There is this growing movement of people who think that peer support is critical in the treatment of people with mental illness – but I would contend that, in spite of this movement, peer support does not treat mental illness. And, in fact, by funding these peer support-based initiatives and peer-delivered services we take away dollars that should actually be spent on the evidence-based treatment of serious mental illness.
Peer Support Initiatives / Peer Support Groups
Some peer supporters and peer support groups are run out of the goodness of people’s hearts, and that’s nice. There’s no doubt that talking to someone empathetic and, likely with a similar illness, gives people warm feelings and possibly enhances both parties’ social lives. But when people start believing that peer support can actually treat a mental illness that’s when I start to pull on the reins. When people start insisting that peer supporters should be licensed so that Medicaid will pay the organization money, that’s where I draw the line. Why are government dollars – your dollars – going to facilitate empathy and a pleasant conversation?
Limited Funds Shouldn’t Go to Peer Support or Peer-Delivered Services
In the mental health care system, funds are extremely limited and all too many of them go to what many of us call the “worried well.” In other words, all too many funds go to people with minor mental disorders and not to people with serious mental illnesses. Getting quality treatment for a homeless person with schizophrenia or bipolar disorder is nearly impossible in our society because of this lack of funds. When you go to an Emergency Room because you’ve just attempted suicide it is equally likely as not that you will get almost immediately released from the hospital because of this lack of funds. When you don’t have good health insurance, you’ll only have access to the older, more side effect-laden drugs because of this lack of funds.
So when I have a choice between a floridly psychotic person talking to a “peer” or actually getting treatment, I’m going to pick treatment 10 times out of 10, and when I think about where our limited dollars should be going, I’m going to pick actual treatment 10 times out of 10, too.
Does Peer Support Have Benefits?
Don’t get me wrong, I’m not saying that peer support doesn’t have benefits, likely for both parties in terms of temporary, warm fuzzies, but there is no high-quality research saying that this will actually improve a severe mental illness.
According to a meta-analysis done in 2014 by Lloyd-Evans et al on peer support for people with severe mental illnesses:
. . . there was little or no evidence that peer support was associated with positive effects on hospitalisation, overall symptoms or satisfaction with services. There was some evidence that peer support was associated with positive effects on measures of hope, recovery and empowerment at and beyond the end of the intervention, although this was not consistent within or across different types of peer support.
Moreover, the analysis notes a “high risk of bias” in studies, perhaps overestimating even this limited finding of benefits.
Another 2014 meta-analysis on peer-delivered interventions for severe mental illness and depression on clinical and psychosocial outcomes by Fuhr et al found that:
The limited evidence base suggests that peers may have a small additional impact on patient’s outcomes, in comparison to standard psychiatric care in high-income settings . . . No effect of peer-delivered interventions for depression was observed on any outcome.
In other words, there is essentially no high-quality evidence that says that peer support or peer-delivered services make people with severe mental illnesses better. The only benefit these services seem to have is that they are cheaper and make people feel like something is being done.
Are There Dangers to Peer-Delivered Services?
And to top that all off, there are dangers to peer-delivered services, too. Because peers are not professionals and do not have professional guidance, oversight or ethics, they often take liberties that are far outside of what is reasonable.
For example, a peer might be talking to someone who is having depressive symptoms and say, “I went on X drug and it changed my life.” This is completely inappropriate. That drug may actually be dangerous for the person in question. The only person who should be making drug recommendations should be a doctor.
Another example might be a person that is dealing with psychosis and a peer that says, “Don’t you know that voices are just part of your subconscious and should be dealt with in therapy and not through medication?”
Again, this is a terrible thing for a peer to say. The peer has absolutely no right to make such biased, ill-advised and unscientific comments.
You say this doesn’t happen? It has happened during my own experiences with peer support and during the delivery of peer-driven services to others I know. This is really what happens. It really invalidates a person’s experience with mental illness. It can really steer a person away from real, evidence-based treatment. It can really make a person run to his or her doctor and demand a medication change that isn’t right for him or her.
Money for Evidence-Based Approaches, Not Dangerous, Peer-Delivered Services
I’m not saying there isn’t a place for peer-delivered services in some way. For example, if a peer wants to facilitate the life of another who may not be functioning at a high enough level to take care of him or herself. This makes sense. But only if the task is simple, non-psychiatric and the peer knows not to try to influence the other with personal opinions.
So if you want to be a peer support person or if you want to partake of peer support, feel free, just don’t use the taxpayer’s funds to do it.
PS: Considering all the comments, I wrote a response to some of them at In Response to the Peer Supporters Who Want Government Funding.
Update: See this great article from an ex-SAMHSA employee that talks about this very issue: The Federal Government Ignores the Treatment Needs of Americans With Serious Mental Illness.
Image by Flickr user Garry Knight.
Interesting outlook Natasha and all those who view things the same way. Being a healthcare professional and diagnosed with mental illness, all I can say is that there should be room for both and that one cannot operate without the other. I can attest to this because I have been on both sides of the coin. It’s unfortunate that definitive sides are taken and produce such negativity in these posts. There was hardly a look at how either side could be represented using a ‘duality’ approach. But it is what it is and no system for the treatment of mental illness is perfect. All we can do or should do is support each other in our quest for recovery whatever that may mean to an individual. Thank you for posting.
Hey Natasha!
Read your own support references.
Peer support is absolutely supported by evidence- the articles your cite actually state as much and propose further research and support to that end. (Going to far as to say there is evidence to support use of peer support in areas with limited resources and that the clinical outcomes equaled those of professionals)
Sorry you had a crappy experience but that’s not really solid evidence to crap on a whole mode of support.
Hope you find what you are looking for.
Agree. I am a peer support facilitator and we go through training and then ongoing training. There are people who come to the group who cannot afford therapy through their insurance and work too much to receive services through Medicaid, so we are all they have and it helps them. It’s better than nothing.
I am doing better with my own bipolar depression as a result of attending support groups – moreso than therapy.
There are some pitfalls. I currently do not like the leader of the group I co-facilitate. I heard him tell someone struggling with chronic anger that “we choose to be angry” – because some therapist told him that.
I hardly agree with this. There are pitfalls, but I find this article a bit heavy handed and negative. I am glad I am in the group I am in so I can chime in with more compassion and less of a Tony Robbins style due to all the therapy I have had and many modes of healing I’ve learned about over my 56 years here.
What can I say after 46 years: You are quite ignorant like most of the so-called ‘experts’ out there worried about their jobs. Called the “worry hells” That keep people in a living hell of psychobabble pharmaceutical land,.. A hallmark of the 21st century. People have been loving people back to health in healing by compassion, prayer, God: not chemicals, for centuries. It is not dangerous, it is what we were created to do: Love One Another (Ref. Jesus)
I’m going to chime in again on this and add that peer support would not be ‘necessary’ if the mental health system as a whole was not abusive and violent. At the moment peer support seems to basically add up to the mental health system employing a small number of people to show compassion to its patients after it has brutalised them. And, quite obviously, yes, abuse, violence and other traumatising behaviour can and does induce mental illness (in fact, it seems to be the sole cause of mental illness), so in this way, peer support workers are ‘necessary’. However, perhaps it would obviously be a good idea if mental health systems weren’t actually bad for people’s mental health in the first place. Terrible :(
I had to add that there is true eye-opening and reassurance in the input of peers who also have bipolar. Although, even in my professionally run DBT group, half the time people can’t admit they even have bipolar or Borderline Personality Disorder to themselves, much less the group although finally after a year people are starting to really open up. I find a huge amount of reassurance in the stories and success and down times of my peers but it is through meds and real therapy that I have made it to a point where this can take effect.
I am sorry other people have felt so marginalized and also that they have found good results with peer support and potential mentoring. That has just not been my experience which is also why I have such a hard time supporting the NAMI local group in my tiny rural town. I am not arrogant, it just didn’t help me when people had their own views and wanted to tell me what to do. Peers just don’t have the emotional awareness and boundaries built in that a professional counselor has…
Just my fifty cents worth…
~Rhea, R.N.
Natasha — you are right on! While I was an absolute basket case, my therapist and my DBT group basically just were there for support while my meds kicked in and I was able to take in what they had to offer. For months, I wasn’t ready and they stood by me — I imagine it must have been difficult since I only remember showing up and hunching up in a ball most of the time after I had my psychotic break.
I am also a huge proponent of keeping the mentally ill off the streets and out of jail but it is just so hard to convince people of this. I really think everybody should have mental health services (can you say “gun nut” anyone?) — and also seriously because of all the unforeseen suicides and hopelessness and dysfunction out in the world, but I hardly ever share this view since I know even truly, that it would just encourage people to fear mental hygiene police and it might actually have that effect, especially in terms of jobs, even though it shouldn’t.
Anyway, I don’t often post but I REALLY believe in what you are saying and I wanted to let you know. Thank you as always for your effort in being a voice for our support!
~Rhea, RN.
Dear everyone at this thread. Thank you Rhea, Natasha, and others whose posts have supported Natasha’s position on peer support not being funded by the government. I’m stopping following it now. Too many emails, for one thing. Also, I’m tired reading all this arguing on this subject. I’ll be at other threads, and you will see me there from time to time. So bye for now.
Wow…first of all peer support services, aka consumer operated service programs ARE an evidence based practice. Do a quick internet search to educate yourself and you will find this out. Second of all, as a person who has been diagnosed with schizophrenia and has been homeless and has nearly ended up dead on a number of occasions from the dangers of being alone in these frightening states I can honestly say two things: 1. being hospitalized and being in a “high level of care” surrounded by providers that believed I could never recover harmed me greatly in many ways and taught me to believe I was forever broken and sick, prolonging my struggle. 2. After 10+ years of perpetual patient hood shuffling around on loads of prescribed drugs, when I found peer support and programs run by peers I experienced rapid recovery of myself as a whole person and am now free of drugs. Now instead of costing my family and my community, I am contributing positively to both of them. I’m not going to say that what worked for me would work for everyone, I am going to say I do not wish to be lumped in the same category with you because I have had severe life struggles that were labelled severe and persistent mental illness. I am offended you attempt to make your own personal belief that hospitalization is wonderful and 10 times out of 10, since you should choose it that often, it should be the only option for all people. 10 times out of 10 I’d choose peer run alternatives-like peer respite, warmlines, peer support services. They help me out way before I’d be a candidate for hospitalization again-they prevent me from getting too far gone because I have social connection, you see? Maybe for you, that doesn’t work. That doesn’t make as a single person worthy of making decisions for all of us with serious labels. Think about it. Then think about revising or removing your article altogether.
