|
Post by Admin on Oct 4, 2022 21:07:17 GMT
|
|
|
Post by Admin on Oct 4, 2022 21:08:11 GMT
|
|
|
Post by Admin on Oct 17, 2022 10:08:01 GMT
Peer Support Effective for Clinical and Personal Recovery A recent meta-analysis of peer support interventions shows that they are effective for clinical and personal recovery from a variety of mental health issues. By Álvaro Gamio Cuervo -October 14, 2022 www.madinamerica.com/2022/10/peer-support-effective-clinical-personal-recovery/A new study published in Psychological Medicine finds that peer support interventions (PSIs) can effectively facilitate recovery from mental illness across various settings. These results allow a deeper look into how peer support services may aid individuals in recovery and what types of recovery may be accessible through PSIs. “Peer support involves a mutual exchange of practical and emotional support, based on ‘shared understanding, respect, and mutual empowerment between people in similar situations with critical ingredients such as shared responsibility, hope, self-determination over one’s life, and the use of lived experience knowledge,” write the authors, led by Dorien Smit, a researcher at Radboud University and Pro Persona GGz. Peer support is a relationship of mutual emotional support between individuals with similar personal experiences. Services of peer support tend to center on wielding lived experience to provide emotional care in a way that also facilitates hope and enhances self-determination. PSIs have been integrated into many programs in various formats, target outcomes, and communities. In recent years, interest in PSIs has grown to meet the growing need for recovery support among individuals coping with psychological distress. Another key driver in this ever-increasing interest has also been formally supported by the World Health Organization in advocating for peer support as a person-centered, recovery, and rights-based mental healthcare approach. Lastly, the COVID-19 pandemic has limited the availability of mental health services, creating a greater need for community-based interventions such as PSIs. Peer support may also be especially beneficial within particular contexts, such as addressing health disparities among Black and Latinx youth and safety planning around suicide in emergency care. However, many barriers remain in implementing peer support programs and ensuring the effective delivery of PSIs. “Engaging in a peer support intervention may be effective for reducing clinical mental illness symptoms, improving overall personal recovery, and more specifically, hope. In particular for individuals with SMI, peer support demonstrated probable efficacy across the three recovery categories.” The research team conducted a systematic analysis and meta-analysis of randomized control trials examining PSIs. A systematic study is meant to locate relevant literature based on a pre-determined list of search terms and criteria. Usually, a meta-analysis is conducted afterward to examine a statistical estimate of the study’s results as a whole. This study was interested in three PSI outcomes: clinical, personal, and functional recovery. Clinical recovery captures the degree to which psychiatric symptomatology improved. Personal recovery describes the extent to which perceived recovery or personal agency improves. Functional recovery is how someone’s quality of life, work engagement, and social functioning improve. The meta-analysis showed that PSIs might facilitate personal recovery and clinical recovery among those seeking support for psychological distress. However, evidence was not found to support the role of PSIs in facilitating functional recovery. “Although the effects were small, peer support is a potentially cost-effective and relatively easy-to-implement intervention and may complement professional treatment. Therapists, general practitioners, and employees of recovery-oriented services may refer their clients to peer support initiatives to expand the individuals’ context to work on recovery when coping with mental illness.,” the authors write. Smit and colleagues recommend that peer support be considered an accessible or complementary support to professional treatment. **** Smit, D., Miguel, C., Vrijsen, J.N., Growneweg, B., Spijker, J. & Cuijpers, P. (2022) The effectiveness of peer support for individuals with mental illness: Systematic review and meta-analysis. Psychological Medicine. 1-10. doi.org/10.1017/S0033291722002422. (Link) www.researchgate.net/publication/363321785_The_effectiveness_of_peer_support_for_individuals_with_mental_illness_systematic_review_and_meta-analysis
|
|
|
Post by Admin on Nov 5, 2022 21:26:05 GMT
