Does Official Recognition of Peers Undermine Their Work?

Peer specialists’ role under Medicaid-managed care: Concerns voiced by a senior peer specialist and recovery advocate working in New Mexico.

32
1241

Peer support specialists are individuals who have had experience with emotional distress, trauma, or other emotional challenges and have been trained to assist others experiencing emotional distress. Peers’ interventions improve self-esteem and confidence, the ability to bring about changes, and the feeling that treatment is addressing the real needs of individuals.

In the past few years, peer support specialists have been officially recognized as essential figures by Medicaid, managed care organizations, and other public health institutions for the delivery of integrated and coordinated behavioral health services.

However, this substantial progress is just one face of the coin. With institutional recognition comes also the risk of loss of identity. Recognition of peers’ official role under Medicaid could undermine the very nature of their interventions by morphing them into a hybrid of traditional medical and clinical recovery principles, structured and supervised by “mainstream” trained clinicians. The result could be the loss of peers’ identity and functions.

This article intends to spearhead a dialogue on the critical issue of maintaining the integrity of the original peer support model.

The role of the peer specialist

Although the recovery movement is not a single entity and includes a variety of approaches, the role of the peer specialist has gained prominence, showing promising and concrete outcomes.

The role of peer specialists is based on the principles of recovery, which are essentially different from the medical model. The medical-biological model views mental illness and diagnosis as a lifelong combination of symptoms and behaviors, which impact one’s ability to manage basic milestones, adaptation to change, and any other essential tasks.

However, the recovery movement provides solid evidence that individuals with a history of emotional distress, commonly labeled as mental illness, can overcome the challenges they face and recover from their negative effects.

Recovery, essentially, is about cultivating a sense of hope, developing a realistic understanding of one’s abilities and challenges, engaging actively in life, fostering and maintaining a deep sense of autonomy, personal and social identity and purpose in life. To attain these goals, individuals in recovery acknowledge the importance of freeing oneself of the conceptual constraints of the medical-biological model, which views emotional distress as a chronic condition from which it is impossible to heal.

Peers focus on assisting others in crafting their own recovery goals; they provide constructive feedback for developing, learning, and practicing new skills and strategies; they communicate a sense of “realistic hope”; they share coping strategies and provide help in monitoring individual progress; they encourage others to advocate for themselves.

Moreover, they encourage input from consumers for the development of recovery plans focused primarily on coping successfully with challenges to achieve the best quality of life possible. These fundamental core competencies are pivotal to the attainment of positive outcomes.

Within this framework, emotional distress is not viewed as a chronic biological disorder, but as a fluid state that can be modified and overcome in different ways, according to individual needs.

Using these skills, peer specialists have been extremely successful in improving the delivery of mental health services. Their interventions are particularly effective in preventing episodes of hospitalization, re-hospitalization, and emotional crisis and in fostering a sense of hope, self-empowerment, and self-efficacy. Also, their ability to promote a sense of connection, especially by sharing individual stories and strategies to cope with life, is one of the main reasons for their success. Their interventions promote a sense of hope, a better quality of life, and a more positive attitude.

There are fundamental differences between peer support and psychiatric and psychological interventions, which cannot be ignored if we want to support the peer specialist’s original role in assisting individuals with emotional distress.

We cannot ignore, for instance, that the relationship between a peer and the individual with a history of emotional distress is essentially egalitarian. Their interaction is between individuals, sharing similar experiences, techniques and strategies on how to cope with the challenges of life.

Therefore, it is radically different from the traditional health provider-patient’s relationship, based on the medical model, in which the individual is in the “sick role” and is viewed as a “passive entity” and just the recipient of treatment and care. Although health care providers have somewhat modified their inflexible roles, the difference between the two approaches remains substantial.

It has been reported that consumers often complain about the condescending and non-inclusive attitudes of health care providers. In this context, it should be clear that peers do not strive to become “clinical” in a traditional sense, but they are willing to support and “balance” the work of health care professionals.

Moreover, the role of peer specialists is critical for an efficient delivery of behavioral health services. As is well-documented, access to mental health and psychotherapy services can be rather cumbersome due to several factors, including insufficient resources and stigma.

