Monday, 21 September 2020

What Makes a Peer Role 'Peer'?

Originally published in the RLC Newsletter, January, 2013


In a recent Newsletter, we printed an article that talked a bit about the meaning of the word ‘peer'  (original article available here); the definition of ‘peer’ seems to be shifting away from one that is based on relationships with others, and toward a replacement for ‘consumer’ or ‘client’ within the mental health system.  There's also a great deal of debate and misunderstanding about what ‘peer’ means when it becomes a job title.

In our state, there are a growing number of paid peer roles, titled everything from Peer Specialist and Peer Bridger, to Peer Advocate and beyond.  And yet, there remains a tremendous amount of confusion about what makes a peer role a 'peer role'.  The biggest point of confusion seems to be understanding the difference between a traditional role filled by someone who discloses that they have experience being given a psychiatric diagnosis, receiving mental health services, and so on; and a peer role

Traditional Role Filled by Someone Who Discloses:

There are any number of traditionally-oriented positions within the mental health system, including therapists, mental health counselors, direct support workers, program directors and so on.  As our belief in the human potential to heal and grow beyond any psychiatric diagnosis strengthens, the belief that these roles can be filled by people who have experienced significant distress and diagnosis at some point in their life has caught on.  However, that does not mean that if someone who has these experiences becomes a therapist or support worker that they are a ‘peer therapist’ or ‘peer support worker’ simply because they have that life experience.

The job title of ‘peer’ is much more than an identity.  It includes a specific job focus and approach. 

Peer Roles:

People who work in peer roles fill positions that – on the surface – can look quite different from one another.  However, there are some common threads that make their positions unique.

  • Use of personal experience as a tool - People who are working in peer roles have specifically agreed to use the wisdom they have gained through their personal experiences in an intentional way.  They are, in fact, using those experiences as one of their primary ‘tools’ on the job.  While people in traditional roles may choose to disclose and also use personal sharing to enhance their connection and impact of their work, it is not typically one of the main focal points.
  • Mutuality - In peer roles in particular, there is a great deal of focus on mutuality.  In the most basic sense, mutuality means a focus on the relationship rather than either individual.  It also means an acceptance that both people involved can learn from and be impacted by that relationship, regardless of their specific roles.  By that definition, there is potential for mutuality between a traditional provider and someone receiving services.  However, there is a particular focus on it in peer roles.  There’s also a focus on using mutuality to reduce power imbalances in peer support, which is a central part of the work.
  • In but not of - There is a foundational concept of peer work commonly referred to as being ‘in but not of’ the system.  This can be a somewhat confusing concept to understand at first, but makes a lot of sense after closer examination. The idea is that the person in a peer role is working IN the system, but does not use the standard language or approach OF the system.  Similarly, although the person in a peer role is working IN the system, they are operating under a different framework than that OFthe system.  Specifically, they have a primary responsibility to support the voice of the individual without having major functions of the system become barriers to that responsibility.

For example, someone in a traditional role who discloses might be responsible for giving out medications under the system’s Medication Administration Program (MAP).  During that process, they might reasonably share a story of talking to a psychiatrist or other related experiences in effort to support a person who is questioning some aspect of their medications.  In other words, their primary responsibility would be to give the medications and document the process under MAP requirements, though some conversation about personal experiences may be included.

On the other hand, someone in a peer role would not ever be responsible for giving out medications and should not be MAP trained.  This would be a conflict of interest because there is an inherent power dynamic in being responsible for administering and documenting someone’s medication.  It also shifts the balance of responsibility toward the system.

In other words, the primary responsibility of the person in a peer role is to support an individual's voice and choice to be heard.

Sometimes, people misunderstand, and feel that it is an insult to not involve people in peer roles in medication administration, rep-payeeships and so on.  They are concerned that the message being sent is that people who have been given psychiatric diagnoses are not capable of managing these tasks.  They see it as a limitation.  However, consider the following example: 

George works as the head chef at a local (fictional) restaurant called Chez Jacques.  George is a terrific chef, and has received rave reviews from all the food critics in the area.  However, George also happens to be a fantastic host, and when Manny the host unexpectedly quits, the owner of the restaurant asks George to step in.  While George does a great job at the front of the restaurant, there’s no way for him to keep up his standards as a chef.  Consequently, the food suffers and the next food critic review is terrible.  The owner immediately hires another host and asks George to return his full attention to the kitchen.

Is the problem that George isn’t good enough to host the restaurant?  Or is the problem that hosting the restaurant interferes with George’s ability to be a great chef?  Similarly, it’s not so much that someone in a peer role couldn’t be good at administering medications, doing assessments or writing treatment plans; but it’s not their job, and it detracts from them being able to do their job on a number of levels.

This type of role is relatively new to many people, and so it makes sense that people are still learning about the values and integrity of the work.  The only way we can find our way to a unified understanding is to talk with one another and share information.  We hope you’ll share this article with others and use it as a piece to help start conversations, if they’re not already happening!



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