Peer Interventions Show Promise for Recent Onset Psychosis A study from Hong Kong finds peer-facilitated recovery groups outperform treatment as usual for psychosis. By Richard Sears -November 1, 2022 www.madinamerica.com/2022/11/peer-interventions-show-promise-recent-onset-psychosis/In a new article published in Schizophrenia Research Wai Tong Chien and colleagues find that peer-facilitated interventions—where people with lived experience of psychosis lead recovery groups, for example—improve outcomes for people with a recent psychotic experience. The study investigated peer-facilitated self-management interventions (PFSMI) for recent-onset psychosis in Hong Kong. The researchers recruited 180 participants that had recently had their first experience of psychosis and randomly assigned them one of three interventions: a PFSMI group, a psychoeducation group (PEG), or a treatment as usual (TAU) group. They then measured outcomes one week and six months after the intervention was complete. The PFSMI group reported greater improvement in recovery, functioning, and insight into their illness, as well as reductions in psychotic symptoms and duration of hospital stays compared to the PEG and TAU groups. The peer-facilitated group also enjoyed fewer hospital stays compared to the other groups. The authors conclude that peer-facilitated groups can improve outcomes for people with recent-onset psychosis. They write: “The PFSMI participants reported significantly greater improvements in recovery levels at both 1-week and 6-month follow-ups than the TAU and the PEG. This finding supported the primary study hypothesis regarding the effect of the PFSMI on promoting recovery from ROP. The finding makes an important contribution to understanding given that the current evidence regarding such an intervention approach is inconclusive/inconsistent.”
|
|
|
Post by Admin on Jan 23, 2023 21:47:52 GMT
Project LETS: Building Peer-Led Mental Health Alternatives on Campus An Interview with Founder and Executive Director Stefanie Lyn Kaufman-Mthimkhulu By Miranda Spencer -January 18, 2023 www.madinamerica.com/2023/01/project-lets-building-peer-led-mental-health-alternatives-on-campus/Last fall, the New Haven Register reported that a group of Yale University students and alumni filed a federal lawsuit against the university challenging its policies and practices around students with mental health disabilities. But according to our guest, a lack of access to appropriate support, as well as discrimination against students struggling with their mental health, are all too common on American campuses. Stefanie Lyn Kaufman-Mthimkhulu is the founder and director of the non-profit Project LETS, which stands for Let’s Erase the Stigma. Project LETS is a national grassroots organization and movement focused on creating innovative, peer-led alternatives to our current mental health system. Their work includes peer support and communicative care, political advocacy, organizing, and mutual aid. Project LETS’s mission looks beyond academia, though; led by and for people with lived experience of mental illness/madness, disability, trauma, and neurodivergence, it “seeks to build a world without systems of oppression where non-carceral responses to crises are the norm.” The organization is now active on about 30 college and high school campuses across the country. Kaufman-Mthimkhulu is a 2017 graduate of Brown University with a degree in Medical Anthropology and Contemplative Studies, and was a 2018 Fullbright Scholar. They describe themselves as a “white, queer, non-binary, disabled, neurodivergent care worker who shows up for their communities as a Disability Justice and Mad Liberation educator and organizer, parent, doula, peer supporter, writer, and conflict intervention facilitator.” The following transcript has been edited for length and clarity. Listen to the audio of the interview here:
|
|
|
Post by Admin on Feb 13, 2023 11:13:21 GMT
|
|
|
Post by Admin on Feb 20, 2023 22:38:30 GMT
|
|
|
Post by Admin on Mar 20, 2023 21:42:07 GMT
New toolkit: Need help developing peer roles? We’ve officially launched the Let’s Develop Peer Roles toolkit! This free resource will help you to introduce and sustain peer support roles. Valuing and providing opportunities for people to intentionally use their lived experience to help others can transform how organisations deliver mental health support. This in turn is creating more diverse opportunities for people to access mental health support that meets their needs. The toolkit draws from learning from our partnership work across the country. It shares knowledge from people both delivering and accessing peer support. Whether you’re a small community-based group, a national organisation or an NHS service, this toolkit will help you to introduce, manage and sustain peer support roles. Get your free copy of this flexible and practical toolkit by submitting the form below. www.scottishrecovery.net/get-your-free-lets-develop-peer-roles-toolkit/
