Peer Counseling: Training One

LETS PEER COUNSELING TRAINING ONE

OUTLINE

01.

History of the Peer Movement

02.

Peer Counseling Introduction, Key Functions, and Ethics

03.

The Evidence

04.

Recovery Basics

05.

Review

THE FIGHT FOR FREEDOM History of the Peer Movement

HISTORY PEER COUNSELING HAS ITS ORIGINS IN THE CONSUMER MOVEMENT, OR THE SELF-DETERMINATION MOVEMENT. IN THE PAST, FAMILY MEMBERS OF THOSE WITH PSYCHIATRIC DISABILITIES WERE OFTEN JUST AS DISEMPOWERED IN APPROACHES TO MENTAL ILLNESS. THIS SENSE OF DISEMPOWERMENT EVENTUALLY CREATED A MOVEMENT OF PEOPLE WHO WANTED TO TAKE CHARGE OF THEIR LIVES.

19TH CENTURY The roots of the consumer movement go back as far as the 19th century, when a handful of individuals began writing about their experiences. These early pioneers brought to light their outrage at the indignities and abuses they had experienced inside psychiatric hospitals.

1950S With the start of deinstitutionalization in the 1950s, increasing numbers of individuals released from psychiatric hospitals began to create informal relationships in the community.

1960S By the 1960s, the civil rights movement inspired these former patients to become better organized into what was then coined the mental patients’ liberation movement. Groups of consumers saw themselves as having been rejected by society and robbed of power and control over their lives. To overcome what they saw as persecution, they began to advocate for self-determination and basic rights.

Many users of mental health services refer to themselves as “consumers”, although the term is not uniformly accepted.

Many people prefer it over the term “patient” or “client”, however others choose to refer to themselves as “survivors”or “ex-patients” to indicate that they have survived what they regarded as oppression by the mental health system.

FAVORED APPROACH

NONHIERARC HIAL

EDUCATION

SELFHELP GROWTH

SUPPORT

LED BY PEERS

PERSONFOCUSED Self-help is based on the belief that individuals who share the same health problem can help themselves and each other to cope with their condition. Another way consumers have adopted a self-help approach is through consumer operated programs and services (COPSs). COPSs generally offer mutual support, community-building, services, and advocacy.

COPSs provide participants with opportunities to “tell one’s story,” engage in formal and informal peer support, be mentored and become a mentor, learn self-management and problem solving strategies, practice skills for employment and everyday life, express oneself creatively, and to advocate for oneself or other peers.

NAMI MEMBERSHIP SURGES; PEER SOLUTIONS ARE INITIATED

Splintered services and a lack of availability of services were motivating forces behind the establishment of the family movement. NAMI was created as a grassroots organization in 1979 by a small group of families in Madison, Wisconsin.

Since then, its membership has skyrocketed to 208,000 in all 50 states.

Over 30% of NAMI members are now mental health consumers. NAMI began providing peer-led community solutions for consumers and families alike, in areas where resources are scarce and for populations that are typically ignored.

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SPLINTERED SERVICES + LACK OF AVAILABILITY = FAMILY MOVEMENT

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NAMI ADVOCACY

NAMI’S FOCUS AND SPAN NAMI’s principal goal is to advocate for improved services for people with psychiatric disabilities. Advocacy by parents on behalf of children with serious emotional or behavioral disturbances has had a driving impact. Through the efforts of these groups and individuals, the most noteworthy accomplishments of the family movement has been the rise of family participation in decision-making about care for children.

WHAT’S A

PEER COUNSELOR?

KEY FUNCTIONS

Peer counselors are also known by several other terms in other states and communities, including “peer support counselors,” “peer specialists,” and “recovery specialists,” to name a few. Services include scheduled activities like: socialization, recovery, self-advocacy, development of natural, informal and formal supports, maintenance and/or increase in community living skills. In addition, peer services can include: self-help support groups, phone lines, and psychoeducation classes.

Preparing peer specialists to help their peers get un-stuck from the disabling power of their diagnosis, symptoms, side effects, and especially a damaged self-image. Ask effective questions, help people combat negative self-talk, support others as they face their peers, facilitate recovery dialogues, and be a culturally competent part of someone's wellness team.

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Assistance in Daily Management

Social/Emotional Support

Linkage to Resources

Ongoing Support

BASIC COMPETENCIES THE RECOVERY PROCESS Understanding the key parts of the recovery process, as LETS defines them; but also understanding that recovery is a unique process for each and every individual — and it is an ongoing, long-term process.

BIOSOCIAL APPROACH Understanding that mental illness is neither a purely biological, or purely social approach. In light of this, we should not be trying to impose our own views and perceptions of mental illness on the peers we work with.

ESTABLISHING RELATIONSHIPS Working with peers through our program will require you to use positive relationship building skills to establish trust and a strong sense of comfort. Remember to be empathetic, and focus on listening.

