their pogrom against the Jews and everyone else.

        This murdering of the “mentally ill in this manner continued on into WWII. Eventually it was stopped but this didn’t mean that the people in the asylums were safe. The psychiatrists in many of these places continued the murdering by starving people. There were American G.I.’s who reported going into the asylums in German cities and finding people dying of starvation, and they were starved on purpose.

      • No one here is denying the holocaust, but to use that as a measuring stick against other atrocities, I find disingenuous.

        In fact the, adjectives, Mr. Stasny used (facile, inaccurate and polemic) when the comparison was made between the millions of people whose lives are lost and squandered (and remains legal), and the Nazi era, those adjectives approach diagnosis. Facile is right next to non-reality based, as is inaccurate, and polemic is right next to what might be used to determine ODD.

        By this time, psychiatric drugging might easily have statistically shortened the lives of more than 6 million people. That’s also systematic, also uses the idea that those people have something wrong with them, and although it doesn’t outright kill them, it ignores the death toll caused by its treatments, which over the years has fooled even more people, or forced more people to follow its tenets, while its death toll continues, and is still in action, and is worldwide and more widespread than Nazi Germany was. To make the moral statement that “the systematic mass murder of innocent people remains in a category of its own” while such a systematic mass murder is going on, only clouded in medical treatment, and then to say that isn’t in the same category I find lacking. In turn, I what if a person who has lost a family member to psychiatry and its lies said about the holocaust: “the systematic mass murder of innocent people hidden as medical treatment remains in a category of its own, and to compare it to the holocaust of WW2 which was open murder I find unwelcome given that murder in the name of psychiatry is covert and thus more corrupt”?

        To name just one class of drug, neuroleptics, that have been proven to shorten a person’s life by 20 years, how many people over the planet (NOT just in Europe) have been put on such a drug, while evidence shows that in the long run they are ineffective? Despite an interim period where “symptoms” are suppressed, or rather trauma that needs attention, or simply room for cognitive understanding that need legroom are suppressed, in the long run the treatment is not only ineffective but corresponds with more relapsing, more cost, and personal and societal paranoia against symptoms that could have been understood, and loss of life.

        That and then the rest of the disabling agents that are touted as cures for emotions, when would one look closely at what this does in society, it adds to the dumbing down of a population that doesn’t acknowledge global warming, or when acknowledged doesn’t do anything critical enough to stop what could be stopped. THAT along with a whole host of other societal issues that aren’t addressed because it might cause discomfort that a disabling agent suppresses. This isn’t as bad as or worse than the Nazi era, which only lasted as long as it had, and is over with. The biological model of psychiatry (which is or during its tenure has been riddled with concept that can easily be seen as clouded versions of Eugenics, Racism, Misogyny, Homophobia, Classism, ) has been around MUCH LONGER than the Nazi era was. In fact it’s worldwide.

        In fact, given the psychiatric drugs Hitler was on, which was massive doses of “happy pills,” or methamphetimes, and the paranoia they created, along with their widespread use in Nazi Germany, there arguably isn’t even a separation between psychiatric drugging and the Nazi killing machine.

        Do a google search
        I did: “Hitler’s happy pill”
        and got a whole list of hits pointing this out
        You could also do
        Nazi’s and Methamphetamines
        of any other number of combinations

        There’s also the fact that Nazis who were put in jail for atrocities, and got out doing half time, then started Bayer aspirin, one of the leading proponents of the medical establishment’s newer aggressive take over of the market, such as we’ve seen with psychiatric drugging.

  1. I know too much to be involved in peer support. I dare not work with any agency because I actually know how to treat some of their patients, which will get me terminated, particularly if the patients I see greatly improve and the professional staff’s initial assessment was shown to be incorrect. This already has happened once, with alcoholics in residential treatment. And I’d have done it again, were I not let go. Fortunately, I’m now on Social Security, so treatment centers can shove it.

