Peer support Mike Slade Institute of Psychiatry South London and Maudsley NHS Foundation Trust Email: m.slade@iop.kcl.ac.uk 29 April 2010

What do recovered people identify as important to their recovery? Hope Identity Meaning Personal responsibility Andresen R et al (2003) The experience of recovery from schizophrenia: towards an empirically-validated stage model, Australian and New Zealand Journal of Psychiatry, 37, 586-94.

RECOVERY SUPPORT TASKS aka The job of mental health professionals 1. Fostering relationships 2. Promoting well-being 3. Offering treatments 4. Improving social inclusion

Fostering relationships with… …oneself …valued others …peers …professionals …the world

What is peer support? A “credible role model” Multiple levels Davidson L, Rakfeldt J, Strauss J (2010) The roots of the recovery movement in psychiatry, Chichester: Wiley-Blackwell Multiple levels Mutual self-help groups Peer support workers Peer-led services

What do mutual self-help groups do? Personal stories and community narratives Role models Opportunity role structures Social support, sense of belonging, connection Randall KW, Salem DA (2005) Mutual-help groups and recovery: the influence of settings on participants’ experience of recovery. In: Ralph RO, Corrigan PW, eds. “Recovery in Mental Illness: Broadening our Understanding of Wellness”, Washington DC: American Psychological Association, 173–205.

Mutual self-help groups Hearing Voices Network (www.hearing-voices.org) Schizophrenics Anonymous(www.sanonymous.org) I surrender. I admit I need help; I can’t do it alone I choose to be well. I take full responsibility for my choices I now come to believe that I have great inner resources and I will try to use these resources to help myself and others I forgive myself for all the mistakes I have made. I also forgive everyone who has injured or harmed me I make a decision to turn my life over to the care of God, as I understand Him…I ask to be changed in depth

Personal stories Stories matter. Many stories matter. Stories have been used to dispossess and malign, but stories can also be used to empower and to humanise. Stories can break the dignity of a people, but stories can also repair that broken dignity Chimanda Adichi

Peer Support Worker policy All mental health services will be expected to recruit and train service users as part of the workforce Department of Health (2001) The Journey to Recovery – The Government’s vision for mental health care, London: Department of Health. Peer support and natural support networks are seen as important in recovery as well as giving good value for money. … A common theme is shifting the balance of staffing…from medical to nursing, social care, talking therapy and peer support workers HM Government (2009) New Horizons, London: Department of Health, pp.16-17.

Peer support workers I have often noticed that when I employed a madman who had just recovered his senses either to sweep or to assist a servant, and then to become himself a servant…that his state improved every month, and that somewhat later he was totally cured. Jean-Baptiste Pussin, Governor of the Asylym at Bicêtre, 1793

Benefits 1. For the Peer Support Worker 2. For other staff 3. For other service users 4. For the system Scottish Government (2009) Evaluation of the Delivering for Mental Health Peer Support Worker Pilot Scheme, Scottish Government Social Research.

Key We Way www.wellink.org.nz/services/keyweway.htm

RCT evidence: peer-led services In-patient mental health services (n=393) Consumer-operated unlocked service vs. locked inpatient unit Improvements in symptoms and great improvement in satisfaction Greenfield TK et al (2008) A Randomized Trial of a Mental Health Consumer-Managed Alternative to Civil Commitment for Acute Psychiatric Crisis, American Journal of Community Psychology, 42, 135-144. Consumer-operated mental health services (n=1,827) Drop-in / peer support / education & advocacy vs TAU Improvements in empowerment, dose-effect Rogers ES et al (2007) Effects of participation in consumer-operated service programs on both personal and organizationally mediated empowerment: Results of multisite study, Journal of Rehabilitation Research & Development, 44, 785-800.

100 Ways to support recovery Free to download from: rethink.org/100wys Practice guide Personal Recovery and Mental Illness Cambridge University Press Book 20-22 Sep 2010, London Further information at: researchintorecovery.com Conference