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What peers have wrought

April 20, 2017

Peers who have endured the sting and burden of a major mental illness or a severe substance use condition have made remarkable contributions to our field. It is primarily through their insights born of direct personal experience that we now understand several essential foundational phenomena that we all take for granted.

Principally, we have come to know these concepts from the first-person accounts provided by these peers. Such accounts are exceptionally important for two reasons. First, they demonstrate that the peer has regained his or her own voice, an essential milestone if one has suffered from a serious mental illness or substance use condition. Second, these first-person accounts have served as the fundamental evidence to document the reality of the very concepts I am seeking to characterize here. They are, par excellence, practice-based evidence.

Let me demonstrate with an example. As a peer offers a first person account, s/he is able to recount in vivid detail how s/he recovered from mental illness, step by step, over time. This personal report about recovery then becomes bedrock evidence that recovery is real and achievable. It also creates a very strong incentive for other persons with similar conditions to seek recovery.

Now, I would like to describe several of the most fundamental and essential concepts that we have learned from peers via these first-person accounts.

Recovery

Until very, very recently, around the turn of the century, the predominant culture in the professional behavioral health community held that mental health and substance use conditions are life-long illnesses, that life-long care is required, and that persons with these illnesses never can recover. A moment’s reflection will convince you that this approach destroys a peer’s hope and a provider’s motivation to do better.

Very fortunately, peers who have recovered have burst this myth through their own words and actions. They also have become wonderful models for emulation by others who have the same conditions.

The possibility of recovery is the most profound change that has occurred in our field in centuries. It offers peers great hope for a much better future.

Regaining One’s Voice

An essential feature of recovery is regaining one’s voice. Without a voice, one does not engage; one only is acted upon by the community. One can be stigmatized, socially-isolated, and sidelined. Regaining one’s voice permits one to engage the community, to be a full participant, and to develop needed self-esteem.

We all have witnessed peers regain their voices, their personhood, and their communities. This is an amazing uplifting experience.

Wellness

The tragedy of premature death has spurred peers to seek wellness and to develop what today are called wellness programs. These peer operated programs have organized a set of interventions that promote the well-being of consumers. SAMHSA has codified this work into eight core dimensions of wellness.

Like recovery itself, wellness derives from the personal experience of peers. Peers have organized wellness programs around interventions that they themselves have found to be useful in addressing a particular health goal. Perhaps the most well-known of these programs is WRAP—the Wellness Recovery Action Plan--developed by Mary Ellen Copeland.

Self-Direction

Like wellness, self-direction is a much desired goal for peers. Self-direction confirms that the recovery process has been successful. It also signals that one can regain a full life in the community.

Self-direction refers not only to health literacy and activation, but also to broader skills reflected in independent living, a job, and a strong friendship network. It is all about becoming a full member of the community.

I must interject a word of caution. Please do not interpret these comments to mean that legions of researchers, providers, and advocates have contributed nothing. It is quite the contrary. Many of these same people have believed in peers and have encouraged peers in their fundamental striving, aspiration, and vision. They also have nurtured these essential phenomena throughout the field.

Thus, we owe peers a huge round of applause for the fundamental changes they have wrought in our field. We also owe those who have supported the aspirations of peers great thanks for encouraging these landmark changes to occur.

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