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Peer providers: Token employees or vanguards of change?

February 27, 2012
by Steve Bell
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In the business world, workforce development requires not only a clear vision of where you want the enterprise to go and how you propose to get there, but also who the best people are to get you to the destination. As we wring our hands about the lack of funding to provide high-quality behavioral healthcare for all Americans and the chronic shortage of qualified professionals to deliver needed services, we seem reluctant to pursue either innovation or adequate investment in transforming the service delivery system.

Yet, even amid these struggles, people in recovery from serious mental illness—in the evolving role of consumer-providers—are not just playing bit parts in this transformation, but are emerging as producers, directors and stars of the "show."

Many of us in recovery feel that consumer-run organizations (CROs) are treated by mental health care and advocacy leaders as recipients of their benevolence, instead of workers and individuals who deserve more than token roles in developing and delivering community mental health services. I challenge public agencies and advocates to do three things:

  1. walk the talk when it comes to recovery-based practices,
  2. invest in consumer-run organizations with large infusions of cash from all sectors of the economy to reduce our chronic dependence on the uncertain resources and unwieldy restrictions inherent in public funding, and,
  3. re-examine current models of advocacy that have not had a measurable impact on the reduction of prejudice and discrimination that continues to fester in many parts of society.

As to the first challenge, developing a mental health workforce that is truly recovery-oriented will require more than evidence-based studies and journal articles or small focus groups. It will require that community mental health service providers open their doors and their minds to the true experts in the field of recovery ... the end users (patients, consumers, and clients).

Are the leaders and line staff of mental health and allied service systems able to undergo the scrutiny of the end-users and then make changes that my peers and I can see, touch, and feel? I hope so because the alternative is to keep talking evidence-based, "recovery-oriented" services even while those striving to move their lives from system-bred helplessness to strength and personal power are met with indifference and tokenism in many agencies.

Investing money in new or unconventional social service start-ups takes courage, driven by the hunger for change and discontent with the status quo. And, just as shrewd entrepreneurs are risk-takers, people moving toward recovery are also risk-takers. We leave the house and drive to the store to buy a few items instead of living in fear and social isolation inside our homes. We find the courage to say to a physician or other health care provider that available 'treatment options' do not work or their side-effects are unacceptable, regardless of what the DSM or Physicians Desk Reference says. We also have the courage to risk rejection when we offer unorthodox solutions to intractable workforce problems.




It sounds to me like what you're advocating for in Mental Health treatment/recovery is what Addictive Disease treatment/recovery has been doing since the inception of Hazelden in the middle 1940's and what, for years, many, if not most, Addiction Treatment Providers were doing under the Minnesota Model and Therapeutic Community methods of treatment.

Glewnn D Richardson LCDC (Texas), AAC, CCS

Thanks for bringing the other dimension of peer-delivered services into focus. Colorados' Division of Behavioral Health is in the midst of creating a new Planning and Advisory Council (that oversees the Medicaid Block Grant for behavioral health services) and unlike the previous Council, the membership will consist of an equal number of people from the addictions treatment and MH worlds. We have much to learn from peers and non-peers who have been providing effective services for many years in addictions recovery programs. I am looking forward to learning more from those who have come before us and from todays' pioneers and innovators.

It is with great appreciation for your article on peer providership:to name how we are not always seen, heard or valued in our society.
Inclusion is a word that get tossed around in many conversation... and
depending on where one might enter such conversations...When or whom is being asked to include others? In my experiences of working in many kinds of systems of care, as a person seeking care to a person providing care. As a peer provider who is honored to provide services to communities, yet sometimes I feel excluded and not always knowing when I am included or for what purpose? Are peer providers another limited to when money is tight or cheap labor? Peer providers come in many forms, some educated traditionally, people like me carry the title as "lived experiences", others have literacy issues when it comes to lack of knowledge or awareness of others who are stigmatized in our society. Yes, we start out as tokens perhaps, we can find people and environments in the workplace where we are allowed to work or make a living over the poverty lines, we can even educate systems and sit in meetings with other professionals who find us interesting. Are we respected? It is really in welcoming and creating relationships with peer providers that opens the door to more understanding. We do have some knowledge about navigating systems and living outside the borders of stigma. Some of us can also be surpisingly brillant with ideas and solutions because we are the evidence of many systems of care that fall short of their intended purpose. Either way we are willing to share inspite of discriminations from our family members,community member,co-workers or any other places who limit our abilities to be seen as citizens with gifts to share- sometimes not intentionally. Some of us have a different learning curve and some learning difficulties, and we still are contributing to our families and communities in meaningful roles.
Mertice "Gitane" Williams, Vocational Wellness Educator


Steve Bell

Peer-Provider and Advocate

Steve Bell

Steve Bell is the co-founder and executive director of  BrainStorm Career Services, a consumer-...

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