In mental health, a peer is someone who shares similar life experiences or challenges. These individuals have navigated mental health issues themselves and can provide a unique perspective and support to others on similar paths. Peer support, therefore, is a system where individuals with shared experiences offer guidance, empathy, and encouragement to one another. This form of support emphasizes the power of lived experience, fostering connections that enhance recovery through mutual understanding and validation.
Peer support is crucial because it offers a type of understanding and connection that professional services alone often cannot provide. It reduces feelings of isolation, fosters a sense of community, and empowers individuals by promoting self-efficacy and resilience. This support can be transformative in helping individuals navigate their mental health challenges with someone who truly understands their experiences.
The Co-Opting of the Peer Movement
In recent years, the peer movement has attracted attention from governments, corporations, and other organizations, leading to a process of co-optation. As peer support becomes more institutionalized, its original grassroots essence is at risk of being diluted. The focus can shift from community-driven empowerment to bureaucratic compliance and financial metrics, potentially undermining the authenticity and effectiveness of peer support.
This co-optation is particularly evident in mental health, where the integration of peer support is becoming more regulated and standardized. While this institutionalization can provide structure and legitimacy, it also threatens to turn a vibrant, community-driven initiative into a bureaucratic function, potentially losing the essence of peer support.
This is reflected in the recent decision by the Westchester County Department of Community Mental Health (DCMH) to not grant a Letter of Support for Mindful Livingās application to provide Community Oriented Recovery and Empowerment (CORE) services. The DCMH cited ācurrent capacity and vacancy levelsā as insufficient to justify the need for additional services in the county.
Integrating Peer Support into Practice
At Mindful Living LCSW PLLC, we envisioned integrating peer support into our treatment model to offer clients comprehensive care that included both professional expertise and the personal insights of those with lived experience. However, the pathway to implementing this vision has been obstructed by systemic barriers. The DCMH highlighted concerns during our meeting, such as the requirement for services to be mobile, with most sessions held in a place of the clientās choosing, and other narrow eligibility criteria that makes it impossible to fill programs to capacity. These constraints underscore the difficulties in aligning peer support with existing bureaucratic frameworks.
Moreover, the credentialing for peers to bill insurance, including Medicaid and Managed Care companies, is highly regulated. As it stands, peers can only bill Medicaid if they work within OMH-licensed programs. This regulation effectively prevents peers from establishing independent practices, thus limiting their autonomy and reinforcing the co-optation of the peer workforce.
As a peer support professional, Phillip has firsthand experience with this co-option. Peer support professionals are sometimes pushed into roles resembling caseworkers or junior clinicians, performing duties outside their training. This shift not only undermines the core values of peer support but also transforms it into a mechanism of compliance rather than empowerment. The DCMHās suggestion for Mindful Living to āreconsider strategies for engaging and enrolling clientsā further reflects this bureaucratic encroachment, as it implies a need to conform to narrowly defined service delivery models rather than embracing the flexibility that is central to peer support.
Implications for the Peer Workforce
Career advancement for peer support professionals is limited, often involving performing clinical tasks. Compassion is replaced by appearances and forced compliance with rules, leaving few peer professionals with a seat at the table.
This preoccupation with numbers and money often leads to unequal distribution among mental health agencies, clinics, and organizations. Peer support professionals who stay true to their values often face ostracism, persecution, and are driven out of clinical and peer spaces due to undervalued trauma, workplace abuse, and not earning livable wages.
Clinicians, therapists, social workers, and the peer support workforce are at odds with an unwieldy bureaucracy, often leading to the departure of valuable professionals. This exodus is rooted in a system that seems to have lost sight of its core mission: to serve and heal.
Systemic Challenges and Professional Exodus
Working within the mental health sector, we have witnessed the disconnect between care ideals and operational realities. Bureaucratic red tape and a focus on appearances over genuine service delivery often overshadow the quality of therapeutic engagement. Protocols often trump empathy, and paperwork overshadows personalized care. This misalignment stifles creativity and initiative, undermining the essence of personalized care.
The departure of dedicated professionals extends beyond the individual level, affecting vulnerable populations relying on these services. The consequence is a diminished capacity to provide high-quality, compassionate careāa scenario that serves no one.
