The peer world is divided. OK, so that’s not news. Neither are the divisions within the mental health community on how to best advocate and push for better healthcare. However, are we really as divided as it seems? Or are we overlooking fundamentally important aspects of providing best practices in mental health treatment so that we jump without thinking twice about the truth of what is and what isn’t good mental health practice?
I’ve said this before about new treatments, bold new ‘miracle modalities‘ that are so laden with buzz words that they say absolutely nothing about how to practice mental health, therapy, or peer support.
I am now suggesting the same formula is true for camps in the peer support realm of mental health advocacy.
Let’s take a closer look at this. So, we have peer specialists that are against using psychiatric labels. Throw away the diagnosis is now what is being circulated in multiple intersections of mental health care. I have a real problem with this as a prosumer. I am a therapist that relies heavily upon uses of the DSM-5, not for a better understanding of my client’s condition, but for creating a language that allows me to communicate with my colleagues in real time and to use that same information to share with my patients why their symptoms meet certain criteria for medically necessary treatment.
The list of why someone should use codified and manualised mechanisms in clinical treatment is endless.
And so is the list for continuing to decode, add multiple meanings to overused words which can limit and restrict a patient’s experience. I get that, too. We need to continue to explore more liberal interpretations of a patient experience with new language, or language reconfigured in use and applied to clinical citations in altogether new contexts and applications.
The issue is that most people are polarised here. It’s either we disband and deconstruct every manual out there in mental health, or, we must only use the DSM-5 and other overly medicalised interpretations of justifying a disorder on paper.
The peer world is similar in its theorising of what it means to be a peer and provide peer support. The going trend is that being a peer doesn’t have to mean that the person carries a diagnosis, it should be based solely on the culture and behaviour of the peer principle of providing mutual support. Well, this a giant leap from good practice.
Why, as a consumer receiving peer support, would I ever, ever, want someone without a diagnosis, label, or identified (either self or through a system of care) providing me services? On a clinical level – which must be considered when we work in a larger system of care, with multiple professional attitudes, perceptions, and generally, ways of doing things, not to mention, medically solvent way of practising – we really need to consider all layers of treatment and the client experience before endorsing this camp’s limited understanding of best practices in mental health.
I say this because, without having a peer in a mental health system identifying as having a condition, what service is this person providing other than their belief in equality.
Egalitarianism is wonderful, I support it. But I am sorry, I am a person with schizophrenia that wants someone who also struggles, who also faces discrimination, who also encounters daily obstacles because of their condition providing me services because there is value in shared experiences.
This is doubly true for peer work, as being a peer is about bonding over shared experiences, and deriving meaning from them, as well as knowledge in how to overcome life’s challenges, given similar experiences. Sure, we don’t need to ‘have a label‘, but there must be some sort of commonality besides a shared notion of equality we can bond over during session or time together as peers.
In the end, if peers are going to be truly savvy about providing services, then we really must get underneath the actual authentic experiences of people and not be afraid to also utilise clinical intakes and manualised forms in the process of providing services. Sure, we must also construct new descriptive and holistic approaches to gathering information and providing services, but that’s a no-brainer.
Let’s connect peers with similar challenges, either psychiatric conditions or environmental challenges, together, so both people can benefit from learning how to take on life challenges together.
That’s what being a peer is! Peers should utilise all information and perspectives out there, not picking and choosing ‘in’ language or approaches because it is ‘hot’ in the mental health community. Instead, choose approaches that connect all the dots, from medical necessity to wellness, and beyond. Just do it in a way that ensures all levels of care, treatment needs, and aspects of the person’s experience in the system benefit them at all times, not just in terms of the peer relationship.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.
