Ronda “Ro” Speight is a mental health peer specialist and recovery advocate at the Mental Health Association of Westchester in Westchester County, New York. She is a person with lived experience with the psychiatric system and a trained co-facilitator in an innovative approach that combines peer support and principles of the Open Dialogue approach called Peer Supported (Partnered) Open Dialogue (POD). POD is currently being tested in a large randomized clinical trial in the UK.

Ro was a service recipient in the Parachute Program NYC, which provided mobile crisis services and implemented respite centers in New York City—combining Intentional Peer Support and Open Dialogue informed practices. The Parachute program was discontinued, but the peer respite model it introduced in New York continues to exist. Her engagement with peers in Parachute shaped her views on mental health care and inspired her to pursue a career as a peer specialist.

Identifying as a person of color, Ro was profoundly affected by her mother’s professional success as a clinical social worker who holds a doctoral degree from the University of Pennsylvania. She is highly aware of the obstacles women of color face in society and brings a racial justice perspective to the highly innovative practice of Peer Supported (Partnered) Open Dialogue.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Ana Florence: How did you become a peer?

Ro Speight: That is a loaded question. I went through a lot of struggles throughout my childhood and young adulthood. I had my first hospitalization in the end of my 20s. I then found myself in and out of hospitalizations and outpatient programs. I finally landed on the Parachute program, once I moved to Harlem, New York, and really was struggling,

I was hospitalized, and someone from Parachute came into the inpatient unit and introduced the program to me. I thought, “this sounds different.” I heard things like “social network meetings.” I heard things like, “you’ll have a say in your services,” and “you’re a part of the process.” All of that seemed new after several hospitalizations, and I was interested once I heard about it.

After that particular hospitalization, I enrolled in Parachute and was a participant, engaged with peers for the first time, and was blown away by the boldness, the confidence of that approach, working directly with a peer as a part of my team. I would meet with them weekly and also see a therapist or more traditional services.

I think for me, personally, what crystallized the peer role in my mind was going to the respite. I stayed there for a week. That was a week of just engaging with peers who worked at the respite and having amazing conversations, wonderful conversations that I had never had with people who “had lived experience” either similar to me or very different than me. Also, just a footnote about Parachute, it was a program that primarily worked with people who had psychosis—of course, we could have a lot of debates about that language.

I was able to connect with people in a different way. I stayed there for that week, and I really was attuned to the people who worked there as peers. I still had a long journey after that. There were other hospitalizations. I moved out of Harlem and got connected with more traditional services after subsequent hospitalizations.

A therapist that I was working with talked to me and suggested: “you know what, I think you would be really good as a peer.”

In the back of my mind, I was not really remembering Parachute; I just thought, “are you kidding me?” No way! You are suggesting that I talk about my story and that I connect to other people who have lived experience in a professional context? So, the idea was not really alluring to me, and I was quite hesitant.

But he kept suggesting it, and I got to a point where I thought, “Okay, I need to think of something that I have to do after this outpatient program.” So, I looked into it and enrolled in the Mental Health Association of Westchester peer training program in 2015.

 

Florence: Was there a big contrast between Parachute and your hospitalizations? What would you say are the main differences that made you like the Parachute program more than other traditional forms of care?

Ro: What was so cool and great about it was that I could wake up in the morning, and I could leave. I was in Manhattan, and I could go to the convenience store, and I could go to the park that was down the street.

I was at the height of a lot of intense experiences, and I had a long list of psychiatric diagnoses. I was able to go about my day and experience my day the way that I wanted to, and if I wanted to have the support and needed to talk to a peer, I could come back from getting a coffee and sit down and have a conversation about what I was going through.

And not have everyone scared about liability. I don’t think anyone wants to be in harm’s way, but it wasn’t like this impending, “my gosh, she’s leaving, you know what’s going to happen!” So, it was very different than hospitalization, and everyone was just so cool, so supportive. Everyone had time. I think that that’s really important because I think in a hospital, you don’t feel like people have time all the time they need to support you.

 

Florence: How have you interfaced with the psychiatric system before Parachute?

Ro: Yeah, it was difficult. You always think that hospitals are going to be a place where you’re going to get support, and you’re going to be cared for and taken care of. When you have physical ailments, and you go to the ER with the issue, hopefully, you’re coming out either feeling better or at least having some assurance that you can go about your life with some optimism. With psychiatry, of course, and mental health issues, I think I had a rude awakening.