    • The mental health system literally held me prisoner. Do I want a job with its prison system? No, I don’t. Where, actually, one has to wonder, would so-called “peer support” be without such a prison system? I don’t want any sort of certificate that says I agree with this sort of thing when I don’t. People speak of recovering from mental illness when the real thing they must recover from is mental health treatment, torture and imprisonment under another name.Torture and imprisonment that is literally killing people. I’ve learned my lesson. Its time for another subject.

      • I feel that the core human wound is lack of connection–with others, with nature, and with the diverse parts of the self.

        Undoubtedly you are right about what happened to you in terms of the mental health system.

        I wound up damaged by it, too.

        Had I been told of an alternative to the hospital, where I could actually connect with people without being judged or given advice, things would have worked out differently and in my favor.

        This is how peer support ideally works, fostering connection. Note the word “ideally.”

  2. Wow! I love the vision of peer advocates who are knowledgeable about legal aspects of involuntary commitment, supporting peers through the degrading hearings, shaming court attorneys to do their job, helping to identify resources for individuals seeking non-drug/non-force alternatives in their community. What a positive vision!

    • Also a common delusion, which ignores the fact that the purpose of psychiatry is social control, and that “peers” who don’t get with the program will be ex-“peers.”

      Looks like a perfect conversation for Stephen Gilbert, wonder if he’s around…

      • Yes, but I decided that I just didn’t have the energy to get into this. The authors are basically correct in their assessment that they made here. Peers cannot do peer work in institutional settings. Your job if you were in these places is to emphasize to people that they must take the drugs, no questions asked. You cannot advocate for people directly.

        These institutions are basically run by the psychiatrists and even if you have a good administration, as I’m lucky to have, they refuse to go up against the psychiatrists or to call them into question. As a peer, if your truly believe in real peer work (because there are peers and then there are “peers”) you watch fairly helplessly, as people are doomed to the ongoing destruction of their lives and you can’t do much about it, if you want to keep your job. So, you know that you’re part of the system that carries out this ongoing destruction. It doesn’t make you go home in the evening with a happy attitude. I can mitigate some of the destruction but I can never stand up and say that if people truly want to find their lives and begin making their own decisions they’ll probably have to get off the drugs they’ve either been forced to take or convinced to take. I seldom use the word depressing because it’s a term used by what I consider the opposition or enemy camp, but it is terribly depressing.

        • I want to make it clear that I never tell people that they must take the drugs. I say absolutely nothing about the drugs, period. I do advocate for people but most of it is in indirect ways. I am successful in the small things that I attempt and most of the staff, outside of the psychiatrists, don’t oppose me. There are more and more staff who don’t believe the lies that psychiatry pushes but they can’t do as much for people as they’d like because their jobs become the bargaining chip. But it is heartening to know that the numbers who don’t believe the lies is growing bit by bit.

  3. An excellent article Dr. Stastny and Darby. These insightful changes are much needed as peer staff having to go with the “status quo” have their hands tied to provide any genuine help. Support is good but peer specialists must be able to actively advocate as well.

  4. “It is time to seriously consider re-focusing our energy and resources away from placing peer staff in roles where they support the mental health system’s status quo, and toward the goal of making high-quality peer advocacy available to people faced with coercion by the mental health system.”

    I agree, they’re still promoting the “chemical imbalance theory” in peer training, a theory which was debunked decades ago. This is shameful. But the real solution is to take away the right of the “mental health” workers to coerce or force their neurotoxic poisons onto innocent human beings, for profit.

  5. Of course, institutions meant to help people shouldn’t be riddled with pundits who, although advertised as peer support specialists, only tout what they’ve gotten rewards for repeating or punished for would they not repeat.

    But this is a little bit like saying that gang members shouldn’t do drugs, shouldn’t be robbing stores and should instead be gardening, going hiking etc.

    Give them something else to do. Someplace to go.

    Psychiatry exists only because society doesn’t promote people simply listening to each other, anything out of the norm is met with alarm from the person experiencing it to society’s inability to want to understand it.

    If society didn’t make people alarmed about normal emotional responses that go against the grain of indoctrination or dogmaticism, if society didn’t find fault with mildly extremist behavior in stark contrast to the extremist alarm going on in society finding fault with such behavior, no one would be looking for help from what creates such faulty peer support.