Challenges and Systemic Issues
Several barriers impede the effective implementation of peer support:
- Bureaucratic Hurdles: Excessive regulations and administrative complexities make it challenging to integrate peer support seamlessly. These barriers often lead to a loss of flexibility and authenticity in delivering peer-driven services.
- Gatekeeping: Access to peer support is often limited by a few individuals who control the flow of information and resources, making it difficult for both providers and clients to benefit fully.
- Role Misalignment: Peer support professionals are sometimes expected to perform duties outside their intended roles, such as acting as case managers, which undermines the core principles of peer support.
- Financial Limitations: Restricted funding options and rigid service models hinder the ability to develop and sustain innovative peer support programs.
To effectively leverage the potential of peer support, it is crucial to address these systemic challenges, advocate for authentic integration, and prioritize empathy, understanding, and empowerment. By doing so, we can enhance mental health services and ensure that peer support remains a powerful force for positive change in the lives of those it aims to help. This requires persistence, clarity, and advocacy to transform mental health services and truly harness the transformative potential of peer support.
Thank you Max and Philip for raising these concerns about co-optation of the peer movement. I suspect the threat of cooptation is not unique to the peer movement and is present in most social movements in general. One of the things that I appreciate most about the modern peer movement that grew out of the broader movements of the 60s was the fact that survivors of psychiatric hospitals drew inspiration from the Black Power movement and other social justice movements of the time and many of them saw the struggle of mental health peers as part of a broader struggle of many types of oppression and for human liberation as manifested by the names of some of the original peer organizations such as the Insane Liberation Front in Portland.
It strikes me that the peer movement obviously exists within the context of a larger society that many see as in crisis and decline. It also seems like today most social movements exists in silos, maybe with the talk of solidarity at best, but that all the oppressions are not fused into a broader movement to end all oppression but often attempt to seek redress and recognition from inside the system, that I would consider the ultimate source of the oppression in the first place.
But if we donāt work within the system, then how do we exist? How are we funded? How are we recognized? How do we appeal to a larger section of peers and potential allies that we want to relate to?
I would posit that the founders of the peer movement in modern times, initially did work at a distance from the system. Through groups like Insane Liberation Front, the Madness Network News and the Mental Patients Liberation Project, peer work was established outside of the official networks of the mental system. Of course in the later 70s most social movements integrated into the system through non-profit work and NGOs. It can be questioned if this integration into the system was beneficial for the kind of grassroots and community based project that you are both talking about, or if this integration was in fact a retreat from the liberation projects of the early 70s and the beginning of co-optation.
It might be that our alignments as peers that are against cooptation into profit driven depersonalized systems should be, like when the modern movement began, with the broader social movements for liberation, like the movement for Palestinian liberation, Black Lives Matter, immigrant rights, and movements that generally seek freedom for the most oppressed and marginalized peoples.
Can we expect the mental health system like the larger system it is a part of to do anything except to attempt to co-opt, corrupt, profitize, and depersonalize? Or do we need to work at a distance from the state with the broader social movements for human liberation? How we navigate these questions will go a long way to determine the future of the peer movement. And the gatekeepers can keep you from integrating into the system, but they canāt stop you from critiquing the system from the outside and building up viable alternatives that are outside of the system orbit.
I am really glad that you co-wrote this article and I hope it can lead to fruitful discussions about real alternatives that can lead to real liberation for peers and humanity.
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Thanks for your article. I feel like the person underneath the piles of paper in the photo.
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As a psychiatrist totally aligned for years now with the peer support movement ; I have witnessed the gradually cooperation and degrading of the incredibly valuable services and support peers provide to those in need. Iāve quietly advocated for years that peers unite into small entrepreneurial groups of practitioners and offer their services directly to those in need outside of any organized medical oriented systems. Psychiatry as a medical specialty is doomed to fail as it continues to medicalize all human emotions trials and tribulations. Peers have to empower themselves and recognize their inherent value to those in need who seek their services. What peers provide is not a medical service and canāt be covered by private medical insurance companies at least not yet. Once peers unite move into the communities to provide valuable and necessary caring to those who will use medical; in time coverage for such professionals will develop. I have hope for that. Donāt wait any longer for medical systems to put you in an inferior position to gain your valuable services and pay you so little for all your experience time education and training and then take unjust credit for advancing āthe peer movementā. It is not advancement but truly cooperation towards annihilation.