Awesome JC! Isn’t it great to know that you’re not alone too? Not being pathologized? A real human being with all kinds of worthwhile gifts to share with the world? I have a thought/mood disorder and am a Peer support specialist for a long time, been dismissed out of hand by pro staff who couldn’t do anything for the “patient” who feared them, and they feared the “patient”. Holding space and identifying with my peer created communication and relief and medication can’t get that. It doesn’t solve problems.
After some years of exposure to the mental health system people with mental illnesses learn not to trust it and to fear it. Peer support workers are there to connect with patients emotionally and basically to encourage patients to know that they can cope with the mental health system and survive it, as they, the peer support workers have demonstrably done. The whole system is beyond ridiculous, and evil, very unfortunately :( :( :( :(
Lives have been saved in a Facebook peer to peer group that I have been running for 5 years. I cannot tell you how many times people have found our group in the wee hours of the night because they are experiencing such severe withdrawals due to bad advice given by doctors. This doesn’t happen infrequently. I do not say what group it is for fear of the pharmaceutical trolls but I daresay we help more people then pharmaceutical back doctors do. How do I know this because the members tell us. Having lost two people in my family do to polypharmacy and following doctor’s orders it would be well for most people to stay away. I recommend for all people who haven’t to read Robert Whitaker’s book, Anatomy of an Epidemic.
That would have to be one of the most ignorant and ill informed posts I’ve EVER read. You do realise that the Pharmaceutical companies are in the top 3 profitable industries in the world? And do you realise the conflict of interest when Pharmaceutical companies fund their own research. In addition to that there are still luxurious incentives for medical practitioners pushing one brand over another, despite that being an illegal practice. Furthermore you should probably know that there is an 86% higher rate of suicide who are on prescribed medication than those who self medicate with illicit drugs? I very much doubt that you have spent much time as a victim of the mental health system, but to me it’s a no-brainer. I would rather take advice from the Peer support worker who has knowledge based on lived experience than an ego tripping text book Professor F*&kwit that is void of knowledge, and full of it.. Information that is… PS: ” Before you diagnose yourself with depression, make sure you’re not surrounded by assholes”
Hello, Jody, I definitely agree with you on 2 points: ” the Pharmaceutical companies are in the top 3 profitable industries in the world. [and ] the conflict of interest when Pharmaceutical companies fund their own research. ” I taught nursing students once. I don’t have your statistics on the “top three.” A professor at the college where I taught told me that the medical profession is the largest industry in the world! I asked him if was more than the defense and military industry, and he claimed that it is. I’m totally opposed to corporations — any corporations — paying universities to do their research for them.
I once had a wanna be psychiatrist (a GP with better access training who the local psych services try to pass off as a psychiatrist) disregard a well established decades old diagnosis of PMDD and PTSD as depression….not because i displayed symptoms
But because I was HOMELESS at the time with 3 kids jumping between crisis accomodation every few weeks surrounded by A$$holes such as a worker who went on vacation followed by 3 weeks sick leave and told no one where i was….or that i existed…while living rent free is nice i have acute health issues and had 3 under the age of 6…..i couldve very literally died and no one find my kids for weeks.
His treatment for this ‘depression’ very literally almost killed me…..i landed in hospital when it caused acute potassium deficiency when my respiratory system started Shutting down one of my acute health conditions is acute asthma….
my current doctor literally outright refuses any and all such classes of drugs without even knowing that history that is behind that day he first met me at the back of an ambulance….because they will kill me…he wont even give me 5mg of diazapam! Because its too high risk let alone an antidepressant…..i wasnt at risk I wasnt suicidal i have MULTIPLE chronic pain disorders and the idiot assumed because i was in so much pain daily i MUST be depressed…..so rather than considering effective pain management he tried to kill me instead….oh the system is great fun!
The mental health systems of the world are human rights abuses, nothing less. The sooner people with mental illnesses get the same rights as everyone else, the better, obviously. And there is no time to lose, (also obviously), as people are suffering terribly under these systems every day around the world. We all need to organise international marches in cities around the world, actually. Meds, TLC, therapy is all good but incarceration, ‘seclusion’ and ‘restraints’ are throwbacks to the dark ages, nothing less, and quite obviously, they are dreadful measures to be subjected to. People with mental illnesses need human rights (you wouldn’t think it would be much to ask for people with disabilities to have human rights, would you?) and with effective early intervention like intensive talk therapy, we would have all been back on our feet and living normal lives decades ago. Because of stigma and discrimination the general public mostly think they don’t ‘care’ about us, and nothing has been changed yet but the UN has called for all forced psychiatry to be banned and it’s a matter of time before it is. There is no time to be lost, really – mental health systems worldwide are destroying lives.
Hi Margaret. I responded to your message this morning with an epic message. It took me about an hour to write, and I lost it so spent the next bloody hour trying to find the fkn thing. I couldn’t and was so mad I got off the computer and spring cleaned my bedroom onstead…. until now.
I just wanted you to know that I acknowledged and relate to your life experience. The only madness in the crazy sense I refer to as ISI – INDOCTRINATED SYSTEMIC INSANITY
There also appears to be a lot of guidance which serves the information informed academically qualified fraternity, who have the additions privilege of Rite of Passage which negates accountability so the outcome of their treatment is unaccounted.
And what a clever move to undermine those who express their authenticity as crazy or mad, because it undermines the Knowledge gained from lived experience which far outweighs the regurgitated information that came from a textbook. Include the socio-economic differences in status & brainwash the people to believe that equates to success, and we’re screwed.
They
Natasha Tracy is very misinformed and takes advantage of young minds. She’s a fake.
After 9 years of ‘evidence-based’ psychiatric services, many of them forced, and none of them effective, my life was transformed when I found peer workers. Instead of diagnoses of schizophrenia and borderline, and messages that my brain was sick … I finally found people who asked about my life and what had happened to me. When I dealt with childhood trauma and the resulting shame, I found healing. Something traditional mental health services had not only failed to do, but they had actually increased my disability. Psychiatry in my experience uses evidence of convenience rather than genuine evidence. There is plenty of evidence that most consumers have a history of trauma – yet this is largely ignored. The evidence for medication is that it’s only helpful for a minority of people – and often not much more than a placebo. And much psychiatric treatment in hospitals has almost no evidence – it’s just historical artefacts. Peer work has evolved because we survivors of poor psychiatric practice have started to help each other. We are a response to the terrible failings of traditional systems. Without peer work I doubt I would even be here today.
Dear Indigo Daya, Such an interesting post. Thanks so much for your opinions and personal experience. My thinking is that everyone has different experiences with peer support, and also mainstream, “evidence based” mental health services. If you read my (very long) recent posts you will see that I experienced a very good peer managed mental health drop in center. I also have had life-changing support from traditional mental health services, including psychiatry, therapy and medications (although I need to change them from time to time b/c one quits working, etc and a new one works). My providers in the city I now live in have been/are superb. I have learned so much from my amazingly compassionate and WISE therapist, for over 8 years. Previous locations where I’ve lived, I found nobody, nothing, no mental health facility, etc etc that helped, and some made me worse. I’ve never been hospitalized. I think that’s be cause my dad knew a man who had been (in the 1950s) and he was treated so horribly that it took his wife going to the governor of that state, to get him out! My dad told me, “No matter how hard it gets, NEVER, NEVER go to a mental hospital.” I assume, maybe wrongly, that psychiatric hospitals nowadays are better than in the 1950s. I don’t know what to say about forced treatment. I don’t know much about it, and I know that the mental health peer community generally opposes it. But here is the one experience I’ve had with it, although not for myself — for a good friend.. One thing I do believe: If someone threatening immediate suicide, asks for y our help, they must accept whatever you can do or advise. This friend threatened suicide twice, to me, on the phone. She was very lonely, I might add. The first time was during the day, and I immediately went over to her place in support. She got through that experience okay. A few months later, she called at night, in the winter. It was cold and raining. I take public transit, and do not go out alone at night. So I called 911. They forced her to go to the hospital. Of course she was super p**ed at me, which I completely expected, because I would have been the same way if somebody called 911 on me! Nevertheless, in a day or two she called me and was feeling better. Later on, she told me I was a very good friend, and had helped her SO MUCH. She subsequently had a very good life, and made a lot of friends, and had a long term b/f. He did break off with her about 10 years later when she became addicted to food. She and I lost contact a very long time ago, when she moved away.
I largely agree with this post: the mental health system has routinely been wrong about almost everything about me, my diagnosis and my life. ‘Peer support’ (are people with colds all ‘peers'[?] – how does having the same health condition make you a peer with someone?) is necessary UNTIL we get rights because mental health systems crush and traumatise people and ‘peer support’ is about helping one through all this abuse, more than anything else.
Thanks Indigo. I actually think the “intangible” And unaccountable practice of Psychiatry and most successful and profitable business in the world now being Pharmaceutical companies that something far more sinister is lurking beneath the surface, and the majority of Professor Fuckwits know exactly what they are doing. A chemical lobotomy with a diagnosis that undermines credibility because it’s equated to madness.
Its incredibly sad that what could have and should have been a life to embrace and celebrate, has been an endurance of unnecessary suffering and oppression, simply so the Ego Trippers with an obsession for power can do it at the expense of truth and the pure side if human nature.
