Positive partnerships: Embracing peers as service providers to enhance recovery

CrossCurrents

By Lesley Young

When certified peer specialist Roy Muise meets with a new client, one of the first questions he asks is, What do you want me to help you with? “The reaction is always the same,” says Muise. “The person says, ‘I’ve never been asked that before.’” This anecdote is a perfect example of the unique role that peer specialists can play in helping clients with schizophrenia along the road to recovery.

“I look at treatment from a recovery perspective as opposed to a medical perspective,” says Muise. “Treatment is very much about getting symptoms under control, often through medication and talk therapy, but there’s more to it. Peer specialists take the time to explore avenues that mental health professionals, because of the number of people they see, may not be able to do. And, of course, peers bring the perspective of someone who has been there.”

Muise has indeed “been there.” He has lived with severe depression for 25 years, but it didn’t stop him from becoming the first certified peer specialist in Canada. He works at a community-based program called the Consumer Initiative Centre in Dartmouth, Nova Scotia, where he helps people with mental illness pursue career and lifestyle goals and work on coping skills.

But Muise’s ambitions extend beyond this role. His goal is to become an integrated member of a mental health treatment team, a position for which he is advocating across hospitals in the province. “My dream is for every psychiatric unit in Nova Scotia hospitals to have one peer specialist,” he says. He may get his wish sooner than he thinks.

That is because peer support plays a clear role in the growing recovery movement, with acknowledgement at the national level through the Mental Health Commission of Canada and provincially, through the Psychiatric Patient Office in Ontario. Both have made formal recommendations to include peers in mental health treatment.

In the United States, more than 10 states have adopted the Georgia State peer support certification model, pioneered by the Division of Mental Health, Developmental Disabilities and Addictive Diseases in Atlanta. Since the first class in 2001, the GA Certified Peer Specialist Project has graduated 497 peers, eight of whom are Canadian (including Muise), according to Bob Patterson, the project’s director.

In Canada, Ontario and Quebec lead the way in creating a made-in-Canada approach to peer support. For example, the Ontario Peer Development Initiative is assessing the viability of a peer support certification program. But with the advancement of peer roles come hard questions, including whether there are valid reasons to be reluctant to include peer specialists in a formal treatment program, and more unsettling for some, whether formalizing the peer specialist role may dilute the peer’s original goal – to be a distinct, experienced pillar of support among a sea of well-intended, well-trained “experts” who have never been tormented by voices in their head or unable to get out of bed for days on end.

An article about peer support in the July 2006 issue of Schizophrenia Bulletin provides optimism but encourages realistic attitudes. “The unique ways in which persons with histories of mental illness and recovery can be useful in facilitating the engagement and recovery of others are just beginning to be explored and developed,” conclude the authors of the article. They insist that this is not a reason to be discouraged, but “a cautionary note about making claims that go beyond existing data.”

In practical terms, peer support specialists on formal teams participate in treatment team meetings, facilitate peer support group meetings, help with discharge transitions and provide individual support by helping clients articulate recovery goals, assisting with treatment (e.g., ensuring that clients take their medication), modeling coping techniques and self-help strategies based on the their own recovery experience and enabling clients to advocate for themselves in obtaining effective services. Underscoring these activities is the core value of peer specialists – the intrinsic (harder to quantify) benefits of having had a personal history of mental illness.

According to Muise, a shared mental health experience opens the door to a unique relationship. “What I have found is that people tend to be a lot more open, more willing to talk,” he says. “You can see this light go on when they find out you’re a survivor too.”

Patrick Veysey is a formal peer specialist with the Nipissing Assertive Community Treatment Team (NACTT) at North Bay General Hospital in North Bay, Ontario. He has lived with paranoid schizophrenia for more than 10 years. “I know what it feels like to suffer from mental illness for a long time,” he says. “I can empathize with the client about the challenges and decisions they have to make regarding meds, with what they have to do to recover. What I bring to the team is demonstrated recovery.”

As a formal treatment team member, Veysey is able to draw on his experiences to offer a different perspective from that provided by clinicians. The team takes advantage of his experience by checking in with him first if they aren’t sure how to approach a client or whether a treatment is right for them. “If it doesn’t make sense to me, it’s not going to make sense to the client,” he says. The connection Veysey makes with clients also allows him to help build a good rapport among clients and the entire treatment team.

While peer support specialists are not matched based on diagnosis (“We don’t see the illness, we see the person,” as Patterson puts it), Veysey explains just how helpful peers can be for clients with severe mental illness. “I’ve experienced psychosis. I can really identify with what’s going on in that client’s mind.” Veysey is able to verbalize what a client is going through to team members when they struggle to do so.

Veysey says he has been treated as a respected, valued member of NACTT. However, the fact that there is a longstanding reluctance among mental health professionals to formally integrate peer support is not news to him. He learned at a recent ACT conference that one-quarter to one-third of all ACT teams in Ontario “don’t have a peer specialist because they don’t believe in them.”

Some peer specialists are hoping that certification will serve not only to train specialists in a standardized manner, but also to add credibility to integrated peer support services. Patterson contends that certification can eliminate clinicians’ concerns, such as those involving confidentiality, for example, by asking members to agree to a code of ethics (as does the GA certification). With standardized training, peer specialists are properly educated in establishing professional boundaries, ensuring that the peer relationship does not evolve into friendship and that the peer specialist does not compromise personal mental health, both valid concerns.

But the most pressing challenge facing the future of integrated peer support is ensuring there is a distinction between what separates the clinical experts from the consumer experts in a medical model. Fiona Wilson, a co-ordinator of Peer Support Services at the Mental Health Addictions Program at St. Joseph's Healthcare Hamilton in Hamilton, Ontario, explains: “The concern when you embed a peer provider on a team is that the purity of the peer role can be diluted. There could be situations where a peer provider is delivering medication to people or negotiating compliance. That’s not the pure peer role, when they are not using their lived experience in a productive or therapeutic way.” Ultimately, upon “professionalizing” the role, peer specialists will need to take care to protect their goals, which should be 100 per cent people-driven, from becoming treatment-driven, adds Wilson. “Recovery is about individual needs. It doesn’t replace treatment goals and outcomes, but rather complements them.”

Any future Canadian certification program will need to take this into account, a reason why it is important to the Ontario peer support community to maintain control over its development, explains Wilson. A program will also need to be flexible and accessible in order to prevent certification from being a monetary or educational barrier to potential peer specialists who don’t have certain qualifications. Because at the end of the day, as Veysey puts it, “peer specialists are really people who have a degree in lived experience.”

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