    • The drug companies act like a drug cartel. There’s a famous book about that whose author I can’t remember, but I was surprised to find that all you have to do is do an internet search for “drug companies act like a drug cartel,” and you get a lot of hits.

      That’s gang activity. And I’ve read many evaluations of psychiatry that parallel their behavior to that of pushers, the way they get people addicted, and how they promote the drugs as a necessary remedy which pushers do the same only calling it an escape. Only it’s from the other side of the ballroom: one legal the other not.

      And now Portugal legalized “illegal” drugs which brought the amount of abuse down, I understand. This makes me wonder whether making psychiatric drugs over the counter (I’m just wondering what that would potentially do), which then would leave people with themselves to talk about regarding its effects, and regarding the side effects, as well as withdrawal. They then wouldn’t have a doctor to have to deal with at all, and neither a psychiatrist. And they wouldn’t have to exhibit behavior that would need approval from the psychiatrist (or social worker, or perhaps even family and friends) in order to make their own decisions regarding the effects of the psychiatric drugs. I wonder whether that would promote a better understanding, as well as discussion at all levels of society, including peer support, as to what those drugs really are doing.

      I don’t know, but the preponderance of people who are supposedly touting “objective” truths about drugs when would they speak negatively about the drugs, they would be met with disapproval and labeled as further diseased: if their experience with the drugs weren’t at such a level, and they truly were free to speak to peers, not having to deal with others called authorities evaluating whether the drugs changed their behavior, whether then things would be different, and to what extent.

      And, regardless of whether the drugs are over the counter or not, people should simply be able to speak about how the drugs effect them, and also have enough informed consent that they can recognize effects the drugs could be having, but then the whole scenario would have to be changed. And the focus wouldn’t be on changing the person or getting them to adapt to a society (or a gang), or eradicating behavior that’s challenging, but listening to them.

    • To make this discussion completely psychotic, not because that’s a disease, because it involves the imagination; and since psychiatry actually is illegal, would one honor the basic tenets of the law regarding harming another or using force that harms another: and would that be uncontaminated with precepts such as a person being a harm to themselves or others, when the implementation of such precepts really statistically has caused more harm to the people seen as a danger, it becomes clear that psychiatry is operating quite illegally in many ways. And to protect people from supposedly doing harm to themselves or others ends up causing more harm to themselves and others. Very much how gangs also operate.

      How do you stop gang behavior? I think that comes from places for youth to go, centers where they can play sports or perhaps get involved with art, social places where they aren’t judged, it’s said that more trees, and parks, and more green from plants helps, there even was an experiment where people prayed regularly, this in Washington DC and the police at first poo poohed it, but crime actually went down to such a degree they asked for it to be repeated. I think that’s a lot like changing society in a way that people are simply listened to, and have a place to go. That they have a place to go rather than have their need labeled as deviant, or diagnosed as symptoms of a disease, that with all of the social parameters of marginalization overlooked.

      And since we are actually talking about illegal behavior, regarding psychiatry, although this is given the facade of being legal, in practice. Were the letter of the law actually honored it wouldn’t be legal. Then changing the nature of peer support, is actually something quite profound. That a person should be welcome to be able to point out what is illegal transcends simple peer support. And not changing that is a bit like when you want to change the social precept governing gangs (because they are illegal, so what governs them is “social” not legal precepts) and that a gang member who would be allowed to be a gang member should only be allowed if they promote other kinds of gang activity that are less rapacious and more non violent. Are the leaders of the gang going to welcome this with open arms? And this doesn’t seem to necessarily work as well as preventing the forming of gangs to begin with.

      But those are just my thoughts, trying to gain perspective using imagination which is subjunctive and entertains potential.

      But yeah, peer support people should be able promote something other than the whole model that’s coerced and forced on people as a cure they aren’t allowed to dissent from nor are allowed to point out its ineffectiveness.

      And with that I am rather blogged out here.