LISTENING SKILLS Listening is one of the most important aspects of our work.

Sometimes, all individuals need is to talk to someone about what they’re going through. Give your peers enough time and space to do this.

INTERSECTIONALITY Intersectionality promotes an understanding of human beings as shaped by the interaction of different social locations. These interactions occur within a context of connected systems and structures of power.

Through such processes, interdependent forms of privilege and oppression are created.

ETHICS When working with peers, don’t hesitate to ask questions, refer to your trainings, or tell someone, “I’m not unsure, I’ll find out and get back to you!” Don’t try to offer advice outside of your expertise.

CODE OF ETHICS •

Peer specialists believe that every person has strengths and the ability to learn and grow.

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Peer specialists maintain high standards of personal conduct.

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Peer specialists respect the rights and dignity of those they serve.

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Peer specialists openly share their personal recovery stories with colleagues and those they serve.

Peer specialists try and maintain healthy behaviors and conduct themselves in a way that fosters their own recovery.

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Peer specialists seek to role-model recovery.

Peer specialists don't enter into relationships or commitments that conflict with the interests of those they serve.

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Peer specialists respect the privacy and confidentiality of those they serve.

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Peer specialists never engage in sexual/intimate activities with colleagues or those they serve.

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Peer specialists never intimidate, threaten or harass those they serve; never use undue influence, physical force, or verbal abuse with those they serve; and never make unwarranted promises to those they serve.

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Peer specialists don't accept gifts of significant value from those they serve.

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Peer specialists keep current with knowledge that's related to recovery and openly share this knowledge with their colleagues and those they serve.

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Peer specialists don't practice, condone, facilitate or collaborate in any form of discrimination based on ethnicity, race, gender, sexual orientation, age, religion, national origin, marital status, political belief or mental or physical disability.

CODE OF ETHICS •

Peer support is voluntary

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Peer supporters are hopeful

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Peer supporters are open minded

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Peer supporters are empathetic

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Peer supporters are respectful

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Peer supporters facilitate change

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Peer supporters are honest and direct

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Peer support is mutual and reciprocal

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Peer support is equally shared power

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Peer recovery support is strengths-focused

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Peer support is transparent

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Peer support is person-driven

NATIONAL ETHICAL GUIDELINES AND PRACTICE STANDARDS FOR PEER SUPPORTERS INTERNATIONAL ASSOCIATION OF PEER SUPPORTERS

VOLUNTARY •

Recovery is a personal choice. The most basic value of peer support is that people freely choose to give or receive support. Being coerced, forced or pressured is against the nature of genuine peer support. The voluntary nature of peer support makes it easier to build trust and connections with another.

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Peer supporters also have the right to choose not to work with individuals with a particular background if the peer supporter’s personal issues or lack of expertise could interfere with the ability to provide effective support to these individuals. In these situations, the peer supporter would refer the individuals to other peer supporters or other service providers to provide assistance with the individuals’ interests and desires.

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Peer supporters advocate for choice when they observe coercion in any mental health or substance abuse service setting.

IN PRACTICE: SUPPORT CHOICE •

Peer supporters do not force or coerce others to participate in peer support services or any other service.

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Peer supporters respect the rights of those they support to choose or cease support services or use the peer support services from a different peer supporter.

HOPEFUL

IN PRACTICE: SHARE HOPE •

Belief that recovery is possible brings hope to those feeling hopeless. Hope is the catalyst of recovery for many people. Peer supporters demonstrate that recovery is real—they are the evidence that people can and do overcome the internal and external challenges that confront people with mental health, traumatic or substance use challenges. As role models, most peer supporters make a commitment to continue to grow and thrive as they “walk the walk” in their own pathway of recovery. By authentically living recovery, peer supporters inspire real hope that recovery is possible for others.

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Peer supporters tell strategic stories of their personal recovery in relation to current struggles faced by those who are being supported.

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Peer supporters model recovery behaviors at work and act as ambassadors of recovery in all aspects of their work.

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Peer supporters help others reframe life challenges as opportunities for personal growth.

OPEN-MINDED •

Being judged can be emotionally distressing and harmful. Peer supporters “meet people where they are at” in their recovery experience even when the other person’s beliefs, attitudes or ways of approaching recovery are far different from their own.

Being nonjudgmental means holding others in unconditional positive regard, with an open mind, a compassionate heart and full acceptance of each person as a unique individual.

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Peer supporters connect with others where and as they are.

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Peer supporters do not evaluate or assess others.

IN PRACTICE: WITHHOLD JUDGMENT ABOUT OTHERS •

Peer supporters embrace differences of those they support as potential learning opportunities.

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Peer supporters respect an individual’s right to choose the pathways to recovery individuals believe will work best for them.

