Peer Support for Mental Health

By Sally Blundell In Health

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3rd March, 2012 2 comments

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It began with a casual chat, a sunny lunch-hour lying on the grass in a Christchurch park talking about hospitals, healing and Jane’s hopes for the future. Jane knew she “had to change the habits of a lifetime. I had to take ownership of my illness.” Jane, 37, had been diagnosed with bipolar, a mental disorder characterised by alternating periods of elevated mood or mania and depression.

In 2010, after a seven-week stint in a psychiatric hospital, she contacted Bipolar Support Canterbury and was teamed up with a peer support worker. Their initial meeting in a Christchurch park was the first step on that path to recovery. “It was really cool. I had never known anyone else who had bipolar. She had been in hospital, but I saw her as someone who had got her life together. I found it really empowering. I realised I was capable of living a life of wellness on my own – that became my objective.”

It seems blindingly obvious – using people with an experience of mental illness to support those trying to find their own place to stand within the swings and roundabouts of medical designations and prescriptions, discrimination and isolation. But only in recent years has peer support become a recognised – and funded – adjunct to other mental health services. Emerging out of the self-help user/survivor movements of the 1970s and 1980s – or, one could argue, dating back to the emergence of Alcoholics Anonymous in 1937 – peer support relies on the expertise of shared experience rather than that of a medical degree (although peer support workers do receive training).

Its aim is not so much the abatement of symptoms but recovery in the sense of independence, self-care and self-determination, a life well-lived even with the limitations of mental illness. “People have always walked alongside friends and given support,” says Sue Ricketts, manager of Christchurch-based Mental Health Advocacy and Peer Support (MHAPS). “But it’s now turning into a recognised way of helping people. It’s not a treatment – it’s a voyage of discovery, looking for answers within yourself. And because that peer has walked along a similar pathway, they can steer you, guide you, support you.

“By the time you come out of that first meeting, you know you’ve been sitting with someone who has been through what you’re going through and who now has a job, who can function well in the world, and you will have heard from them the strategies that have got them through those hurdles. When working with people who are unwell, we sometimes forget they can live hopeful, empowered, directed kinds of lives.”

New Zealand is a leader in the recovery approach, says University of Canterbury senior lecturer in sociology Anne Scott. There’s less stigma surrounding mental illness here, she says, and “a lot more willingness to accept mental illness as a normal part of life”. Most district health boards fund some form of peer support, whether it be Kaupapa Maori peer support, the Mind and Body model, intentional peer support as used by bipolar support services, or one of a number of in-house models.

The goal of all these services is not to offer top-down solutions but to support people as they build on their own strengths to find a way forward. “This means making plans, identifying triggers and early warning signs, and putting in place mechanisms to quell the triggering,” says Bipolar Support Canterbury manager Frances Caldwell. “A lot of people are stuck in a revolving door in and out of hospital. They’re distressed, lonely, stuck in their homes. Having that daily stuff in place keeps us well, even if it’s just going for a walk every day or putting things in place for when you are unwell.

“Bipolar is a cyclic thing – it’s not like you take a pill and you’re cured – but people learn to live well with their bipolar. You see them get relationships and jobs and start to walk with more pride.” In this sense, the relationship with a peer support worker is the key to recovery, says Anxiety Support manager Ian Johnson. Operating alongside Bipolar Support Canterbury under the umbrella of MHAPS, Anxiety Support offers oneon- one peer support by telephone, text or email, or in person, as well as information, education and the RecoveryWorks workshop-based programme.

“People are always pleasantly surprised when they find themselves talking to somebody who understands the language they use to describe their feelings. You get that ah-ha moment when they realise they are understood, perhaps for the first time. These are people who have been to a GP or counsellor or secondary mental health services – sometimes all of these things – without having met an individual who really understands what has happened with them.”

There are challenges. Although referrals from GPs to services like MHAPS are increasing, most peer support services are available only to the 3% of patients under specialised mental healthcare. Scott believes more peer support should be offered at the primary level of healthcare, before people deteriorate to the point where they need those secondary services. She is also concerned about current age restrictions (MHAPS peer support is funded only for 18- to 65-year-olds), saying we need to see peer support services aimed at older people and at young people at schools and universities.

There are also calls for more relevant research into the effectiveness of peer support. “We need research that looks at outcomes that matter to consumers,” says Scott, “rather than the outcomes as defined by services on high. “The kind of outcomes you might get in peer support might be someone finding hope in their lives or going down to the shops when before they were too anxious to do that. How do you measure that? That person still mightn’t have a job but their life is completely transformed and it makes the next step – such as employment – easier to face. It’s about shifting the notion of recovery all the way through the system.”

Such outcomes have a knock-on effect. Central to the success of peer support is its impact on the people giving it, as much as on clients. Back at the MHAPS office, Jane now works 14 hours a week as a peer support worker, using her personal experience of bipolar as a resource to help others “live a life of wellness”. It’s not about rescuing people or giving advice, she says. It’s about leading by example and empowering people. Which, says Scott, is no easy job.

