By Brian W Major
In this time of cuts to public healthcare and attacks on Safe-Injection Sites by conservative governments across Canada, there are serious concerns and debates about the proper delivery of healthcare.
In 2023, there were 8,049 deaths in Canada due to drug poisoning. Governments like Doug Ford’s Conservatives in Ontario are insisting that complete abstinence from substances is the only way forward if someone wants healing and recovery. But this approach ignores the value of peer support and social investment in community mental health care, as well as the importance of client choice in recovery.
Peer support is a relatively new approach which has been establishing itself as a more holistic and progressive model for healthcare delivery, particularly for mental health and addictions. The key idea is that people with lived experience could remarkably aid or, for many, replace the provision of traditional “medical model” mental health and addiction care.
Peer supporters work in a range of healthcare settings. Some work for agencies, often called “consumer-survivor initiatives” (CSI), which exclusively feature peers. Some community agencies, such as the Canadian Mental Health Association, employ a large number of peers (including this writer) who are placed on almost all interdisciplinary health teams. The other end of the model includes peers who work in maximum security forensic psychiatric hospitals.
Some peers have advanced degrees and may come from regulated health professions, while others emerge from peer recovery courses offered from a CSI. Regardless of education or professional training, peers establish a close bond with the person receiving care, who they support as a fellow peer rather than as a traditional patient or “client.”
In most models of healthcare delivery, it is considered inappropriate for physicians or nurses to make personal disclosures with their patients. But for peers, it is that very crucial interchange of shared life stories which serves as the essential building block of rapport. Based in a “recovery model,” peer support sees empowerment and mastery of one’s own life as critical.
Many people who access mental health supports have said that they appreciate and need their psychiatrist for the prescription of meds which help reduce the symptoms to the point that they are manageable. Social workers, nurses and occupational therapists can also offer critical support which can jointly help someone toward a journey of recovery, and peer support can be part of this as well. Many people find that medications take away the worst elements of symptoms, to the point that a peer group can lead to strategies for recovery.
The modern peer support movement has its roots in the patient rights and liberation movement, which came of age alongside the Black, Queer and women’s liberation movements. For many decades, patients were admitted to psychiatric hospitals which did not focus on recovery or improvement – instead, it was a custodial environment designed to protect the public from “dangerous” or “insane” people. In contrast to this approach, the patient liberation movement is based in valuing patients’ choice and freedom to choose what methods their recovery will take.
Back to the issue of substance use in the current context, Ontario’s Ford government has prioritized the abstinence model – this can certainly help people who are committed to that choice for themselves, but should the debate really be one of “abstinence vs. harm reduction” or should it be one of “what does the recovering person choose for right now?” This is a key issue for peer supporters, who build rapport with clients and provide support no matter what their decisions are at any given point.
Peers are also well placed to help clients understand how medications, treatment models and other mental health professions have worked for them. Far from telling patients what to do (taking meds, for example), peers hold the hope of recovery and empower clients to make positive choices. Compassion for our fellow person is the key way that change happens.
Mental health and addictions care cannot be separated from other social programs and supports. One of the successes of the patient liberation movement was that thousands of patients across North America were discharged from psychiatric hospitals that had held them for long periods of time. While undoubtedly progressive, there was an insufficient social investment in supportive housing, community social work and community-based mental healthcare, so many patients became homeless or lived in inadequate housing. Over the years, some of this social investment has been developed, but there is still much to do. To be frank, it is much cheaper and healthier to house and support a person in the community than inside a hospital or prison.
Some governments have funded community mental health initiatives. But Canadian society has a long way to go in funding mental healthcare as much as physical health.
The author has worked in community mental health for over 20 years, including 10 years of peer support for mental health and addictions.
[Photo: Peer Support Canada]
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