  6. Today’s false words – mental health care – remind me of the false words – on the entrance of Auschwitz and other concentration camps – Arbeit Macht Frei- (work sets you free)
    I am also the son of Shoah survivors .My mother who was transported to Auschwitz from the Lodz ghetto survived 14 selections . I am a psychiatric survivor . If all the psychiatrists in the world experienced what I have , those that survived would maybe understand the crimes against humanity they have committed .

  7. Excellent review – much thanks.

    Question: what do you think about the formation of state-based trade associations for peer workers to represent their individual and collective interests to employers, such as misuse of skills? (I’m not stating the problem you assert sufficiently, but you get the idea.)

  8. The article ends with:

    It is time to seriously consider re-focusing our energy and resources away from placing peer staff in roles where they support the mental health system’s status quo, and toward the goal of making high-quality peer advocacy available to people faced with coercion by the mental health system.

    But who exactly is doing the “placing”? Doesn’t the hierarchical nature of the system prevent this from happening? I doubt that peer staff will ever be “placed” in any position where the hierarchy can’t control them.

    As Paulo Freire wrote in Pedagogy of the Oppressed, “Freedom is acquired by conquest, not by gift.” No one in power will ever “place” you in a position of not supporting their status quo.

    Seems like an act of futility. It’s better to spend the resources on ending the system of oppression rather than in trying to fix it from within. There may be dissidents in the system, but they are few and far between and have relatively little power.

    A good defense attorney with a solid background in civil rights is the only true advocate of someone locked in a psychiatric prison. Resources should be spent on defense attorneys so that everyone facing forced treatment has a real advocate.

    • “A real advocate”?

      The Mental Health Law Centre where I live conspires with authorities to conceal criminal offences. They are quite prepared to accept fraudulent documents and then throw victims under a bus with claims they don’t know what a burden of proof is. And then of course any attorney you approach gives them a call to further slander you. When they say “there may be things we can’t discuss with you” they’re talking about the fact that they are not actually acting as your advocate but ensuring that when the knife goes in to your back it hits home. Disgraceful people whom i hope sue me for speaking the truth, because I have a defense. And I don’t think the Chief Psychiatrist is too impressed with their uttering of documents purporting to be from his desk. More cover ups, when does it all end?
      I can not believe that the response to my complaint was written by the Chief Psychiatrist, he believes that AMHP s can travel through time and space and read minds? No, this was done on instructions from someone else right? Start with getting his name wrong and head downhill from there. The reason for the delay (of 14 months) was because the manager was on holidays over Christmas. Regarding the drink spiking with benzos I dunno, nobody wrote down what they did so I guess its a mystery forever more. And I’ve rewritten the law to enable arbitrary detentions of citizens because those stupid law makers have got no idea how difficult it can be when citizens need to be shut up. Nah, he isn’t that stupid and nor were the people at the Council of Official Visitors who took his offensive letter to him, and then ran away. Wasn’t your huh Doc? The frauds at the Law Centre acting on instructions?
      Yep, I don’t think anymore, I know. Conspiring to pervert the course of justice. Well, except these people are above the law and will under no circumstances be held to account. They won’t even deal with the Nurse who is authorising the use of known torture methods and kidnapping folk by procuring police services with ‘throw downs’ and ‘spikings’.
      I mean given the way I feel about psychiatry I wish it was the Chief Psychiatrist but ….. credit where credit is due. This was people who were out to conceal crimes, and it was designed to cause me serious harm, by people with an intimate knowledge. They sure have got him a bad name around town though lol. Coz a lot of people have looked at ‘his’ letter and must be thinking “What? This is absolute rubbish” More than thinking it, i’ve heard them say it lol.
      Section 28 of the Corruption and Crime Commission Act. Mandatory reporting of suspected offences carrying a prison term of more than 2 years. Serious misconduct if you don’t report. Procuring the apprehension or detention of a person (ie Me) not suffering from a mental illness, prison tern 3 years. Hmmmm One of these things belongs with the other one Doc.