This problem has been magnified by the Covid-19 epidemic, which has caused so much emotional distress and has shown the shortcoming of the current behavioral health system. Peer support during the current epidemic is certainly a viable venue for persons who cannot access behavioral health services.

In the past few years, due to its efficiency and success, peer support interventions have become an integral part of the healthcare system.

The recognition of its value has come from numerous entities, including SAMHSA and the American Psychiatric Association. Peer support services are currently available in every state and are reimbursable under Medicaid.

Concerns regarding the integration of the peer’s role

What has been said, so far, would convey the impression that peer specialists have found a respected and independent role within the American behavioral health system.

However, several peer specialists working in New Mexico have expressed substantial doubts about their roles and future in behavioral health, which may reflect similar concerns nationwide.

Donald Hume, an experienced peer specialist and one of the authorities in the field of recovery in the state of New Mexico, provided a clear account of the current issues peers are facing in New Mexico. Donald stated that, with the formalization of the peers’ role under Medicaid and managed care, their functions are becoming progressively more constrained within the boundaries of a medical/business model.

He stressed that peers will be required to perform interventions following specific diagnostic categories and relative billing codes. They may also be compelled to accept mainstream clinical measures instead of focusing on the experience and the narrative provided by individuals in recovery.

Without a doubt, this shift will interfere with the original goal of providing recovery-based interventions based on the development of realistic hope, along with skills leading to a better quality of life. Recovery language will be reabsorbed by, or blended with, clinical and medical language, which will shift the focus from achieving existential balance to targeting signs and symptoms of mental illness.

The peer model has been already lumped in with other credentials, such as those of community health workers and community support workers. This has created a general air of confusion surrounding the actual role of peer support workers. The courses, offered in New Mexico, on cross-training community support workers and peer support workers, sharing the same code of ethics and the same essential functions, are a clear example of this trend.

Moreover, although peer workers have been included in many different treatment modalities in New Mexico (i.e., outpatient medication-assisted treatment facilities, abstinence-based treatment facilities, outreaches, drop-in centers), they are still frequently seen as merely low-ranking, eager workers who can help with patient retention.

Over the previous years, several new initiatives have been created to further regulate the peer support profession, mostly with the goal of providing more extensive oversight or to offer a way to bill for services that peer support workers are capable of offering. These changes have been endorsed by the managed care companies under Medicaid.

By establishing new modalities to offer peer support-based services, managed care organizations are slowly changing the essence of this type of recovery work. A provider working under a community support worker structure may be earning more money, but he/she is also losing out on “raw feel” and techniques that built and maintained peer support as a necessary staple in the world of recovery.

Many peer specialists who have tenure in their field have begun to recognize that the changes proposed by managed care organizations and state-funded facilities could mean that peer specialists may slowly evolve to offer services according to models based on regulatory and administrative paradigms rather than lived experience.

As stated by one of the peers, “There is an inherent danger in losing the foundations that built the peer support field. As we begin to take comfort in complex documentation, long taxonomies of billing codes, and the writing of treatment plans for every service, we are also letting go of the hands-on model that started with one person in recovery giving back to another.”

Therefore, the very nature of the recovery process could be altered and reduced to a hybrid of clinical and recovery principles, controlled by traditionally trained clinicians operating under the managed care model. One of the most dire consequences is that individuals who want to follow a recovery-based plan and not necessarily get involved with a traditional clinical paradigm will potentially be deprived of a substantial source of support.

This shift in peers’ roles and functions could be particularly harmful for frontier states like New Mexico, which experience consistent problems of access to mental health services.

Also, given that there may be no alternative resources to Medicaid for the provision of peer support, recovery-oriented agencies utilizing peer specialists will have two options: accepting the new trends and rules, or trying to survive without Medicaid funds, which will put their survival at stake.

In conclusion, according to Donald Hume and other peers in New Mexico, this shift to incorporating peer specialists under the umbrella of the medical model has the potential to undermine the core tenets of recovery. Without the freedom to engage with individuals as equals, peers will lose the essential elements that make them successful.

Their testimonial should be followed up by a nationwide survey exploring the views of peer support specialists on their changing roles and functions under Medicaid.