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“Don’t wait any longer for medical systems to put you in an inferior position to gain your valuable services and pay you so little for all your experience time education and training and then take unjust credit for advancing the “peer movement”. It is not advancement but truly cooperation towards annihilation.”
Ken not only speaks the truth, but also reminds me of something called “power hoarding”, a dynamic that involves inflating one’s value or diminishing the value of others by doing any one of the following:
Sabotage – Interfering with the performance results of other employees
Overloading – Giving assignments that are impossible to carry out successfully
Belief that power is a limited resource that must be protected
Dismissing the demands of the broader workforce, and insisting that leadership alone has the insight and expertise necessary to make organizational decisions
In short, if possible, it’s wise to know ahead of time the kind of monster you’re dealing with which in this case just happens to be something called “psychiatry”.
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I always love seeing professionals who are brave enough to speak about their experience. I am trying to organize some panels and maybe even keynotes at APA and would love to collaborate on some projects together. Not sure if you are aware but homosexuality was removed from DSM because a brave psychiatrist was able to speak out at APA in 1973.
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Max and I will be more than thrilled to be panelists for an upcoming event you and/or your team of professionals are doing. Feel free to contact us. Max ([email protected]) and Phil ([email protected]). Thank you.
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I agree!! Iām a peer specialist and lived experience and a threat to many.
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This situation is as old as trying to create a peer role in a clinical environment. Enough already. Every single sentence in this article was written somewhere else at least 15 years ago and people just keep trying to fit the square peg in the round hole. In my best Bob Newhart voice, “Stop it!” You are wasting so much time.
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I LOVE the “Stop it!” skit! But you are right. The problem is opposing goals. The peer movement’s intentions were contrary to those of the main MH system, and so they had to be coopted or snuffed out. And the MH system was very effective in doing so. You can’t change the basic purpose of the MH system. It’s built in.
‘
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This is not a difficult problem. If we prioritize kindness, compassion, and understanding OVER harming, drugging, and colonizing the so-judged mentally ill, then a very different model of care is possible.
Arthur
https://arthuroshea.substack.com/
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Thank you for writing and sharing. Looking at peer support as a possible career choice and entry into being an effective helper in the Veteran community, it is stories like these that make me rethink that idea and instead contemplate what kinds of adaptations I would need to make in order to counter any or all of these issues. I decided to try starting a writing for wellness group with independent funding, where the result can certainly be therapeutic, and is not meant for individuals with diagnosed mental illness/mental health challenges, but could surely be beneficial. I would be a peer who is not offering therapy, but a potentially therapeutic experience, outside of institutions and in the community, at no cost (cost is not an issue with this type of group anyway). Insights like yours helped me to formulate the idea.
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Aurora said
āStop it!ā You are wasting so much time.
Steve said
The peer movementās intentions were contrary to those of the main MH system, and so they had to be co-opted or snuffed out. You canāt change the basic purpose of the MH system.
I agree with and understand the sentiments of Aurora and Steve but does that mean we just give up and except the mainstream MH system as being unchallengeable and unchangeable? There seems to be an increasing number of people singing that song lately.
Here in Australia there is a new initiative getting under way to set up a Lived Experience Worker owned and operated mental health services co-operative.
Lived Experience Workers are also known as Peer support workers.
This is possibly something along the lines that Ken Blatt was referring to in his response to this article.
Even in the early discussion phase the naysayers are coming out of the woodwork saying “it can’t be done” or “it won’t work” etc. Obviously there will be significant challenges including likely opposition from mainstream MH but what many people don’t seem to be noticing is that increasing numbers of mainstream mental health professionals are getting pretty fed up with the old biomedical approach and are advocating for something better.
David did eventually topple Goliath. It has happened more than once in history.