|
|
|
Post by Admin on Mar 27, 2023 21:40:20 GMT
Inclusion as Assimilation, Integration, or Co-optation? A Post-Structural Analysis of Inclusion as Produced Through Mental Health Research on Peer Supportjournals.sagepub.com/doi/10.1177/10497323231163735Abstract In the last 20 years, research on the inclusion of peer support within mental health settings has burgeoned, paralleling the broad adoption of service user inclusion within policy as a moral imperative and universally beneficial. Despite the seemingly progressive impetus behind inclusion, increasingly peer support workers talk of exhaustion working within mental health systems, the slow rate of change to oppressive values and practices, and ongoing experiences of workplace exclusion. Such experiences suggest differences in the way in which inclusion is produced across different stakeholder groups and contexts. In this article, we adopt Bacchi’s ‘what’s the problem represented to be?’ approach to identify how mental health research, often understood as an a-political activity, produces versions of inclusion. We argue current research predominantly produces inclusion as ‘assimilation’ and ‘integration’. We use critical inclusion, mental health, and survivor scholarship to evaluate the effects these productions have for peer support and peer support workers, finding that both problematise peer support workers and those seeking support. We consider possibilities for more liberatory productions of inclusion, building on the notion of inclusion as ‘co-optation’. Our analysis points to the need for researchers to engage with an uncomfortable reflexivity to enable more emancipatory possibilities regarding inclusion and peer support. Introduction In this article, we consider the role of mental health research in producing problems of ‘inclusion’ relating to peer support (PS), evaluating whether such problematisations ‘replicate or transform the status quo’ for individuals deemed ‘mentally ill’ or ‘mad’ (Russo, 2022, p. 1, see also LeFrancois & Voronka, 2022). Individuals accessing mental health services are often denied control, safety, and dignity. Much of this exclusion has been linked to psychiatrisation; that ‘mental illness’ or ‘madness’ are traits innate to certain individuals, requiring medical intervention and marking them as essentially inferior to others (Burstow et al., 2014; LeFrançois et al., 2013; Russo & Sweeney, 2016). Through psychiatrisation, support becomes ‘treatment’, often imposed involuntarily. Psychiatrisation is linked to other systems of oppression including white supremacy and colonialism, heteronormativity, capitalism, ableism, and patriarchy (Gorman et al., 2013; Joseph, 2019; Piepzna-Samarasinha, 2018; Redikopp, 2021; Ussher, 2011). Such systems contribute not only to experiences of distress but also to who is deemed ‘mentally ill’, effects of such diagnoses, as well as access to, and experiences of ‘treatment’. In response, the consumer/survivor/ex-patient (C/S/X) movement has long highlighted the right to self-determination and the value of experiential knowledge in conceptualising, and responding to, ‘mental illness’. We use ‘distress’ and ‘madness’ (as a reclaimed term) rather than ‘mental illness’, unsettling the framing of these experiences as purely biological processes, and, particularly for the latter, to highlight the politicised nature of labels. C/S/X advocacy has contributed to de-institutionalisation, moves towards ‘recovery-orientated’ approaches, and involvement of some mental health service users in service design, delivery, and evaluation (Gooding, 2016; Voronka, 2017). These reforms parallel broader policy engagements with social inclusion and rights of individuals to participate in health-care planning and implementation (Spandler, 2007; Wright & Stickley, 2013). Increasingly, these inclusionary measures involve employment of individuals with lived experience of distress and/or navigating mental health systems, to deliver PS (Voronka, 2017). Practices of PS originated as a response, particularly within Black, Indigenous, brown, and Queer communities, to a lack of safe and humane supports for individuals experiencing distress (Piepzna-Samarasinha, 2018). Unlike support underpinned by psychiatrisation (psy-care), PS challenges dualisms of care provider/receiver, emphasising solidarity, mutuality, and self-determination (Stratford et al., 2019). Whilst historically sitting outside of, and often resisting, mainstream mental health practices, PS is increasingly drawn into such assemblages through ‘peer support work’. Drawing on wider discourses around social