Jenelle Clarke ~ People Who Heal Us: the role of peer support in mental healthcare treatment

As part of the Art in the Asylum exhibition currently underway at Lakeside, I recently attended the Ancient and Modern Mental Healthcare lecture held on 2 October 2013.  Speaking at the lecture were Jules Evans with Dr Arun Chopra and Dr Ben Di Mambro.  All three speakers focused on different aspects of mental healthcare treatment as depicted from Greek philosophy, films, politics and popular culture.  Rather than give a summary of the evening, I would like to instead highlight the question I have been mulling over following the lecture, namely the use of peer support as a treatment for mental distress.

The ideas of peer support started off with Jules Evans giving us an overview of Cognitive Behavioral Therapy (CBT) and explained how it derives from Greek philosophy, particularly stoicism.  His talk was centered on his own personal story of mental health difficulties in his early 20’s as a result of drug use and his recovery from social anxiety through the use of CBT.  Interestingly, rather than the traditional CBT model of individual therapy with a mental health professional, Jules received help from a peer support group that used a computerised CBT course.  There were no clinical practitioners or mental health professionals – just others who also struggled with anxiety helping each other.  This raised the question for me as to whether it was the principles of CBT or the peer support that had been the most helpful in overcoming social anxiety.  Furthermore, in terms of the peer support, what was it specifically that was beneficial?

The importance of peer support in a therapeutic process is not a new concept, least of all in mental health research.  Many others (Lapsley et al., 2002; Corrigan and Phelan, 2004; Hogan et al., 2002; Davidson et al., 1999; Haigh, 2005; Pilgrim et al., 2009) have done an admirable job of highlighting the use and benefits of peer support.  But it does raise some important questions when exploring the use of peer support as a form treatment, either on its own, or in conjunction with another form of therapy.  What mechanisms are actually at work that make it ‘effective’?  What happens when it goes wrong?  What about the role of power, social control, peer pressure and marginalising?  We (and I definitely include myself in this!) often use sweeping statements, such as relationships are central within mental health treatment.  But as I unpack that I am constantly asking myself – what does that actually mean?  What are we saying matters most?  Contact with people?  Contact with certain types of people?  What types?  And so on and so forth…

My point is that as a form of treatment, peer support is not a routinised model of care in the same way as CBT.  Thank goodness!  Yet it does mean that as a mechanism of change, it receives far less scrutiny.  In addition, much of the social support research focuses on the outcomes of support and does not explore the processes at work within these interactions.  For instance Corrigan and Phelan (2004:519) in their study of individuals with a diagnosis of mental illness found that whilst social support seemed to reduce distress symptoms, it is unclear ‘how social support promotes symptom remission’.

As a form of mental healthcare treatment, peer support can play a vital role in recovery.  After all, the old adage carries a lot of truth: it is people who hurt us and people who heal us.  Yet as Haigh (2005) notes, our question should not be so much do the relationships work and is personal change achieved, but rather what do these relationships and interactions actually mean, how are these meanings constructed and how do they play a role in transformative change.  Questioning, challenging and extending our knowledge of peer support is necessary as, for many people, it forms such an important part of personal change.

Jenelle Clarke, ESRC PhD student, School of Sociology and Social Policy, lqxjmcl@nottingham.ac.uk

References:
Corrigan, P.W. and Phelan, S.M. (2004) Social Support and Recovery in People with Serious Mental Illnesses.   Community Mental Health Journal 40(6): pp.513-523.

Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D. and Kraemer Tebes, J. (1999) Peer Support Among Individuals With Severe Mental Illness: a review of the evidence. Clinical Psychology: Science and Practice 6(2): pp.165-187.

Haigh, R. (2005) The Trouble with Modernisation: we need better relationships, not policies and procedures. Mental Health Review Journal 10(3): pp.3-7.

Lapsley, H., Nikora, L.W. and Black, R. (2002) “Kia Mauri Tau!” Narratives of Recovery from Disabling Mental Health Problems. Report of the University of Waikato Mental Health Narratives Project. Wellington: Mental Health Commission.

Pilgrim, D., Rogers, A. and Bentall, R. (2009) The Centrality of Personal Relationships in the Creation and Amelioration Mental Health Problems: the current interdisciplinary case. Health: an interdisciplinary journal for the social study of health, illness and medicine13(2): pp.235-254.

Advertisements

8 Comments

Filed under Uncategorized

8 responses to “Jenelle Clarke ~ People Who Heal Us: the role of peer support in mental healthcare treatment

  1. Yes, while we deliver peer support to each other, various nameless people run off with the resources meant to deliver services to enable a recovery (whose recovery is it anyway – I ask anyone who’s listening – ). Resorting to historical perspectives does not tell the story of skeletal resources, a worsening delivery of support for Patients and alarm bells of crises looming: let’s all take cover behind History and maybe current crises will blow over, though I don’t know why they will. Gathering in ill-gotten gains behind a smoke-screen of peer support must be just another stunt to be pulled along with the wool over the eyes of bewildered clients of ever-depleting services and dysfunctional mental health delivery deceptions. Healing is a mirage therefore. Better relationships can only be delivered with Open dialogue and current Western orthodoxy is delivering nothing of any value whatsoever. On current predicaments, the silence is deafening.

  2. mat

    As part of the peer support training the IMH Education team deliver we do consider potential underlying mechanisms, the evidence that supports them and the implications for practitioners and services. I agreed more research is needed and we would welcome

  3. mat

    Agree not agreed (sorry small phone and large thumb!)
    Good place to catch up on the latest findings and thinking is http://www.researchintorecovery.com/rrn

  4. Jenelle Clarke

    Hi Mat, thank you for your comments and the useful link for the Research Recovery Network. I would be very keen to continue the conversation and hear more about the Managed Innovation Network. Am I right in thinking you are based at Nottingham? Would it be possible to meet up at some point? If you want to contact me to discuss further, my email address is lqxjmcl@nottingham.ac.uk.

  5. Much though I would like to ignore content on here, there you are, right in my road. Maybe with a studied disregard, you will disappear? Here’s hoping.

  6. Jenelle Clarke

    Hi Rodney, my sincere apologies for a delayed response. It’s really good to get people’s perspectives on these issues, particularly people who have first hand experience. Thank you for taking the time!

  7. Does peer support work differently online?

    This was the question at the back of my mind when I first met Neil Coulson . Back in 2011 I was involved in helping set up a network of self help groups so people had more choice when it came to accessing peer support for help with addictive behaviours. The issue of accessability was key: from my own experience I knew the last thing I’d want to find at an alcohol recovery group would be people who recognised me from my ‘normal’ existence. I’d managed to remain fairly ‘high functioning’ and do much of my drinking in secret. So I was curious, if the mechanism of support was totally anonymous, me hidden by my computer screen, would I be more or less likely to engage? And was this true of everyone? The point about the face to face meetings was that I dreaded going and always secretly hoped they would be cancelled, but once there I felt relaxed and comfortable and so glad I’d made the effort. Would ‘lurking’ and then contributing on forums require the same level of commitment and produce the same benefits? Neil had been researching these groups for sometime so I went to him for the answers. There was a lot to learn. We’ve pulled together our insights into an event to be held at the Institute on 11th February. See http://www.institutemh.org.uk/images/Online_Peer_Support_Flyer_v0.4.pdf for more details.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s