***

Helpful Links

  1. Substance Abuse and Mental Health Services Administration. Core Competencies for Peer Workers. https://www.samhsa.gov/brss-tacs/recovery-support-tools/peers/core-competencies-peer-workers
  2. Jeffery L. Ham. (2009). Medical model versus recovery model: an analysis of the SC department of mental health’ s approach to treatment.

***

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.

Previous articlePhilosophical Approach to Loneliness Yields new Insight into Treatments
Next articlePolice Investigate If ‘Antipsychotic’ Drug Caused Lecturer’s Death
Marcello Maviglia
Marcello Maviglia is a psychiatrist and specialist in the field of drug addiction. His main areas of interest are: behavioral Health issues within the framework of the Recovery Model, research on Historical Trauma and integration of effective culturally based approaches with social determinants of health in clinical practice. He is a clinical professor with the UNM (University OF New Mexico) Department of Family and Community Medicine, and Scientific Advisor for CNAH/UNM (Center for Native American Health/University Of New Mexico).
Ashley Charzuk
Ashley Charzuk is a Certified Peer Support Worker from Albuquerque, NM. Ashley works as the Peer Support Supervisor at Courageous Transformations Inc. in Albuquerque. She leads a Hepatitis C Testing Initiative. She is the founder and Director of New Mexico Harm Reduction Collaborative Inc., a non-profit organization offering harm reduction supplies and assistance to the state of New Mexico.
Donald Hume
Donald Hume is a Peer Specialist who lives in New Mexico. He has a long experience in the field of recovery. He is one of the leading experts in this field nationally. His contribution has had a major impact in the creation and development of a network of Peer Specialists who are integral part of the New Mexico healthcare system.

32 COMMENTS

  1. Alas, there’s no place for me among the peer specialists, as I recognize the principles of orthomolecular medicine and wouldn’t hesitate to use high levels of certain vitamins and minerals in treating some conditions, thereby making me an Evil Sorcerer of mental health who uses forbidden enchantments and substances, following the guidance of the renegade High Priests Hoffer and Osmond, and who should therefore be kept away from the “mentally ill”.

    • Actually, the peer support model respects and recognizes all forms of recovery and medical intervention. As a peer myself I utilized a vitamin regimen to discontinue antidepressants and again when discontinuing methadone. There’s no wrong way to apply any evidenced based practice.

      • The problem isn’t lack of ability or keeping peer respect, but trying to convince a straight supervisor that I actually know what I’m doing with stuff and methods (s)he’s probably never seen or heard of, unless (s)he’s read a screed about quackery.

  2. I think and I am sorry if I am not fully knowledgeable about the framework of working as Peer Support, what does “equal” mean in a context where the two people are not equally relating?

    IMHO, I am a wounded healer (well that is a bit too much). I am a person who experienced a violent and systematic abuse for long period of my life and recovered enough to lead satisfying life including in training to become a therapist myself. I have experienced power imbalance during my recovery in therapy process not so much hospital (which power imbalance is more prevalent). What I learned from my personal experience is that power and authority are mainly perception issues (unless a physical material is involved where one is being held)…but in mental health power and authority are perception.
    I never had that perception (or more likely) I have had it intellectually but understood it enough not to act on it and also not to endow on any therapist that helped me along the way that my vulnerability is equal to less power of my autonomy.

    Now the word “equal” is problem. Because a person is seeking help and one is giving help in terms of “empathy” and “support”. That mere giving has a power to stop giving…but also the taker has a power to refuse taking…so that power and authority are shared BUT ONLY if both are verbally, consistently, remaindering each other in almost every step of the way consistently and purposefully.

    Equal power and authority only exist if it is verbalized often and both are allowed to say what they think about it.

    I think peer support to believe they are “equal” while working and have obligation to a system, organization or other authority is not really equal anymore and forget if there is even payment involved. We are just stretching the surface and creating a real doublebind here.

    I hope I am not coming off as semantic expert (I am far from that) but I think the equality of the peer support and a patient/client can only be real if both actually speak of it as negotiation in such that the client/patient can say something like (and allowed to say)…I do not want that code in billing (and the question is truly why a peer support is even involved in coding)….all the roles seem to be mixing.

    A peer support framework does not seem clear.