I guess it could be worse… we could have been of them…. Eeeek
1.) Reading carefully the author of this blog is grossly misinformed as evidence is pouring in that peer support does effectively treat both the illness and socio-economic consequences of mental illness which drugs (his preferred choice) have been shown to exacerbate. 2.) Peer support “groups’ may be run out of the “goodness of people’s hearts” however the Peer Support Specialist role is a valued role and vocation paid for by Medicare/Medicaid for over 21 years now. 3.) I find the “worried well” argument archaic, judgmental and insulting. There are clearly defined definitions of disability. While it is not clear in the blog which (minor) illnesses the blogger is talking about. So-called minor mental illnesses do not cause the level of disability required to meet the SSA standard of disability and therefore by definition have little or no funding in the current system of care. 4.) The blogger may pick “treatment” 10 out of 10 without saying what that treatment is, however, I would and millions would not and there is growing evidence that alternative treatments such as Peer Support, Diet, Exercise & meditation play an ever increasing important role in reducing the consequences of our illness (recovery), enhance our wellness, and in many instances preventing illness. 5.) In the natural world the sharing of experiential wisdom including the successes of individual treatment and medication type and dose including but not limited to mental illness, Diabetes, Heart Disease & cancer, has proven to raise awareness, increase health and bolster informed choice. In review of the peer reviewed literature there is nothing to suggest that more information one has about one’s condition is harmful.
i forgot to add two things in my big message about drop in centers. One, it’s the state and county system that’s corrupt — NOT the professional mental health people such as LCSW and other sufficiently degree’d therapists. Also the psychiatrists who work for publicly funded mental health programs are fantastic! Prior to coming to this city 20 years ago, I had suffered from depression and mood swings since I was 3-4 years old. I tried getting competent professional help in several different cities. Those cities’ professionally qualified providers were incompetent and some services harmed me. I found the agency I wrote about in hits heyday when I was 53 years old, and gradually began doing much better. I have had therapy and meds funded by the Federal government via State programs. (The person who wrote here that funding comes from the states not the feds is mistaken — the states manage and distribute funds that come from the federal government, primarily, but yes, states, counties and cities can of course provide additional funding.) As for being corrupt: at the time I was involved with the system — as an independent consultant, not working as an employee- I investigated how the funding was managed. I found out — and it was confirmed 2-3 years later by an investigation – that “nobody knew where the money was coming from or where it was going.” The state’s human services auditor told that none of the mental health agencies in the state were keeping financial records! Nobody knew where the money went, or who stole some of it! The people in charge at that time quietly resigned, and disappeared from public view. Long Live Corruptors in their tropic paradises.
Dear Natasha, Thank you for this article, and your follow up on it. I wrote to all my state and federal officials after reading this one, and urged them not to fund peer support for mentally health services. One thing you wrote I might have an answer to, though: You wrote: “….with the right oversight, professional conduct and setup, it is possible that peer support people could provide a service that would be evidence-based, I’m just not sure what this would look like.” There used to be several mental health drop in centers where I live. Not sure about evidence based on drop in centers as a whole, but my understanding from a lot of people who went there, that it kept them out of the hospital when they went to the drop in center regularly. (Later, the Powers that Be closed all the drop in centers here. Several deaths happened under questionable circumstances immediately afterwards — we think from suicides or drug overdoses.) But anyway, I was the person who kept one center (initially) from closing. The agency was about to close it, laid off all but one professional therapist, and told the clients that it was up to them to do a “consumer run drop in center.” I was shocked — but it did work out very well. I wrote the grants that got it funded. The agency provided space, a therapist who did NOT have power to run it, but provided support and oversight, as you say. My grant achievement provided the first real paid work for consumers, in the state. The rate started at minimum wage, and had a scale increase for every X number of hours worked. The agency had a security guard for emergencies, but some members of our group were trained for keeping the peace in the drop in center. We created peer-run groups such as a political awareness and action group and a schizophrenia support group. For some reason the bipolar group attempt was not successful! Because of the cutbacks, we no longer had a professional Art Therapist or Recreation Therapist. Anyway, my contention was that to have a successful “consumer run” drop in center, we needed to be independent. To become finally self sufficient. I disapproved of our center being dubbed “consumer run,” and many of the actual peers there were fooled into believing that we ran the center. We managed it — we did not run it. So, of course, we had no control when the agency first fired all the experience people (consumers) who created it and ran it. Then, the agency hired their own yes-people instead. Eventually, the agency, as I said above, closed the center. But it was a great thing when we had it. Prior to our peer run center, clients there would not do anything to help out. People would not even wipe up their crumbs or spills from the lunchroom tables, not pick up any litter they made. But, with our center, our people were employed — for money — to run the whole kitchen! Then served food in the cafeteria line and kept the place clean. There were also at least two other mental health, client managed, drop in center in our city. These two had small businesses that help with funding. These programs, too, were closed by the agency. The mental health Powers that Be in our city and county SYSTEM are corrupt, high-handed, cruel, etc etc. They “smile while they stab you in the back,” as they did me when they fired me. I think they thought I was too powerful — but they said I was costing too much!!! I was making only $200 a MONTH!!! BUT I do think that government funding of consumer run drop in centers is only okay IF they have a timeline, a plan, and produce good training to create a self-sufficient, self-funded consumer run center. I don’t know if this is being done anywhere in the United States, or elsewhere. Does anyone have any info about this issue?
Way off base… you still dont understand which is why you get these responses in the first place
Peer support services are state funded…not federally funded
As are many community based services.
NONE of these services take gunding from hospital beds their grants snd funding come from options not available for providing hospital beds. Abolishing funding for peer based services will not obtain more hospital beds for crisis patients….
Actually the funding only exists to relieve the pressure on limited hospital beds….the point being is to provide access before individuals hit crisis point…
Maybe you havent dealt with the system for very long….
I’ve racked up over 30 years….how about you?
Hi all,
For anyone who is curious, I have responded to some of these comments here: https://natashatracy.com/treatment-issues/response-peers-government-funding/
– Natasha Tracy
The problem is in thinking that medication us “evidence based” or efficacious. The studies that supposedly prove that medication is helpful in addressing people suffering psychosis and severe mood variations, are biased in their methods and do not actually prove anything. The medications have, however, been shown to have serious negative side effects and, in most cases exacerbate the symptoms that they were intended to mitigate.
There is a serious misunderstanding of this in the public at large and also among “so-called” professionals.
At least peer support would do no harm and would provide safety for the people being treated.
The context of this blog – as I understand it – in Natasha’s viewpoint, is that governmental tax paid funds should not be utilized for Peer Support but for other known needs in the treatment of those with seriously recognized mental illness and not just the minor fluff and stuff mental disorders (In that she reportedly struggles with a seriously recognized mental illness.. ).
The only treatment that is recognized predominately here, on this blog, is pharmaceutical and well, ECT. Other forms of treatment or co-morbid types of treatment (ie., holistic, naturalistic, illicit street, therapy of any type at all, faith, etc.) are not, on this blog it seemingly appears, recognized as “treating” mental illness.
All those are, in truth, supportive and not treatment based…. cause, as I’ve always noted here and on other sites: The meds are FOR THE SYMPTOMS (ya know, the hallucinations, the agitation, the maniac behavior, the depressive behavior, lack of focus and concentration, insomnia, the suicidal impulse, etc.), whereas the therapy and supportive measures are for THE ILLNESS.
To me, there is a distinctive separation.
You have the symptoms manifested due to the mood swings and emotional distress. Yet, the illness is still there running and humming underneath. So, the therapeutic support systems (such as Peer Support, DBT, CBT, WRAP, etc.) are to help distinguish triggering mechanisms and situations and to not necessarily avoid them (though that is optimal) but to work “within and around” them so that the “symptoms” do not increase and exacerbate.
So, for governmental funding to partially go towards Peer Support is a plus.
Group therapy in a hospital setting and/or outpatient setting… at least from my past experiences with… are a group of mentally ill people sitting in a room with 1-2 facilitators and there is at least 1-3 patients who primarily have the floor each meeting. Then the rest of us, tend to get maybe a moment or two.. if the facilitator/s do their job appropriately. It is not a “therapy session” with your clinical professional and YET, Natasha should argue that governmental funding should not easily be available for GROUP therapy.
In NC… the governmental funding will have every mentally ill person in a group therapy regimen, if possible. For those patients with limited resources and rely on governmental funding sources… you can get all the group therapy your heart desires but you try getting a actual 1:1 therapy session or G forbid a psychiatrist appointment…. you would have better luck obtaining a tour of Saturn. It’s not that it is not there to be obtained (if you have the “right” situation warranting an authorization)… it’s just way cheaper to pay $9 per head for group therapy and well… the patient is getting therapy, right?
No… government funding should not necessarily be spent on regimens or therapeutic models that do not necessarily help the patients long-term. Except that many, with mental illness serious or otherwise, have no other means of obtaining help except to rely on what the government feels is “best” for them and well, cheaper for the government.
Peer Support, if handled appropriately and by well trained specialists and overseen by well trained and intention-ed clinical professionals… does help for many on the personal “ground” aspect. It does help to be able to connect with someone that not only knows what it is to live with the illness/es but also are trained well enough to convey to the clinical professionals as an add-on assistant. Plus, they represent what everyone hopes to have at some point… stability and ability to function in the larger society.
BTW… the Peer Support Specialists are… well… mentally ill themselves. They have their “ups” and “downs” and symptoms manifesting and triggering mechanisms as well.
and in some weird cosmic way… Natasha, to many (many), is seen to be a Peer Support herself and fairly acts as such… when she espouses the pharmaceutical is the only sole… etc. etc. etc.
As has been stated in several of the comments, there are different types of Peer Support.
In Illinois, we call it Recovery Support. Basically, recovery support and peer support have the same principles and your article is quite misinformed and narrow in perspective.
You state “we take away dollars that should actually be spent on the evidence-based treatment of serious mental illness.” This falsely implies that recovery/peer support is not evidenced based. Research indicates that Wellness Recovery Action Plan (WRAP) is an evidence-based approach. Research indicates that having a Peer Specialist in hospital emergency room departments decreases psychiatric admissions among individuals who have been hospitalized four or more times per year. Research indicates that Assertive Community Treatment (ACT) Teams, which include Recovery Support Specialists, are evidence-based. Research indicates that Community Support Teams (CST), which also include Recovery Support Specialists, are evidence-based. Most importantly, I am the evidence. Having experienced homelessness and hallucinations, recovery support contributed to my health and wellness when other mental healthcare options were failing.
You state “Because peers are not professionals and do not have professional guidance, oversight or ethics…” This is false and I’m actually wondering if there is any legal liability with your statement. Illinois has the Certified Recovery Support Specialist (CRSS) credential, which is a competency-based and peer-delivered human services professional credential. CRSS professionals are accountable to the Illinois Certification Board (ICB) which oversees a number of human service professional credentials. CRSS professionals abide by the CRSS Code of Ethics, similar to how certified WRAP Facilitators abide by the Values & Ethics of WRAP.
In fact, the two examples you site (I went on X drug and it changed my life…voices are just part of your subconscious and should be dealt with in therapy and not through medication) violate the following CRSS Code of Ethics and a CRSS professional could potentially lose their credential and ability to provide recovery support in a professional capacity. #1 – With regard to medication, “CRSS professionals will never…use undue influence…or make unwarranted promises of benefits to the individuals they serve.” There is a distinctive difference between sharing that a medication did/didn’t help verses identifying and promoting a specific medication. #2 – With regard to how to deal with hearing voices, “CRSS professionals will be guided by the principle of consumer self-determination while also considering the needs of others and society. The primary responsibility of CRSS Professionals is to help individuals they serve achieve their [consumer/client] goals,based upon their needs and wants.”
