With the rise of better medications (medications with supposedly fewer side effects) for treating psychosis, people with SMI (Serious Mental Illness) are now entering the workforce in higher numbers. These folks are not just entering entry-level positions but at the managerial level or above. Peers are also now considered professional when they get certified by their Office of Professions and graduate from APS, the Academy of Peer Services.
Certified Peer Specialists are not supposed to engage in clinical work. There seems to be ongoing confusion around the role of the peer in mental health. Peers are thrown into the roles of case managers, engagement specialists, front desk staff in clinics, and just about every position where labor is short and high turnover. In some cases, peers take on assessment forms and other clinical paperwork outside their scope of practice. So, then what is the scope of practice of a peer?
The closest model established for practicing as a peer is Intentional Peer Support (IPS). If peer work had a code of ethics or practice that sets it apart from other disciplines, IPS would be that. Since most peers don’t practice IPS, new peers in the system don’t take up arms or protest when they are asked to fill the jobs of case managers, therapists, and other treatment gaps in the system.
Today, more people are coming out as peers with lived experience who are nurses, social workers, and other mental health professionals. In my book, these are sincere people as we all have stuff, and this should not stop us from learning more and being our most professional selves. Given this new space for Prosumers to enter the mental health system, the term is not gaining its momentum in public mental health.
Being a Prosumer should be marketable. After all, with a more global perspective are ‘in the know.’ They’ve experienced many issues firsthand because they’ve learned about them in higher education or professional work experience. Being ‘in the know’ in a field with so many variables and unknowns around every corner is challenging.
Prosumers also connect with clients at the heart of their trauma. Authenticity and humility go a long way in a field that often evokes images of institutionalization and haunted wards in old closed-down psychiatric asylums. Pat Deegan refers to this dual understanding and calls it the Politics of Memory. Despite the nuanced and global perspective of the Prosumers, the rise in the study of intersectionality, less fear of disclosure, few people take on this calling.
People with jobs in mental health are underpaid already. I suppose these folks feel taking on the identity of the Prosumer have had a hard time quantifying all their experience and training. Let’s face it, being a Prosumer is stressful. The work can feel like you’re walking through a minefield. What therapists can picture themselves working with reactive, labile, and unstable patients, desperately trying to negotiate a working boundary in session.
Further medicalisation in mental health, the steady increase in prescribed interaction continues to bleed into the clinical picture. This is a new stage of Evidence-Based Practice, some giant exaggerated way of turning every inch of psychotherapy in which everything needs to be measured. Everything has become mapped out in clinical work and mental health treatment. With fewer and fewer spaces in the mental health universe uncharted, why then is the identity of the Prosumer left absent? My theory is that the public mental health system is still too rigid to allow new space.
The issue is also inherent and one of the most significant issues with identifying as a Prosumer: maintaining boundaries. I have experienced the precarious, certainly liminal, and uncharted boundary issues and narrow pathways to negotiating these issues. I am an incredibly complex person whose many identities need to be respected by everyone.
Given the rise of new and existing reforms, the justice movement is being reborn. It might also be a great time to investigate this niche area in mental health without enough airtime. I explained earlier that it could have legal and other HR or clinical ramifications that could potentially cause harm to vulnerable people in the community. My recommendation is that industry leaders need to evaluate these precarious conflicts in our respective and congruent industries; The guidance agreed upon must be disseminated.
The truth is prosumers have a unique identity among ‘mental patients.’ Even with lived experience and a mental health diagnosis, the field is more heteroFirst and foremost, I identify as a Prosumer. As a Prosumer, I have ‘lived’ and ‘professional’ experience in Mental Health. The term Prosumer came into being in the 1980s by the American futurist Alvin Toffler and didn’t get much airtime. In terms of the etiology of the word Prosumer, people used the word in the context of the economy and or consumerism-based fields. The word never gained much traction in mental health.
I have long since tried to explain the phenomena of ‘living in two words.’ The peer world is grounded in lived experience and the traditional mental health professions, e.g., social work, psychiatry, and psychology. I believe the term prosumer is the best term to describe people who consume mental health services (peers) and function as traditional professionals in mental health care.
Today peers have a vast array of credentials. The Certified Peer Specialist is supposedly more eligible for different positions and niche areas in the mental health peer workforce. These specialisations make the peer a professional in today’s mental health workforce. But most folks dont think peer work is professional. Today, most people will agree that peer work is vital, influential, and critical in the mental health workforce, including me. Despite the rise in their notoriety, Peers rarely make it into higher-level professional roles.
Reformers need to address these increasingly visible issues related to being a Prosumer. Until then, more folks hurt than helped. This group requires formal recognition by the public system now.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.