inclusion, employment of peer support workers (PSWkrs) is predominantly understood as a ‘moral imperative’ (Spandler, 2007, p. 3), politically neutral and thus unquestionable (Barlott et al., 2020). Yet, despite this progressive impetus, PSWkrs report workplace exhaustion, slow rates of change to values and practices, and ongoing experiences of exclusion (Byrne et al., 2019; Edan et al., 2021; Irwin, 2017). Such experiences suggest variations to ‘inclusion’ and the effects of such. Thus, whilst the near universal recognition of the importance of including PS within mental health systems marks a significant move towards social justice, closer scrutiny is required regarding ‘inclusion’. We argue, not that ‘inclusion’ is implemented incorrectly but rather multiple versions of ‘inclusion’ are produced through socio-material practices, including research, with varying effects on PSWkrs and mental health practices. The contestable nature of ‘inclusion’ has been highlighted in other fields including international development (Calkin, 2015; Cooke & Kothari, 2001a; Koehler et al., 2020), critical race/ethnic studies (Peterson & Åkerström, 2014), health and disability (Marshall, 2012; Pereira & Whiteford, 2013; Taket et al., 2009), mental health (Barlott et al., 2020; Davey & Gordon, 2017; Spandler, 2007; Wright & Stickley, 2013), and mental health service user involvement broadly (Voronka, 2016a; Voronka & Costa, 2019). Challenging ‘inclusion’ as a fixed and universal concept, these works highlight ‘inclusion’ as multiple, with versions ‘brought into being through different social and material practices’ (McWade, 2016, p. 62). For example, when social justice movements use ‘inclusion’ to highlight exclusionary systems and practices, as such concerns become popularised, ‘inclusion’ becomes about behaviour change in excluded individuals rather than changing exclusionary relations. Similarly, concepts such as ‘recovery’ and ‘storytelling’ are shaped a-new as they become entangled with mainstream forces (Barlott et al., 2020; Costa et al., 2012; Harper & Speed, 2012; McWade, 2016; Morrow, 2013). Whilst objects such as ‘inclusion’ are produced through multiple, entangled practices, for this article, we focus on ‘inclusion’ as produced through mental health research on PS. This body of research has burgeoned in the last 20 years, with literature reviews examining ‘barriers to implementation’ (Vandewalle et al., 2016, p. 234), ‘influences on implementation’ (Ibrahim et al., 2019, p. 285), and ‘facilitators of peer support’ (Kuek et al., 2021, p. 1). Challenging assumptions of research as a neutral, ‘problem-solving’ process investigating pre-existing problematic situations, we consider research as social production (Bacchi, 2012; Mol, 2002; Oliver, 1992), actively shaping ‘the reality we study…with political consequences’ (Rönnblom, 2012, p. 123). We challenge ‘inclusion’ as a fixed ‘problem’, existing independent of research. Rather, research (re)produces specific knowledge, assumptions and ‘problems’ of ‘inclusion’ and ‘peer support work’, and proposes ‘how we ought to proceed’ from such problems (Bacchi & Goodwin, 2016, p. 28). Power operates through such problematisations, governing how one should act, feel, be (Bacchi & Goodwin, 2016). Problems of ‘inclusion’ thus have implications for how PSWkrs are understood by others and themselves and are interacted with and, consequently, how workers support those accessing mental health services. To consider how ‘inclusion’ of PSWkrs is continually produced through research, and the effects of such, we utilise Bacchi’s (2009) ‘what’s the problem represented to be?’ (WPR) approach. Foucauldian in nature, WPR unsettles conceptual logics of problem representations and how they come about. However, unlike a Foucauldian non-normative analysis, WPR aims to evaluate effects of such problematisations; ‘tak[ing] the side of those who are harmed’ (Bacchi, 2009, p. 42). We adopt an explicitly political lens grounded in the C/S/X movement (Beresford & Russo, 2021) and draw on critical mental health and inclusion theorising to focus on the potentially limiting effects of ‘inclusion(s)’. WPR has been applied to a range of governmental and non-governmental technologies, including the DSM-5 (Buller et al., 2022), media representations (Atkinson et al., 2019), interview transcripts (Lancaster et al., 2017), and symposia (Månsson & Ekendahl, 2015). Yet, despite the role of research in knowledge production, and therefore governing, the application of WPR to academic literature is limited. Martin and Aston (2014) are a notable exception, using WPR to critically analyse representations of women in drug-related research. Our analysis, therefore, is also useful for considering the potential of WPR as a tool to examine political effects of research. As Mad-identified scholars and allies, unsettling inclusion sits uncomfortably, given its status of moral imperative, achieved through significant social justice advocacy. We do not wish to undermine valuable advocacy that has seen inclusion brought to mainstream political agendas, the progressive effects of inclusionary measures, and the work of scholars who are continuously working towards social justice. It is this work that enables our analysis. However, we believe unsettling enactments of ‘inclusion’ is a discomfort worth sitting with to continue moving towards achieving dignified and socially just mental health services. Rest in link
