Academic journal article New Zealand Sociology

Gaining Acceptance: Discourses on Training and Qualifications in Peer Support

Academic journal article New Zealand Sociology

Gaining Acceptance: Discourses on Training and Qualifications in Peer Support

Article excerpt

Introduction

The creation of new occupational groups in health care is an ongoing phenomenon (Timmons, 2011: 338). However, peer support is also a new type of occupation in mental health, in which paid or funded volunteer services are provided by people who are, or have been, service users themselves (Clay, 2005; Orwin, 2008; O'Hagan, McKee and Priest, 2009). It had its origins in the self-help movement (Archibald, 2007) and the mental health consumers movement (Chamberlin, 1977; Campbell, 2005) in the context of deinstitutionalisation during the 1970s and 1980s. In particular, peer support developed in the context of two different movements operating in the wealthier English speaking countries in the 1970s. These included the reformist self-help/ mutual aid movement, which focused on personal support complementary to the medical system, and the more radical mental health consumers/psychiatric survivors' movement (Everett, 1994; Nelson et al., 2008: 193). Within the consumers/survivors movement, peer support emerged as a key part of a liberation agenda (Chamberlin, 1977; Campbell, 2005: 19; Adame and Leitner, 2008).

Judi Chamberlin (2004) has described the way peer support emerged in Canada and the United States as consumers, psychiatric survivors and mental patients began organising informally, and discovering that they could provide support that addressed each other's unmet needs. This was accomplished in spite of discouragement for such horizontal relationships by the mental health system (Chamberlin, 2004). Similarly, in Aotearoa New Zealand, peer support first emerged in the 1970s as an informal arrangement of ex-patients visiting, and providing support to, current patients on a voluntary basis.

Peer support as offered by the consumer/survivor movement had a rather oppositional relationship with the mainstream mental health system. As Mead, Hilton and Curtis argue, it saw 'recovery' as undoing the cultural processes by which people develop careers as mental patients (2001: 135-136). Psychiatric labels were thus discouraged; peer supporters instead encouraged their peers to talk about the experiences themselves, and thus to normalise experiences of extreme mental distress (Chamberlin, 2004; Adame and Leitner, 2008: 149). They strove to minimize hierarchy and to encourage mutuality in relationships (Chamberlin, 2004; Mead and MacNeil, 2006). Choice and empowerment were cornerstone principles, in response to a sometimes coercive mainstream mental health system (Campbell, 2005; Clay, 2005).

During the past twenty years, peer support has been moving into the mainstream of mental health provision. In developed Anglo-Saxon countries, it is now often funded by the public sector and provided by paid workers (Bradstreet, 2006; O'Hagan et al., 2009). This has been driven by the development of the 'recovery' approach (Deegan, 1988; Anthony, 1993), and its institutionalisation in the mental health systems of many liberal democracies (Ontario Ministry of Health, 1993; Mental Health Commission, 1998; President's New Freedom Commission for Mental Health, 2003; Scottish Executive, 2006). At the same time, the consumers movement which gave it birth has become larger, more diverse and generally more pragmatic and reformist, even while the links between the consumers' movement and peer support are becoming somewhat attenuated. These developments, along with a shift towards consumerist models in healthcare more generally, have led to a willingness to experiment with funded peer support. A meta-review of the evidence found that peer support is at least as effective as other forms of mental health provision (Doughty and Tse, 2011).

Peer support now takes place in a broad diversity of forms and through a wide variety of organisational structures. In Aotearoa New Zealand, most peer support involves a former service user walking alongside a person currently undergoing mental distress. It might involve facilitating support groups; producing educational programmes; doing advocacy; providing face-to-face mentoring; providing safe accommodation for people in crisis; running drop-in centres; supporting people to find employment or housing; visiting inpatients; operating telephone support lines; or providing activity programmes. …

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