Increasing hierarchical power structures within peer support? Author: Sandy Lancaster I have been having some thoughts about what constitutes "peer support" and I have to say I am feeling quite unsettled by what I am reading lately. I am seeing a lot of terms bandied about on social media ie "patient leaders" "leader leaders" "super allies", "Lived Experience Professionals " (LXP) to name a few. All these terms have one thing in common - Hierarchical power structures. This is one of the things that terrifies people who have been abused, brutalised and damaged within mental health services or other state systems which involve one person having power over another as an authority figure. I can't quite believe what the people associated with these movements think this a good idea. That they envisage this will build bridges with the people they are working with. Presumably the opposite. In my opinion it is the antithesis of what a peer is/does. The saddest thing are that some of these people who seem to be starting a new movement were once seen as "allies" of people who are involved in the mental health system. I feel like they have thrown us under the proverbial bus. Nowhere in the principles of peer support (which was a theme of the NSUN conference 2018) does it say that to be a peer you need to be part of of a hierarchical power structure, where you have a grandiose title and appear put yourself on a pedestal with your needs placed above others. I can only imagine this is about 'peers' having their work and skills recognised and renumerated appropriately. However when I hear peers describe their work with service users as "being at the coalface" I think of back breaking, laborious work which carries high personal risk. It makes me think "do people who say these things really want to work with someone like me"? Someone who is broken and utterly bereft of hope. When someone describes themselves as a "Post Personality Pioneer" are they saying they have overcome a mysogenistic oppressive label by ascribing themselves a professional title and contributing to the oppression of others deemed "personality disordered? I don't feel that people who have been oppressed then contributing to the oppression of others is the answer. I feel it is more likely part of the problem as history has taught us. To the contrary to be a 'peer' you need to be aware of inherent power dynamics within what seems in most cases to be a formal working relationship via the NHS or charity whether this is paid or voluntary. To be honest I don't have much time for organised peer support. Some time ago I attended an event for people with "lived experience" to tell their stories. It was the first time I had done this and I became distracted and upset as people were discourteous and moving about getting food whist I speaking. It became so noisy and I was talking about deeply personal stuff I lost my train of thought. I got no support and I left in tears. Not one of my 'peers' asked if I was OK,but a man in the street in work overalls offered me a light for my cigarette as I was shaking so much I couldn't find a lighter. This simple act of kindness was the only thing that was good about the day. When I went back in to collect my belongings and told someone they recoiled in horror and said "eugh you smoke?" The point I am making is just because we might have "lived experience" of mental health does this make us peers? I would argue not. We all come from different backgrounds. Different life experiences. I probably have more in common with this random stranger in the street than a white, middle class Lived Experience Professional working in a university or the NHS. There are issues around class, ethnicity, where you life, social capital and your life experiences. Experiences of trauma. As a care experienced person I feel isolated without any family support. I was told "find your tribe" but even amongst other care leavers I find I have nothing in common with them. Possibly because the people I found online were lacking in empathy towards me. I felt people who had never met were trying to negate or deny me my right to speak of my negative experiences within these systems. Telling me I wasn't "positive enough". I just wanted to accepted as I am. Nobody knows what I have had to and continue to endure day to day and the devestating consequences this has had upon me. I find that within the neoliberal agenda of co-opted peer support. There is a hierarchy and the idea that locates "fault" within the individual with one taking the postion of leader and the other as subject to be shown the "right way" and takes no account of the trauma and disadvantage an individual may have experienced. To be honest I don't care if an individual has "lived experience" as after the kind of life experience I had had I don't we will find an common ground. What I do care about is someone just being kind and non judgemental. Peer support is the thing we have been doing for centuries. Just being there for someone. In the moment.