How do we protect authentic peer support from the threat of professionalisation? Could peer support be used as a cheap form of labour?

How do we protect authentic peer support from the threat of professionalisation?

As peer support models are increasingly adopted by mainstream mental health services, Anne Beales, Director of Service User Involvement at mental health charity Together argues that the formation of ‘good practice’ guidelines is essential to ensure the survival of authentic, user-led peer support and to safeguard it from being used as a form of cheap labour. 

The benefits of peer support are well known and proven. It has evolved over decades, in many cases as an antidote to the ‘system’ which many people with mental health issues have experienced as dispassionate, undermining, even abusive. For marginalised groups who have traditionally found it difficult to access mainstream services, local user-led peer support groups have provided a vital lifeline against isolation and despair.
Of course, there are times when someone in distress needs the support of specialist professionals, but the ability of peer supporters to speak from the ‘I know because I have been there’ perspective provides comfort and hope in a way that is unique and special. Peers act like a guide, with their insight as the compass, travelling with you and providing you with simple practical support, but also the confidence, humour, common sense which are signposts to wellbeing.
In a report we commissioned: The Freedom to be, the Chance to Dream, to be launched next week, we discovered disturbing testimonies which could emerge into a dangerous trend: the ‘professionalisation’ of peer support; where the distinctive roles and tasks of peer supporter and conventional staff becomes blurred.

This, we warn, dilutes the unique power of peer support and can engender mistrust and suspicion from the people who would normally benefit from it.

For instance, I was horrified to hear a peer supporter talking at a conference about being taught how to physically restrain and control patients in a hospital before working on an acute ward. Others I have spoken to have been used as low paid nursing assistants, or being asked to serve meals and go shopping.

Disturbingly, some respondents in the report alluded to resistance and suspicion from some staff in formal health settings, perhaps mistrustful of the autonomous and organic nature of peer support and wanting to shoe-horn it into the ‘medical model’ with its rigid policies and procedures. Clearly, being asked to come into contact with vulnerable people in formal settings requires creating certain procedures to create a safe and protective environment for service users. Indeed our report advocates the need for peer supporters to receive training in important things like listening skills, and equality and diversity.

But, there is also clearly work to be done to create mutual respect for two very different ways of working which, when done well, can be complementary and ultimately beneficial for the user. This also applies to the charity sector. At Together, we are in the process of putting peer support at the heart of the transformation of services. Admittedly we are faced with the same professional and philosophical dilemma: how to balance the need to preserve the informal, organic nature of the peer support relationship with our duty of care to service users to ensure their safety.

We believe that the peer support ‘movement’ is at a crossroads, and that the creation of a framework which enshrines the user-led element of peer support, values its heritage, and offers good practice guidelines is essential to ensure its survival and maintain its distinctness and integrity. Naturally, this work needs to be done from the grassroots up to have real meaning.

And, at a time when funding is driven by the need to deliver on hard outcomes, it is vital that more work is carried out to consolidate the evidence for the effectiveness and benefits of peer support if we are to preserve the existence and growth of those thousands of groups and organisations who are a critical and innovative part of the future of the voluntary sector.

In the worst case scenario peer support could be used as a cheap form of labour rather than an alternative or complementary resource of choice, pulling people into giving their experience without any investment around building capacity or infrastructure, or regard for the peer supporter’s own wellbeing. This would be to ride roughshod over the values of peer support, and ultimately nullify its power. 

We need to stop the erosion of this unique and valuable work.

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