When I had my first hospitalization, the rooms were cold, and there was no television, no type of entertainment, and no internet. It was very sterile, and I realized very quickly it was not about comfort. So, my first-time interfacing with the psychiatric system was really, really harsh. It was also shocking because I grew up with a very different ideal of mental health.

 

Florence: I wonder if there was a moment in your recovery journey when something worked for you.

Ro: When I reflect on my whole journey, from the beginning to now, I think what shifted was about dialogue and having my supports all be on the same page. I am understanding that it wasn’t just me and that it could be that my community or my family factor into why I experience the things that I experience. So, there isn’t one particular point, but I think things started to shift when other people and other factors were added to the conversation other than myself.

 

Ana Florence: One very innovative thing that Parachute did was combine Open Dialogue, which was, in its origins, a clinical approach, with the tradition of peer support. So, you experienced that same approach and then went on to become yourself a POD facilitator. How did that happen?

Ro: I am wondering the same thing! Yeah, that’s the stuff that, there’s no way of plotting that out. To go back to Parachute quickly—along with having a robust respite, they had amazing, fierce, passionate peers.

My mother and I would have social network meetings as frequently as I wanted them, and I think we had about maybe four or five social network meetings. I think that planted the seed. It was being able to hear my mother for the first time, without us arguing, without us having a lot of rage against each other. We had really developed a pretty toxic relationship over the years. By the time I started getting hospitalized—and definitely by the time I was enrolled in Parachute—our relationship was pretty toxic.

In the social network meetings with Parachute, my mom was sitting at the table, I was sitting at the table, the peer was sitting at the table, and everyone was at the table, so there was no hiding. I was able to hear my mother, and my mother was able to hear me in a safe space.

You are absolutely correct that it wasn’t quite POD, but it pulled from Open Dialogue and need adapted treatment models.

 

Florence: I wonder if you could tell me what your day as a peer specialist looks like? What is your work like?

Ro: After the Parachute experience, it was a good five, six years that passed before I went and completed the peer training. I became a peer specialist, got certified in New York, and just started doing the work.

That’s when the passion came alive in me. I guess I found my lion’s roar, because all of my experiences—in a way unbeknownst to me, of course—led up to me being in a position where, not only did I get trained to be a peer for MHA Westchester and certified in New York State, but I was able to meet Cindy Peterson-Dana. Together, through MHA Westchester, we started focusing on POD and trying to figure out how to develop a way of experiencing it, learning it, with the highest regard for the mutuality between a peer specialist and a clinician, or any other mental health professional.

When I think about implementing the practice of POD, it’s about developing relationships with the people that you’re working with. It’s not about trying to stay so peer that you miss out on the opportunity to connect to and relate to the very best that a clinician or a mental health professional brings to the table for support.

I’m very aware and conscious that there are many different opinions out there about peer and clinician relationships. I respect those opinions. But there’s something that happens when you’re working with families, and they’re not only seeing the clinical perspective, but they’re also seeing the peer perspective equally. That is the key component. In POD, we aim to have equality. The peer perspective that is shared in the social network meetings is equally valued with the perspective of whoever else is in a more clinical role.

 

Florence: How do you think this way of working rebalances things between the person at the center of concern, their network, and the clinicians? How do you view this relationship between peers and clinical professions, and this issue of power that plays in treatments?

Ro: It is tough. Probably when people think about a peer and a clinician, well, obviously, the peer is not going to have that much influence because historically—and it’s very heartbreaking—the clinical role has had that dominance.

In POD, and I hope this is clear, we try to break down the power differentials. The emphasis is on the peer perspective being equal and on tolerating uncertainty—which is a feature of Open Dialogue—and allowing that to exist while being mindful of safety.

I have had many meetings where a person might bring up thoughts of wanting to harm themselves, or where there were some concerns around that. We don’t neglect that. But we’re not going to freak out and immediately jump in and call the cops. We want to hold space for dialogue.

I think one of the most compelling components of POD is that it allocates space in the conversation to get an understanding of what is needed the most. If that is a decision for someone to go to the emergency room, then fine, and if that’s mutually understood, or agreed to, that will be one of the outcomes, but we don’t lead with that option.