    Another issue that bothers me about the process for peer support is the loss of identity as you mentioned. Not only identity, but autonomy and ownership of their experience (one experience must determine their profession) and also if they get sick – they are not given the same flexibility…all of sudden the question is what? I thought they recovered? they are “shrink” to that experience forever! Having a peer support should be a generic like being a psychiatrist and having MD in your name…a peer support should not be reduced to their “emotional challenge” actually IMHO< that should not be even a requirement…cause all humans have challenges in emotions – divorce, job loss, grief, loss, sickness etc….peer support should be based being human who wants to support anther human without being a clinician. Otherwise, the peer support cause you have been hospitalized reduces the person' human value to the contribution of humanity!

    The peer support needs to create their own framework without the system that created their need. They need to flush out all the possible scenarios including minimizing their own recovery experience to a template but not the foreground cause we are all different humans and our experiences are not alike ever! maybe to a point but not to duplication. To me this sounds a little boy who wants to be like his father but will never be because the father is created in different world so forever striving to be like the father is useless…what the little boy needs to do is become his own man. (use of gender is to make a point easier).
    Now the peer support needs a system that is not modeled in the system that created but based on their own coming to a new paradigm of what is mental health. But that will also require some quality control for huma interaction and if there is a confusion of service…a peer support must be protected as much as the person they are supporting. Any time two humans meet, there will be some misunderstanding so that needs to be addressed as well – I never see this being addressed. Safety, protection, privacy, ownership of experience are all things that need to be worked through outside of the known system to start afresh!

    ps. I am operating from non-believe of power in mental health, diagnosing of human emotion and making some emotions into monsters and others to friends and also from the point view of peer support is more than just those who had experienced the system but those who also learned how to become independent in their mind from the system enough to work to through it but who are still humans and may have remissions but do not need to perform to show others how much they have come or be validated for their experience (I know mouthful)….but peer support need their own framework outside of the system. The system should come to them not the other way around.

    • Dogworld, I agree with your statement and the perspective of this article. As part of my recovery of my humanity I decided to become a psychiatrist and correct the power imbalances created in the mental health service delivery world. Being too much of a task to take on individually I joined the consumer/survivor movement and co-founded the National Empowerment Center. Our Emotional CPR program is designed to rebalance power in every helping relationship within and outside the mental health system. Thank you Mad in America for highlighting the challenges of peers working as providers.

    • I think peer support to believe they are “equal” while working and have obligation to a system, organization or other authority is not really equal anymore and forget if there is even payment involved…

      I hope I am not coming off as semantic expert but I think the equality of the peer support and a patient/client can only be real if both actually speak of it as negotiation in such that the client/patient can say something like (and allowed to say)…I do not want that code in billing…

      And to be a “peer” situation, as previously defined by Webster et al., both ends of the relationship would have to receive equal compensation.

      Semantics are what they are — but you are obviously adept at logic and consistency of definition. I don’t know which of us posted first but we’re in synch on this issue at least — I could have highlighted practically all of your comments, not just the the ones I chose. You’ve put your finger on some the multiple contradictions involved in “peer counseling.” Thanks for expanding.

    • ps. I am operating from non-believe of power in mental health, diagnosing of human emotion and making some emotions into monsters and others to friends and also from the point view of peer support is more than just those who had experienced the system but those who also learned how to become independent in their mind from the system

      Why do we even need to define what “peer support” is or “should be”? It’s one of those concepts that no one needs in the first place, and certainly a far cry from what people such as Judi Chamberlin were talking about during the early days of the mental patients liberation movement. People who are sincere can always find ways of extending genuine mutual support to their friends and comrades — no labels, fees or corporations needed.

      Psychiatry is not a legitimate form of medicine and cannot be reformed, nor should it be; it must be abolished, not mimicked. Survivors (“peers”) working in the master’s house is not a “step up.”

      • Oldhead, you’re operating within a very narrow conception of what peer support means and assuming all such opportunities are paid positions within the mental health system.

        This isn’t about being there for the people you care about. It’s about being there for the people who maybe don’t have others caring about them. Do those people matter to you? Do the people who will otherwise fall through the cracks deserve to be supported when they’re struggling? Because those are the people most likely to end up in the direst places within psychiatry.

