What Is the Role of the Prosumer in the Mental Health System?

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First and foremost, I identify as a prosumer. As a prosumer, I have both lived and professional experience of the mental health system.

The term prosumer came into being in the 1980s, coined by the American futurist Alvin Toffler to describe both consumer and producer. The term is mostly used in the context of technology, the economy, and/or consumerism-based fields. The word never gained much traction in mental health.

I have long tried to explain the phenomena of “living in two words.” The peer world is grounded in lived experience, but also in the traditional mental health professions, e.g., social work, psychiatry, and psychology. I believe the term prosumer is the best term to describe people who are consumers of mental health services but who also function as traditional professionals in mental health care.

Today, peers have a vast array of credentials. The Certified Peer Specialist is supposedly more eligible for different positions in the mental health peer workforce. Peers are also now considered professional when they get certified by their Office of Professions and graduate from APS, the Academy of Peer Services. These specializations make the peer a professional in today’s mental health workforce. But still, many people don’t consider peer work to be “professional,” and peers rarely make it into higher-level professional roles. Nonetheless, there is general agreement in the mental health field that peer work is vital, influential, and critical in the mental health workforce—and I agree.

There seems to be ongoing confusion around the role of the peer in mental health. Certified Peer Specialists are not supposed to engage in clinical work. Instead, peers are thrown into the roles of case managers, engagement specialists, front desk staff in clinics, and just about every position where labor is short and there is high turnover. In some cases, peers take on assessment forms and other clinical paperwork.

So, then what is the scope of practice of a peer?

The general model for practicing as a peer is Intentional Peer Support (IPS). If peer work had a code of ethics or practice that sets it apart from other disciplines, it would be IPS. According to the IPS website:

Intentional Peer Support is a way of thinking about purposeful relationships. It is a process where both people (or a group of people) use the relationship to look at things from new angles, develop greater awareness of personal and relational patterns, and to support and challenge each other as we try new things. IPS has been used in crisis respite (alternatives to psychiatric hospitalization), by peers, mental health professionals, families, friends and community-based organizations.

IPS is different from traditional service relationships because:

      • It doesn’t start with the assumption of “a problem.” Instead people are taught to listen for how and why each of us has learned to make sense of our experiences, and then use the relationship to create new ways of seeing, thinking, and doing.
      • IPS promotes a ‘trauma-informed’ way of relating- instead of asking ‘what’s wrong’ we think about ‘what happened’?
      • IPS looks beyond the notion of individuals needing to change and examines our lives in the context of our relationships and communities.
      • Peer Support relationships are viewed as partnerships that enable both parties to learn and grow- rather than as one person needing to ‘help’ another.
      • Instead of a focus on what we need to stop or avoid doing, we are encouraged to move towards what and where we want to be.

Yet most peers don’t practice IPS, and new peers often don’t even know what their role should be. As new peers enter the mental health system, they therefore don’t protest when they are asked to fill the jobs of case managers, therapists, and other gaps in the system of treatment.

Today, more nurses, social workers, and other mental health professionals are coming out as having lived experience—having mental health problems, having a psychiatric diagnosis, having experienced the system from both sides. In my book, these are sincere people: we all have “stuff,” and this should not stop us from learning more and being our most professional selves.

This means that many people—even those not traditionally considered “peers,” are actually prosumers. And therefore, being a prosumer should be marketable! After all, we’ve experienced many issues firsthand, both as a service user and because they’ve learned about them in higher education and in their professional work experience. Being “’in the know” in a field with so many variables and unknowns around every corner is valuable.

Perhaps even more important, prosumers are able to connect with clients at the heart of their trauma. Professionals without lived experience of being a service user can be seen as cold, authoritarian, and failing to understand what it’s really like. Because of this, the authenticity and humility of peers goes a long way in a field that often evokes images of institutionalization and haunted wards in old closed-down psychiatric asylums.

Despite all of these benefits, and the nuanced and global perspective of prosumers, few people take on this calling. Why is that?

I believe that in a profession that is already underpaid, being a prosumer isn’t worth it in terms of compensation for experience and training. Let’s face it, being a prosumer can be stressful. The work can feel like you’re walking through a minefield. One of the most significant issues is maintaining boundaries. I have experienced precarious boundary issues and the narrow pathways which peers are allowed to negotiate them. Given the implications of sloppy therapy on reactive, labile, and unstable patients, working along the prosumer boundary may be more work than it’s worth.

And the role of the prosumer—that ability to connect and understand without “treating” people as an authority figure would—is being restricted. More and more, the focus is on “evidence-based practice,” which is really an exaggerated way of turning every inch of psychotherapy into an unfeeling machine in which everything needs to be measured. Everything has become mapped out in clinical work and mental health treatment. With fewer and fewer spaces in the mental health universe uncharted, the identity of the prosumer is left absent. My theory is that the public mental health system is becoming too rigid to allow space for real, non-hierarchical connection.

Industry leaders need to evaluate the position of the prosumer. I explained in a previous piece that peers exist in a complex world that has legal, HR, and clinical ramifications that could potentially cause harm to vulnerable people in the community—peers themselves as well as their clients. As I argued in that piece, agencies need to have clearly defined guidance for how a peer is expected to behave and, more importantly, how the agency itself assesses peer performance, to prevent peers from being stigmatized, with their every behavior construed as evidence of “mental illness” that makes them unfit to do their jobs.