The clinical perspective is there to do their clinical assessments and tolerate and partner with the peer perspective. We’d rather hold more uncertainty and feel okay about it then hold too little and then making decisions out of fear. I think that the psychiatric community historically has reacted out of fear instead of out of a response.

 

Florence: I was wondering if we could focus on the relationship between clinicians and peers. As you know, there is a lot of controversy in both worlds. The Open Dialogue world may consider itself a clinical approach and may not be willing to incorporate peers into that practice. In the peer world, sometimes partnering with the clinician can be seen as something bad or a way that peer work gets co-opted or how peers start acting like clinicians. How do you see that relationship between clinicians and peers, their roles in this, and these problems that I just raised?

Ro: I am going have to go back to my history, and I hope that the community out there can hold space for my personal history. I was raised by a mother who was a clinician who was getting her doctorate while I was eight or nine years old. I really held what she did with such high regard. I saw her level of commitment and dedication with the people that she was working with, and that was part of my lived experiences in my childhood.

There’s another element to this that lays the foundation for why I have the perspective that I do and the passion that I do. I identify as a person of color. My mom is a person of color. She built a legacy from her work that stayed with me. I saw her working until midnight on her doctorate. I saw her private practice and saw her commitment.

So, my perspective was that a clinician wasn’t this scary individual that I automatically had to be defensive around. Now, of course, that changed as I went through my journey. But for me, personally, I can’t vilify clinicians and people in the clinical community because I saw what my mother went through, I saw her labor as a person of color getting her doctorate. She eventually became a dean; she built a life, and I think left a legacy through her commitment to being a clinical social worker.

I think that’s important for people to understand and that it factors quite a bit into my perspective. I have to respect her legacy and the sacrifices she made to put all the work into doing that. What she did and, you know, really having that level of commitment for the field. This is my own personal anecdote of what might have shaped a lot of my perspectives.

Fast forward. I am interested in working with clinicians because it is so elusive. People don’t want to do it, and I say: “Okay, why?” Why are we resisting this dynamic? If we have an opportunity, if we’re getting certified, if we’re getting trained, if we’re able to try and make a decent wage out of supporting people and offering another way of looking at things, why be against the very people who are a part of the process?

I just became curious about that; I became curious about where the peer perspective fits. Because obviously, it’s necessary. With Parachute that was very clear to me. This is imperative, and this is a view that needs a platform.

Unfortunately, for better or worse, creating that platform sometimes involves being a part of the same system and structure that historically has oppressed peers. I say that with caution because I’m aware that I would never want to feel like I’m oppressed or marginalized in my role. I try my best not to be. I think I have a very loud and clear voice, and I will disagree with something that I don’t agree with. But I have that position to disagree. I think that is important. It is important that peers who are working within the clinical context at least have the opportunity to represent the lived experience perspective.

 

Florence: I wonder if there are difficulties on your day to day that are related to that dynamic and how do you experience that.

Ro: There are tons of difficulties! This is not easy. Advocating to build a relationship and to change the conversations that are happening, all of that is uphill work every single day.

Luckily, I’ve been able to help create spaces where I’ve been able to partner very successfully with other clinicians and even a psychiatrist. They started to see the value of the peer perspective and started inviting me into conversations. I think a part of that was because I was so strong-willed. That’s where I began to develop my voice, and my voice got stronger.

Coming from that space, I developed a sense of confidence. My voice matters and can make a difference and be helpful. If there are negative experiences, why can’t we go in there as peers and bring our voice to the table? We can inform people who maybe don’t even know anything different.

A lot of clinicians and psychiatrists have been taught in a certain way, and that’s all they know. And I think in bringing the peer perspective, you’re bringing something new and offering the opportunity to inform people.

 

Florence: It feels like there is a long way ahead of us, and there are many challenges. I wonder how you see the future of POD. Do you think it will expand outside of these small initiatives, or are these very localized experiences?

Ro: I think it has every possibility of being implemented. I just think that the right individuals have to support it. I want to make it very clear: POD comes out of Open Dialogue, but it’s very different.

As I mentioned, the peer perspective is completely encouraged, supported, and necessary for the facilitation of the meetings. There have been variations that we’ve done with groups. We’ve done POD groups with people who might not necessarily have a family or identify social supports, but the group itself becomes a social support structure. I’m willing to do things differently!