        • We all will be struggling until this system is overthrown, and humanity will remain alienated on a collective level at least until that point, no matter what limited compassion or support may be proffered to those most desperately affected by the ravages of corporate tyranny. Objectively speaking it’s not overly relevant what “matters” to me, but I certainly don’t judge those who reach out for whatever emotional band-aids may be offered (though I hesitate to use such a medical metaphor). Nor do i consider any “programs” or “techniques” to be more than that; my standard of legitimacy pending victory is “whatever gets you through the night.”

          The political problem presented by the “peer” label can easily be ameliorated by all of us engaged in direct support of fellow humans — without compensation or hierarchical power relationships — NOT using the term “peer” to describe the sorts of interactions and interrelationships we are involved in. This would help disarm and neutralize “mental health” careerists and others who use the “peer” concept to mystify and exploit.

          I see the development of the “peer” industry as paralleling the manipulation of language and symbolism by those who started the diversionary “mental health consumers movement” in the 80’s & 90’s, when the first incarnation of the AP movement was defeated using similar Trojan Horse tactics.

          Eliminating the “peer” label would eliminate “peers” (i.e. survivors) being subject to “accreditation” and “training,” by shrinks or other “greater than peers.” It would highlight and smoke out some other contradictions inherent in the “peer” word as well. I think it’s something we all should consider.

          • “Peer” simply means anyone on an equal social standing as you. I would assert that anyone getting paid to provide a service isn’t truly a peer, whether or not they identify as such. I choose to use this word by its actual definition and not how it’s been bastardized but the psychiatric industry.

            “my standard of legitimacy pending victory is “whatever gets you through the night.”

            I don’t see true peer support as something that gets me through the night but how I can be of service getting others through the night. Perhaps that’s where our view of the world and our responsibilities toward our fellow humans diverges. eCPR meets the definition of mutual aid.

            If your heart stopped, would you not want to receive CPR because the person who provided it learned it through a program rather than intuiting how to do it on the fly?

            If we lived in villages and grew up learning how to be supportive members of such, maybe these things wouldn’t need to be taught.

            Surely some of the goal of a legitimate AP position would be learning and promoting methods of preventing people from getting caught up in psychiatry at all? Just shouting into the wind about how bad it is does nothing to help the people who will turn to it in the absence of care in the community. It seems like you are deliberately not getting that concept.

          • Training and education are a part of how any culture transmits its knowledge to another generation or to other members of the society as a whole. There is nothing wrong with someone with higher skills in a particular area teaching someone who doesn’t have all those skills how to do what they know how to do. It would be silly for an expert blacksmith to not teach others their blacksmithing skills because it somehow prevents them from a purely egalitarian relationship. And I also see no reason why the blacksmith would be wrong to charge for that service of training.

            The serious problem we are really talking about is the cooptation of a movement to empower people by an institution dedicated to putting people down. The word “peer” has been so seriously coopted by the “mental health” system that it is difficult to use it in its original meaning. But KS is right, a “peer” is simply someone who is at an equal social status or standing as you are, rather than possessing some kind of power advantage. Co-workers are peers, as opposed to management. Students in the same class can be referred to as peers without any negative implications. It appears to me that it is only in the field of psychiatry/”mental health” that the term has come to mean something potentially nefarious. And of course, the “peers” who are buying into the system are no longer “peers” in the true sense, as they are granted a certain “power over” their ostensible “peers,” but only as long as they toe the party line.

            So the problem isn’t “peers helping peers.” The problem is the authoritarian power distribution in the “mental health” system that pits people against each other and requires compliance with certain dogma in order to be granted “power over” those deemed beneath you in the system. In my view, there is absolutely nothing wrong with teaching certain approaches or techniques or ways of thinking about how we help each other, as long as 1) these approaches are offered in a “take what you need and leave the rest” style, rather than a “this is the right way and anyone who disagrees is wrong” approach, and 2) the training is not offered in the context of an authoritarian system where those higher in the hierarchy are permitted, nay, are EXPECTED to put those beneath them in their proper place.

  3. @ Marcello, Ashley, and Donald,

    As the father of a son completing his healing road back to a psych-drugs-free and natural life, and soon to become a peer-supporter, I want to you thank for your very interesting paper.

