The Battle of the Peer

Peer support is simple. It is the very natural, very normal, coming together of humans where they share their experiences of living with very natural, very normal, human distress. But, If I had to give it an in depth, thorough, formalised definition it would probably go something like this… Peer support occurs when people share their own lived experience of mental health difficulties with others who live with similar challenges. Through the sharing of these similar experiences, meaningful connections are made and emotional healing ensues. This peer connection is based on mutuality and reciprocity which aims to establish a deep, transformative relationship. By building an empathic trusting relationship, peer support creates a space which encourages empowerment and offers hope in the possibility of recovering from debilitating mental health. Peer support also seeks to reframe the concept of recovery where people can make sense of what happened and move on, as opposed to focusing on the reduction of symptoms and defining them as dysfunction, which is predominate under the medical model of care (Repper 2013). Peers often share a communal understanding of the frustrations they carry as recipients of mental health services. In many cases peers express how their interactions with services and mental health professionals have left them feeling isolated, disempowered, harmed and re-traumatised (Repper 2013).

Organic ‘authentic’ peer support has existed for many years outside of services in communities worldwide. Voluntary and community organisations have long believed in its worth and potential.  Over the past 20 years, many countries across the globe have adopted a formalised version of peer support and integrated people with lived experience of human distress into mental health teams (Watson & Meddings, 2019). Here in Ireland, it is a relatively new addition to the public and private mental health services. In 2017 the HSE employed the first cohort of peer support workers to join existing multi-disciplinary teams nationwide. Since then, private mental health services in Ireland have also employed peer support workers, as the value of the role is increasingly recognised. However, there have been many challenges documented with the implementation of the role into services and these challenges are echoed internationally. Re-emerging themes in peer support literature include stigmatisation, tokensim, role clarity and team readiness (Berry et al. 2011, Hunt & Byrne 2019, Jacobson et al. 2012, Kemp & Henderson 2012, Kilpatrick et al. 2017,  Wall et al. 2021). In Ireland these are reoccurring difficulties and can be mirrored with peer support workers in Canada, New Zealand, Japan, and the U.S, to name but a few. If the whole idea and concept of peer support is really that simple, why do peers the world over continue to face such complications?

Back in 2017 I was one of the original guinea pig peer support workers released into the system, the HSE. Driven by my unwavering passion and grá for the role I decided to pursue a masters in mental health where the focus of my research was peer support workers experiences of integrating into mental health teams in Ireland (Glynn 2022). Having left school at 16 years old, I am not a natural academic. I found the whole process extremely challenging and stressful but that deep rooted sense of righteousness for the role and persistent rebelliousness to keep up the good fight carried me on through. Aside from my own daily overwhelming self-inflicted pressure, there was the pressure to represent the voices of my wonderful peers. I hoped to do this justice and in a manner which was truthful and respectful of the exceptional work they did and continue to do while integrating this role into services. The past 6 years was no easy task for anyone and I am so privileged and proud to call these peers my colleagues.

For my qualitative study (Glynn 2022), I interviewed 8 peer support workers from across Ireland. They were based in various mental health services which included – community mental health teams, in-patient psychiatric units, rehab and recovery teams, and early intervention of psychosis teams. The findings suggest that peer support workers in Ireland experienced many challenges with integrating the role into services. The role of the team was identified as being vital in the implementation process. Team readiness (in this case unreadiness) and lack of understanding of the role, had led to negative experiences for peer support workers. Incidences of stigma, tokenism, and isolation were voiced by the peers. Understandably these experiences acted as a barrier to integration. Several peer support workers vocalised positive experiences when introduced into mental health teams. The recovery ethos and non-hierarchical approach within a  team had been identified as the reasoning for these positive experiences which facilitated successful integration in some areas. Peers appeared to integrate well into teams where their co-workers supported, respected, understood, and accepted the role.

Other challenges which emerged in the study were related to role clarity (Glynn 2022). Confusion around the role had been identified as having a profound effect on integration. Both peer support workers and their teams were unclear of how the lived experience would be utilised in services. Peer support workers articulated the need for a clearer role description and an enhancement of the training for both the peer workers and their teams.