|
|
|
Post by Admin on Apr 9, 2023 14:02:20 GMT
An introduction to peer-supported open dialogue in mental healthcare Published online by Cambridge University Press: 02 January 2018 Russell Razzaque and Tom Stockmann www.cambridge.org/core/journals/bjpsych-advances/article/an-introduction-to-peersupported-open-dialogue-in-mental-healthcare/E7A34021A8266DF280BD12FD2C0FAB8BSummary Peer-supported open dialogue is a variant of the ‘open dialogue’ approach that is currently practised in Finland and is being trialled in several countries around the world. The core principle of the approach is the provision of care at the social network level, by staff who have been trained in family, systems and related approaches. These staff include peer workers, who will help to enhance the democratic nature of the meetings around which care is centred, as well as enabling such meetings to occur where networks are fragmented or lacking. Certain organisational and practice features and underlying themes are key to the approach. Crucially, open dialogue is also a system of service provision. Staff trained in peer-supported open dialogue from six National Health Service (NHS) trusts will launch pilot teams in 2016, as part of an intended national multicentre randomised controlled trial.
|
|
|
Post by Admin on Apr 9, 2023 16:08:32 GMT
Peer-supported Open Dialogue (POD) in NHS mental health services Kent and Medway NHS and Social Care Partnership Trust About 2 mins to read Improvement project Mental health Innovating for Improvement www.health.org.uk/improvement-projects/peer-supported-open-dialogue-pod-in-nhs-mental-health-servicesLed by Kent and Medway NHS and Social Care Partnership Trust, with research and evaluation support from Canterbury Christ Church University. Developed and implemented a Peer-supported Open Dialogue (POD) service for patients and their social networks, in an adaptation of a novel mental health care model from Finland. The service provides a more consistent and co-created understanding of mental distress than current service models, by accessing people's social networks to strengthen their recovery and maintain wellbeing. Project ran from September 2016 to November 2017. Current mental health treatment models often see high hospital admissions and use of psychiatric medication. Adult mental health care is predominantly individualised treatment and often means patients seeing a number of different clinicians and services. Open Dialogue is a novel approach to mental health care that originated in Finland in the 1980s. It involves people and their family or social networks being seen within the first 24 hours of crisis, and seeing the same clinicians throughout their care; so that hasty treatment decisions are avoided and all discussions are held in their presence. This approach can lead to reduced relapse rates, lower medication use and increased chances of employment. Kent and Medway NHS and Social Care Partnership Trust has developed Peer-supported Open Dialogue (POD), an adaptation of the original approach, with the involvement of peer support workers. More than 90 patients and their networks have been seen so far, and there have been encouraging initial results, particularly around patient satisfaction, mental and social wellbeing, support for carers, and reduced hospital admissions. On the Community Mental Health Survey, the POD service is rated higher than both the local NHS Trust services and the national average. A key challenge was gaining agreement to staff the service from within existing resources, without clear UK outcome evidence or national benchmarks. However, Board and executive level commitment, and staff dedication helped bring the service to fruition. Funding from the Trust has been secured to support the POD service for an additional year, and there are plans to spread the innovation to other sites across Kent. Contact information For more information about this project, please contact Dr James Osborne, Consultant Psychologist, Lead Psychologist for East Kent, Community and Recovery Services.