You state “I have a choice between a floridly psychotic person talking to a “peer” or actually getting treatment, I’m going to pick treatment 10 times out of 10” and I wholeheartedly agree with you! I celebrate that you have identified what works for you! That’s the whole point. At a micro level, recovery support (aka peer support) is all about having choice and assuring that individuals define and drive their healthcare decisions. At a macro level, recovery support is about advocating within systems to promote person-centered services. I guess the thing is, there is no “one size fits all” solution. I would not impose recovery/peer support on you and deserve that you not impose what you have found helpful upon me or anyone else. We should consider making room for what has been helpful to many people.
I’m not asking you to change your mind. I am asking you to not present your conclusions as the only way.
As a peer professional, A lot of times, I find the mental health professionals take the road of the person/consumer/patient with the mental illness as being a threat, scary or just crazy. I am so glad that I’ve been through the system and that I can lend my belief, my experience, and my education to assist people who the evidence-based mental health system is failing day to day.
It’s almost too absurd to respond to this blog, but I will say after over 30 years working in the public sector as a highly paid licensed professional, the staff who have made the most significant impact are those with lived experience. Health comes from human connections, real connections, people with lived experience know what it’s like, the fear, trauma, loneliness and isolation one experiences in the typical mh clinics and hospital settings play a major part in preventing wellness, the heart and mind of someone who has lived this, survived, and now is there to support others is worth every tax dollar and I hope to see more!
Here is a blog from other sage providers who continue to work in the mainstream….peer support is only just beginning, and the case for “evidence” based best practice services is here too.
http://www.behavioral.net/article/advanced-training-peers-gain-credibility
When a nest friend was subject to a mh section we had tracked her down across 3 states to bring her back home for help.
Her father has schizophrenia. Admitted to the same ward almost as frequently as my mother. I visited she never had. Her mother felt it wasnt an appropriate environment. The ward for me had almost been my second home through my teen years so every couple of days from the time she was admitted i went in to spend the afternoon with her. I introduced her to the staff. We played pool table tennis i showed her what was abailable and simply by being comfortable visiting her in that setting it helped her calm down and relax emough to speak to staff that she could be more accurately diagnosed and treatment accepted. She has never had to be admitted again. Peers able to ease transition for those forcefully admitted (which actually doesnt harm long term prognosis the way people think it does) is a worthwhile investment.
I’m in agreement with the author on this one, and will offer the comment that I have mostly been influenced against peer support being safe, though I can see that is can sometimes help (whatever that specifically means) some people, by the people supporting it. When I first heard of it, I thought it might be an exciting development.
While I would never disagree with the assertion of any person about themselves, the ease with which people appear to me to be extrapolating from their specific case or experience, to a general truth here is quite concerning to me. How could such projection be ADA compliant when that is called for? I suppose that doesn’t matter if no one is being paid, but it does if they are, I’d think?
Though there are a few exceptions, mostly it’s `I/we `help’ because we say so! The vehemence and `splaining (talking down to the author for no reason it seems other than her disagreement) has a cult like feel to me.
I think the MH industrial complex is dangerous enough already. The potential to cause harm, not the impossibility of ever helping anyone, is the real concern here.
what most people don’t realise is the funding actually doesn’t pay for the time of the individuals in most cases…..(and where it does it isn’t the wage of a professional and is substancially cheaper than even mental health nurses who have specialist pharma training)
what it actually pays for when it comes to funding from medicare. is Venue, electricity, Morning Tea supplies, Books, references and other media resources.
the people who facilitate are the least of the cost.
this is WHY so many peer support groups are actually run by and out of churches…while the spiritual bent they put on the programs scare most of the REASON they can be provided by church communities for little to no cost is because Venue and Morning tea supplies basically are provided by the church by simply opening their venue for an hour to three hours once a week.
and some even use their Missions donations to supply the media and materials for the programs.
I have helped run such programs through the church….
Costs for Materials are an Average of $200 per program…
Tea Coffee Morning tea – Another $200 for the duration of the program an average of 12 weeks.
Venue……is actually more than both combined……hence why the church opens its doors…its the most cost effective way to support local communities is by providing a venue for such programs.
Oh that $200 is literally ONLY handbooks per participants for that 12 week course
DVD’s Facilitator Manuals Training and Supplementary Materials are well over a couple of thousand JUST to have the people equipped trained and prepared to provide the twelve week program…..although the cost of which can be spread across multiple groups…..
Wow, a “consumer leader” that doesn’t believe in the power of peer support. You are definitely no leader to me! Although there are a lot of problems with the notion of “evidence-based” and the process to becoming such is more political than factual, Consumer Operated Service Programs, of which peer support is central, are now considered evidenced based. Hospitals are not. Someone who has been through a similar experience supporting another person who has been through a similar experience is more often than not quite helpful. It’s not rocket science.
As someone who’s been hospitalized where treatment included lessons in how to make trail mix out of nuts raisins and M&Ms, extensive discussions as to exactly how everyone in the room celebrates Christmas, and group therapy with patients voicing their grievances over each other’s farts for an hour I have to wonder if there’s even a point in worrying about wasting money on peer to peer services.
Hear, hear. The mental health system is useless, idiotic, and cruel. The UN is onto it – they’ve called on governments worldwide to ban all forced psychiatry – in the meantime people with mental illnesses still have to put up with the brutality and, yes, stupidity of mental health systems worldwide and stigma and discrimination from the rest of the population. Change to these ridiculous and brutal systems can’t come fast enough.
Hello,
I lost the energy to make my way through all of these comments about halfway through. This article – and many of the subsequent comments – is so disappointing.
I *do* agree that most peer-to-peer support is ineffective. HOWEVER, I agree that that is the case *only because* it is all too often influenced by the truly terrible attitudes, myths and misconceptions represented throughout this thread. Said issues lead to lack of adequate training and support, co-optation, and a push to have people in these ‘peer’ roles simply replicate the system. This dramatically reduces their effectiveness and can sometimes lead to abusive or otherwise terrible ‘support’.
Jaffee is correct that some studies look only at the *addition* of peer support, and not the addition of peer support *as compared to* the addition of other offerings. However, he fails to mention that these sorts of flaws are often (read: almost always) also relevant to the research he himself so loves to cite in favor of Involuntary Outpatient Commitment (so lovingly and euphemistically called ‘Assisted Outpatient Treatment’). It’s also a fact that few research studies that look at the efficacy of psychiatric drugs also fail to take an in depth look at impact of psychiatric drugs verses an influx of other supports – particularly peer support.
Meanwhile, it pains me to read people above offering out the ‘science’ of chemical imbalance as if it is known fact and has not essentially been debunked. Now, that’s not to say there’s no biological component, but those of you speaking to biology and science as if anyone has come even close to understanding the true mechanisms by which biology is truly involved in the experience of emotional distress that gets labeled as ‘mental illness’… Well, you’re just contributing to the same old ‘one size fits all’, dishonest messages circulating out there that lead people to believe that a lifetime on psychiatric drugs is the only way to move forward for most people (in spite of the actual research that says it’s only a small fraction of people that seem to do better when these drugs are prescribed long-term).
It’s also absurd to suggest that peer support is only about empathy and pleasant conversations. Well-trained peer supporters who are good at their job would never *tell* someone what to do. But they would be highly skilled at asking the sorts of questions that almost never get asked and can, in fact, be LIFE CHANGING. While I realize this doesn’t rank as ‘evidence’ to those who only want to consider double-blind studies, I’ve seen people’s lives literally saved by connecting with the sorts of supports where people will take the time to ask them what their voices are saying (in a non-assessment way), what they really mean when they say ‘I feel suicidal’, why they use self-injury as a tool and whether or not it’s working for them, what ‘bipolar’ looks like in their life, and so on. That’s just one example of how peer support is *different* and yet still demands high skill, attention and talent. I’ve seen people go from in and out of the hospital and on lots of psychiatric drugs to living very full lives in roles that anyone would be proud to hold – not just those for whom a limited vision had been projected.
I sincerely hope you will take some time to poke around and educate yourselves on what you don’t know about all these diagnoses and the ‘science’ behind them, on what peer support should *truly* look like, and so on.
Here are just a few suggested places to check out:
1. Western Massachusetts Recovery Learning Community: http://www.westernmassrlc.org
2. Peer Support Resources – http://www.psresources.info
When peer support is practiced with intention and discipline, it goes far beyond mere empathy or sharing of stories. I hope the author will find a way to become more educated; the model of Intentional Peer Support would be an excellent place to start. I am a recovered alcoholic (28 years of continuous abstinence and work with my peers practicing wellness and healthy relationship skills) who has also experienced depression since my teens. While my life improved overall after I got sober it has not been without challenges, including some severe bouts with depression. During the worst time, in the summer of 2000, despite having a secure job and decent pay, I had no health insurance. I used the resources I had, the support of my peers and the 12-step groups I was a part of, to get through it and keep going. And not for the sake of others, or out of duty, or fear of death or damnation; but because I had developed a habit of keeping my commitments after 12 years of sobriety I was present to experience a joyful moment, when for weeks I had not experienced joy from any of the many things I have in my life to be grateful for. Don’t get me wrong: I was not feeling sorry for myself while my life was easy and full of comfort and joy. I was experiencing the onset of a serious incurable auto-immune disorder that affects all aspects of my life, an important relationship had just ended badly, and I was struggling financially because my growing jewelry business ground to halt with the onset of the auto-immune disease, and I had to let go of my dream of making a living as an artist, at least for the moment. Anyone would be depressed with all that. Dealing with past and present challenges can make anyone angry and sad; knowing some of those challenges will never end, and might get worse, makes it hard to believe the future will be any better. And it has not been without challenges. But today I am happy to be here, although I still have down days and I have had some very dark weeks and months, and it is due 100% to the support of my peers, and the skills I have learned with them and practice in my life. I have nothing against doctors or medication or therapy, but peer support can and does effect powerful change in people’s lives when practiced with intention and purpose. I am grateful I connected with a new recovery community in 2008 with the practice of Intentional Peer Support. Real connection, respect for the value of everyone’s experience and the opportunity to learn from each other, and the focus on what we are moving toward can create measurable healing and growth in our lives and wellness.
the irony, chris, is that you do not understand the difference beetween a sign to get hired for speaking engagements…and doing one to one for hire as a pewer, which is what you seem to have misunderstood. The irony is that you don’t know the difference betyween privately paid out of pocket (the hire me) and tax supported , perhaps paid or subsidized peers, infrastructure costs as well as billing or unbilled time. the irony is that you don’t understand that inside the system there are things like tracking outcomes.