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David didn’t “reform” Goliath and convince him not to attack. He beat him physically and defeated him. Peer workers are a great option, but they need to understand that their efforts will be OPPOSED by the mainstream system, and that system must be DEFEATED in terms of losing its power before any peer “reforms” can become mainstream and the label-and-drug model dies a well-deserved death.
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Hi Steve,
I’m not really talking about trying to reform Goliath and when I speak of naysayers I do not mean to be disrespectful. Some reform advocates are highly intelligent, well informed people who have been engaged in reform activities for years. The problem is that these activities just don’t seem to be getting anywhere at least not here in Australia.
There have been about 55 high level enquiries and royal commissions in Australia over the last 30 years but almost nothing has changed. We still have a mental health system that has been publicly criticised by one Royal Commissioner as “not fit for purpose”. Many of the battle weary reformists unfortunately seem to be succumbing to fatigue and a sense of hopelessness seems to have set in. Goliath and his army are just too big and too well organised. To some they seem undefeatable.
Some of us think it is time to try a different approach and the approach we are currently looking at is to train Lived Experience Workers (LEW’s) in the art and practice of Open Dialogue facilitation. The objective is to get a significant number of these people working together in an owner run workers co-operative providing MH facilitation services direct to the public.
Open Dialogue is not anti psychiatry or anti medication so the Open Dialogue approach understandably angers some people. While understandable it doesn’t take into account the complexity of the problems. Trying to solve a complex problem with simplistic solutions is, in my view, at least part of the reason why MH reform has got stuck in the mud and isn’t going anywhere.
As said we are expecting challenges from the mainstream MH fraternity but in order for them to stop us they have to try and get new laws enacted in Australia that effectively prevent trained LEW’s and others in this field from engaging in what are currently legal practices. If such attempts are made they can and will be challenged both politically and legally.
Open Dialogue can be difficult for many people to understand. It has been described as a political solution to the mental health problem. Current Australian government policy is for mental health services to provide recovery oriented practices like Open Dialogue as a move away from the predominant institutionalised biomedical approach. It is not happening to any large extent because it is currently resisted by both the main stream biomedical people and the traditional “no drugs, no psychiatry” reformists.
Trying to summarize Open Dialogue in a few words is difficult but it is essentially about getting all the client’s stake holders (Usually family) together with the client and then actively listening to each other, reflecting on the different views and ideas and attempting to work together as a team towards a mutually agreed plan for the best way forward. It is not the way most people think or behave so it can be quite a difficult skill to learn, particularly for many traditionally trained MH professionals. People with lived experience have a big advantage because they often know from their own experiences what it is like to be on the end of a dictatorial process where their input is ignored or disrespected and they have little or no control over the outcome.
I previously mentioned that there seem to be quite a few mainstream mental health professionals in Australia and probably elsewhere who are getting pretty fed up with the old biomedical approach and are advocating for something better. MIA interviewed one of these people are couple of years ago. Dr Jureidini is a child psychiatrist and professor of medicine at Adelaide University in Australia. Here is the link to the interview with him https://www.madinamerica.com/2022/09/jon-jureidini-evidence-based-medicine-post-truth-world/
Dr Jureidini’s book “The Illusion of Evidence Based Medicine” is an absolute “must read” for anyone who wants to go beyond sound bytes and look at the real story about what has been happening in the mental health industry over the last 50 years or so.
Another advocate of the Open Dialogue approach is Dr Paul Denborough who is a child and youth psychiatrist and Director of Child Youth Mental Health Services at the Alfred hospital in Melbourne Australia.
There appear to be a number of other mental health professionals that I am aware of who like these people are patiently waiting in the wings and looking for a better deal for both their clients and their profession.
According to the World Health Organisation (WHO) “Many mental health conditions can be effectively treated at relatively low cost, yet health systems remain significantly under-resourced and treatment gaps are wide all over the world. Mental health care is often poor in quality when delivered. People with mental health conditions often also experience stigma, discrimination and human rights violations”
Whether you want to call this reform or a battle doesn’t really matter. We are inviting Australian Lived Experience Workers to form a worker owned and run co-operative to help deliver the sort of effective low cost mental health services that the World Health Organisation claim is necessary and possible.
