I would like to begin by telling you a bit about the peer support worker I know best, which is to say, myself. I have been doing this for ten years. The South Team is my mother ship. I did my practicum here and then I was hired when a position became immediately available. I have worked altogether in seven different mental health/addiction sites. My work is my sole source of income, I have never been on disability and my job is my only income. I currently work six contracts in four sites: the South Team, Kits Team, ACT, and Venture. I was treated by a private psychiatrist for four years, without medication, without hospitalization. My lived experience of mental health recovery, along with my peer support training and experience make it possible for me to work well with clients in their journey towards mental health recovery.
Peer support is very simple yet very complex work. The core strength of peer support is in having had lived experience of mental health recovery. Other skills and experience are often necessary and helpful. That is the simple part. Where peer support gets complicated is how each therapeutic relationship between client and psw becomes a kind of unique dance because peer support is very relationally based. We are out in public with the client, in the community, as we support our clients towards meeting their goals towards a fuller quality of life. I have often noticed that my clients are more confident, and present as more well when we are out in public together. As they gain comfort and confidence the public sphere becomes for them their personal canvas on which they can paint a new version of their lives. Their posture changes and they walk with confidence. The conversations become interesting, open and unguarded. There is often laughter and humour, and time taken to appreciate interesting and rich details of our surroundings.
Being out in public is sometimes very scary for someone who is not used to venturing beyond their home environment except for clinical appointments, especially if they have been ill and hospitalized for significant periods. This is where the role of the peer support worker can be critical to a clients' journey towards recovery. We often become a trusted link for the client to become accustomed to being out in the community. It's like helping someone grow accustomed to the shallow end of the pool, first dipping in a toe, then the foot, and only slowly moving a little bit deeper according to their level of trust and comfort. The objective of course is client independence.
Peer support is goal oriented, but not goal centred. The client is always at the centre. The goals, made by the clients with clinical support and input, are made by the clients. Many clients are ready to make significant steps forward in their recovery, and may only need a peer support worker for several weeks or two or three months to access volunteer or part-time employment, or learn a transit route, or access activities, like an art class, or yoga or swimming or routes for going for walks or bike rides. Some require longer term support, especially if they are isolated and lack experience living independently or being out in the community and are on extended leave. These clients, or peers, will often need longer support with a peer and the role of the peer support worker, as well as facilitator, will be also to provide ballast and support. These peer arrangements also involve goal setting, but the pace is going to be slower, gentler and longer term. What we try to do is move at a pace to which the client is comfortable, only very slowly and gradually picking up the pace and speed to help them move forward. Some of the clients I have worked with who have benefited from longer term support, say for even up to or longer than two years have one or any combination of these life situations: they are on extended leave, they are living with addictions, they are chronically and severely ill with little hope of recovery and need maintenance and long term support, or there is a language barrier that the peer support worker is best qualified to assist with. In my case, because I speak Spanish fluently, I have often worked with Spanish speaking clients who have little or no command of English, and having someone longer term to offer support in their own language and help connect them with the community has been invaluable to helping enhance their quality of life and also to motivate them towards learning and improving their English..
There has been a recent trend towards trying to shorten peer support arrangements and this appears, in my experience, to produce mixed results. It seems that the best and most thriving arrangements are when the client, the psychiatrist, the rehab worker, the case manager and the peer support worker are all onboard together and are able to work in a spirit of collaboration and collegiality. It would be primarily the client's decision as to when the peer support should come to an end. This will need to be taken into account along with other considerations according to the observations of everyone involved in the client's support. For example sometimes a client will want to prolong the relationship with the peer support worker because the arrangement has taken on the characteristics of a friendship. This is counterproductive because one of the chief goals of peer support is to encourage independence while maintaining safe and secure boundaries within the continuity of care. There are other situations where the client might want to end things prematurely without fully taking into account some of the benefits they stand to gain while working on other goals with the peer support worker.
There is no perfect length of time for peer support. If a client is ready to become more independent and self-actualizing the arrangements are going to be shorter term, perhaps for one or two or three months. In some situations that require more intense and longer term support it might have to go on perhaps for a year or two or even longer, though ideally six months to a year is usually sufficient.
I would say that the heart of good peer support lies in encouraging client empowerment. While I try to suspend expectations and sometimes even personal hope for the outcome for some of my clients I try to never lose faith in them and I believe that by believing in the client without preconditions, judgment or expectations can be key to blowing upon the seemingly dead coals until they begin to ignite again. This is a work that of course involves a complete and integrated team approach. I have found that my most productive situations with clients have involved a thorough contingent of all professionals involved in their support and recovery and for this reason it is invaluable for the peer support worker to be in close contact with the case manager and often with the psychiatrist as well as with the rehab professional they are working with. Good team work where there is trust and good communication, I have found, can often help generate a dynamic symmetry that supports and helps energize the process of working well with our clients.
The process of setting up a client with a peer support worker is very straight forward. At the case manager's, and psychiatrist's discretion, a client who either needs extra emotional and moral support, or support in moving forward in recovery, or as in many cases both, will be referred to the rehab team to be set up with a peer support worker. Depending on the nature of the client\s goals or needs, either an occupational therapist or a recreational therapist will supervise the arrangements. A prior meeting will be set up, attended by the client, the peer support worker, the occupational or recreational therapist and the case manager. The client will express their stated goals and expectations which will be written down on a goals and outcomes sheet, either by the rehab worker or the peer support worker and they will agree together on the most propitious approach that would be required for meeting the goal. During this meeting the peer support worker will explain to the client the nature and purpose of peer support work and will in his own words disclose that he has also been through a mental health crisis from which he has recovered and has received the appropriate training to work as a peer support worker. It is always essential that the peer support worker and only the peer support worker self-disclose about their mental health background. This helps maintain an atmosphere of respect as well as clear boundaries. Things are usually reviewed after the first three months. If the client has not achieved their stated goal, needs more time, or would like to work on a new goal, or simply needs more time of basic support from the psw, arrangements can be renewed for another three months and so on. Throughout it is good to remind the client that peer support is a short and limited time arrangement and completely voluntary.
Sometimes the client might experience a relapse, might need respite or a medication change and could wind up in hospital or at Venture. At the case manager's and psychiatrist's discretion it is often appropriate that the peer support worker continue seeing and supporting the client during such periods of transition.
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