EMPATHETIC •

Empathy is an emotional connection that is created by “putting yourself in the other person’s shoes.” Peer supporters do not assume they know exactly what the other person is feeling even if they have experienced similar challenges. They ask thoughtful questions and listen with sensitivity to be able to respond emotionally or spiritually to what the other person is feeling.

IN PRACTICE: LISTEN WITH EMOTIONAL SENSITIVITY •

Peer supporters practice effective listening skills that are non-judgmental.

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Peer supporters understand that even thoughothers may share similar life experiences, the range of responses may vary considerably.

RESPECTFUL •

Each person is valued and seen as having something important and unique to contribute to the world. Peer supporters treat people with kindness, warmth and dignity. Peer supporters accept and are open to differences, encouraging people to share the gifts and strengths that come from human diversity. Peer supporters honor and make room for everyone’s ideas and opinions and believe every person is equally capable of contributing to the whole.

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differences can contribute to their lives and the lives of those around them.

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Peer supporters practice patience, kindness, warmth and dignity with everyone they interact with in their work.

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Peer supporters treat each person they encounter with dignity and see them as worthy of all basic human rights.

IN PRACTICE: BE CURIOUS + EMBRACE DIVERSITY •

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Peer supporters embrace diversity of culture and thought as a means of personal growth for those they support and themselves.

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Peer supporters encourage others to explore how

Peer supporters embrace the full range of cultural experiences, strengths and approaches to recovery for those they support and themselves.

FACILITATE CHANGE •

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IN PRACTICE: EDUCATE + ADVOCATE

Some of the worst human rights violations are experienced by people with psychiatric, trauma or substance use challenges. They are frequently seen as “objects of treatment” rather than human beings with the same fundamental rights to life, liberty and the pursuit of happiness as everyone else. People may be survivors of violence (including physical, emotional, spiritual and mental abuse or neglect).

Those with certain behaviors that make others uncomfortable may find themselves stereotyped, stigmatized and outcast by society. Internalized oppression is common among people who have been rejected by society. Peer supporters treat people as human beings and remain alert to any practice (including the way people treat themselves) that is dehumanizing, demoralizing or degrading and will use their personal story and/or advocacy to be an agent for positive change.

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Peer supporters recognize and find appropriate ways to call attention to injustices.

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Peer supporters strive to understand how injustices may affect people.

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Peer supporters encourage, coach and inspire those they support to challenge and overcome injustices.

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Peer supporters use language that is supportive, encouraging, inspiring, motivating and respectful.

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Peer supporters help those they support explore areas in need of change for themselves and others.

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Peer supporters recognize injustices peers face in all contexts and act as advocates and facilitate change where appropriate

HONEST + DIRECT •

Clear and thoughtful communication is fundamental to effective peer support. Difficult issues are addressed with those who are directly involved.

Privacy and confidentiality build trust. Honest communication moves beyond the fear of conflict or hurting other people to the ability to respectfully work together to resolve challenging issues with caring and compassion, including issues related to stigma, abuse, oppression, crisis or safety.

IN PRACTICE: ADDRESS DIFFICULT ISSUES WITH CARE + COMPASSION •

Peer supporters respect privacy and confidentiality.

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Peer supporters engage, when desired by those they support, in candid, honest discussions about stigma, abuse, oppression, crisis or safety.

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Peer supporters exercise compassion and caring in peer support relationships.

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Peer supporters do not make false promises, misrepresent themselves, others or circumstances.

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Peer supporters strive to build peer relationships based on integrity, honesty, respect and trust.

MUTUAL + RECIPROCAL •

In a peer support relationship each person gives and receives in a fluid, constantly changing manner. This is very different from what most people experience in treatment programs, where people are seen as needing help and staff is seen as providing that help.

In peer support relationships, each person has things to teach and learn. This is true whether you are a paid or volunteer peer supporter.

IN PRACTICE: ENCOURAGE PEERS TO GIVE AND RECEIVE •

Peer supporters learn from those they support and those supported learn from peer supporters.

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Peer supporters encourage peers to fulfill a

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fundamental human need -- to be able to give as well as receive.

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Peer supporters facilitate respect and honor a relationship with peers that evokes power-sharing and mutuality, wherever possible.

SHARED POWER •

By definition, peers are equal. Sharing power in a peer support relationship means equal opportunity for each person to express ideas and opinions, offer choices and contribute. Each person speaks and listens to what is said. Abuse of power is avoided when peer support is a true collaboration.

IN PRACTICE: EMBODY EQUALITY •

Peer supporters use language that reflects a mutual relationship with those they support.

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Peer supporters behave in ways that reflect respect and mutuality with those they support.

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Peer supporters do not express or exercise power over those they support.

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Peer supporters do not diagnose or offer medical services, but do offer a complementary service.

STRENGTHS-FOCUSED •

Each person has skills, gifts and talents they can use to better their own life. Peer support focuses on what's strong, not what's wrong in another’s life.