|
|
|
Post by Admin on Apr 9, 2023 16:10:17 GMT
|
|
|
Post by Admin on Apr 9, 2023 16:12:33 GMT
Peer supported Open Dialogue research project Date added: 21 March 2022 Staff from KMPT were the first to conduct a research study to evaluate the implementation of a new Peer supported Open Dialogue (POD) approach in a large NHS mental health trust. What is Open Dialogue? Open Dialogue is an approach to mental health care that emphasises the importance of social network support, generating dialogue about the mental health crisis and involving the service user in all decisions regarding treatment. The aim of Open Dialogue is to actively listen and respond, generating dialogue between the service user, their social network (usually family members) and members of the clinical team. What is Peer Support? Peer support is when somebody with lived experience is then trained to share their knowledge and experience to support those going through a similar situation. In the KMPT POD service, peer support workers were employed members of the clinical team who provided a unique contribution to service users by utilising their lived experience to build trust and engage people in their treatment. What did our study want to achieve? We wanted to evaluate the implementation of a POD service in KMPT by looking at changes in wellbeing and experience in those who used the service over a period of six months. What did our participants do as part of the study? We recruited fifty service users and their family/social networks who received care from our POD team to take part in a series of questionnaires at three time points (before staring the intervention, three months after, and six months after) to measure service user wellbeing and experience, and carer wellbeing and support. Clinical data around the health and social functioning of service users was also gathered from clinicians, and these were analysed together to see if the service users and their family/social networks wellbeing and experience changed during the course of the study. What were the results? The study indicated that Peer supported Open Dialogue was a clinically effective service. Service users and clinicians reported improvements in service user wellbeing and carers reported greater satisfaction in terms of the support received. What next? Following this work, we were involved in a larger national clinical trial being led by University College London. This study is hoping to understand if Open Dialogue can be implemented nationally, by exploring whether Open Dialogue is more cost-effective than current care, and how Open Dialogue can impact service user recovery, quality of life and experiences of shared decision making. You can read more about the project here bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-03731-7www.kmpt.nhs.uk/news-and-events/news/peer-supported-open-dialogue-research-project/
|
|
|
Post by Admin on Apr 11, 2023 12:37:52 GMT
|
|
|
Post by Admin on May 10, 2023 9:51:19 GMT
Despite Focus on “Inclusion,” Mental Health Peer Support Workers Face Marginalization A recent study highlights the tensions and limitations of the dominant notions of "inclusion" within mental health peer support research. By Justin Karter -May 3, 2023 www.madinamerica.com/2023/05/oppressive-tensions-experienced-by-mental-health-peer-support-workers-despite-focus-on-inclusion/A recent study published in Qualitative Health Research reveals that despite the growing focus on inclusion in mental health peer support, these workers often experience exhaustion, slow rates of change to oppressive values and practices, and ongoing workplace exclusion. Peer support work, which emphasizes solidarity, mutuality, and self-determination, has been increasingly incorporated into mainstream mental health practices. However, the study’s authors argue that multiple versions of inclusion are produced through socio-material practices, including research, with varying effects on peer support workers and mental health practices. The study was conducted by Aimee Sinclair, Sue Gillieatt, Christina Fernandes, and Lyn Mahboub from Curtin University in Australia. They write: “As Mad-identified scholars and allies, unsettling inclusion sits uncomfortably, given its status of moral imperative, achieved through significant social justice advocacy. We do not wish to undermine valuable advocacy that has seen inclusion brought to mainstream political agendas, the progressive effects of inclusionary measures, and the work of scholars who are continuously working toward social justice. It is