“It’s a pretty special skill set. You have to be able to listen to difficult things and remain optimistic and hopeful for people and not try to fix the problem but find the right things to say to help them come along. To do it well you have to be prepared to put yourself out there in a way which is quite brave, quite courageous. It can be taught but not entirely.” Johnson agrees. “It helps in this work to have gone to hell and back. It takes a long time to get there and an especially long time to get back.”

3rd March, 2012 2 comments

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2 Responses to “Peer Support for Mental Health”

  1. Jocelyn 1949 Mar 27 2012, 11:00pm

    I believe that mentoring from someone who has found a way through this nightmare called mental illness is invaluable. You have to have experienced the condition to have empathy and for the people you are mentorting to have faith and belief in you. They want to be YOU.
    I have had a Bipolar condition since I was 8 years old. I am now 63. I wasn't diagnosed with Bipolar until I was 57!!! I have been seeing psychiatrists since I was 10 years old, done many manic things including jumping off the school roof at the age of 13 believing that I could fly. Yet no one picked up that it was a manic episode.
    I cannot take medication as the mood stabilisers almost killed me. Within a month of taking them I had lost my hair and my liver and kidneys were failing. That is when I decided that now I had a face to my enemy, I could fight it.
    I went to every self help training that I could get my hands on. I took a course in college and am qualified as a stress management counsellor.
    When I believed that I knew enough to help others I started a self help group and found that most people had never had the oportunity to speak to another person with the same condition. That in itself was a huge relief to them. They told me that they found it very difficult to convey the knowledge and self help techniques to their families and I realised that I had to come up with a systen which could be used by children, adults and people with a learning difficulty. It also had to cover the people who were audio, visual and action orientated. I wanted one system which would work for everyone.
    The system I came up with is very simple. It is an A3 colourful board (which catches peoples attention immediately). It has sixteen boxes, each box containing a question and a picture. There are sixteen answer cards. They also have a picture as many people will remember the picture and the words that go with it and a Question and Answer sheet.
    This works really well for both families and smal groups. The main benefit of using this system, is that it concentrates on the condition and not the person.
    We always divide groups into threes. This enables everyone to see the board and read all the answer cards and there is always a majority answer.
    The idea is to place the answer cards at random around the board and someone reads out the first question and the rest of the group (or an individual can do this on their own, but it is not the best way) have to read all the cards to find the correct answer. They then read this answer out loud to the others. It has to be agreed before it is placed on the board and if someone thinks that it is the wrong answer they discuss it and then the majority vote wins.
    They carry on until the board is complete and then they use the Question and Answer sheet to check their answers. The facilitator reads out the first question and asks a member of the group to give their answer. The facilitator checks if everyone has the same answer and if they disagree a discussion begins to discover what everyone feels is the correct answer and why.
    The methodology of using these boards and answer cards was undertaken by the University of Glamorgan, here in Wales and the results were astounding. 96% better than any other form of training for attention span and knowledge retention.
    We started off with the Bipolar Boards but were soon commissioned to produce many other subjects. These can be seen on our website You can also read my life story and see how far I have now travelled on my own journey. I have been stable for over three years. My family now understand my condition and can recognise when I am in front of them and when the condition is in front of them and treat me accordingly. This in itself helps me to stay stable.
    We have already helped many families who say that they have been let down by the NHS. The difference after one session is amazing and for the first time they say they have hope.
    However, we do have a problem. The more success we have with individuals and families the more obstacles are put in our way. We have become a threat as this system works and is so cost effective. The mentality of some people working in mental health makes me want to cry. They could incorporate our system into their own work and be even more successful instead of trying to destroy us. I thought the whole idea of mental health professionals was to help people to get better or maybe it is just a job to pay their mortgage. Why can't we all be on the same side?
    Oops, OK less of the sarcasm.
    I would like to thank you if you have read this far and please feel free to contact me, if you would like to know more.
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  2. Ian Johnson Mar 7 2012, 3:20pm

    We have been very pleased that the Listener took up the challenge to research and write an article on the role of peer support in mental health. At MHAPS Trust we appreciate the work that Sally Blundell put into understanding the concept of peer support and the valuable exposure that the Listener has provided.

    One small niggle but one that goes to the heart of our original issue with the Listener's article 'Bipolar Creatures?' which gave rise to our contact with you. One of the main tenets of peer support and the recovery approach in mental health is to focus on individual strengths. Thus in the mental illness- mental health continuum we would caption this online article either: - 'Peer Support for Mental Health' or perhaps 'Peer Support for Recovery from Mental Illness. Can you see how this shifts the emphasis away from people's deficits by providing hope and positive direction for change?

    Ian Johnson, Manager, Anxiety Support
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