Peer supporters share their own experiences to encourage people to see the “silver lining” or the positive things they have gained through adversity.

Through peer support, people get in touch with their strengths (the things they have going for them). They rediscover childhood dreams and long-lost passions that can be used to fuel recovery.

IN PRACTICE: WHAT’S STRONG, NOT WHAT’S WRONG

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Peer supporters encourage others to identify their strengths and use them to improve their lives.

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Peer supporters focus on the strengths of those they support.

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Peer supporters use their own experiences to demonstrate the use of one’s strengths, and to encourage and inspire those they support.

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Peer supporters encourage others to explore dreams and goals meaningful to those they support.

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Peer supporters operate from a strength-based perspective and acknowledge the strengths, informed choices and decisions of peers as a foundation of recovery.

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Peer supporters don’t fix or do for others what they can do for themselves.

TRANSPARENT •

Peer support is the process of giving and receiving non-clinical assistance to achieve longterm recovery from severe psychiatric, traumatic or addiction challenges. Peer supporters are experientially credentialed to assist others in this process.

Transparency refers to setting expectations with each person about what can and cannot be offered in a peer support relationship, clarifying issues related to privacy and confidentiality. Peer supporters communicate with everyone in plain language so people can readily understand and they “put a face on recovery” by sharing personal recovery experiences to inspire hope and the belief that recovery is real.

IN PRACTICE: SET CLEAR EXPECTATIONS + USE PLAIN LANGUAGE

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Peer supporters clearly explain what can or cannot be expected of the peer support relationship.

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Peer supporters use language that is clear, understandable and value and judgment free.

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Peer supporters use language that is supportive and respectful.

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Peer supporters provide support in a professional yet humanistic manner.

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Peer supporter roles are distinct from the roles of other behavioral health service professionals.

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Peer supporters make only promises they can keep and use accurate statements.

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Peer supporters do not diagnose nor do they prescribe or recommend medications or monitor their use.

PERSON-DRIVEN •

All people have a fundamental right to make decisions about things related to their lives. Peer supporters inform people about options, provide information about choices and respect their decisions. Peer supporters encourage people to move beyond their comfort zones, learn from their mistakes and grow from dependence on the system toward their chosen level of freedom and inclusion in the community of their choice.

IN PRACTICE: FOCUS ON THE PERSON, NOT THE PROBLEM

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Peer supporters encourage those they support to make their own decisions.

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Peer supporters, when appropriate, offer options to those they serve.

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Peer supporters encourage those they serve to try new things.

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Peer supporters help others learn from mistakes.

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Peer supporters encourage resilience.

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Peer supporters encourage personal growth in others.

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Peer supporters encourage and coach those they support to decide what they want in life and how to achieve it without judgment.

GOALS 25% 25%

A goal is at the heart of the recovery process. If people identify an important life goal to work toward, they're more likely to follow a service plan.

Because they share the lived experience, peer specialists have a unique ability to help people achieve their recovery goals and explain clinical and medical terms in a way that the average person can understand.

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Peer specialists use recovery-oriented tools to help their peers address challenges.

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An important part of the peer specialist's job is to connect people with practical tools, tips and techniques that help them make each day better.

Another important part of the peer specialist's job is to help people move ahead on their own recovery journey.

GOALS BECAUSE THEY SHARE THE LIVED EXPERIENCE, PEER SPECIALISTS HAVE A UNIQUE ABILITY TO HELP PEOPLE ACHIEVE THEIR RECOVERY GOALS AND EXPLAIN CLINICAL AND MEDICAL TERMS IN A WAY THAT THE AVERAGE PERSON CAN UNDERSTAND.

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A goal is at the heart of the recovery process. If people identify an important life goal to work toward, they're more likely to follow a service plan.

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An important part of the peer specialist's job is to connect people with practical tools, tips and techniques that help them make each day better.

Another important part of the peer specialist's job is to help people move ahead on their own recovery journey.

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Peer specialists support peers in their decision making. In recoveryoriented settings, people living with mental illness are in charge of making decisions.

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Peer specialists help others create their own self-directed recovery tools.

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Peer specialists play a powerful role in empowering people to develop daily plans, identify wellness strategies and create their own self-directed recovery tools.

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Their own experience with creating these tools is a model of possibility.

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Peer specialists support peers in their decision making. In recoveryoriented settings, people living with mental illness are in charge of making decisions.

There's no such thing as a "typical" day for many peer specialists.

Their day might include running a support group in the morning and then documenting peers' progress and doing paperwork for a few hours. They might chat with three or four peers over the course of the afternoon. The next day might include visiting some peers at home, running a peer-led artists group and doing more paperwork. Peer specialists have many roles in many different settings.

