The inconvenient complications of peer support, Part 1

By Alison Faulkner, survivor researcher (based on a talk given at the Refocus on Recovery conference in Nottingham, 2019)

I have borrowed the title of this talk from an excellent paper by Nev Jones and Timothy Kelly (2015) in the U.S. exploring the heterogeneities of madness and their relation to disability... it seems an appropriate phrase to describe the complications and dilemmas surrounding peer support in its many different forms.

When I first started preparing this talk, I imagined tracing a path of rationality through these complications, but I am sorry to say that I was unable to do that. I probably raise more questions than I answer here, but I hope that some of the issues raised will nevertheless be of interest.

As a survivor researcher, I find myself with one foot in academia and another in survivor activism. Much of my work has been and is in the voluntary sector, where peer support work has been undertaken by Mind, Together and a number of other mental health charities. I stand most comfortably in and with the National Survivor User Network, a user led network and registered charity, supporting people and groups with experience of distress and disadvantage across England.

I want to say at the start that I am aware of my own privilege, being both white and middle class educated, which has given me platforms from which to speak from. There are many people who are working with and for peer support within marginalised and racialised communities whose views and perspectives are not often heard. I think it is important for us all to remember and consider whose voices are not represented in these spaces.

This is an overview of the questions I am covering:

  1. Who is a peer?
  2. What is peer support?
  3. A divided path?
  4. Finding common ground?
  5. Imagining our futures

1. Who is a Peer?

'whiteness must not escape structural scrutiny'

Colin King, 2007, p.27

First of all, I think it is important to remember the meaning of the word peer: that it is a person of equal standing - something I was reminded of recently at a workshop held by Sascha Altman DuBrul in Mind in Camden, London. Within current mental health services context - and beyond - it has come to mean 'someone with lived experience of mental illness or distress' simply by default - and this is regardless of what they are doing or what their role is as a 'peer'.

Furthermore, it is important to recognise that, for some people, a shared identity or background in another context can be more important than a shared experience of mental distress. But... there are many ways in which our experiences differ and change over time...

  • Language
  • Severity
  • Dimension
  • Course, temporal trajectory
  • Intersectionality
  • Medical vs Social model

 The heterogeneities of madness and distress

There are so many ways in which the experience and the expression of madness and distress vary, and very often these differences are effaced by the need to speak - or represent - a view or a service or to convey a neat narrative.  

We can differ on the basis of the language we use about ourselves, the severity and nature of distress we experience, the course and temporal trajectory of distress - the extent to which it disables us or interrupts our lives.

And there are large intersectional differences between us brought about by race, sexual orientation, gender, and these things matter. They make a difference to our privilege, disadvantage, inclusion and exclusion in society as a whole. Being white and middle class makes a difference to my experience within services and within society.

I raise these issues because they matter in peer support too: it may not be enough simply to share a background of mental distress if you are different in significant ways that mean you cannot feelas if you are experiencing a peer, equal, relationship. Remember that concept of the person of equal standing.

2. What is Peer Support?

There are so many different terms for peer support in its many different manifestations that we can be forgiven for not always being able to recognise it when we see it... and it has become very much more complicated in recent years as so many of us have tried to define and redefine it... So, I will take a few steps back in time.

'On our own terms', published 2001: Centre for Mental Health

In or around the turn of this century, Jan Wallcraft and others at Centre for Mental Health (previously the Sainsbury Centre) undertook a survey of service user groups across England, and found that 79% were engaged in what was described as mutual support, self-help, supporting each other. It is at the core of what many people think of as the user/survivor movements.

The significance of peer support and self-help spaces

For me, what is at the core of peer support is the space that enables us to share our experiences, tell our stories, with the expectation of being believed and heard and without fear of judgement or pathologisation. Peer support is the bedrock of experiential knowledge - it is where we come to validate our experiences and learn from and with each other, where we develop our own knowledge and ideas, strategies and value.

Respecting our history and communities: here are some images that represent just a fraction of some of those spaces, both physical and virtual, where experiential knowledge develops and grows.

Telling our stories is at the core of peer support and how we come to share our experiences and support each other. We don't have to tell our whole stories, but the sharing of experiences raises our own awareness of the complexity surrounding us and of routes through our distress.

'Narratives are important to all cultures; indeed it is how we, as human beings, make sense of our lives, our identities and our worlds.’ Morgan et al, 2016

‘The centrality of storytelling within self-help/support enmeshes individual trajectories with understandings of similar ones, criss-crossing individual’s narratives with those of others and using (parts of) others’ to rework the individual’s own.’ Noorani, 2013, p.62

To read Part 2 of The Inconvenient Complications of Peer Support, click here