      If that weren’t bad enough our newspapers are sitting on a bunch of hospital cover ups that have been silenced by the government. Not in the public interest to know whats really going on in our hospitals, despite the fact that its us paying for it.
      I wouldn’t be too quick to place my trust in attorney in my State anytime soon. Because they are not representing their clients but the interests of power and priviledge. Still, by the time folk figure it out they can always claim “it was soooo long ago”

        • Bruce Ennis is dead I believe. And you probably named the only other two (& I doubt Tina does court cases). Lawyers are unable to adequately defend psychiatric cases; they always end up making deals to get you the best possible “treatment,” and are clueless as far as opposing psychiatric ideology and rhetoric. First THEY need to be educated by US.

          • Yes, I’m aware that Bruce Ennis passed away. I was using him as an example and an ideal. He was very aware that psychiatry was – and is – racist, misogynistic, and at that time, relying on unpaid patient labor to run the state hospitals.

            In fact, in his book Prisoners of Psychiatry: Mental Patients, Psychiatrists, and the Law, he writes, “Abolishing patient labor, or requiring hospitals to pay fair value for that labor, would shut down the hospitals in several states.”

            And he knew that “mental illness” didn’t exist and was being used to incarcerate people unjustly. In an interview with Leonard Roy Frank in the Madness Network News Reader, Bruce Ennis states, “I personally have seen no evidence at all that there is such a thing as ‘mental illness.’ I have seen people who behave in ways that seem to me most strange, that I can’t understand, and that I do not approve of. . . . but to call it ‘mental illness’ seems to me to be an inductive lead that is not justified by any evidence.”

            As far as the statistics go, according to Ennis, “Studies at Bellevue, for instance, show that if you have a lawyer at your commitment hearing, the chances are about 300% greater that you will not be committed than if you don’t have a lawyer.”

            Oldhead, I hear what you’re saying about “making deals to get you the best possible ‘treatment,'” but consider how rigged the criminal justice system is regarding how few people have any real legal counsel whatsoever (see this report from Human Rights Watch – “An Offer You Can’t Refuse: How US Federal Prosecutors Force Drug Defendants to Plead Guilty” – https://www.hrw.org/report/2013/12/05/offer-you-cant-refuse/how-us-federal-prosecutors-force-drug-defendants-plead).

            And meanwhile, the makers of the neuroleptic drug Zyprexa – a drug that according to Dr. Peter Gøtzsche has killed 200,000 people worldwide – go free.

            These systems of incarceration – the legal system and the parallel police force known as psychiatry – are both out of control as the US Empire becomes more and more authoritarian.

            I agree 100% with you, Oldhead – we do need to educate them. There have only been a handful of attorneys who left legacies of true human rights work. But the fact that they did gives me hope that others will follow in their footsteps. That’s why I wrote about channeling resources in that direction.

            Since most of the people who write for MiA are also in the “better deal” camp – even with all of the information here that speaks to the moral justification for psychiatric abolition – it’s easy to see why the concept of civil rights falls on deaf ears in venues with less information.

            There’s clearly much work to be done.

          • Didn’t know Bruce was so clearly skeptical of “mental illness.” This should be a starting point for ALL psych attorneys to understand — that they are dealing with fraud, not “bad medicine.”

          • Yes, Bruce Ennis was very skeptical of “mental illness.” In fact, Dr. Thomas Szasz wrote the Introduction to Ennis’s book Prisoners of Psychiatry.

            And you can see Szasz’s influence in Ennis’ writing. I think Szasz should be required reading in law school (and in all academia, for that matter).

        • My Government has got covering up down to a fine art anomie. Oh what i’d give for access to effective legal representation

