Stronger together

Peer support is central to the implementation of recovery-focused practice and it can inspire hope and empower others to take control of their own recovery. Jennifer Glyn reports

For people with mental health problems in some states in the United States, peer support services have been a staple for years. They are recommended as best practice and are backed up with empirical evidence. But in the UK paid peer support roles within statutory services are still a relatively recent concept, although increasingly evidence shows that these services can improve people’s quality of life and help them to recover. They may even save money.

There are now more than 250 formal peer worker positions in the UK, and an increasing awareness that changing the balance between traditional mental health professionals and people whose expertise comes from ‘lived experience’ in mental health services is key to the concept of recovery.

Peer support workers are distinct from other support roles. This is because peer support workers are required to explicitly draw on and share their own experiences of emotional distress, or of using mental health services, to inspire, support and inform people in a similar situation.

In March 2011, Sian Maidment took up the position of peer support worker at Richmond Fellowship, one of the biggest voluntary sector providers of mental health care in England.

For Maidment, lived experience of mental illness is the key to getting people to engage. “As soon as you say ‘well, actually, I’ve had my own mental health problems,’ then the key goes in the lock and that’s it, the door is open.”

Peer workers in Maidment’s team arrange regular meetings to support each other in their recovery journey. The concept of recovery itself represents a reimagining of mental health service delivery. In recovery-based practice professionals are ‘on tap not on top’ and people are supported to get better and lead fulfilling lives.

The focus on peer support also dovetails with the Government’s emphasis on patient and user empowerment set out in its 2010 vision for adult social care.

Peer workers

Richmond Fellowship in West Sussex employs five peer workers on a part-time basis and has trained eight peer mentors who now work as volunteers. Peer workers are matched with people with mental health problems who have been referred by GPs through the secondary mental health system, other support organisations or self-referred.

Maidment works with six peers. “Generally the sessions are between an hour and an hour and a half [long],” she says. “This is not because of any clinical or medical requirement. It is hard to hold your level of concentration for longer if you are listening effectively, and some of the people we work with can be challenging.”

For Maidment, there is no such thing as a typical day. She arranges her support sessions to fit in with her peers’ schedules, managing her own diary. No two meetings are ever the same.
“It all depends on what we have been talking about before and what strategies the peers have tried during the week.”

The peer support project model in West Sussex is based on the delivery of 10 support sessions. Maidment explains that it can take peers awhile to engage and identify their specific support needs in the time available.

For example, one of Maidment’s peers, a young woman she describes as seeming to be ‘closed’ when they first met, took some time to open up to her. “For nine of those sessions every question I asked her I either got ‘I’m not sure’ or ‘I don’t know’. Then, in the 10th session, it was like a switch had been turned on in her brain and she was able to communicate with me. It was clear from everything she said in that last session that she had been listening and processing the whole time.”

As well as managing the inevitable paperwork; maintaining contact with community psychiatric nurses, care co-ordinators and members of early intervention teams and attending regular supervisions, Maidment meets with her colleagues to discuss successes, challenges and to share best practice.

Understanding recovery

But it requires more than lived experience of mental illness to be a peer worker – they need to understand recovery, and this can come through training. There are different kinds of training available in the UK, for example, Maidment was trained by Arizona’s Recovery Innovations team. She talks about a ‘moment of epiphany’ that gave her the confidence to walk with her peers on their recovery journey.

“When I first heard the phrase ‘recovery is remembering all you are meant to be’, I remember thinking it was just one of those American things and I didn’t quite get it. Six months later I was driving down a country road and I suddenly understood it. It’s about losing the labels and not being ruled by the mental health problems you have had in the past.

“I have found that mental health professionals often ask me whether working with someone in a peer worker capacity will ‘trigger’ my own mental health problem. They ask ‘won’t it make you relapse?’ I don’t understand the thinking behind that but, to be honest, if I did experience mental health problems then so what? I’ve got a smorgasbord of strategies which I can use to benefit my own mental health.”

It’s not just peers helping peers – there is anecdotal evidence from the US that peer workers ‘help the system to recover.’ In Implementing Recovery: A methodology for organisational change (Centre for Mental Health, 2010), Geoff Shepherd and Jed Boardman argue that in order to achieve consistent change in staff attitudes towards mental illness we should expect to see a greatly expanded role for peer workers.

Shepherd and Boardman believe that both peers working independently outside the mental health system or alongside traditional mental health professionals in teams and wards can be effective. Within NHS services, they recommend that: “organisations should consider a radical transformation of the workforce, aiming for perhaps 50% of care delivery by appropriately trained and supported ‘peer professionals.’”

Beyond diagnosis

One of the key tenets of recovery is the idea of moving beyond a diagnosis. “Of what value is a diagnosis to a non-clinician?” Maidment asks. “We are not therapists. All I need to know is that they are safe and that I am safe. We don’t have to box anyone into a diagnosis.”

Maidment explains that not having the same experience of mental ill health as your peer is no barrier to forming a supportive relationship, and, whether it’s family life, work or relationships, most people can find an area of common ground.

She stresses that she visits peers, rather than ‘service users’ or ‘clients’. Knowledge and expertise is shared, and relationships are built on mutual respect. This shift in thinking goes straight to the heart of how people engage with services – and the transition isn’t always straightforward. Maidment explains that she has problems with weak engagement and missed appointments and it seems that there are no easy answers.

“It’s difficult. Some people do need a fair amount of support to keep appointments, but it’s got to be their responsibility not mine. If I’ve got to hold someone’s hand and send them a letter and then a text then that’s taking the responsibility away from them. My role is to hold out hope for their recovery.”

Peer recovery

One of the well-documented effects of peer support is the impact it has on the recovery of the peer workers themselves. For instance, at Recovery Innovations the effect on the health of the peer workers in paid employment was staggering. Some 87% of peer workers who responded to a recent survey reported that ‘helping others has helped my own recovery’.

It’s too soon to determine whether the same results can be expected here, but Maidment is convinced that her job as a peer worker has contributed to her continuing recovery, in part because of the culture of peer support in her team.

“I have met people further behind in their recovery journey, I have met people who are at about the same stage as me and I have met people who are very much further ahead. Many of the people I work with have their own mental health story and we help and support each other,” she says.

Maidment’s training as a peer worker has also had some unexpected knock-on results. For example, her relationships with friends and family have improved. “By rights my children should be knuckle-dragging teenagers but it is extraordinary how I am now able to empathise with them and talk about situations at school. I have found that I have been using the skills I have developed as a peer worker.

“The best way I can explain it is that it is like a wave effect that goes out. It just ripples out.”

For more information on peer support and recovery visit the Centre for Mental Health website http://www.centreformentalhealth.org.uk/recovery/index.aspx

Jennifer Glyn is press officer for the Centre for Mental Health