COMMUNITY MENTAL HEALTH CENTERS PUBLIC AND PRIVATE AGENCIES JAILS AND PRISONS HOMELESS SHELTERS HOSPITALS CLINICS SCHOOLS DAY TREATMENT PROGRAMS RESIDENTIAL FACILITIES

I WANT MY LIFE BACK.

RECOVERY: DEFINED

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Before 1980, the mental health system seemed to believe that people like us couldn't experience recovery. The system worked to stabilize and maintain us. Keeping us safe and out of the public's way is what the system seemed to be working towards. Then a positive shift took place. There was a 20-year period or so that started to introduce the concept of recovery for people with a psychiatric diagnosis.

Then, around 2003, a report came out of Washington -- the President's New Freedom Commission Report on Mental Health -- that introduced a new paradigm. The report pushed us to make the goal of mental health treatment ‌ recovery. Recovery is the expectation we should have for everyone.

The losses are incredible that a person experiences once they've been diagnosed with a mental health issue. And it's not just about symptom reduction today. It's not just about taking a pill and feeling better. It's a lot more than that. It's being an active member in our community. It's being an active participant. It's having friends ‌ it's being a student. Those are the things that we want today. And those are the things that make recovery possible.

“Recovery provides the essential and motivating message of a better future— that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others.

Hope is the catalyst of the recovery process. Mental health recovery not only benefits individuals with mental health disabilities by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches the texture of American community life. America reaps the benefits of the contributions individuals with mental disabilities can make, ultimately becoming a stronger and healthier nation. - SAMHSA

RECOVERY •

This statement expresses the values and principles of recovery that are at the very heart of the PMHA program and this training.

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Throughout the world, many people with psychiatric disabilities have experienced significant recovery from the impacts and losses frequently associated with mental illness.

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As they found their way, they inspired others, proving that ‘getting better’ was not just a possibility, but given the right support, to be expected.

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Recovery has been cited as the “single most important goal” for the mental health service delivery system.

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To clearly define recovery, the Substance Abuse and Mental Health Services Administration (SAMHSA) in partnership with the Interagency Committee on Disability Research, along with six other Federal agencies, convened the National Consensus Conference on Mental Health Recovery and Mental Health Systems Transformation on December 16-17, 2004. Included in this group were consumers and family leaders.

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“Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.”

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"Recovery refers to the process in which people (with a mental illness) are able to live, work, learn and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and productive life despite a disability.

For others, recovery implies the reduction or complete remission of symptoms.” -- The President's New Freedom Commission on Mental Health "Recovery is a process, a way of life, an attitude, and a way of approaching the day's challenges.” -- Dr. Patricia Deegan, Consumer and Psychologist

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An important goal of psycho-social rehabilitation and recovery is to provide programs and services that are recovery-oriented, and are culturally, geographically and gender relevant.

Rehabilitation strategies in mental health reform aim at encouraging client recovery, competency and empowerment. This entails taking an individual approach to assess and decide with each consumer/survivor what rehabilitation services are most appropriate for the consumer/survivor’s specific rehabilitation needs.

There is no expectation that an individual must enter at the initial stage or move through these stages in a step-by-step fashion. Rather, services must be planned on an individual basis, with each individual’s initial entry being at the point most appropriate to personal needs and circumstances.

ELEMENTS OF RECOVERY

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Self-Direction

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Strengths-Based

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Individualized & Person-Centered

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Peer Support

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Empowerment

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Respect

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Holistic

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Responsibility

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Non-Linear

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Hope

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Some basic assumptions of a recovery-oriented mental health system are that:

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Recovery from mental illness can occur even though symptoms of illness reoccur; recovery is not a linear process but it is unfolding and on-going;

Individuals living with mental illness [may] need support to lead personally satisfying, hopeful and contributing lives;

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Recovery assists individuals to reduce symptoms’ frequency and duration;

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Recovery requires recruitment and involvement of people who believe in and assist individuals to pursue their hopes and goals; and,

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Recovery assists individuals to deal with losses and consequences associated with mental illness;

Recovery requires dedicated human and fiscal resources.

RESILIENCE

1. 2. 3. “Resilience� means the personal and community qualities that enable individuals to rebound from adversity, trauma, tragedy, threats, or other stresses, and to live productive lives.

Another way to say this is the ability to bounce back or regain stability after loss, trauma or other distress.

Resilience is an important concept to understand as it plays a critical role in supporting and sustaining one’s mental health recovery.

THE EVIDENCE.

"Consumers who work as providers help expand the range and availability of service and supports that professionals offer. Studies show that consumer-run services and consumer-providers can broaden access to peer support, engage more individuals in traditional mental health services, and serve as a resource in the recovery of people with a psychiatric diagnosis. Because of their experiences, consumer-providers bring different attitudes, motivations, insights and behavioral qualities to the treatment encounter."