That guidance must be agreed upon by all the relevant stakeholders—peers and their supervisors in the mental health system—and disseminated universally.

The truth is that prosumers have a unique identity among service users and those with lived experience. Even for peers, the field is more heterogeneous than you think. Reformers need to address these increasingly visible issues related to being a prosumer. Until then, more folks may be hurt than helped. This group requires formal recognition by the public system now!

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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.

12 COMMENTS

  1. Max, I find this sad. All health professionals are also health consumers.

    I feel you feel forced to stand in two places at the same time, here. Yet if a professional has a hernia fixed, for example, there is no major conflict in being a patient, or in later returning to work as a health professional.

    Both professionals and patients know that physical health professionals access services for their bodies. And there is no whispering or derision, no changed boundaries at work. They can mention their own experience of surgery, or whatever, to patients when relevant, and feel that their practice and understanding are enhanced as a result of it. Many live with chronic conditions and have to alter work schedules as a result.

    What I’m trying to say is that there is no need to find a middle ground, and nor is there a special title, because every one of them knows they occupy this ground. At different times they are professional and patient, and the middle is simply any enhancement that one role might possibly offer the other.

    What I’m hearing, and I could be wrong.
    The patient-prejudice you experience hurts and undermines you, and it would be a relief to be able to lose it;
    And also there is guilt and artificial distance in the prejudice that those you work with suffer, and a sense of a need to bridge a vast gulf that secrecy seems to be a part of?

    You are the same person with the same set of experiences regardless of your previous patient status being known or not. It seems to me that what you are talking about is the effect of severe, wide-reaching and damaging bigotry.

  2. I am one of those people that truly believes we all have experiences and that my experiences is not my identity or a mole on my forehead.

    Therefore, I recovered from a severe childhood trauma – a major experience. I recovered both in living long enough and using therapy though (the latter) there were many hits and misses – the overall experience worked for me.
    Now I am helping others. Should I often tell them my experience? No because my experience has absolutely no bearing on theirs (that happened) prior to meeting me. However, if they ask me directly, based on my own creation of boundaries, ethical obligation, and such, I will answer as truthfully as I can.

    All these identification is another way to put people in a box and to abuse them and to undermine them. AND ultimately to control their subjectivity and thoughts for good.
    What I mean the latter comment is that for me to give you my history, I am giving you a power to use it in your own way. This non-challenged trust in authority is a major problem for anyone dealing “loss of self power” which is ultimately what mental illness mounts to at least in my experience – see how narrow my experience of mental condition is. That is my experience and sharing with others to induce trust in them would not be justice in my mind.

    I want them to grow, be creative, be who they are or want to be not model after me.

    However, I want to close this comment that I really appreciate those who feel their experience is helpful to others in this vulnerable way. I am sharing my comment for the same reason – sharing my experience in non-vulnerable way to relate.

  3. Dogworld, Diaphonous Weeping, Steve, and Joshua.

    I feel what you are saying are aspects of my own feelings. All of them. Struggling to explain here. I hope you know what I mean.

    DW, I too believe we are equal, all human, and, from my own understanding of your previous comment, that the words that live inside us are truly only words, neutral in themselves as mere words, empowered or not inside us according to our own beliefs and feelings. And there is a real need to take responsibility for that. And also to see through a broad lens to not get bogged down in taking things personally. I thought about what you said then, and also after.

    Dogworld, I also agree, but want to add that humanity is between as well as within us. Sharing our stories, or just a few words of commonality can break down the barriers that can imprison us from our common humanity. At the same time, we can build internal fences from them, or grasp hold of them when we are lost and what we really need is to find own own compass and follow it even when our own path seems impenetrable.

    Humanity is our birthright, denial of it causes suffering and damage.

  4. I remember being introduced to Toffler years ago. I don’t remember the word, “prosumer.” I am all for made up words that come from the imagination and creativity of an individuals or even a free-thinking group of individuals; but the word “prosumer” seems artificial, contrived—not like it come the heart of the imagination, but a worn-out, tired brain who may have been at the mall and wished he might have been in a group of happy shoppers at Christmastime. I am sorry, Mr. Toffler. I think he was an intelligent person, but the word “prosumer” was not his best idea. We all make mistakes. Perhaps, we should remember him for his successes and throw the word, “prosumer” where it belongs in the trash can of useless words that need to be extinct—because deep down inside we really do love our native language, English. “Prosumer”…I am laughing all the way to English class…. Thank you.

    • The best way to break free of the mental health system is to just ignore it. Otherwise, as my father would tell me, “You stoop to their level.” And when you do “stoop to their level” you assist in legitimizing it. What we can do is forgive those who have hurt us. Or we will never grow and they, even if, we are not “patients” in their system let them win. We need to stop letting the mental health system live in our heads, “rent free.” Forgiveness frees us, anger keeps us “in chains.” Thank you.

  5. I truly do not want to be disrespectful, but I find myself confused by this piece.

    If people hired as peer supporters are being plunked down into case manager or receptionist roles (etc) then… They aren’t actually in peer roles at all. And I worry about any writing that suggests that that is even vaguely acceptable..

    And as much as I appreciate Intentional Peer Support, its not seen as the “general model” for peer support, although wed probably be way better off if it was rather than some of the persistenty medicalized and co-opted nonsense that is…

    I guess I’m just not quite following where you are heading here, or what you are arguing for and I worry that some of it will confuse or appear to be validating discriminatory or otherwise problematic practices…

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