Peer support
We all experience peer support every day, from telling our best friend our deepest worries to laughing with the shopkeeper on the way home.
Peer support work in the workforce context, however, is more formal as peer support workers are employed in their roles. Peer support workers come from all walks of life, and they all have personal experience of periods of mental distress, illness, and or addictions that they have learned and grown from. This highly valued expertise informs and enhances the work they do.
Recovery philosophies underpin this work and the life experience of the worker creates common ground to form relationships with people accessing the service. Empowerment, empathy, reciprocity and choice are the main drivers in peer support work.
Peer support services
There are many different styles of peer support services, from volunteers providing phone support services, to peer run 24-hour respite and alternatives to acute inpatient stays. Peer support work is as diverse as the people who use it. Peer support can be provided in people’s homes and communities, hospitals, face-to face, via the internet or mobile phone or from within specific services.
Peer support roles and services can come from within NGOs, DHBs, and mental health and/or addiction services or be service user owned, developed and operated.
Peer support workers are trained before they begin their work. Several models of peer support work are used. Many are from overseas models adapted to a New Zealand context but we also have our own indigenous models. Peer support workers need robust supervision or coaching and mentoring to effectively do their work and maintain their resilience.
What is peer support?
Peer* - person of equal standing with another: somebody who is the equal of somebody else, e.g. in age or social class [13th century. Via French< Latin par 'equal']
Support* - to give active help, encouragement, or money to somebody or something, : to give assistance or comfort to somebody in difficulty or distress.
* From Encarta World Dictionary
We are referring to purposeful peer support roles rather than the informal peer support we get from our friends and family.
Peer support work in mental health and/or addiction workforce is provided in a purposeful contextual framework. Peer support workers are trained to support people currently experiencing mental illness/distress and/or addiction issues towards wellbeing.
- It is non-clinical.
- It is not a treatment.
- It is optional – people cannot be compelled to use it.
Peer support is person-centred and underpinned by recovery and strength-based philosophies. The life experience of the worker creates common ground from which the trust relationship with the person is formed. Empowerment, empathy, hope and choice along with mutuality are the main drivers in purposeful peer support work. There is great deal of strength gained in knowing someone who has walked where you are walking and who now has a life of their choosing. In this way it is different from support work, it comes from a profoundly different philosophical base.
There are many different styles and contexts for peer support services. From Warmlines where volunteers provide phone support services, peer run 24 hour respite and alternatives to acute inpatient stays. Buddy systems for within hospital, a meeting place in a small rural town, to practical positive support within the community. Peer support work is as diverse as the people who use it. Peer support can be provided in people’s homes and communities, hospitals, face to face or via the internet or mobile phone or from within specific services.
Peer support roles and services can come from within non government organisations (NGO), district health boards (DHB), mental health and/or addiction services or be service user owned, developed and operated. Currently funded peer support services sit within secondary service levels but there is huge potential for the development of peer support within primary health services to be very effective as well.
The potential of the peer workforce is a positive one. Within the painful mayhem of mental illness/distress and/or addiction, finding solace, strength and hope in being with someone who has “been there, done that” and found ways through is compelling.
Who is a peer support worker?
A peer is someone who shares some previously specified characteristic with you e.g. age, experience, education, career which provides an agreed upon equity. It is a bridge that is the foundation of many relationships - the shared experiences, knowledge and/or history that connect people with each other. In the peer support relationship it is the experience of mental illness and/or addiction and the journey to wellbeing that provides the beginning platform for the relationship.
Peer support workers can and do come from any avenue of life - any age, ethnicity, gender, background or place. Many are in paid roles, some are volunteers.
People enter peer support work in a variety of ways. Usually organisations that provide peer support advertise for people and then provide training for them. All workers must be willing to identify as having have lived experience of mental health recovery and be prepared to use this experience and the principles of the recovery approach to guide their work. They must also have personal strengths, skills, values and qualities compatible with the role.