- ACHIEVING THE PROMISE: TRANSFORMING MENTAL HEALTH CARE IN AMERICA REPORT OF THE PRESIDENT'S NEW FREEDOM COMMISSION ON MENTAL HEALTH

GEORGIA STATEWIDE PEER SUPPORT PROGRAM.

BENEFITS

RECOVERY SKILLS BENEFITS IN PEER SUPPORT VS. DAY TREATMENT “What we found incredible, was that we were able to compare people in day treatment and people in peer support.

What we discovered is that people in peer support, in a randomized study, improved in three major areas: functionality, natural supports in the community, and skills enhancement. The subjects that were studied in day treatment had zero improvement on their individual service plan. There was no recovery improvement in those three categories.

FINANCIAL SAVINGS

PRISON WORK

SIGNIFICANT FINANCIAL SAVINGS TO PROVIDERS AND CONSUMERS

SUCCESS WORKING WITH INDIVIDUALS IN PRISONS

Administrators discovered that the cost savings were in the millions of dollars.

Peer support costs, on an average, $1000 per person per year. Day treatment costs, on an average, $6400 per person per year. It was a nobrainer. The state decided to spend more of its dollars on peer support - a service that was changing the system to strengths-based recovery, having real outcomes and saving a lot of money.”

Georgia’s peer specialists work with inmates in a county detention center. In this setting, peer specialists often work with individuals in the ‘Change is Possible’ stage of recovery. This stage is one where some of the consumers she works with get stuck, because it's often easier to stay with the identity they've adopted over time-that of a mentally ill person. And in this case, that of a mentally ill criminal. Imagine the challenge of changing your self-image when all you're surrounded by are guards, bars and other inmates.

RESEARCH CHINMAN THERE ARE A COUPLE OF PEOPLE WHO HAVE REALLY LED THE WAY WHEN IT COMES TO RESEARCHING HOW EFFECTIVE PEER SPECIALIST PROGRAMS ARE.

Dr. Matt Chinman’s work suggests that consumerproviders, peer specialists, seem to bring about either outcomes that are either better than, or equal to, the outcomes that traditional, non-consumer mental health professionals provide. He's also done some other great research on the different roles that consumer-providers can play … how they provide support by being a sounding board … how they model the possibility of recovery … how they help peers reintegrate in the community … and how they serve as a two-way link between the mental health system and the patient.

CAMPBELL Dr. Jean Campbell from the Missouri Institute of Mental Health has done some great work as well. She has studied peer-run support programs all over the country. One of her own research projects shows that the stigmatizing attitude among providers contributes to the poor well-being of clients. It also shows that peer support promotes wellbeing.

CHINMAN

FACTORS THAT CONTRIBUTE TO POOR OUTCOMES + “PEER FIXES” •

Chinman’s research addresses a final key point: peer support benefits mental health providers as well as patients. One of the major benefits is cost-effectiveness. The consistency of findings showing decreased hospitalization and shortened length of stay “translate into financial savings” (Solomon, 396). Additionally, embedding peers in the system allows mental health providers to appreciate an alternative view of individuals with mental illnesses functioning in social roles, as opposed to being an ‘ill patient’. This integration further allows for stigmatizing perspectives and opinions to be challenged. Research supporting benefits to providers as well as patients is equally as important in creating sustainable partnerships.

PSYCHOSOCIAL PROCESSES

SOCIAL SUPPORT •

The availability of people on whom we can rely; people who let us know that they care about, value, and love us, and are willing to assist us to meet our resource and psychosocial needs. Primary forms of support include: emotional support (offers esteem, attachment, and reassurance), instrumental support (offers material goods and services), and information support (offers advice, guidance, and feedback). One of the most debilitating aspects of having a mental illness is social exclusion, isolation, and overwhelming of physical or perceived loneliness.

Peer relationships “help to enhance the number of individuals that a person with a psychiatric disorder can turn to for support and assistance, offer a sense of belonging and positive feedback of a person’s own self worth” (Solomon, 394).

EXPERIENTIAL KNOWLEDGE •

“Specialized information and perspectives that people obtain from living through the experience of having a severe psychiatric disorder” (Solomon, 394). This knowledge is often unique, pragmatic, and specific.

As Salzer describes, these relationships promote “choice and self-determination that enhances empowerment, as opposed to the passivity engendered by “participation in services with a hierarchical structure” (Salzer, 6). In addition, as therapists are not there to provide patients with ‘advice’, peers offer a chance for individuals to validate their own approaches to solving problems.

PSYCHOSOCIAL PROCESSES

SOCIAL COMPARISON THEORY •

Individuals are “attracted to others who share commonalities with themselves, such as psychiatric illnesses, in order to establish a sense of normalcy for themselves” (Festinger). Thus, by interacting with those who are perceived to be in a better place than themselves, peers are given a sense of optimism and something to work towards.