this work that enables our analysis. However, we believe unsettling enactments of ‘inclusion’ is a discomfort worth sitting with to continue moving towards achieving dignified and socially just mental health services.” The consumer/survivor/ex-patient (C/S/X) movement has long advocated for the right to self-determination and the value of experiential knowledge in addressing mental health issues. These advocacy efforts have contributed to de-institutionalization, recovery-oriented approaches, and the involvement of mental health service users in service design, delivery, and evaluation. The researchers employ a post-structural analysis to examine how inclusion is produced. To do so, they adopt Carol Bacchi’s “What’s the problem represented to be?” (WPR) approach to explore how mental health research produces versions of inclusion, examining the implications for peer support workers and mental health practices. By applying the WPR approach, the study analyzes how mental health research on peer support produces specific knowledge, assumptions, and problems of inclusion and peer support work. Through this lens, the authors present three problematisations of “inclusion” within the literature: inclusion as assimilation, integration, and co-optation. Assimilation Assimilation refers to the process by which individuals conform to the dominant culture or system in order to be included. For example, in the context of mental health peer support, this could mean that peer support workers are expected to adopt the language, values, and practices of the dominant mental health care system to be recognized as legitimate providers of care. Inclusion as assimilation is a perspective that views the employment of peer support workers (PSWkrs) as a political move without sufficient evidence of efficacy and effectiveness. Proponents of this view argue that high-quality trials are needed to determine whether peer support interventions can resolve psychiatric symptoms or improve patient self-management. This problematization is mainly driven by the dominant positivist paradigm in medical research, which focuses on gathering evidence about a singular reality. As a result, clinical measures in randomized controlled trials and meta-analyses have become the gold standard for measuring peer effectiveness. Unfortunately, these measures often decontextualize distress and support, neglecting social factors influencing outcomes. The assimilation view of inclusion requires PSWkrs to adopt ways of thinking and working that align with psychiatric authority, producing clinical outcomes. This may lead to PSWkrs becoming “mini-clinicians,” focusing on individual identity and experience markers, such as diagnosis and history of accessing services, to support psychiatric outcomes. This approach often excludes alternative practices that challenge psychiatrization and leaves dominant mental health practices unquestioned. Inclusion as assimilation can involve PSWkrs having limited control and may implicate them in oppressive practices associated with treatment. Integration The second problematization of including Peer Support Workers (PSWkrs) in mental health systems involves treating inclusion as a foregone conclusion. These texts highlight the unique and valuable contributions of PSWkrs and the importance of maintaining the authenticity of peer support (PS). However, the problem is framed as a technical issue of overcoming barriers to inclusion, which can be related to PSWkrs, PS work, or external factors. In this positioning, PSWkrs are often problematized as lacking the disposition or skills for mental health work, leading to suggestions for training and accommodations. Similarly, PS work is complicated due to factors like emotional stress, role confusion, and lack of professional standards. Therefore, solutions often involve making PSWkrs more like existing mental health workers through training, standardization, and credentialing. External problems include stigmatization by non-peer staff, unsupportive work environments, and poor compensation. These problems are attributed to a lack of organizational readiness, with solutions focusing on more explicit policies, procedures, and job descriptions. Thus, inclusion is constructed as integration, where aspects of PSWkrs’ lived experiences are valued, but the alternative epistemology they bring is often excluded. This approach to inclusion can conceal and reinforce oppressions and injustices, as limiting experiences are reduced to technical rather than political problems. Co-optation Co-optation