    For peer-supporters, to get a decent and gratifying job is a good boost for their dignity indeed. But what job?

    Now, to reassure you (or to worry you?), …

    Same in Europe : in the present situation, as psychiatrists are not prepared neither to loose nor even to share their power, IF peer-supporters want to keep their job, in the psychiatric system which for the moment being has no alternative, THEN, just as the other psychiatrists’ servants, i.e. psychologists, nurses, sociologists, etc, they must abide to the rules of the psychiatrists. They have no choice.

    As we know, the guy who has the gold, the power, defines the rule, doesn’t he?…;-)

    There is one critical way to overcome psychiatrists’ selfish and greedy rule, it is to apply the recommendation of Richard Buckminster Fuller (1895 – 1983): “You never change things by fighting the existing reality. To change something, build a novel model that makes the existing model obsolete.”

    That is precisely what they have done in the District of Western Lapland, North-Finland: they did not fight against the existing reality. Better, they invested their scarce resources into the development of their innovative model and curative approach, “the Open Dialogue Therapy”.

    As a result, they rendered the following items obsolete :

    * the DSM-books,
    * the ghost-written psychiatry textbooks published for the last 25 years,
    * the toxic psych-drugs,
    * the academic psychiatry literature of the last 70 years,
    * the dogmatic and symptomatic approach to mental illnesses,
    * the existing psychiatry as practised in the Western cultures and rich countries (W.H.O. meaning),
    * the expensive psychiatric hospitals,
    * …

    In this innovative and curative “Open Dialogue” approach, where, with all due respect to polyphony, every voice counts, and with the flattened hierarchy, peer supporters have a place equal to psychiatrists.

    Their place is also equal to psychologists, nurses and sociologists.

    That is how and why, in Western Lapland, they succeeded to eradicate schizophrenia from their District.

    (smile)

    The good news:

    1) In Norway, with their Law of 2015, obtained thank to Associations of parents-tax-payers (taxes used so far to pay fat fees to psychiatrists), they are thriving to reach the same result.

    2) In the little Kingdom of Belgium, although we have a late start, we are thriving too.

    (smile again)

    With all my encouragements to build your novel model on your side of the pond too, …

    (many more smiles)

    Luc

    🙂

    • Dear Luc de Bry,

      I love the quote you quoted. I agree, there is way too much fighting and not enough creating.

      I think what is happening in Finland is truly fantastic. And Open Dialogue. I am not sure it is entirely new. I think it probably has its roots in what human societies have always done with the very unwell, which is listen to what they themselves need and nurture their potential.

      As somene with schizophrenia myself, I know I could not write a sentence as I am doing now if I were on my old antipsychotics. What people often regard as the overt signs of schizophrenia are the drug effects, and once off these drugs those iatrogenic effects dramatically may sweep aside, and this can feel like getting your loved one back all one hundred percent “cured”. For many schizophrenics who are miserable on their drugs this reduction or cease of drugs is like ceasing heroin addiction, in as much as quite obviously there is going to be an amazing “before and after” transformation once off drugs. But a transformation may not be a “cure” to some schizophrenics. It has not been for me. My hallucinations, delusions, paranoia is still here. It is easier to cope with without the appalling side effects but it is STILL my schizophrenia. Some could argue that my symptoms are the long lasting damage from antipsychotics. But again, for me this is not how my reality is. I had all of my symptoms long before I took psychiatric medication. That is not to say antipsychotics have not left their mark. They almost certainly have damaged me. Some may argue that my schiziohrenia is not an illness but is from something, like trauma or poverty or environmental pollution, but I would say that I really dont care what anyone says might be the “cause” of my schizophrenia, any of these causes can have a deliterious enough effect on the brain as to upset it in some temporary or permanent way, enough to result in that which the world currently chooses to call schizophrenia. I dare say in cavemen times it was not called schizophrenia but something like “scary mammoth disease”. It matters little to me what anyone dresses up schizophrenia to be, as a sufferer of it I think mostly only fellow sufferers should chip in with helpful remarks about their notions of it, not any ignorant spectators of it.

      I am so pleased you have found the answer to your prayers in your son’s transformation through coming off antipsychotics and embracing an outlook that works for him. I wish you and he good fortune as you both venture forth in life.