I want to get in there and acknowledge that we traditionally and historically have been at odds with one another and, even personally, I’ve been at the receiving end of some horrific decisions from clinicians and psychiatrists. But I want to understand where they’re coming from, and if we can work better together and support a family and an individual better together, then why not do that? Why not make that possible?

So that’s where my passion comes from. I think there’s strength in working together if it’s done correctly, and I think POD is one of the most successful ways I’ve seen it done.

 

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Image titled “Day 182.5 from 2010” by Ro Speight

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MIA Reports are supported, in part, by a grant from the Open Society Foundations

12 COMMENTS

  1. Such a powerful and moving description of the value of peer-professional partnerships in dialogic work. POD facilitators that include a 50:50 balance between peers and other professionals seems to be a great way to both help prevent the cooperation and tokenization of the peer approach and to address the balance of power in social network meetings.

    • “But he kept suggesting it, and I got to a point where I thought, “Okay, I need to think of something that I have to do after this outpatient program.”

      Not the best way to go about finding a job, but a way that most probably do it, although sometimes, it can actually become something one practices, leading into something positive within a tired and sick system. As long as one does not become part of the system without knowing what is transpiring.

      “The clinical perspective is there to do their clinical assessments and tolerate and partner with the peer perspective. We’d rather hold more uncertainty and feel okay about it then hold too little and then making decisions out of fear. I think that the psychiatric community historically has reacted out of fear instead of out of a response.”

      I’m glad you referred to it as a clinical “perspective”, and not actually more than a “perspective”. I suppose it would be difficult to allow the subject’s perspective have any true meaning. It would seem that the clinical perspective overrides most other perspectives and it only allows for voices to be heard, but not ultimately have power.

    • “a 50:50 balance between peers and other professionals” would NOT be “a great way to both help prevent the cooperation and tokenization of the peer approach and to address the balance of power in social network meetings.”

      Because the peers are the lowest rung on the “mental health” industry’s caste system, thus would have no actual power or authority within that caste system. And because the “mental health” workers still believe their DSM stigmatizations are caused by “chemical imbalances” in people’s brains, despite the “chemical imbalance” theory being debunked.

      https://www.psychiatrictimes.com/view/debunking-two-chemical-imbalance-myths-again

      I know this is true, since I went through a peer training class, and they are still promoting the debunked “chemical imbalance” theory in the peer training classes.

      There should be options to help distressed people, that are completely controlled by peers. True alternatives, not controlled by people who are obsessed with calling themselves “professionals.” “Professionals” who are actually people who know nothing about the common adverse effects of the drugs they force onto innocent others. “Professionals” who also know next to nothing about how to wean people off those neurotoxic drugs.

      • I hear you and would want a peer partnered dialogic approach such as Intentional Peer Support combined with a humanistic and systems oriented therapeutic dialogic approach (not biomedical type of practice) which I have found helped our family keep my young adult son out of the hospital completely many years ago and as a result he never landed in the horrible system you describe. I also have experience with the medical models‘ dominating and closed minded and sometimes horrible practices… I think all types of systemic power and compensation need to be equitable between peers and other professionals. Thank you for your thoughts.

  2. How and why do you not include the banker, the financial system in some of these meetings? Our non-profit had started the Peer Program, but without the appropriate resouces to grow salaried positions, then how could one ever expect real empowerment in the State where Lincoln was from? Withe the death of Ginsburg, I suspect the PAC money is pouring in to the coffers, but that does not necessarily mean WISDOM in rulings and votes!

    • Yes, agree that the economics of for-profit health”care” including the medicalizing of mental health”care” has led to the co-optation (and colonization) of the wisdom of lived experiences. Big Pharma and the Big Healthcare Industry profit from the status quo. This is a huge problem, driving so many other oppressive forces including robbing us in the U.S. of the last bits of our democracy with Citizen’s United in 2010 and now the loss of RBG:-( Systems of power are all related. Thank you for speaking to this one, perhaps the biggest and most inequitable of all!

  3. At one psychiatric clinic that I was at for a long time, I was forced for a time to go to “peer counseling.” They all believed in the medical model of “mental illness.” They didn’t seem like particularly bad people, but none were helpful. At least one of them took the position of an adjunct clinician “helping” an inferior.

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