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I am sorry if I misinterpreted your comments. I have seen OD trainings and participated in one myself. It seems like a great approach. I’m also not opposed to the availability of drugs to assist anyone who finds them helpful. My point would be more that Dr. Jureidini should not expect to be congratulated for his success. As has been clearly demonstrated with many examples, successful healing of patients is threatening to the status quo, and anyone who is successful can expect to be attacked as a quack, a religious nut, or an irrationally hostile force. Initial reactions to Bob’s book are more proof. No one can really undermine his basic premises, yet he’s seen as a kook or an antipsychiatry nut or a “Scientologist,” as if any of those are scientific analyses of his work. And such tactics are generally successful, and will be until the public catches on that the mainstream of psychiatry does NOT have our best interests at heart.
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And GO, ALEW!!!!
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What I admire about Jon Jureidini is his courage in publicly speaking out in such a strong and forthright way from his role as a high profile psychiatrist and academic working in the midst of an ultra conservative and potentially hostile environment. It is a point that MIA Podcast host James Moore also made in his interview with Dr Jureidini.
As mentioned, I believe that there are many mental health professionals, at least in Australia but probably also elsewhere who are not enamoured by the mainstream biomedical approach. I have spoken to a number of such people. They have been willing to privately discuss their concerns with me but inevitably are unwilling to take any sort of a public stand, even when pressed hard to do so. This in my opinion makes Dr Jureidini’s stance commendable and worth while. The reluctance by most to speak out simply boils down to career and job as well as professional status and peer acceptance. If you want to keep your job and career prospects open, keep your mouth shut. At least that’s the way it works in Australia.
His book, “The Illusion of Evidence Based Medicine”, co-authored with Leemon McHenry, A US bioethicist and professor of philosophy in no way undermines or diminishes any of Robert Whitakers books in fact it compliments them with some exceptional research that involved considerable perseverance to get hold of original test data from pharmaceutical companies. They then analysed it to reveal deliberate wide spread, substantial criminal fraud. Some of these fraudulent practices have been successfully prosecuted in the USA but continue to go on regardless
While the pharmaceutical industry is undoubtedly a key player in these legal and unethical practices, Dr Jureidini’s book explains the impact that this has had on the entire medical (not just psychiatric) supply chain. It also establishes a basis for exploring the way in which these sorts of practices seem to have become common place in a wide range of industries. This in turn has impacted science and cultural values throughout the whole of western society and this very definitely affects mental health.
I maintain that simply blaming the pharmaceutical industry or psychiatric fraternities for the immense global mental health problem fails to look realistically at the situation. As I said previously, it is extremely complex. I don’t believe the situation can be effectively dealt with or even understood through simplistic black and white “blame and shame” type thinking.
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I’m ready sign me up. Tell us how?
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I wish I had a plan!
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That’s the problem.
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Please see response to Sharilyn Wells
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The easiest way to access more information about the LEW/Peer Workers coop is to go to the Pink Panther Movement website https://pinkpantheractivists.au/
Follow the lead article “Mental Health Lived Experience Workers Co-Op” on the home page to the end via more. There you will find links to our temporary Meetup home and the current version of our business plan. Please be aware that this business plan is a work in progress. It will undoubtedly change over the coming weeks and months. I will endeavour to make sure that the latest version is always online.
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Very good points Steve! And as an ordained minister, I always appreciate biblical references to everyday life and the David-Goliath story definitely applies to the peer support movement. To add to your comments, Goliath may have had his height and strength but David had a sling with five stones (only one was used and was enough to topple Goliath to the ground) and faith in God to win the battle. I firmly stand on the promise that God in me is stronger than the strongest, most powerful person or institution on Earth. Another example: the mustard seed. The mustard seed is the smallest seed ever in existence. However, with water and care, that seed grows to be the tallest tree in the land. Thank you so much for your prospectives!
