I have been chatting to friends and reflecting on what I have learned through writing this blog. From what I gather so far, the benefits of peer services outweigh the limitations, and like anything else there are issues that will have to be considered and new ways of doing things developed.
A study of prison peer programmes (Devilly, Sorbello, Eccleston & Ward, 2005) highlighted good outcomes through provision of peer support programmes in substance abuse counselling and reducing self-harm/suicidal ideation. It mentions risks of 1) prisoners rejecting peer support due to negative stereotypes 2) health professionals being alienated due to preference for peer services. To me both of these illustrate how new services and new paradigms require rethinking roles and relationships. Issues of education for peer supporters will have to be sorted out, as will support for the peers themselves. A more difficult issue may be that of conflict of interest/accountability. If a service user reveals violent or criminal intent, whose "side" is the peer on? Other than trying to persuade the user not to proceed, are they equally bound by loyalty to fellow users as they are bound professionally by confidentiality laws?
My opinion on all this is we are generally headed in the right direction, increasing the rights and empowerment of service users, supporting people's recovery journeys, enabling people to make connections with others and contribute to the community. All this sits well with my philosophy as an OT, enabling people to make their own decisions, empowering people to find their unique solutions, supporting people to participate in meaningful activities, such as work, social contact, reintegrating into society. Giving people the support to find personal solutions to their problems and then enabling them to help others do the same, there's a sustainable process which holds much promise, especially since there will always be more users than healthcare staff. There will be some issues to rethink, but they are merely teething problems, such as working out new relationships, roles and accountability processes within the user-peer-staff triangle which could replace the old patient-staff relationship. As Mary O'Hagan says in the video in my previous post, all stakeholders' perspectives have to be considered - users, staff, families, and now, peer workers as well who are both users and staff.
OTs have a role in facilitating this phenomenon for mental health services because we believe in occupational justice for traditionally marginalised groups, we believe in enabling people to take control of their lives, and we acknowledge that every person is unique and we don't have the answers to everyone's problems, but that they do, and they can find these solutions with support from us.
Anecdotally, when I think back to my first mental health placement, I see a stark difference between users who believed they could help similar others and users who didn't. The first group was enthusiastic, productive, positive, excited about the future, even though they might have had symptoms. They infected me with excitement and anticipation of all the positive changes that were in the pipeline and I felt enthusiastic and hopeful. The second group didn't have any meaning or structure or hope, and didn't feel they could contribute anything, or didn't value themselves. Sometimes they refused to do self-care even though they had done it before, they claimed they couldn't do it, or said "What's the point?" That hopelessness and lack of a future to look forward to made me really sad and discouraged. If peer services can help in some measure to transform the second group to the first, then as an OT I really want to be part of that process.
Reference
Devilly, G. J., Sorbello, L., Eccleston, L. & Ward, T. (2005). Prison-based peer-education schemes [Electronic version]. Aggression and Violent Behavior, 10,219-40.
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