Late last year SAMHSA issued a new definition of recovery and support services. This definition includes peers with lived experience in the areas of mental health and substance use. One of the unintended consequences of adopting this definition was to reopen the debate about who is a peer and what constitutes peer support in both communities. What become clear is that peers from both communities and policy makers have yet to reach a consensus on what these terms mean to those within each recovery community and what they mean to those outside of these communities.
There are several initiatives within SAMHSA and leaders of both the mental health and substance use communities to reach some common ground. For example, during a SAMHSA sponsored Leadership Forum that was held in July 2011, leaders of these communities focused on reaching a consensus about creating a definition that includes peers. The issue remains unsettled but community leaders are committed to adopting a definition that is inclusive and acknowledges and values lived experience. In an effort to be inclusive, both communities have begun to define a peer as someone with lived experience with the issues faced by individuals that they are providing services to.
This definition acknowledges the different experiences of various groups with systems such as the criminal justice and behavioral health systems while clearly articulating the importance and value of shared life experiences. Many of these experiences are unique and it is possible to use your own personal experience to provide hope to your community without devaluing the experiences of others. In sum, a peer is someone who has walked in your shoes, has a first hand and intimate knowledge of the challenges you face and therefore, he/she is a role model who inspires hope and the fact that recovery is indeed possible in the expected outcome of services.
A related issue is what constitutes peer support and what distinguishes it from other types of treatment and support. While clinicians can support a person’s recovery process and support principles of recovery such as self-direction and choice, it is fundamentally different from peer support. Similarly, peers have made it very clear that they do not want to replicate the approaches that are not strength based, promote dependence and further stigmatize individuals.
So what is peer support? There are many definitions of peer support, but the definition that best captures the unique features of this model is:
Peer support is a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful. Peer support is not based on psychiatric models and diagnostic criteria. It is about understanding another’s situation empathically through the shared experience of emotional and psychological pain. When people find affiliation with others whom they feel are “like” them, they feel a connection. This connection, or affiliation, is a deep, holistic understanding based on mutual experience where people are able to “be” with each other without the constraints of traditional (expert/patient) relationships. Further, as trust in the relationship builds, both people are able to respectfully challenge each other when they find themselves re-enacting old roles. This allows members of the peer community to try out new behaviors with one another and move beyond previously held self-concepts built on disability, diagnosis, and trauma worldview. The Stone Center refers to this as “mutual empowerment” (Stiver & Miller, 1998).
This definition eloquently captures the essence of peer support and its relationship to a person’s recovery. We all need different kinds of support as our needs change over time. The opportunity for new and varied relationships enhances our recovery. It reinforces the fact that we are indeed a part of a larger community that has as much to give us as we have to give them.
We would like to hear about the impact that peer support has had in your recovery and whether there are additional components of peer support that you would add to this definition. Tell us how your definition of peer support has changed over time and what has precipitated this change. Please email us with your comments.