Hey there Walt,
Non profits, charities, and health providers of course accept private donations is the point. Moreover, individuals and groups find value in lived experience, whether its shared at an association conference or at a case conference.
Cheers
The irony of the argument presented by N. Tracy is the fact that she herself is a peer replicating on social media exactly what peer workers do every single day, both inside and outside of the conventional mental health system. Peers exist in many forms: There are formal peers and informal peers, voluntary and paid peers. And, of course, many professionals (including psychiatrists) also identify as having lived experience of mental illness and openly draw on this experience to inform their practice. If Tracy truly believes what she claims, perhaps, she should take down the “hire me” section of her website and ask that funding be redirected towards “real” treatment programs, instead. But, of course, that won’t happen b/c the voices and perspectives of service users are more in demand now than ever. Which is exactly as it should be.
Peer support run groups such as NAMI, DBSA, SAMHSA, and MHA should never be funded by the government. They are strictly volunteer non-profit. They fundraise and ask for dues. They are trained in empathy and facilitation. This is not a substitute for mental health providers. It is a safe place to share and know you are not alone in how you feel and what you are going through. I agree with Natasha. Money is limited and insurance companies are limiting the time you spend with a trained licensed therapist as it is. They can’t limit the amount of visits so they limit time to 45 even though some therapist want 60 minutes a visit. These are things that need addressed. Money should not go to these Volunteer run support groups ever.
Lisa, I agree with what you’re saying. Everything else is getting needlessly complicated. People are usually able to get the help they want and need, free support or paid support, according to what makes the most sense in their circumstances.
Sometimes it can be difficult to find strictly volunteer non-profit support in a person’s area. When this happens and people don’t have the means to pay, it can be heartbreaking.
AA has been extremely successful with peer to peer support all over the country. I wish those of us who have mental illness had the same kind of support where we live.
It has been mentioned already ( and I agree ) how people who have never experienced being mentally ill are incapable of comprehending what it’s like.
They can use their imagination, compassion, empathy and professional training – all good qualities- but, the hard reality is until they get sick with mental illness they’ll never understand.
Of the four organizations that you listed, only DBSA is a peer organization. NAMI is a family advocacy organization, SAMHSA is a federal government agency, and MHA is a mental health advocacy organization. None of them are “strictly volunteer non-profit organizations”. SAMHSA cannot ask for dues….they are funded with tax payer dollars! MHA also does not have “dues.”
Insurance companies are private and they most definitely do limit the number of visits.
Call me at 812-697-4347. I will explain what a being a peer support specialist is really about. I do peer support and have seen wonderful results.
Natasha wrote:
“In the mental health care system, funds are extremely limited and all too many of them go to what many of us call the ‘worried well.’ In other words, all too many funds go to people with minor mental disorders and not to people with serious mental illnesses. Getting quality treatment for a homeless person with schizophrenia or bipolar disorder is nearly impossible in our society because of this lack of funds. When you go to an Emergency Room because you’ve just attempted suicide it is equally likely as not that you will get almost immediately released from the hospital because of this lack of funds. When you don’t have good health insurance, you’ll only have access to the older, more side effect-laden drugs because of this lack of funds.”
Natasha, I don’t know where you’re getting your information, but I know you live in British Columbia, so perhaps things are different there, but this is NOT the situation I see in Manitoba.
Here, the people I meet with diagnoses of schizophrenia or bipolar disorder have been on medications for years, are hospitalized repeatedly at state expense, and have psychiatrists. There are NO extra services for the “worried well” that don’t exist for those with more severe diagnoses. In fact, there are less! You have to pay out of pocket to access a psychologist’s service, which is what I imagined most of the “worried well” would want.
With my BP1 diagnosis, I have not only NOT experienced denial of service, I have had services (e.g. hospitalizations) forced on me repeatedly. I can’t count how many different medications I have been on over the years. Although provincial pharmacare doesn’t kick in until you hit your deductible for the year, once it does, you can be maintained on all sorts of medications – current medications – for no extra money. When you’re really poor, this deductible gets very low.
I see my current psychiatrist once a month, I could probably see him more often if I needed to, and he’s always available to return phone calls and discuss medication options. And he is not an anomaly. I have had a similar level of service with past psychiatrists. And due to provincial Medicare, this has cost me nothing. As well, the system is so adamant that people like me stay on medications – even if they’re not working well – that if you are in the hospital more than 3 times in 2 years, they can put you on an outpatient commitment order. This does not sound to me like overlooking the “seriously mentally ill”.
The real problem, IMO is that despite the availability of medications, there are next to no psychological services available for anyone. And people are asking for these services. They need help that goes beyond medications, because the medications aren’t cutting it on their own. I could use a person to help me work through my life problems and emotions, but instead all I get is access to the guy with the prescribing pad. The psychologists are $120+ per hour and not covered under provincial healthcare.
I don’t think it’s well-founded to say that most of the money is going to the “worried well”. The most a “worried well” person can expect is exactly what everyone else gets – maybe a GP prescribing an antidepressant, or the same costs for private psychotherapy, or perhaps a tiny bit of free but short-term counseling if you get on a waiting list at one of the few places that provide such services.
Why don’t you write about the shortage of psychotherapy services instead of pulling out the old canard about SMI being overlooked? Over here, we’re medicated to the hilt, and people still kill themselves. Everyone I’ve known who’s committed suicide has spent years being medicated, and been hospitalized repeatedly, and is definitely not being denied psych drugs and psychiatrists. What they are being denied is high-quality empathetic therapy. (Which, I agree, peer support is not. And especially not, if you just regard it as a kind of babysitting of the “low-functioning” by the “high-functioning”.)
Peer support is not the same as therapy in how it is is practiced, but can peer support help people achieve some of the same goals as therapy? I believe it can and does, when practiced with intention. There are many models of peer support being used today, here in Maine we use an Intentional Peer Support model developed in collaboration with Shery Mead.
I recently visited with a peer support worker at the Missouri state hospital. She works with people who were deemed not guilty by reason of mental illness. I questioned her about effectiveness of peer support with the seriously mentally ill. (My son has schizophrenia and is incarcerated). She told me how many patients felt more comfortable opening up and sharing with a peer. It occured to me, in the beginning of my son’s illness, he had no insight, thus refusing treatment. He may have benefited from a peer support specialist to talk with. They may have helped him accept treatment over time. So I do believe they can be a help. I also believe if there is no standard of practice , i.e. licensing, we would run a risk. In addition, I struggled with even getting my son a therapist, Psychiatrist, because there were to few to go around. Peer workers can fill a gap in visit and help a person stay focused on there recovery. I absolutely believe funds need to increased for smi, but am beginning to think a place exists for peer support to be a benefit.
There is no research I know of that compares the addition of peer support to the addition of professional or other support. The research compares the addition of peer support to the addition of nothing. Even in that scenario peer support is not ‘evidence-based’ if the term means: “independently proven to improve a meaningful outcome in people with serious mental illness.” It is not independently evidence, the target of the research is not SMI, and the outcomes are, as you described ‘warm fuzzies’ not reductions in homelessness, arrest, incarceration, etc. I believe (not based on research) the biggest benefit of peer support is to those who give it, not receive it. They have a job and meaning in their life and that is valuable. That is why almost all the support for peer support comes from those who give it not receive it. Peer support program managers have basically become like union bosses, insisting government hire their members, in spite of no evidence they are better than others at helping SMI. That is my opinion.
I know in my intake you can not work there and receive services there. So it is not “hire our own” and as far as the benefits I received they were as a consumer first. I became inspired to become a cpss because of the support I received NOT JUST BECAUSE of how it would make me feel.
I am a cpss,just graduated from The Acadamy,I was diagnosed with Bi-polar 1 when I was a teenager. I am now 50. From all of my years of experience my peer support helped me more than anyone. Yes, I still have to take my meds to maintain my stability but it took people with lived experience to show me how to do more than just survive day-to-day. I live in Tucson, AZ and my peer supports showed me how to take and use skills (along with my meds) and really live. There is something about “lived experience” vs looking in the book on page 28 to see how to help me figure out what I want to do that makes a HUGE difference. I firmly believe that with education, peer supports are far more valuable than those who have no”lived experience” because they can offer you HOPE that indeed a diagnosis is not a life sentence to just surviving. So I would have to respectfully disagree with you oh this issue because without my peer supports I would still believe that there was no hope for my life to have a real purpose and value.
Love this. I am in Indiana and started a peer run recovery center as a certified recovery specialist. I am mow in my recovery coach training and then go for credentialing. I have seen so many changes in people that come to my program.lived experience is what they relste to.
For me personally, peer group support was a waste of my time. I tried several. I did not find them productive; in fact, they had the opposite effect. I left them feeling depressed and unhappy, rather than bolstered. I have made it clear to my docs and therapist that peer support groups are a waste of my time. I have several friends I’ve made through the years who have depression/anxiety/bipolar, and a family member with bipolar disorder. None of them know each other. When I need support, I seek out whoever can probably handle me at the moment. One is a pen-pal I’ve never met in person, and she is probably the most important friendship I’ve made (and she feels the same). The fact is, support groups, if run correctly, might be helpful to some, but I did not find them helpful at all. I also think it has to do with the type of person you are. One issue I have is a short attention span. That’s why I prefer online support, such as the kind provided by Natasha Tracy. I can skim rather than be forced to sit and listen for an hour.
You all are talking about two different things. There are peer groups and then there are those trained by their state to be peer support specialist.
SAMHSA consideres well trained peer support a worthwhile and effective expenditure. I am sorry that your limited experience with peer support has been asociated with those who may not have been well trained in the core competency. I hope you have an opportunity I the future to learn more and maybe gain some first hand knowledge of how valuable there services can be.
http://www.samhsa.gov/brss-tacs/core-competencies-peer-workers
What Is a Peer Support Worker?
The role of the peer support worker has been defined as one who offers help, based on the shared understanding, respect, and mutual empowerment between people in similar situations. Peer support has been described as a system of giving and receiving help based on key principles that include shared responsibility, and mutual agreement of what is helpful. Peer support workers engage in a wide range of activities, including advocacy, linkage to resources, sharing of their experience, community and relationship building, group facilitation, skill building, mentoring, goal setting, and more. They may also plan and develop groups, services or activities, supervise other peer workers, provide training, gather information on resources, administer programs or agencies, educate the public and policymakers, and work to raise awareness.
