Why aren’t peers going out on calls? The police are hurting people who are emotionally disturbed! When is this going to change?
The ongoing spirited conversation about the peer role in emergency mental health and community response protocol is getting tired. When I say exhausted, I mean it is about time we reached a consensus that, if we are to keep pace with our claims’ intensity and rigour, reform is urgently needed. In this advocate’s opinion, this highly contensted subject seems to be the most significant issues to talk about in advocacy circles over the last few years.
Wait, what? Do advocates argue? You mean we all don’t get along because we are feeling people? The answer is: ‘No. We all don’t get along.’
With the reinvigoration of the social justice issues plaguing our country, this issue will only get more attention. As our society reevaluates the intersections of disability, mental health, and social inequality, we can be sure the ‘spirited’ nature of this debate persists. I only hope all the enthusiasm is put to fair use. Let’s apply all this energy in taking a really pragmatic approach to reform.
For the same reason we are advocates, we argue with each other. We are passionate people from all walks of life. We don’t always agree with the way things are in society and will question the status quo.
For this conversation, I want to encircle my puzzlement. I seem to be either getting confused or feel something is a bit skewed about how we advocates are approaching this subject. Specifically, why are we still at odds? Why haven’t we reached a consensus and passed the debate phase of how this talk is going to translate into the new policy. When are we going to reform the way crisis intervention in the community operates finally.
At it’s root, the peer workforce is not ready or competent to be emergency mental health responders in the community. I can hear it now from other advocates and peers supposedly ready to take on roles in crisis response teams: Not ready! What exactly do you mean? I mean in terms of preparedness – training, education, practice, and skill set.
I am making these claims because we measure these areas of readiness through competencies and a system for evaluating them. The Social Work Accreditation Boards (Association of Social Work Boards) and other regulatory bodies measure, credential, and assess content areas at universities which teach and train students. They assess the rigour of the discipline and the quality of the education and curriculum. A lot more is lacking, but let us start there for this conversation.
The Academy of Peer Services (APS) in New York state, which oversees the peer curriculum and certifies peer specialists, does not target educating peers on how to be crisis responders in the community. The curriculum does not focus on it. Generally, in this programme, learning about a crisis is theoretical and abstract, a superficial and academic understanding of what it means for someone to be in distress. Extremely problematic, right?
In terms of theory and practice, or praxis, the curriculum needs to bridge the academic understanding of what it means to be in crisis. Indeed, we can start with arming peers with real skills and interventions beyond social work 101. I’m afraid learning motivational interviewing and basic de-escalation strategies is not a sufficient skillset to take on emergency response calls. We need to think about what practice means, given the current regulatory instruments already established for determining if these disciplines are ready and competent to perform the work. In my opinion, my recommendations would at least be a start, and a big one, towards advancing the curriculum towards peer workforce readiness in crisis intervention.
What would this look like and how would we roll it out? The next steps would be requiring peer internships to have some crisis intervention components We need to (as much as possible) prepare peers to go on crisis calls. Adapting the practice component to peer education through a revision in the internship would provide the peer workforce with credence. It would also extend the peer certification merits and make our trade more marketable to people and the community. All of this revision, and credence, takes time. I would hazard to say it will take years.
Before we make a big mistake and prematurely throw peers into precarious situations where there can be the potential loss of life, we need to re-evaluate these aspects of the peer education and certification process. I see no reason to be hasty and potentially make a bad name for our emerging discipline.
I’m not suggesting, or hinting, that peers, or someone with lived experience, are not better suited to take on an emergency worker’s role. However, peer training, education, and how the community understands the discipline needs to shift and be better understood. Peers are not included on calls in so many American cities. I believe, the absence of peers in crisis models is less about stigma and more about the misunderstanding of our role and what our lived experience might mean in relating and helping someone in crisis.
Optimally, being proficient enough to get in and get out of a situation safely without causing unnecessary harm is very different. People are hiring for jobs in crisis response and measure competence this way. Peer training and curriculum needs to centre around these areas, so the peer workforce is crisis response ready.
Maxwell Guttman teaches social work at Fordham University. He is also a mental health correspondent for Psychreg where he shares his insights on recovery and healing.