refers to the process by which the dominant system or culture absorbs and repurposes elements of a marginalized group to maintain power and control. In the context of mental health peer support, this could involve the co-option of peer support practices and language by the dominant mental health care system, potentially undermining the original intentions and values of peer support. In this section, the authors highlight the gradual shift in PS from a grassroots, user-led approach to a more institutionalized, professionally-led one. This shift is seen as problematic, resulting in a loss of integrity and the devaluation of lived experience expertise. The authors also critique essentialist narratives of co-optation, which can sideline the diversity and dynamic nature of PS and inclusion. The literature on PS often fails to engage with issues of race, gender, class, sexuality, or diagnostic differences, which has led to the continued production of predominantly white, western, and ‘sane-performing’ PSWkrs. This exclusionary approach ignores the long history of mutual aid and expertise within marginalized communities and the differential effects of taking up a peer identity. The authors call for critical reflection and engagement with the experiences and expertise of marginalized groups. Lastly, the analysis suggests that the co-optation problematization can erase dissent and complexity within the PS movement. The authors emphasize that PS has always existed within politics and that individuals are continually shaped by various forces. The authors encourage a more nuanced understanding of the psychiatric and mental health fields and the workers within them. The authors argue that current constructions of inclusion may contribute to oppressive tensions experienced by PSWkrs, who are caught between wanting to practice in anti-oppressive ways and needing to exist within a system that readily excludes them. They suggest that researchers should engage in “self-problematization” to critically examine their own role in producing and reinforcing these notions of inclusion. To move beyond current limitations in the concept of inclusion, the authors propose exploring how various inclusionary forces impact peer support in different contexts and across intersections of gender, class, diagnosis, and other axes of oppression. They suggest considering the productive potentials and limitations within both “inside” and “outside” engagements with mental health systems rather than focusing on an “authentic” form of peer support. The study underscores the importance of engaging with uncomfortable reflexivity to enable more emancipatory possibilities regarding inclusion and peer support. The critical analysis of inclusion in mental health peer support highlights the need for further examination of the political effects of research and the potential for more inclusive and socially just mental health services. In addition, by recognizing and critically examining the different forms of inclusion, researchers and practitioners can work towards fostering a more inclusive and equitable mental health care system that values peer support workers’ unique perspectives and contributions. The authors conclude: “We have highlighted how dominant notions of ‘inclusion’ produced through research have potentially delimiting effects for PSWkrs and leave oppressive power relations unexamined. An alternative enactment of ‘inclusion,’ constructed predominantly through Mad/survivor research, provides the potential to move us closer to social justice outcomes if we continue to engage with its limitations and do not allow it to solidify. This critical reflection on the role of research in the production of ‘inclusion,’ whilst often uncomfortable, is integral for ensuring, as researchers, we are aware of the problematic effects of our own well-intentioned efforts and, thus, how we might continually adjust our practices such that we move closer to achieving justice and equality for individuals with lived experience of distress and/or psychiatric oppression.” **** Sinclair A, Gillieatt S, Fernandes C, Mahboub L. Inclusion as Assimilation, Integration, or Co-optation? A Post-Structural Analysis of Inclusion as Produced Through Mental Health Research on Peer Support. Qualitative Health Research. 2023;0(0). doi:10.1177/10497323231163735 (Link) Inclusion as Assimilation, Integration, or Co-optation? A Post-Structural Analysis of Inclusion as Produced Through Mental Health Research on Peer Support journals.sagepub.com/doi/10.1177/10497323231163735
|
|