      There are different sorts of severity of schizophrenia, as Robert Whitaker acknowledges in his caution to proponents of Open Dialogue, when he suggests not bolting a door against conventional treatment like antipsychotics, used sparingly as a short term “cure” for emergencies. I do not fully understand why he might have said that if he ever believed the hellishness of hallucinations, delusions, paranoia, illness, were not REAL, or were, as some in the comments section like to argue are FAKE.

      As for the DSM I own a medical book full of diagnoses. A diagnosis of myocarditis helps a physician quickly understand what specific issues are going on for that patient. It is a neutral explanatory time saver. We can get rid of the DSM but I suspect we may need replacements for it of some sort, even a “trauma paradigm of care” will probably want to train healers in how to specialise (get good at) or (focus their energies on) looking after the “extreemly traumatized” rather than the “moderately traumatized”. These already are sounding like diagnoses. And to prepare someone to leave a Soteria house we may have to “diagnose” them as “not ill anymore”. A society can still bully someone who has been in a Soteria house who was once ill with trauma. Especially if there comes a backlash from economically devastated and fed up society, at what they could wrongly but easily perceive as all the moaning or weak “traumatized” self-indulgent. Not that the traumatized are ever, ever, ever such things. But society can be mean to the suffering regardless of what they call their suffering.

      For all of the above reasons, I think that for myself, I want to just retain my diagnosis of schizophrenia but I do not want drugs, or treatment of it. Time is my healer. Though I do need support for my severe mental illness. I am excited by all that is going on in Finland. It seems the way to go. But I do not think it is a “cure” of schizophrenia, not my severity if chronic schizophrenia. Giving up my pills has been a rebirth back to pre-pill health, but that “health” was a decade of suffering hallucinations, delusions and paranoia. Yes, I do cope better with those without medication, but everyone is very different. And I cannot say I wont need emergency pills tomorrow if I attack a town centre with a loaded cheese baguette or worse. For that reason I do not want to replace one snake oil simplistic attitude about “how to fix schizophrenia with gallons of pills” with a new snake oil simplistic attitude that says new paradigms of care will be sprinkled with a Disney charm of rose petals. I think human anguish, in all its manifestations, what ever its causes, is a stubborn problem to heal, however we try to heal it. That is why I vote for having all different alternative AND traditional options of care. But I stress that traditional forms of care have to be reformed radically.

      Anyway, I am so glad your boy is doing brilliantly. Now he is pill free I imagine he should find it easier to deal with his symptoms without awful side effects.

      So wonderful he is going to be a peer. I do think that only peers who have actual lived experience of schizophrenia should be allowed near anyone with schizophrenia.

      This is an unintentionally long reply. So no nèed to respond to it.

      Thankyou for sharing your son’s story. Have every confidence in his healing.

      • Niacinamide and C may be able to ease the hallucinations used at the basic level of 3g/day for each (1g ea. TID in doctorspeak) You shouldn’t flush, like you would with niacin (which is why I didn’t suggest it, instead of the amide). And you won’t go on the nod, like you did with the meds.

  4. Peer support specialists are individuals who have had experience with emotional distress, trauma, or other emotional challenges and have been trained to assist others experiencing emotional distress.

    This makes them “mental health” workers in essence, which is part of a power hierarchy, hence the term “peer” is an oxymoron essentially.

    Who does this “training”? — and what objective standard of correct thought and behavior do the “trainers” base such “training” on?

    If one end of a “peer” relationship is getting compensated and the other end is not this is, again, a power relationship, not a “peer” relationship. It is in the end based on ideology, not humanity.

      • @Steve — You are (again) addressing this as an individual matter rather than a systemic one. Stephen realized that the entire setup is corrupt and that he was essentially a pawn in their game. Nonetheless he tried to push back against the whirlwind — which is not an argument for the whirlwind.

        • Sometimes I am just trying to meet someone where they are and create some common reality. Not everything I say is intended as advocacy for the cause of ending psychiatry. Sometimes I’m just talking to someone. I don’t like the idea that you are hovering around waiting to pass judgment on the adequacy of my communication. It was not intended for your consumption, and frankly isn’t really your business to critique, IMHO.

