In the last two years I’ve been involved in two reviews of peer support and peer led responses in Canada – one for Ontario (click to download) and the other for the whole of Canada (which has yet to be released by the Mental Health Commission of Canada).

Services run by and for ‘mad’ people have been a small but growing part of the landscape since the 1970s. Peers have supported each other informally since they were first thrown together into the lunatic asylums, and probably even before then. In the last few decades formal, funded peer support services have provided people with a huge variety of supports, information, work opportunities and advocacy. There’s huge potential for peer led responses but they are still few and far between in the mental health landscape, amounting to less than one percent of total mental health expenditure in most countries or jurisdictions.

Peer led services and responses will probably use more of the mental health dollar in the future. But a threat lurks on the flipside of this opportunity. Peer support is at risk of being corrupted by the powerful and controlling system that funds it. This is already happening in some places in the world. To counteract this risk, we urgently need to reach an international consensus on what defines peer support and peer led responses. To start we need to define our values.

When we asked people about the values of peer support for our two reviews in Canada, they told us that peer led responses apply values that differ from those applied in mainstream services. This is hardly surprising, since the drive to develop peer led services arose out of experiences of oppression, harm and lack of responsiveness from the mental health system. The values people talked about to us revolved around three themes:             

Equal power relationships

(Described by respondents as egalitarian, reciprocal, autonomy, self-determination, empowerment, choice, voice, social justice).

“We don’t have to fake it at a peer service”

“We can say what we need after years of being told what’s good for us”

These equal and empowering power relationships show up in a number of ways: Consumer/survivor members control the organization, they are free to choose their supports, and there is a commitment to social justice in many peer groups. In contrast, respondents often described the power relationships operating in mental health services as controlling, directing, hierarchical, patronising or authoritarian.

Identification with each other

(Described by respondents as reciprocity, mutuality, camaraderie, empathy, acceptance, no discrimination, community).

“In peer support we can see what professionals can’t see.”

 “I want to be listened to and validated in my pain, not shut up and locked up.”

Identification with each other is reflected in the relationships inside peer led services.  Peer support involves reciprocal roles of helping, learning and responsibility. There is also less role distinction between peer staff and clients or members than there is between professionals and clients.  In contrast, people often described mental health services as trying to do things to people rather than do things with them, and as valuing book learning over lived experience.              

Holistic understanding of madness

(Described by respondents as holistic, recovery, hope, different language).

“Peer support is not about how ill we are but how well we are”

“Professionals forget we know how to live with mental illness as we do it each day”

Peer support emphasises whole of life issues, our strengths, and the validity of personal experience. The value of personal narrative is elevated, particularly one that moves people away from an illness and victim identity. A belief in hope and recovery enables people to believe in each other, feel better about themselves and their future, and to make positive changes to their lives. In contrast, many people criticised the mental health system’s reductionism, pessimism and the dominance of a narrow biological approach.

In conclusion, these peer support values should permeate the whole mental health system, but it is more likely that they will be diluted as more peer run initiatives are funded by the mental health system and delivered within mainstream mental health services. We need to act now to preserve the integrity of the biggest hope we have of ensuring that future generations of mad people get a better deal than we have.

(Download the Ontario report here)