I think it’s best if I begin by acknowledging that I have pro-Peer bias and conflicted feelings about my job doing Peer Support in a disease model agency. I believe most state-funded community mental health centers (CMHC’s) provide poor and harmful disease model care. People in those systems do not support recovery if they are complicit with harm, such as coercive or non-informed “treatment” with dangerous medications and the use of clinical language that supports stigma.
Peer Support in disease-based agencies can challenge the medical model or reinforce it, depending on the agency and how the peer does the job..
The current landscape of services and practice is in a strange juxtaposed limbo between the coercive medical model and the empowered recovery model. It’s interesting to see all the different forms that roles and experience take in different contexts.
Clearly, the system challenges Peer Support, which is based on mutual relationships. The ethos of Peer Support and disease model care often directly conflict. Peer support in disease model CMHC’s is sometimes used in ways that undermine recovery, for example pushing compliance with medication, and accepting and adjusting to the disease. Often, recovery is just a word that is tossed around because it looks good on brochures.
How Peer Support in Disease Model Agencies Can Help
Then again, in some settings that receive state-funding, Peers are encouraged to participate in people’s recoveries.
In ways that hold a high degree of humanity, I facilitate recovery education classes, and, even as the person at the front of the room, the dynamic is mutual and responsive. Co-learning is acknowledged and celebrated.
In keeping with the principles of the Wellness and Recovery Action Plan (WRAP ). I do not refer to people in clinical terms, and I support them in self-advocacy in their dealings with other providers within the organization.
It is not an ideal scenario. At some point, I’d like to work in a Peer Respite center.
However, I cannot deny the value of having Peer support in disease model agencies, even if the fidelity to the ethos of Peer Support is often compromised by the culture and practice within the centers. The core of the work I do is helping people transform their ideas about illness and wellness, and encouraging them to be self-directed in considering what is helpful and harmful to them, what they hope for.
Many people would have no access at all to recovery ideas and skills without this state-funded Peer Support in disease model agencies, though the protocol of state-funded practice can compromise the pure Peer Support ethos of voluntary, mutual relationships.
Within the curriculums I facilitate, people learn skills to help them to rebuild their damaged support networks. Just today, I copied a Shery Mead essay on Peer Support to use in my WRAP group next week. One of our experienced students has been discussing recovery skills with some of the people that live in the poorest neighborhoods in the semi-rural county. Thus, true peer support – such as that which occurs between neighbors and friends – is empowered.
While I wish that our public systems were managed by Peers, and employed only Peers, and let Peers make all the decisions about how they wanted to run and participate in services, that simply isn’t the case.
There is a fellow in Vermont opening a respite house based on Soteria, that will include a psychiatrist on staff and use state funding. The psychiatrist is there to help people practice harm-reduction coming off medication, and to support people who choose to use medication as a conscious tool. It’s not Peer Support in true form, but, it’s much better than nothing.
Recovery education is vital. It helps people learn to manage their experiences in a way that reduces crises. Of course, these same skills can be learned in community and in families, but many communities and families are not meeting people’s needs either, due to compounded challenges, such as joblessness, substance use, and the general hard times that a lot of people go through.
It’s disheartening to see that some Peers advocate for medication compliance as the only key to recovery. Advocating for any specific treatment conflicts with power boundaries and the presumption of mutuality. It also undermines the idea that, in recovery, we are “the experts on ourselves.”
I’m sure that disease model settings are padding themselves with complicit and brainwashed Peers who just want a job, and who might be inclined to enjoy power and influence, to abuse the privilege of trust. Some people are opportunistic and unethical, even as Peers who are purportedly there to “help.”
I Like and Don’t Like My Job and Professional Certificate
For a long time, I really liked the letters CPS (Certified Peer Specialist) behind my name. To me, they signified my decisive strength in pulling myself away from a death’s door state of hopelessness (exacerbated by psychiatric medications and psychosocial trauma) to apply for a job which, at that point, was probably the only job I could have gotten. Suddenly all the things that precipitated the gaps in my resume were something that could get me an interview.
Additionally, the letters represent specific training and experience as an entry-level professional. I’m proud of that, and it seems peculiar that Peers would tell other people what they should or should not be proud of it. The training actually supported many of the perspectives I gleaned from the radical mental health movement, and made me hopeful that perhaps things may be changing, bit by bit.
At the same time, I’m troubled by my involvement in an outbranch of a system that I do not believe in or support. It’s tough. After further reflection, I’m not so fond of “my letters.” Why should I be proud of the approval of the state? I don’t need their approval, except I do if I want to work in settings where poor and vulnerable people seek help.
Someone once asked me if I’d still work at my job if I weren’t getting paid. In complete honesty, I told them I’d much rather do the work I do for free. However, doing the work you love for free is a luxury afforded by time and the availability other ways to meet basic monetary needs. I sometimes think I should have applied for disability after my last crisis. I’d make more money and could spend more time doing community mutual aid. I could have qualified for disability, though I’m not disabled. Instead, I settle for doing work that I love in a setting that I’m not entirely supportive of (but, that is generally recovery-oriented) for a wage that is meager compared to the money I save the state by helping people to learn how to navigate extreme states without costly (and traumatic) hospitalizations.
Can peer support in disease model agencies help people, or is it too big a compromise with principle? What do you think?