The development of additional core competencies may be needed to guide the provision of peer support services to specific groups who also share common experiences, such as family members. The shared experience of being in recovery from a mental health and/or substance use condition or being a family member is the foundation on which the peer recovery support relationship is built in the behavioral health arena.
What Is Recovery
SAMHSA developed the following working definition of recovery by engaging key stakeholders in the mental health consumer and substance use disorder recovery communities:
Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.
This definition does not describe recovery as an end state, but rather as a process. Complete symptom remission is neither a prerequisite of recovery nor a necessary outcome of the process. According to SAMHSA, recovery can have many pathways that may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches. SAMHSA has identified four major dimensions that support a life in recovery:
Health — Learning to overcome, manage, or more successfully live with symptoms and making healthy choices that support one’s physical and emotional wellbeing
Home — A stable and safe place to live
Purpose — Meaningful daily activities, such as a job, school, volunteer work, or creative endeavors; increased ability to lead a self-directed life; and meaningful engagement in society
Community — Relationships and social networks that provide support, friendship, love, and hope
Peer workers help people in all of these dimensions.
What Are Core Competencies?
Core competencies are the capacity to easily perform a role or function. They are often described as clusters of the knowledge, skills, and attitudes a person needs to have in order to successfully perform a role or job. Training, mentoring, and supervision can help people develop the competencies needed to perform a role or job. This will be the first integrated guidance on competencies for peer workers with mental health and substance use experience.
Why Do We Need to Identify Core Competencies for Peer Workers?
Peer workers and peer recovery support services have become increasingly central to people’s efforts to live with or recover from mental and/or substance use disorders. Community-based organizations led by people who have experienced mental health conditions and/or who are in recovery from substance use disorders are playing a growing role in helping people find recovery in the community. Both the mental health consumer and the substance use disorder recovery communities have recognized the need for core competencies and both communities actively participated in the development of these peer recovery support worker competencies.
Potential Uses of Core Competencies
Core competencies have the potential to guide service delivery and promote best practices in peer support. They can be used to inform peer training programs, assist in developing standards for certification, and inform job descriptions. Supervisors will be able to use the competencies to appraise peer workers’ job performance and peers will be able to assess their own work performance and set goals for continued development.
Core competencies are not intended to create a barrier for people wishing to enter the peer workforce. Rather they are intended to provide guidance for the development of initial and on-going training designed to support peer workers’ entry into this important work and continued skill development.
Core Competencies, Principles and Values
Core competencies for peer workers reflect certain foundation principles identified by members of the mental health consumer and substance use disorder recovery communities. These are:
Recovery-oriented: Peer workers hold out hope to those they serve, partnering with them to envision and achieve a meaningful and purposeful life. Peer workers help those they serve identify and build on strengths and empower them to choose for themselves, recognizing that there are multiple pathways to recovery.
Person-centered: Peer recovery support services are always directed by the person participating in services. Peer recovery support is personalized to align with the specific hopes, goals, and preferences of the individual served and to respond to specific needs the individuals has identified to the peer worker.
Voluntary: Peer workers are partners or consultants to those they serve. They do not dictate the types of services provided or the elements of recovery plans that will guide their work with peers. Participation in peer recovery support services is always contingent on peer choice.
Relationship-focused: The relationship between the peer worker and the peer is the foundation on which peer recovery support services and support are provided. The relationship between the peer worker and peer is respectful, trusting, empathetic, collaborative, and mutual.
Trauma-informed: Peer recovery support utilizes a strength-based framework that emphasizes physical, psychological, and emotional safety and creates opportunities for survivors to rebuild a sense of control and empowerment.
It’s interesting that you link to SAMHSA on your “get help” tab.
SAMHSA accepts peer support as an evidence-based practice and has underwritten a lot of the technical assistance to peer support programs throughout the US. It’s a “go-to” resource for me as a trainer of peer specialists and as a provider of support to consumer-run organizations.
I’m sure there’s some bad peer support out there, but that’s why training and technical support programs like the one at which I work exist. There are bad therapists and psychiatrists out there, too, to which my own lived experience will attest.
It’s true that there are limited funds for mental health services, but part of the reason community-based services such as peer support have come on line is the realization that institutionalization doesn’t promote long-term recovery, and medications, while they make some people feel better, don’t give you your life back, nor do they treat an underlying chemical imbalance, as even such luminaries in psychiatry such as Ronald Pies now readily admit. As the work of Laysha Ostrow, Bevin Croft, and others is beginning to show, good peer-run programs can lower overall system costs by reducing hospitalization, allowing already stretched systems to make better use of the dollars they have
The losses associated with having a mental health diagnosis are not only about an extreme state of mind but the consequences of experiencing one. Peer support, and to a certain degree case management, engage people in addressing the social, educational, familial, and professional losses that result from periods of debilitating psychological distress. They are “treatments” only in the sense that they treat the whole person, but they can help a person plan a way forward and self-advocate for the right mix of formal treatment (if that’s what works for a person), individualized recovery tools, and supports and resources a person will need to move on with her life.
Formal therapies and drugs may make you *feel* better, but recovery is a process of *getting* better, and that goes way beyond the prescription pad and the therapist’s couch.
If you’d like to deepen your understanding of peer support, I’d love to chat more with anyone who is interested about what we do at the Center for Behavioral Health Initiatives and at other peer support training agencies around the world.
That’s ironic that a peer who is for hire to help, would write such a viewpoint. Do you find your personal experience helpful to others? Do you believe someone with book knowledge is more helpful than real-life knowledge?
As a person who has worked in the field for the last decade providing peer support services, I have come across this type of attitude with decreased frequency. Frankly, I am a bit surprised to still be seeing this level of ignorance among so called professionals. While some of the concerns mentioned are legitimate to someone who has been under a rock for the past 50 years, to hear this from clinicians is somewhat disheartening. Please don’t get me wrong, I am sure the author has noble intentions; however, in most parts of civilized society, these myths and rumors have been summarily debunked and discarded. I’m not saying that in some parts of the world, some of these issues, such as ethical and professional boundaries, may not be addressed appropriately among certain groups of peer specialist, and admitedly, my experience has been limited mostly to my local area. There is significant emperical data supporting the efficacy of peer services. I feel no need to defend that. I would, though, suggest that it is quite likely the author’s experience is far more limited than my own. In fact I recall having worked with numerous professionals early on that held similar beliefs. For those with the ability to look beyond their own pride, the substantial efficacy became quickly and easily apparent in the form of outcomes. Now it may be that my particular situation was the exception rather than the norm. Certainly I am not a highly educated man, save self education. I have no advanced degrees; however, I soon found that my experiential expertise was being sought out by therapists, psychiatrists, and administrators. Maybe this was due in part to my willingness to do the research, or perhaps my common sense and people skills, or it could have been my extensive personal experience with having to deal with mental illness and substance use disorders. Regardless, I would suggest that there are, as with any profession, a range of competencies regarding peer providers, and that with continued development of curriculum and training programs, for both clinicians and peers, both of which I have taught, there is a growing and developing workforce of qualified, effective, and competent peer specialists, that whether this author chooses to accept or not, are here to stay. Natasha, I hope you have an opportunity to see what peer support is supposed to look like. In fact, in many parts of the country, career tracks for peers ate being developed that include counseling and therapy services. One ought not be surprised at this fact, especially considering the fact that the vast majority of clinicians enter the field to discover the nature of their own disturbances.
40 years of continuos treatment at VA that is alotof documented&*€€__^%==.AA was the hugest peer support 30% we dnt like 30%dnt care 20% we love gravetate where your omfortable but stick with the winners not the weiners or winers.we all need friends 1 ,2,3, close we will share any and everything be carefull they call on you youstart and a small chors goes “whats your name” and i let im have it with “ITS ANONOMYS”silence falls aa has evoved i liked it when it was shameful and we snuck in back doors low bottom drunks raised the bar and their going hopping to run into a movie star. That 20%will allways be near and dear to my heart 12 step came from 6th step oxford it is christian but you are to find it your self took 20 yrs of none stop off and on trying have 25 yrs now and i realy cant say liiving w bipolar sober or drunk is easyer the out come is obvious both hard but sober does not triple your problems the big book says alcohal is but a meer symtom there are underling problems it also say ther are those too who suffer from grave emotional and mental disorders but many of them do recover if they have capasity to be honest
Here is a true story about how a certified peer support specialist can truly make a difference.
CHANCE or FATE?
I met a gentleman in the psychiatric hospital where I facilitate a group. He was determined to change his life. More importantly, he was motivated to to make those changes. He had struggled with addiction for quite away. His only goal was to avoid the pain and trauma of his past. By complete happenstance, he encountered a person working for a a local behavioral health agency. But this worker was so much more than just an employee. She was also a certified peer specialist. She was a person who had faced and over come much adversity in her own life.
She talked with this gentleman and helped him to see that he has been focusing on surviving and not living. She inspired him to look at the big picture and to seek the help he needed to change his life. As he told me this story, he informed me that it might have seemed like a chance meeting but it really was fate that lead him to this woman and to the possibility of new life clean and sober.
As I quietly listened to his story, I thought about the twists of fate that intertwine all of our lives. I have never met this gentleman before. But our paths are intertwined by random chance or maybe truly by destiny. When he is finished with his tale, I looked him straight in the eyes and then I shared how one conversation can create a ripple that affects so many others. Just like throwing a pebble in the pond.
A year ago I went into a local mini market to buy a drink. On my way out, the cashier asks what is hope. For a second I was confused, then I realized I am wearing my work shirt. I explained to the cashier that I worked at the first peer and family run behavioral health provider in Arizona. I shared with her some of my story and she shared some of her story. She was very interested in my work a certified peer specialist.
I recommend she check out HOPE’s Recovery Coach Academy. Her face lit up when she realized she could take the things most of society would consider weaknesses and turn them into positives to help others. She applied to the RCA and was accepted. She graduated and soon was hired by a local Behavioral Health Provider. Then one day she randomly encounters a gentleman down on his luck. She shared some of her own experiences and she inspired him to want to stop living (dying) for the moment and to face some of the trauma of his childhood so that he could have a life of meaning and purpose.
When I finished this tale, we both just smiled at each other. For me, knowing that one small pebble produced a gigantic ripple. For him, this tale only reinforced his belief that a higher power was guiding his life and maybe it was really possible that this his life could be different.