          As I’ve stated elsewhere they have the right to ‘coerce’ attorneys, doctors and priests in order to have them breach confidentiality. Most seem to be prepared to tell them what they want to know when their families are being threatened. (Ses for example Gobbo a lawyer who was also acting as a paid police informant)
          Then we have the newpapers/journalists who are not allowed to publish anything that the government doesn’t want published lest they be sent to prison. They even collectively printed a blank front page last week protesting their lack of rights to publish information from whistleblowers.
          Our Prime Minister claims we need to strike the right balance. This seems to be that wholesale corruption ion our hospital system is a no go for publication, and they have said that this particular area is one that they are being silenced on.
          The right to know? When it’s completely out of control, and they are doing nothing more than cover ups? It will take some brave journalist to expose that without ending up being unintentionally negatively outcomed, and have his/her family ‘fuking destroyed’.
          So, denied access to legal representation, denied access to a voice, denied access to your own property and family, denied access to your human and civil rights its not looking good.
          I know that the things I have written here sound as if I may be mistaken and in fact i’ve been positively slandered for some of it. But let me say that if you don’t check first you might find that things are a lot worse than you thought.
          The State government has been tying their corruption up in the State watchdog as a means to silence anyone who is the victim of corrupt public officers, Its fairly easy to do. And goes against everything it was set up to do in the first place. Even the PM has labelled them ‘kangaroo courts’.
          What I find disgusting in my instance is that they have even managed to silence the use of a known method of torture. This despite ratifying the Convention which has a clause stating there is “no superior authority” and “no emergency provisions”. The State watchdog would be breaching the Convention by holding up any complaint about the use of torture. Still, not a lot of complaints about the Waffen SS got thorough to the authorities either. The words “insufficient evidence” are the standard outcome despite having what a lawyer called “proof” (note not evidence but proof). You know like the documents that say I was spiked with benzos that the police were set to retrieve? How corrupt does it need to get? Its clever using hospitals to torture and kll any inconvenient truths and it is obviously alluring for governments who find themselves in positions where they might be embarrassed, and with the Devil in your ear that theres a means to silence it all available …… glad it’s not me being tempted.

          Being able to do cover ups by killing people in hospital Emergency Depts is highly effective though. Especially when the reporters are aware it is going on and can’t write a damn word about it. It’s being left to doctors who “don’t have the stomach for it” to pick up on when its going to be done and interrupting the outcoming. It’s quite surreal to explain this stuff to police only to have them tell you “it might be best I don’t know about that”. This because pursuing euthanasing “patients” is “not in the public interest” The proverbial ‘blind eye’.

  9. Thanks for this thoughtful article about reviewing the peer specialist role. A recent article by the Executive Director of iNAPS suggested that all too often peer specialists are co-opted into being “clinical peer specialists.” Proper training and supervision for peer specialists may contribute to helping them resist falling into the medical trap. Would you be willing to have your article reprinted in our non-profit’s The Peer Bulletin Magazine”? We’d provide appropriate citation, author biographies, and send you a copy when published.

  10. I appreciate hearing the history of peer support, and of it’s problems in terms of being co-opted.

    Actually, the history was a little off. I was a member of Mental Patients’ Liberation Project (not your mentioned “Alliance”). Back in the 1970’s (before the ’80’s that you mention) we ex-mental patients did advocacy work in the hospitals, even though we were not highly trained, nor was there a legal system to support it then.

    When I consider my experience at the Woodstock Festival of Peace and Music, 50 years ago, it was not the music that was most important for me. It was the brotherhood/sisterhood. For example, many tents were destroyed during the storm. This was not a problem because your brother or sister nearby had a tent you could hop into.

    For me, this was the proof of what human nature is about. We’ve slipped far away from those ideal times, but since it happened, it can happen in the future–a day I hope to see in my lifetime. When this happens, we will not longer need “peer support.”

    What does it mean when someone is trained to be a peer and the person helped is not trained, but going through difficult life experiences? A “trained peer,” to me is at a different level, no longer a “peer.”

    I think Sera Davidow discussed this quandary in this article: https://www.madinamerica.com/2017/04/downfall-peer-support-mha-national-certification/

  11. I would have to say that I have all too often seen peer workers push unwanted treatment on people. If the peer workers are working for the hospital, then naturally they’ll be hired to work to the hospital’s financial advantage.

    I see an issue with defining good health with more consumption of medical services. Maybe it’s good financial health for the institutions and providers.

    I was saddened to see on a forum a bunch of peer specialists saying that if their jobs were canned they wouldn’t be able to get jobs anywhere else. They defined themselves as unhirable. This saddens me, since many of these capable people would be welcome in other workplaces, doing completely other things. Isn’t it time that survivors got themselves hired doing something besides working for the MH industry?