          • It was not intended for your consumption, and frankly isn’t really your business to critique, IMHO.

            ??? I’m responding to your response to my comment, how is that “not for my consumption”? This sounds defensive, or something.

            The “adequacy of your communication” is not my concern, but your addressing the “peer” concept in terms of individual character rather than its inherent contradictions.

        • I agree with Steve here that we shouldn’t overgeneralize. In reality, the concept of “peer support” has multiple meanings. I agree with the pushback toward those who are essentially mental health workers. But not all that is labeled peer support is promoting the psychiatric paradigm. I think it’s important to be able to distinguish the differences between something like eCPR and IPS from psychiatric “consumers” working directly in the mental health system and promoting the psychiatric paradigm.

          The truth is that systemic change doesn’t happen without collective change and collective change doesn’t happen without individual efforts. And so suggesting that individual efforts are pointless is self-defeating when working toward a larger goal like systemic change.

  5. I don’t consider graduation from professional “mental patient” to para-professional “mental health worker” much of an improvement. I would tell both groups of people to abandon their fields of oppression, futility and victimization, and I would encourage them to get a life. That is, a life in a less nonsensical field. The same applies to “mental health professionals” in general.

  6. I can certainly understand the pushback this article has received. I would never personally work in these settings as I view it as substantially promoting the psychiatric paradigm, even if within a recovery framework. I still find myself a fan of such concepts as peer respite, eCPR and other initiatives that are operated by those with lived experience for the purpose of normalizing distress and our collective response to such. It’s unfortunate that the term “peer” is so very loaded within this context.

    I think the problem at its root isn’t with peers so much as it is a monetary system that keeps the majority in conditions that amount to slavery (debt bondage). In an economic system such as ours, where even before Covid, 60% of people couldn’t afford a $400 emergency, we now have Republican governors refusing extended unemployment benefits in an attempt to force people back into the work force. Yet a CNN poll in several of these states found that over 60% of respondents said they were currently caring for a child or dependent adult and 70% of respondents said that the wages they’ve been offered were less than they were making before. But in these states, the leadership doesn’t care if the populous can’t afford to work or ensuring that businesses offer a competitive wage, they are fine with placing constituents in a catch-22 with all bad options. And the situation isn’t much better in more liberal states, because survival has nothing to do with actually providing for oneself but instead prostituting one’s labor in exchange for a pittance in order to make money for a company’s board and stockholders (for a large portion of us anyway).

    The despair that a large portion of humans are experiencing isn’t correctable by psychiatry or by notions of “recovery” from emotional distress. Continuing to place emphasis on “recovery” concepts in this way is a bit of a sleight of hand trick concealing the actual source of despair underlying our ill physical health and mental functioning.

    I think it’s reasonable to put into context the cultural and systemic factors that are effecting our good peer supporters here. I have no doubt their intentions are honest and genuine. But I think these regulatory issues that are being raised don’t really go at the heart of the problem and are instead largely putting a bandaid on the underlying issues with how our society (western values generally) is structured.

    I applaud peer support based on mutual aid practices and I certainly believe eCPR falls under that umbrella. But I think that the concepts of recovery that are being promoted here are unfortunately more of the same “bootstrap” mentality by another name. Coping skills, hope, and the like individualizes distress responses that are now fairly widespread.

    The question I have at this point is: what percentage of the population in “treatment” will it take before we collectively realize that our way of life is totally hosed? And will this realization lead to an understanding that we have to change our ways to be more cooperative for group survival or will it lead to violence, destruction, warring factions? I’m not totally sure I want to live long enough to see how it plays out but I know that conditions are deteriorating and that we are a heavily armed and angry bunch, at least in America.

    My big picture view is that this is more chasing our tails trying to make a bad system work with a twisted version of “survival”.

  7. Thanks for your article. What you describe sounds like the fuel for “peer drift” which may spontaneously occur if one is not aware of the forces at play. In the french speaking part of Belgium, we thrive to strenthen our peer support worker organisation (En Route) to offer opportunities to peer support workers to gather and reflect on what it means to be a peer support worker and the values we want to put in our work. This, in the end, counterbalances the potential weight that the “system” may put on our profession. http://www.pair-aidance.be

LEAVE A REPLY