All of the above is well documented and mirrored in peer support literature worldwide and the full findings of this study undergoing review for publication elsewhere. The struggles with peer support integration are echoed internationally. As I read through the transcripts the feeling of familiarity was present throughout, from my review of the literature which was embedded in my brain but also from my own experience of integration. I got overwhelmed with emotion at times reading through the words of my peers. When analysing the data it became clear that one pattern was emerging – The Battle of the Peer.   It is this pattern that I reflect on here.

Fighting language was used by peer support workers when sharing their experiences. Peers described aspects of their integration into teams as a “battle”. Similar powerful terms and words like “win-over”, “fighting”, “war” and “take a stand” were used to articulate the struggle. Peer support workers referred to a revolutionary aspect of the role and how they can challenge or change the system. One participant described “leaving the peer support course in DCU like Che Guevara” and being employed to carry out a “recovery mission” within the services. The concept of changing the system can be linked to the origins of peer support and its radicalised history. Embedding peer support workers into the system where they can offer something different is suggested as the reasoning for their employment. They bring a more recovery orientated approach and this may challenge the dominating medical model. These are often seen as opposing views in mental health services and can cause some conflict.

Peers spoke about how they had to debate and push for their recovery approach in services. When offering an alternative perspective went favourably or after successfully advocating for their role, peer support workers described these interactions as “victories”. This idea of going to “battle” was highlighted again when peer support workers spoke about conflict between themselves and other members of their team. A sense of resistance was experienced by peers. They reported being excluded from aspects of the service when other disciplines were not. Having to “take a stand”, “stand up” and “resolve” issues around restrictions that were being imposed on their role was articulated throughout the interviews.

Several peer support workers spoke about the “confidence”, “energy” and “stamina” that it took to continuously fight for the role and prove its worth. One peer expressed feeling exhausted and stated that “It’s almost like continuous battles”. Having to step back sometimes to protect their wellness, then go and face these issues again was tiring. Re-charging whilst re-evaluating their strategy, opting for an alternative route to instigate change.

Throughout the interviews peer support workers expressed pride and joy at bearing witness to the role’s effectiveness and development within the services. Playing a significant role in this had a positive effect on their recovery journey. The passion for the role was evident when peer support workers spoke about the future development, they expressed caution in relation to expansion and recruitment. Several peer support workers felt that a pause on employment was wise until these challenges with integration are addressed. But will these challenges ever be addressed? Are we trying tirelessly but failing miserably to force a square peg into a round hole? There is no debating the effectiveness of peer support, this is evident in the words of the people who access our service. Yet uncertainty around the development of the role here in Ireland continues, so too does the battle.

For the purpose of this blog ‘The Battle of the Peer’ was the main focus. The full findings of the study (Glynn 2022) will be published at a later stage.

 References

Berry C., Hayward M. & Chandler R. (2011) Another rather than other; experiences of peer support specialist workers and their managers working in mental health services. Journal of Public Mental Health 10(4), 238–249.

Glynn C. (2022) A Qualitative Exploration of Peer Support Worker’s Experience of Integrating into Mental Health Teams in Ireland. (unpublished)

 Hunt E. & Byrne M. (2019) The Impact of Peer Support Workers in Mental Health Services. Health Service Executive, Dublin.

Jacobson, N., Trojanowski L. & Dewa C. (2012) What do peer support workers do? A job description. BMC Health Services Research 12(1), 205.

Kemp V. & Henderson A. R. (2012) Challenges faced by mental health peer support workers: peer support from the peer supporter’s point of view. Psychiatric Rehabilitation Journal 35(4), 337–340.

Kilpatrick E., Keeney S. & McCauley C. (2017) Tokenistic or genuinely effective? Exploring the views of voluntary sector staff regarding the emerging peer support worker role in mental health. Journal of Psychiatric and Mental Health Nursing  24(7), 503-512.

Repper J. (2013) Peer Support Workers: Theory and Practice. ImROC. Retrieved from  https://imroc.org/wp-content/uploads/2022/04/5ImROC-Peer-Support-Workers-Theory-and-Practice.pdf

Wall A., Lovheden T., Landgren K. & Stjernswärd S. (2021) Experiences and Challenges in the Role as Peer Support Workers in a Swedish Mental Health Context – An Interview Study. Issues in Mental Health Nursing 43(4), 344-355.

Watson E. & Meddings S. (2019) Peer Support in Mental Health, 1st ed. Red Globe Press, London.