HELPER-THERAPY PRINCIPLE •

The personal benefits derived from effectively helping others: the helper feels an enhanced sense of interpersonal competence for making an impact on someone else’s life; the helper feels that they have gained as much as was given; the helper receives ‘personalized learning’; the helper acquires an enhanced sense of self from received social approval (Riessman).

CORRIGAN

EDUCATION. PROTEST. CONTACT. First, he looked at education - in other words, he tried to change people's minds with facts and figures about people with mental illness.

Secondly, he looked at what he called “protest.” This is taking the “shameon-you” approach with the public and telling them they should not think bad things about people with mental illness.

The third thing he tried, he called “contact”, or personal stories.

Dr. Corrigan found that contact, or one person telling another person their story of mental illness and recovery was the only approach or the only system that really worked - people talking about their real lives and challenging stereotypes by just being themselves, not an idea of a person with a mental illness, but a real person.

There are some great examples of certified peer specialists working in hospital settings, especially in Emergency Rooms.

Often, people with mental illnesses are admitted to a hospital, and that in itself can be a very traumatic experience. To have someone there like a peer specialist, who has a lived experience and maybe has been hospitalized before can be powerful medicine.

SAGAMORE HILL • There are also peer specialists

that work in psychiatric intake units. When someone is admitted, they serve in several different roles.

• They help new patients

understand that the hospital is a place to heal, not a punishment or something to be embarrassed about.

• They help family members

understand that people hospitalized for mental illness do get better.

• And they keep their peers from

being overwhelmed by the impact of diagnosis. They serve as an advocate, a sounding board, and most importantly, an example of wellness on the other side of a psychiatric diagnosis.

So often people are just stuck within the bubble of mental health care, which serves an important role at certain stages in our recovery ‌ but there's a time when we have to reach beyond what the mental health system has to offer. Peer specialists who have made that transition can help us connect to those resources

RECOVERY BLOCKS HOPE Have a belief that recovery is possible.

WELLNESS PLAN Have a plan for managing our wellness.

SUPPORT NETWORK Have a strong network of support.

PERSONAL RESPONSIBILITY Take personal responsibility for our situation.

SYMPTOM CONTROL Have a way to control our symptoms intensity.

SPIRITUALITY Have a sense of meaning, purpose and connection in our lives.

PERSONAL GOALS Are in touch with our hopes and dreams.

PHYSICAL HEALTH Have no untreated or under-treated physical illness that complicates or worsens the mental illness.

KNOWLEDGE Have a good understanding of the illness.

POSITIVE SELF-IMAGE See ourselves as more than the illness.

ECONOMIC STABILITY Have our basic needs met.

CHOICE Have many chances to make choices.

RECOVERY STAGES

01.

Impact of Illness

02.

Life is Limited

03.

Change is Possible

04

Commitment to Change

05.

Actions for Change

THE IDEA OF "5 STAGES IN RECOVERY" IS A HELPFUL FRAMEWORK FOR PEER SPECIALISTS TO USE WHEN THEY WORK WITH FELLOW CONSUMERS. AT DIFFERENT TIMES IN THEIR JOURNEY, PEOPLE WITH A MENTAL ILLNESS RELATE DIFFERENTLY TO THEIR ILLNESS AND ITS DISABLING EFFECT ON THEIR LIVES. THE FIVE STAGES ARE FIVE WAYS THAT PEOPLE RELATE TO THEIR ILLNESS AND ITS IMPACT ON THEM.

FIVE STAGES

THOSE OF US LIVING WITH A MENTAL ILLNESS KNOW IT'S HARD TO MAKE OUT ONLY FIVE STAGES ON OUR ROAD TO RECOVERY.

Most of us would say we've experienced thousands of stages, and millions of small steps, to get where we are today.

These five stages are just a framework to help us understand the experience most people have as they recover from a mental illness.

People go through these five stages as they move past the disabling power of mental illness. In other words, these stages are five ways they relate to the disabling power of that illness at different times in their lives. As we go over these stages, it's important to note that they don't happen one after another in a "straight line." In fact, for most of us, the recovery experience isn't linear at all.

People living with mental illness often talk about three separate, but related, aspects of their illness that they find truly disabling. The first is, clearly, the symptoms of the illness. The second is the stigma that comes along with the diagnosis.

And the third is the striking change that many people experience in their self-image after a diagnosis.

It's important for peer specialists to remember all three of these disabling aspects of mental illness. And because they've "been there," peer specialists can have the greatest impact on the third aspect-not symptoms ‌ not stigma ‌ but selfimage.

Let's go over the basics about the five stages in recovery. In this overview, we'll go through each stage separately. We'll talk about what's happening in that stage, what dangers might be lurking to keep a person stuck there and what interventions peer specialists could use during that stage to help their peers.

STAGE 1

IMPACT OF ILLNESS

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There are times when the disabling power of a mental illness can overwhelm a person. This stage starts when someone's symptoms first begin and continues through the experience of being diagnosed.