It is important that peer support workers are well trained and followed up by robust supervision/coaching/mentoring that supports them to be effective in their work and maintain their wellbeing.
The values that underpin peer support work
It is mutual lived experience that makes peer support work both different from other roles and effective. However this experience alone does not make a good peer support worker, many other things including training, values and attitudes come into the mix. Below are some of the important values, principles and attitudes that underpin peer support.
Open mindedness
Peer support workers are open-minded about what they might discover, and alive to the possibilities in themselves and others. They are non-judgemental and believe in the potential and right of all people to find “a life worth living” for themselves.
Reciprocity
Peer support is a negotiated process of giving and receiving. All participants have the potential to learn from each other and much to offer in the context of relationships. This two-way process is in contrast to many people’s experience of traditional mental health treatment as a one-way process where the recipient is seen as perpetually in need with little to offer in return. Both parties identify, develop and value self-expertise. There is mutual trust, respect and honesty.
Resilience
Peer support acknowledges that setbacks are part of life’s path and that they can offer opportunities for growth. It is in the recovery from these that confidence grows.
Shared responsibility
All relationships have a power dynamic of some sort. It is acknowledged that because peer support workers may have knowledge due to training and experience and they may be employed and paid for their part of a peer support relationship this could imply a power imbalance. However, the responsibility for engagement is mutual and shared. This quality has also been described as “being alongside, not above or below”.
Authentic constructive regard
Peer support workers operate with respect to create a safe, honest and non-judgemental relationship. Positive hopeful regard is genuine and authentic and borne out of the experience of recovery. People are accepted in their entirety, including their right to choose their own path to wellbeing.
Self-determination and choice
Peer support provides as much choice as possible in response to anything identified by the person accessing the service as something that supports their wellbeing. These choices are defined and led by the service user, not by the worker. They may include, for example, having a worker or not, which worker they see, what they do together, when, where and for how long.
“Withness”**
This word describes the unique ability of peer support workers to be totally alongside and ‘with’ someone due to the empathy engendered by shared experience of mental illness/distress and/or addiction.
**“Withness” is of course not a proper word (as yet). However the propensity today is in using language differently, creating new ways of expression with language that are often highly appropriate - as in this case.
Other points of note
In collecting feedback, there was occasionally the dilemma of directly conflicting feedback. For some people it was most important that people were highly and thoroughly trained, for others there was tension about becoming too professionalised and losing something in the process. The equality of relationships was questioned- one person is trained and probably paid to be in that relationship- the need for some set boundaries and the blurriness of a ‘professional friendship’. This really reflects the newness, diversity and complexity of peer support work and the unique opportunities presented to learn as we go. Therefore connection with each other and opportunities for discussion, learning and support are very important at this stage.
If in reading this you get the picture that peer support work is about sugary encouragement and rainbows then most often that would be wrong- although if it helped then maybe sometimes. More often though it is ensconced in a gritty realism that says ‘yep this bit is incredibly hard and it isn’t fair. You can get through though, I will be here with you while you do. I know this because I have already done it’.
In April 2009 in Christchurch, Te Pou and the Mental Health Commission held a National Peer Support Forum to discuss the development of purposeful peer support work and its workforce. There was a very ‘New Zealand Peer Support’ flavour to the forum that is difficult to reflect and yet is really relevant. The following are quotes from the day hopefully reflect some the essence of the day.
It’s like asking someone who has never tasted apples or apple juice to describe the taste of apple juice to you.
If you were building a house, who would you want to help you? Someone who had read a book about building a house or someone who had done it successfully?
A mutual shared relationship based on love, trust, respect, positive regard between people with foundations of hope, believing in the uniqueness of self-determination of people and their communities.
Mad mentors
Navigational- we each have a piece of the map
F.U.T.U.R.E – Faith, Understanding, Trust, Unity, Recovery, Empowerment
H.O.P.E – Holistic, Opportune, Positive, Empathy
