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.”