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During this time, the danger is that people will redefine themselves in terms of their illness.

Identifying themselves with their illness can automatically put limits on their future. Imagine the change in their self-image when they feel their lives are out of control with the symptoms they're experiencing … and then suddenly, on top of that, they're told they have a mental illness.

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In this stage--the Impact of Illness stage-the role of mental health services is to reduce their emotional distress by reducing the symptoms.

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A major question in this first stage concerns identity.

People who are just diagnosed may ask themselves, "How do I feel about the idea of living with a mental illness? How do I see myself now? How do I see my future?

STAGE 2

LIFE IS LIMITED

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There are times when people surrender to the disabling power of a mental illness. In this stage, they give up. They see their lives, hopes and dreams greatly and severely limited by their diagnosis.

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The danger here is that people will identify so strongly with the stigma of the illness that they won't see any positive potential in their lives.

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The role of mental health services in this stage is to foster hope, a sense of possibility and to restore a positive self-image.

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A major question for people in this second stage--the Life is Limited stage--is, "How do I feel about hope and possibility if I now define myself as a 'mentally ill' person?”

STAGE 3

CHANGE IS POSSIBLE

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In this stage, people start to question the idea that a mental illness is disabling. They begin to realize that maybe they weren't as sick--or disabled--as they, or others, once thought.

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Here, the danger is that they'll be afraid to take the risks they need to, to move on with their lives and that they'll get stuck in this "life is limited' stage.

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In this stage-Change is Possible-the role of mental health services is to help people see they're not actually so limited by mental illness … and to help them understand that, to keep moving ahead, there are risks they'll need to take.

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An important question people often ask in this stage is, "When I rediscover a sense of possibility, how do I feel about the risks I might have to take to 'get there?’

STAGE 4

COMMITMENT TO CHANGE

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There are times when people challenge the disabling power of a mental illness. They've seen-maybe for the first time in a long time-that there's something they can do that might have a positive impact on their lives. They need support to be able to commit to take the steps needed to move forward.

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In this stage, the danger is that people won't get the necessary skills, resources and supports they need to do what they want to do.

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The role of mental health services during this stagethe Commitment to Change stage-is to help people identify their strengths and figure out what skills, resources and supports they'll need to move forward.

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A major question during this stage is, "When I decide to take risks, how do I feel about the need I have for support?”

STAGE 5

ACTIONS FOR CHANGE

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This stage is when people actually move beyond the disabling power of a mental illness. They begin to see more clearly the direction they want their lives to go.

And they also begin to grasp how much it will demand of them to work in that direction .

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The danger is that they'll start to doubt that they can function on their own and be responsible for their own actions.

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The role of mental health services in this stageActions for Change-is to help people trust their own decision-making abilities and to take more and more responsibility for their lives.

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A major question people will ask themselves in this stage is, "When I decide to make a major change in my life, how do I feel about having to rely more and more on my own decision-making ability?

REVIEW •

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First, these five stages are definitely not linear - they don't always happen in one right after another in perfect order. As we listen to stories of how people relate these stages to their own lives, we're always amazed by how they really see how they've been in each stage at certain times. But one thing that they always say is that those stages didn't necessarily happen in that order.

Many people say their recovery experience wasn't as easy as five stages or steps. They talk about how they moved quickly from the Life is Limited stage to the Commitment to Change stage. And they say that, because they didn't have a support structure, they quickly lost their nerve to take the risks needed to move on.

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Often, we hear stories from people who have taken Actions for Change, but because of some kind of setback, they quickly find themselves back in the Impact of Illness stage.

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These stages are a tool for peers to use to think about how best to connect with, and help, a fellow consumer with what they need right now. We know that medicine and talk therapy can't fill all of a recovering person's needs … especially the needs involved with the risk and responsibility of moving on with our lives on the other side of a psychiatric diagnosis.

REVIEW •

On another note, one of the beauties of peer support is that it's intrinsically sensitive to the cultural realities in which people live their lives. Peers — those people from our communities with experiences similar to ours — can relate to each other on a much deeper level than outside professionals often can.

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Peer support does wonders in terms of cultural appropriateness — for example, when support is delivered and received by veterans, who have a unique culture and set of experiences that only they can truly understand.

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There have been examples of Peer Specialists working great within inner-city, faith-based services that were focused on the needs of traditionally African-American church congregations.

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Its truly amazing how the focus on strengths, the flexibility of services, and the nature of true peers make peer specialist services very culturally inclusive and appropriate.

REFLECTING: •

Can you relate to any of these five stages in recovery?

How?

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Have you ever felt stuck in your personal journey with recovery? What has helped you get "unstuck"? (Think broadly … beyond medications and therapy to everyday strategies that you've used.)

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What aspects of your own culture have influenced your personal recovery journey?