Peer Support Working in Mental Health: A system in need of change?


This is written from lived experience of mental ill health and also in the involvement of training Peer Support Workers.  In this post Martha Griffin, lecturer in Mental Health in Dublin City University, examines the challenges faced by peer support workers and how social workers interact with the peer support discipline in a systematic way.

Similar but different origins.

The global definition of social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work.

Peer Support working is also a practice based and academic discipline albeit at an earlier development stage in Ireland. Peer support is “offering and receiving help, based on shared understanding, respect and mutual empowerment between people in similar situations” but it is also about empowerment through dialogue, human rights and social change.

Both workers have similar principles, values and ethos spanning from person centered to societal factors and sharing roots of social activism, resistance and rising up against oppressive societies and practices.

Social work has supported user involvement in many countries and indeed in Ireland. Huntand Byrne (2019) for the Irish Mental Health Services found that Peer Support Workers in the Health Service Executive are predominantly supervised by social workers alongside nursing staff and occupational therapists.

However, does social work now stand as a gatekeeper in the Irish mental health system? In some parts supervision of Peer Support workers is seen as belonging and owned by Social Work exclusively and student placements and positions on teams are delayed until the matter is resolved at a national level. In other areas Peer Support working is being actively blocked and used as a pawn to get more Social Work roles.

Systemic power struggles 

Have Peer Support Workers and Social Workers caught up on systemic power hierarchies within a health system while losing sight of interpersonal team working and aligning professional values and indeed the people receiving the service? Should and could they have more power coming together and be stronger together being mindful of the differences of expert by experience and expert by profession but working towards empowerment and liberation and holding power to account?

Redesigning the Healthcare system? 

Vision for Change, Government of Ireland (2006) called for a review of models of leadership of mental health teams and legislative change to be in line with international best practice, and Sharing the Vision: A Mental Health Policy for Everyone, (2020) reaffirmed the need in the interim for team coordinators to be put in place to facilitate intra-team management of referrals and clinical inputs. Such a shared governance model necessitates a focus on team effectiveness, requiring each team member to work to the maximum of their scope of practice, as well as to develop shared team competencies. In this way, each member of the team takes responsibility for the effectiveness of the team so that there is appropriate service delivery and the outcomes set out in this policy are achieved. In this vision there would be no gatekeepers, no one expert but experts and the person receiving the care would have equal access to all health care providers.

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