As I walked out of the room, all I could think about was what if I had worn another shirt that day or maybe if I had decided I was too tired and did not feel like stopping at the market. Would we still have met a year late. I just don’t know.
Chance or Fate? I leave that up to you to decide.
To learn more visit https://www.facebook.com/landlordofyourbrain
Peer support is an intervention that can facilitate one of the most crucial elements that persons with behavioral health issues face: connection. Connection, and support thereto, can facilitate personal growth as well as growth through other offered services of care. Peer support can offer hope, which, at times, can be a crucial element the recovering process.
I understand and relate to some of your concerns vis-a-vis certification through 40 to 80 hour courses and the ability of a Peer Support to offer ‘medical’ attention. Please realize this industry is relatively new in the public sector (as of 2007) and as with all new modalities, Peer Support is morphing into what it will become and thousands of peers are employed; giving and receiving benefits that peer support offers.
Numerous forms of Peer Support exist including Forensic peer support and Peer Support in the private sector. Providers and social entities utilize peers in a myriad of additional areas according to market needs.
Thank you for providing space for further discussion on Peer Support.
The Lloy-Evans et al comment was interesting – peer support helps people find ‘hope and empowerment’ because the rest of the mental health system basically destroys these – ‘peer support’ is an odd concept in the first place – how is someone with the same health condition as you your ‘peer’ – are people who have colds all each others’ ‘peers’? Of course, the whole mental health system is redundant, and always was, and merely a blatant human rights abuse, as the UN has declared last October in calling on the governments of the world to ban all forced psychiatry.
Wow Natasha, I do not think you fully understand what Peer Support Services (PSS) are…if you can identify in the title, they are SUPPORT services. PSS are not considered treatment, but a support service to enhance treatment. PSS provides hope to the individual who has spent most of their life in and out of an institution. It provides additional support the the family member who has been struggling to support their loved one.
It would do you some justice to be educated on the subject prior to discounting it. I know you are ignorant to Peer services because you identified them as treatment. So do yourself a favor and take a WRAP class, go to a NAMI seminar and then see if you would write this same blog. I read somewhere that people perish due to lack of knowledge. Become knowledgeable about this topic before you pass judgment…ijs
Hello Monica,
Actually, what I said is that peer support services do not treat mental illness and it’s treatment that is needed with limited funds.
As for experiencing them? I have. I’m not impressed. That said, others may find them useful. I’m just saying that the extremely limited tax money shouldn’t go to them.
– Natasha Tracy
I would make the argument that well trained peer support is more effective than most “treatments” because those treatments are designed to only temporarily stabilize people. Not to help them move forward to becoming more productive and healthier citizens. Like most challenges and adversity that people face in life, there is no simple cure or fix for those living with mental health challenges. The goal is to help improve the quality of life. People only get a diagnosis in the first place if it effects their quality of life or if they have trouble coping with symptoms on a regular basis. The question really is not whether peer support programs are cost effective or too dangerous but rather is treatment and services provided by effective and well trained and certified peer support specialist more cost effective than poorly trained case managers (college degree rarely prepares you for working in the field) and therapist (not accessible to most people in the public system) and even doctors who rely on people making progress but getting those people to comply with their treatment wishes and who very often lack even the most basic of rapport building skills. It is so much more cost effective over the long term to actually help someone decided to want to make changes in their own lives and be invested in making those changes.
From my ten years working in the behavioral health field and a wealth of personal lived experience dealing with mental health challenges, I am convinced people need three things to move forward in life. The first, they need better copping skills, they next need to learn they can learn new things and then they need something in their life that gives them meaning and purpose. Yes you could spend money keeping people out of the hospital a little longer period of times or you could focus on programs where people are inspired and motivated to help them selves realize they can be so much more. Programs that help teach people how gain the coping skills they need, how to ht employment skills and find jobs and how to keep those jobs. There is a place for psychiatrist and therapist (in a perfect work they will be certified peers). But we have a case management system that can not begin to provide services to low income individuals until a diagnosis has been give and then they are assigned to case managers to be managed. But those case managers are over worked, under paid, and asked to be experts in everything and then given larger case loads. Yes poorly trained peers can be dangerous but well trained peer support specialist certified by their state is less dangerous than a system designed to put out fires and definitely more cost effective.
So, actually what your saying is allow Peers to continue to work on a voluntary basis, even if the evidence-based practice of “What Works” has been found to be effective? Peer Support Services is creating a new job market for individuals who would otherwise be considered unemployable. The fact of the matter is Peers are.being paid, not through Medicaid or Medicare but through grant dollars. I’m not sure where you live, but Maryland has found these services to decrease recidivism of mentally ill and co-occurring individuals at an alarming rate. It is assisting individuals move from a state of Dependence to Independence. Peer Support Services are NOT treatment, unlike treatment that only treat the symptoms the individual presents, PSS address the individual, their feelings and emotions associated with stigma and public biases. It helps the individual maneuver through daily life issues that someone without a mental health disorder does not understand. I am one of those clinicians you reference in practice for 10 yrs, but I support this movement, because regardless of how many theoretical orientations I’m familiar with, their is nothing like watching someone with LIVED EXPERIENCES share those experience with another. You may not agree with this practice, but it’s here and you can’t stop it. And lastly, for years the methodology of treating this population has as you stated not been effective, so sometime me methodologies have to be explored…finally something that’s EFFECTIVE!!!
Monica, I could tell you are a clinician straight away – you seem to think that people with mental illnesses are ‘unemployable’ and you refer to them as ‘recidivist’, which is a word most commonly applied to criminals who re-offend. The only things keeping people with mental illnesses from the workplace proper (apart from their illnesses) are the trifecta of stigma, discrimination and the oppressive and violent nature of the mental health system. Many people with mental illnesses can and do work for years and decades whilst coping with their conditions and the afore-mentioned trifecta of additional handicaps. Peer support (which will one day be redundant when all forced psychiatry is eventually banned) is about supporting people emotionally to cope with this horrific trifecta in addition to these horror health conditions.
Treatment without whole-person support is often akin to “Pissing in the Wind”!
IE: No amount of treatment will be effective or lasting if an individual’s basic human needs are not met. Shelter, food/water, clothing, healthcare – and the peace of mind to know these things will not be arbitrarily taken away – are essential to a person’s treatment process.
When I worked as a Peer Supporter, I always started with the above in mind. If a peer was homeless, we worked together to secure housing. If they had no/not enough money to buy/obtain food, we worked together to acquire food. If they were at risk of being incarcerated, we worked together to decrease the likelihood of incarceration – and so on.
One of the ‘pluses’ inherent in the peer support relationship is that the PSS has the option of going to where the peer is/lives and working with him/her in their real-life ‘setting”. To the best of my knowledge, most psychiatrists and therapists do not/are unwilling/are prohibited from doing this.
But why not? What better way to observe and assess an individual than in his/her home setting? Treatment decisions are enhanced when they are based on qualitative and complete information.
Do you do actual PSS work (paid or volunteer) with individuals? If so, I am confused. How do you justify working as a PSS when – based on the above claims – you have such a negative view on Peer Support’s value to “the system” (other than casual, feel-good moments) and/or to the individual?
Natasha, You are so brave to take this on! I was in a 12 step program for 15 years. It was an Adult Children of Alcoholics group and kind of a subset of that where abused folks got together. That group was so valuable to me. BUT – I could never have even attended the group without being treated for Major Depression first. The medication allowed me to stop listening to the Greek Chorus moaning and cajoling long enough to hear what others were saying. It (the group) didn’t treat my illness, that’s for sure. It did teach me a lot about life which I had missed. You are the absolute best. (not perfect, that’s not in the job description) Gloria Harrison
Perhaps this can be looked at as part of the treatment of the overall person, not just the illness.
Peer support is so intensely needed; however, no, it’s NOT medication and it WON’T cure you in the slightest.
But in a person, and no amount of scientific everyone l evidence is going to make me feel any relatable form of a human being when u feel like shit.
I need a person who can say they’ve been there AND MEAN IT, in the bad days I feel so alone. I can’t just pop a pill and have that loneliness taken away.
You absolutely must have peer support.
And you know what?
I donate every chance I get to help support groups because it’s not like people are popping out of the woodwork volunteering all the time.
It’s an exhausting necessary business.
This time I disrespectfully disagree with you in the most extreme way, Natasha. I credit two peer support groups for my present existence, and I further credit their members with 90% of my knowledge about medications and their effects and side effects (many of which current medicine flagrantly disavows.)
I don’t dispute the value of traditional sources of help like psychotherapists and psychiatrists – they have been essential to my mental health for 15 years. But to diss peer support groups on the spurious and egregiously misleading premise that they are nothing but a source of “warm fuzzies” – well, that’s simply fucking ignorant. Next time, do your research before you publish drivel.
Paul…. Thats great for you. I am happy for you. Issue for many is that the peer support is not available and if so is by the goodness of peoples hearts. I have to travel 30 miles to get to a DBSA meeting and the facilitators quite frankly are terrible and hard to get any support when ther are 20 in the room and only 2 hours of which the first 1.2 hour is full of rules, etc. Our local NAMI is a joke. Cant even find support groups run by social workers, and professionals and I live outside a metro area and have searched and searched to no avail.
Thanks for your kind support, Michael. At the time to which I was referring, I lived in a small rural community with one small support group for 5 people with various mental illnesses. We didn’t really have all that much in common other than the willingness to listen to one another. But bipolar has its own special challenges, so in 1997 I turned to the internet and found what I needed there. The other members taught me a great deal about my condition when the professionals wouldn’t even listen to my cries for help. I have maintained my memberships through many ups and downs, in four different support groups (three now since one folded.) That’s where I learned most of what I know about bipolar disorder.
I agree with you, Michael. I went to a DBSA meeting at the recommendation of my therapist. I thought, OK, it would be nice to talk to others who can commiserate. Wasn’t too far away, so no biggie there. It was just as you said, Michael. There was NO moderator, nothing. People just started talking. We spent the whole meeting listening to some guy who was having trouble with his mail-order drug company. He was still talking when we left. Tried once more just to see if it was a fluke, but no luck. There was no help there for me or anyone else. No idea why some people keep going there. I’ve yet to find one in my area that is anywhere close to normal (as normal as we can be anyway).
Hi Paul, please keep your language clean at a young lady’s website.
