Monday, September 8, 2008

From Mental Health Patient to Peer Counselor

Last week I received a letter from a former patient - someone I first met during my residency who now lives elsewhere in the country - describing work as a peer counselor. Over the years the person (as part of the disguise process I'm avoiding terms of gender) has had to struggle with a very severe psychiatric ailment, with multiple hospitalizations, episodes of substance abuse, suicidality and more. For me the trajectory from the initial role of disabled patient to the new role as helpful peer is inspiring. Here are some excerpts from the letter:
1. Almost every work day I sit down 1 to 1 with a client who is either anxious, depressed, or has a myriad of problems, some of which I can help with, some for which moral support is enough, some for which advice is appropriate, and some that require referral.

2. I help some clients with their job search. We look on line and also check the local paper. I sit down with each one and do role playing, as in an interview. Clients seem to find that helpful. We then struggle to write a reasonable resume. This can be difficult. Many clients here are not well educated and don't have a good work history. It is a challenge but we keep plugging away.

3. I accompany clients to various appointments when necessary. For example, one client is a young parent (a recovering alcoholic) whose child has been diagnosed with ADHD and needed an evaluation. The client asked me to go to the appointment and sit in on the discussion with the doctor. Another situation is X, who was diagnosed with brain cancer. X's spouse, who is also a client at the Center, was devastated by X's illness and could not provide good support. I accompanied X to the hospital so many times I can't count. I'm glad to say that X is currently in remission. There are a hundred other little stories.

4. Another counselor and I run a "share and support" group twice weekly. It's pretty popular and well attended.

5. We help people find housing too. That's about it!
Peer counseling programs didn't exist when I was a resident. Innovators like my mentor Gerald Caplan proposed the concept, but at the time it was seen as a far out idea.

My former patient's recovery process reflects hard work, innate abilities that have weathered the disease process, and strong support from facilities in the new location. The example of effective peer support in AA and NA has helped the wider community recognize the possibility that people recovering from severe psychiatric ailments could provide powerful support in the way AA and NA sponsors often do. Consumer advocates have fought for recognition of the peer counselor role, and many state and federal agencies have endorsed the function (see here).

So while my former patient's story reflects courage, resilience and innate strengths, the environment offers opportunities and supports that were not present at the onset of the illness forty years ago. It has been a difficult life, but the letter I quoted from conveys a sense of pride and self respect.


Anonymous said...

This important new peer counselor role does offer the benefits described in your post. It also has raised issues in our organization about whether/how to change rules prohibiting a person who is an employee also receiving mental health services from the organization employing her/him. I'd be interested in others' perspective on this issue.

Jim Sabin said...

Dear anonymous -

Most of the systems I'm aware of have the same rule that your organization has. That said, my clinical impression is that the rule is too rigid. A complex, transference-based psychotherapy should not be conducted in the patient's work site. But lots of mental health services are more like other psychologically attuned medical services and involve counseling, guidance, and often medication. Over the years I had many experiences of treating folks who worked for the group I practiced with as patients that were very successful.

I would personally favor a "guideline" that urged caution and that spelled out some clinical recommendations (no intensive, transference-based psychotherapy, but CBT, medication, and the like could be assessed on an individual basis) rather than a strict prohibition.

Some of the most interesting, and successful, self-referrals I dealt with were clinical colleagues who observed the way I practiced as a form of kicking the tires and decided they could trust me.