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Tim, I hope you and your colleagues pursue your goal. No, the current system canāt be toppled by the Peer Movement. It doesnāt have to be. Just deprive the system of its victims. The system crumbles or more likely transforms into the medical discipline known as neurology; the doctors who truly work with patients who have defined brain diseases. The emotional suffering of us humans need not be dealt with by MD doctors but by all of us and by those with particularly valuable skills sculpted by their lived experiences and additional training. Peers are not clinicians or āmental health (illness) professionals. Peers do not take medical insurance since they are not dispensing medical care. Peers work with those who will seek them out to find compassion and understanding of their situations and be with them through their ordeals. People will seek out Peers once they know what Peers provide. Donāt be quiet! Be bold! Unite as Tim says. Let your communities know who you are and what you offer. People will come to you! Not as an alternative but as a way to grow.
Ken Blatt
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Hi Ken
Thanks for your feedback. It is very helpfull. I think we are both very much on the same wavelength.
We have had a better than expected response to our initial reach out. Our first and most important task is to try and build a strong core team.
Feel free to join us for a no obligation ride if you have the time and inclination. More information as per my response to Sharilyn Wells and Steve McCrea is available on the ‘Panther website https://pinkpantheractivists.au/
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Hello
As a lived experience to my husbands Suicide
I have a lot to say after watching him deteriorate after 16 years of marriage being on psychiatric meds. The longest one being Lithium. Iām also a surgical nurse of 38 years. His toxicology report showed a cocktail of mental health drugs and nothing more. I have plenty to say after much research and other holistic methods for depression that a nurse can suggest.
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On behalf of Max, thank you for all the responses we have receive from folks about this article. Max and I wanted to shed light on a subject that, oftentimes, get swept under the rug or minimized. We believe it’s awesome that fellow peers and allies have began open dialog on a topic that has been in the dark for far too long. Please feel free to leave comments, words of wisdom, your own research, etc. The more we talk about co-optation in the peer workforce, the more exposure it gets…and the hope is that something will be done about this.
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Dear Dr Fleming,
I am an older person with a lifetime of lived experience with schizophrenia. I have been involved with voluntary peer support work on and off for about the last 38 years and have been interested in/researching Wellness Model/Active Listening/Soteria/Open Dialogue etc for the past 5 years or so.
Open Dialogue is being used very sparingly in a couple of Australian main stream mental health facilities that we are aware of but as would be expected, uptake is slow and resistance is high.
The Pink Panther Movement is an Australian mental health reform organisation that is attempting to promote the establishment of an Australian worker owned and operated Cooperative for Mental Health Lived Experience Workers (LEW’s) a.k.a. Peer Support Workers or people aspiring to such roles.
The objective of the co-operative at this point in time is for suitably trained LEW’s to provide low cost mental health services, based on the Open Dialogue/Active Listening approach directly to the public on a fee for service basis.
Getting a good team of people together is an essential first step.
We have scheduled an online Zoom meeting for Wednesday, October 2, 2024 7:00 PM to 8:30 PM AEST (09:00 UTC) for anyone interested in this initiative. The meeting time has been optimised for East Coast and Central Australia so it may be inconvenient for people from other parts of the world. Response to date has been encouraging.
People who are not LEW’s or aspiring LEW’s but have an interest in mental health reform are also most welcome to attend and participate
This is an opportunity to ask questions, make comments or suggestion or just listen in to find out more about what is happening.
Participants in this discussion are encouraged to at least have a look at the business plan on the ‘Panther web site so as to have some understanding of what this discussion is about. The business plan can be downloaded here.-
https://pinkpantheractivists.au/wp/wp-content/uploads/2024/09/Acacia-Business-Plan-Version-3.0-9-Sep-2024.pdf
The zoom session will be opened 15 minutes before hand. Participants are asked to join the session for a prompt 7:00pm AEST start.
For further information including, please see the lead article on the ‘Panther web site. https://www.PinkPantherActivists.au and the EVENTS page for the Zoom link to the meeting.
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Wouldn’t it be cool to create a national organization in the United States, similar to Australia’s Pink Panther Movement, dedicated to creating spaces of inclusion for peer support professionals to have an active voice at the table when it comes to peer support advocacy and state mental health regulators? I think so. This new organization can also serve as a union for peer support professionals, each state can have a chapter (like the National Alliance on Mental Illness) and each state has its own chapters.
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Thanks everyone for reading our article
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