I think peer support is about emotional support, which, of course, people with mental illnesses shouldn’t need any more than anyone suffering from any other health condition. Because people with mental illnesses tend not to get any emotional support from anyone much, and the mental health system is heavily abusive, peer support is ‘necessary’ at the moment (arguably). Of course, mental health systems should not be abusive and the friends and families of people with mental illnesses should be emotionally supportive (but they tend not to be). The sooner people with mental illnesses get rights, the better, and much of this situation, if not all of it, will be solved and then there certainly will be no ‘need’ for peer support.
Here in NC we have “Certified Peer Support Specialists”…. they are to take extensive training from a clinical based hospital system… they are then to have so many hours of supervised work from no less than 3 differing clinical supervisors (I’ve been informed) that must assess and report via sealed documents that the prospective Specialist is not to see… and they are over seen by clinical therapists when working with “the population” (or is supposed to be)… they are also to be managed on treatment and ok’d by their own support network…
you are against “peer support”…. then you are against “group therapy” because group therapy is basically peer support but with 1-2 facilitators… but the point being, socialization and peer support by “the group”… and yet is billed both commercial insurers and government funded entities
also, in general, severe mental illness (psychosis, you noted) would not be managed and/or handled by a Peer Support… outside of being someone perhaps that the patient can contact until clinical/emergent help can be ascertained… ya know, like as if at home and you need some help so you call your “support network” (ie., family member, etc) in order to seek help until more clinical/emergent help is obtained….
yes, I get that there are P Poor programs and likely folks crossing boundaries… so, are there equally therapists and psychiatrists who are P Poor clinicians and cross boundaries
also… you, who claim not to be a professional therapist nor psychiatrist, are now noting that certain issues or disorders are not “de facto” mental illness? “1. I wouldn’t consider people who have experienced sexaul abuse to have a serious mental illness de facto (although, obviously, some do)”
Considering that NO mental illness has a “de facto” diagnostic tool to actually diagnose correctly…. how would you know that something is not “de facto” a form of mental illness?
I’ve learned that bipolar is an illness in our brain where biochemicals cause a mood disorder. Another person can’t make you bipolar, whereas a victim of CPTSD was sexually abused; someone hurt the child, oftentimes causing a mental illness to occur when the child could have had normal mental health had the abuse not occurred.
This is my understanding. Perhaps I’m misinformed ?
Peer based support groups vary as to how helpful they are. I don’t believe they are capable of treating bipolar, no matter how good the support is.
The main benefit, from my point of view, is they get you out of the house avoiding the isolation tendencies a lot of us have.
A peer support situation needs to be managed by volunteers. I’m not in favor of financial arrangements with peer to peer support.
They are actually quite effective when there is a structured program such as mindfulness or CBT worked on as a group, even for those with bipolar.
CPTSD isnt solely trauma. Some develop other mental illness as a result which either becomes comorbid or dominates….although the trauma dtill contributes. Cptsd is at its core an acute anxiety disorder when the flight and fight response essentially breaks. It is far more severe in adult victims of child sexual assault because they need to learn to process it as an adult emotionally their responses are those of a child…..
Margaret, I’m not understanding what it means when Cptsd becomes a break with flight and fight. If you’re comfortable with explaining more I would be appreciative. The anxiety part I understand.
I agree with you about peer support when it’s structured as you’ve described. In fact, I was in an excellent group with a professional therapist, which meant it had to be paid for. The price was too high and some people left for that reason- not because they wanted to leave.
The group ended only because there weren’t enough of us to satisfy our therapist who wanted at least three people. which isn’t a lot to ask. I miss group, wishing I could find another one.
It gets stuck in on and leaves people in the flight or fight state indefinitely….
As sleep deprivation and exhaustion sets in psychosis and hallucinations set in
And that is on top of the flash backs and essentially waking nightmares….which are nothing compared to what is experienced when they do manage to sleep….
Abuse as a child is experienced as a child….and remembered as a child…..
Its not something easily combated by rationalisation and logic….the emotional response and memory is that of a child the same betrayal fear self blame…..many children think it their fault….because their abuser tells them it is.
Doesnt matter whetherit is medication one on one therapy group therapy….nothing ‘cures’ and no one treatment service or support is the ultimate….it takes a combination of treatments and therapy and a whole lot of time….
The whole reason peer support groups exist particularly with video and written programs to essentially have a trained volunteer facilitators walk them through the program is to make such programs accessible particularly to low incomes. Because they are so expensive…and by doing so the only costs become venue and materials.
Margret, thank-you for helping me to better grasp what Cptsd means regarding the fight or flight response. This is a complicated problem, understanding and treatments are difficult, the adult is like a child … This is a groaning planet.
I’ve changed my mind about peer to peer support.
After reading the comments, and thinking about it, I’ve come to the conclusion that peer to peer must be extremely helpful when it’s well organized, and if it’s available.
Actually, a well trained certified peer support specialist is more effect than most because of stigma. Stigma so often prevents people from even being willing to try medications that might help. Of course if you have lived with such a diagnosis as bipolar for any amount of time than I can guarantee you that there is no magic pill that will fix all a person’s problems. A medication at best can unlock the front door but people still need to open those doors walk down the hall and up the stairs into the next room. I am blown away by how often I succeed where the “professionals” fail. Of course I am also a professional, but my goal is not to fix people but to help people figure out that they need and how to go about reaching their goals. I do not l do things for people or force them to comply with what I believe is best. This empowers people to make choices and be invested in the process of change. Of course this article exist in the first place because with a few exceptions we do not fund peer support service very well in the first place. Those regions that have embraced certified peer support and the empowerment model are producing wonderful results.
I want to be a peer specialist.
And I’m angry and hurt by your dismissive Trumpish edict on peer specialists.
(harrumph- evidence-shmevidence)
I had HMO evidence-based treatment for 30 years. Not. helpful. KP writes their own evidence based edicts. I suggest you take them on. they do far more damage than a few wayward peer specialists..
(on the other hand)
At our amazing mental health center, I finally got stabilized (bipolar 1,35 years.). they basically teach
wellness classes . and we clients get to know each other. we did a couch to 5k. and the camaraderie and support was meaningful, warm, life affirming. We felt like we were getting healthy. And it was taunt by one of those Peer Specialists.
Just getting to giving a damn -supporting each other- helped get me back on my feet. knowing others struggles, being there for them, enjoying our times together. these are things that heal.
so I challenge you to do some more research. try the mental health center in Jefferson county, Colorado . They use PSs in a profound way.
Hi Natasha, I am confused by this blog. Mainly because it seems to equate money with appropriate treatment. It seems to me that this argument is more political than health related. I currently live in California but I am from Oklahoma. Oklahoma is currently defunding all mental health treatment in order to balance their budget (and those services were few and far between to start with). California is where then governor Ronald Reagan closed mental hospitals because they were too costly to operate and the care being provided was characterized for the most part as abuse. This is how the huge number of chronically and seriously mentally ill homeless has grown beyond manageability. I guess what I am saying is any treatment beats no treatment at all and I rely heavily on peer support counseling. If I go to a psychiatrist they do not spend much time with me at all before they want to try various medications and then send me onto peer counselors for talk therapy. iif I won the lotto tomorrow, where could I go to get the best nondangerous, nonabusive, evidenced based and successful treatment that money could buy?
I’m a trained peer group facilitator and state trainer for facilitators for a very large grassroots mental health organization. I don’t want to speak for them in this, so I haven’t named them.
Despite this, I agree with a lot of what you say. While I support true peer-run groups run by volunteers, I’ve been to some really dangerous groups run by untrained people from other organizations. I’m sure some of ours get off the right track too, but I train facilitators to *not* try to actually treat a mental illness. That is indeed for professionals, and out of the scope of a peer run group.
What we do offer is su[pport. Yes, sometimes that is warm-fuzzies, but that can be helpful. Sometimes we convince people to give professionally provided services and meds another chance. Sometimes we share resources, such as where to go for treatment with X insurance. Or no insurance at all. Sometimes we help people learn that they have value and dignity beyond what society might have told them that they have as a person with a mental illness.
And sometimes it is indeed about social life. Sometimes a peer run group is the best thing that’s happened to some people’s social lives. Not really a bad thing.
Should valuable mental health funds go to support peer support? Probably not. If the funds were unlimited, sure. Fortunately, there are plenty of people willing to volunteer in this field and many of them seek out and get decent training to at least prevent harm.
So, I partially agree with you, but not 100%
Seriously iv been a carer for both acute bipolar 1 and CPTSD……id deal with bipolar no matter how severe any day of the week…..
There is nothing more hell bent on dying than a child sexual assault victim….keeping them alive to one day recover slowly kills you from the inside…..
Margaret,
I agree, that would be hell. I do have some experience with sexual abuse and I have nothing but compassion for anyone who has lived it.
– Natasha Tracy
Depends on the model tbh….i agree most are shit….even programs which are provided for facilitators to present many get hijacked by participants when facilitators are not adequetely trained but i have also seen them done exceptionally well where 80% of the proggram is structured video and written content which sets the pace and guides discussion….
It also depends on what tou are trying to acheive/what you are treating. For male victims of child sexual assault peer support groups are CRITICAL. But what is also important is that the groups are led by qualified psychologists.
Oh the reason group therapy is so important for male victims is because outside such settings men simply dont speak of their experience. Male victims are incredibly isolated. The learn that they arent alone…..and it doesnt make them less of a man.
Hi Margaret,
I do agree with some of what you’re saying except I would add two things:
1. I wouldn’t consider people who have experienced sexaul abuse to have a serious mental illness de facto (although, obviously, some do).
2. You said it yourself, it needs to be psychologist led, thus not really making it “peer” support any longer.
– Natasha Tracy
If you dont think complex ptsd isnt a serious mental illness you obviously dont know many victims first hand… sorry but its just the reality of it…..many suicide before they hit 30
Hi Margaret,
That’s not what I said. What I said is that people don’t de facto have a mental illness but some do. Clearly those with complex PTSD are in the group that do.
– Natasha Tracy
There is a reason child abuse is considered such a heinous crime CPTSD isnt an uncommon response to abuse…its the normal/most common response
Its still peer support…..its just a different model…..
There are in fact many models…the biggest flaw in the metaanalysis is variations in the different studies it looks at….a common problem…they dont all use the same standards.
More obvious still as they dont all use the same models and their facilitators have varying levels of experience and training…. which leaves it as not a study of peer support…but more an indirect study of training models of facilitators peer or otherwise.
Oh FYI its frequently misdiagnosed as Bipolar 1, Schizophrenia, disassasociative disorder, up until the day they disclose which can take a decade or more…. if they survive that long.