Abstract
Several years ago, I was fortunate enough to participate in the development of a primary care behavioral health integration clinic that was initiated by a SAMHSA (Substance Abuse and Mental Health Services Administration) grant. This clinic is truly providing the “whole health connection” in one geographic location. We included a peer specialist on our staff and subsequently attended a presentation by Nanette Larson on the role of “peer to peer” work in the Integrated Behavioral Healthcare Home. I immediately knew that she was extremely knowledgeable, funny, and could help us understand how to support recovery through the lens of a person with lived experience.
There is growing evidence that providing peer support that includes positive self-disclosure can effectively engage people into care and increase their sense of hope, self-care, sense of community belonging, and satisfaction with various life domains while also decreasing their level of depression and psychosis (Davidson, Bellamy, Guy, & Miller, 2012). As nurses move toward more interdisciplinary team models of care, one of the traits that has been identified in successful interdisciplinary teams is respecting and understanding roles (Nancarrow et al., 2013). I believe that fostering connections with health care team members and with our patients is a key function of our “whole health connection” role as psychiatric-mental health nurses.
Nanette graciously took the time to sit down with me and provide insight into the role of peer to peer connection in promoting whole health for persons with mental health and substance use disorders. The interview is detailed here.
I have seen in the literature that there is discussion about the lack of a clear role for the peer to peer specialist (Mahlke, Krämer, Beck, & Bock, 2014).
I have difficulty with the term peer. I didn’t want yet another word that defined my job by who I am. I was hired as a consumer specialist and one of my first questions was, “What do I specialize in, being a consumer? That makes no sense to me; please define my job.” But what I got back was, “Well you’re here to help us define your job. We really don’t know what that’s going to be yet.” A lot of people in these roles have been faced with that very same response, “We don’t know; what do you think your role should be?” That was in 1999 for me—so that’s 20 years—during which the field is still trying to figure out a clearer way to define the role.
I was incredibly grateful that I was hired. I was truly hired because I have a history of mental illness. I want you to know that nobody wants to be hired because they have a certain trait; you want to be hired because you have skills. We had to figure out the unique role for these folks, not just hire token consumers.
So how would you title the job for starters?
Recovery Support Specialist. It states the goal of the role. I know we have been through a number of iterations of how people in psychiatric care are named. Patients, clients, consumers, peers, people with lived experience. Then they come to hate it, for the same reason they hated the others . . . because it became a label that denoted this is a person with a mental illness. When we use a term that is labeling, it becomes a problem.
Can you talk about the recovery support specialist role? What would you identify as the unique functions of a recovery support specialist?
Number one: The instillation of hope through positive self-disclosure (Davidson et al., 2012). One of your questions to me was, what are the qualities of a good peer specialist and who should not be a peer specialist? This is part of it. Do I use my storytelling to provide you hope or do I just drone on and on about myself? What we found is that a consumer does not always make a good recovery support specialist. Just because you have the lived experience doesn’t mean you’re good at this. Part of being good at this is knowing when to talk about yourself and when to shut up, knowing how to share stories from the lived experience in a hopeful way and not just, “You had tragedy, I have a tragedy, let’s all be tragic.”
Number two: The role modeling function (Davidson et al., 2012). What makes a good recovery support specialist is one who’s living recovery. This is the role modeling function through self-care of one’s illness. Part of what makes me really, really good at my job is taking really, really good care of myself.
Right, practicing what you preach, right?
Right. What the patients see from a recovery support specialist is someone who really does what we’ve been taught. So, the more I take care of me, the better I do my job. It’s not selfish. It’s you doing your job well because if you’re not taking care of your own wellness, you’re a crappy role model and that’s your number one job is to show people how to live with this illness and live well.
I say that to my staff, Nanette. We in psychiatry should be modeling mental health. We really should go further to modeling whole health.
Another point that shows up in research is that role modeling includes negotiating daily life—not only with the illness, but also with other issues you can imagine—little or no income, housing issues, dealing with stigma, dealing with the maze of the human service system (Davidson et al., 2012). What individuals receiving our services get from us is: I too am dealing with this stigma and discrimination and here’s what I do. I too am having to navigate the maze of this complex mess because I too am maybe on Medicaid, for example. People that benefit from the service of recovery support specialists are benefiting from seeing someone who is not above all of that, but who is either still living in it or has survived it. And, as much as persons with these illnesses need a role model, their families desperately need to see someone who has this illness who is living well.
Right. And maybe has a few clues as to services that even well meaning friends and professionals might not know about.
The third role of a recovery support specialist is the unique use of empathy based on having been in the same shoes (Davidson et al., 2012). Anybody can offer empathy, but obviously, what the recovery support specialist brings that others either don’t or don’t disclose is that unique use of empathy. What I’ve said many, many times is that one out of five Americans are living with mental health issues. That probably means one out of three or one out of two of the staff working in our field are living with mental health issues. (N. Larson, October 2, 2018, Personal interview)
What does this mean for us? When I asked Nanette about psychiatric-mental health nurses, she said, “Psychiatric nursing is about the care of the whole person. What the psychiatric nurse brings that enhances his or her role is the additional ability to bring that emotional comfort.” How does knowing about the unique role of a recovery support specialist affect how you approach the whole health care you provide? As psychiatric-mental health nurses strive to embody the “whole health connection,” it is valuable to consider the roles our fellow team members play in connectedness and well-being, and how we help foster and value those essential connections.