Transcript Building Resilience Through Peer Support

Building Resilience
Through Peer Support
The Mood Disorders
Association of Ontario
• The MDAO offers free support and recovery programs to
people across Ontario living with depression, anxiety or
bipolar disorder.
• We provide drop-in peer support groups, recovery programs,
individual counselling support, early intervention for mood
disorders and psychosis and online tools focused on wellness
and recovery.
MDAO Values
• Recovery and self-discovery are possible
• Building hope is key
• Peer support based on lived experience can contribute to
recovery
• We support a comprehensive approach to recovery that meets
the unique needs of each individual
• Supporting families can help them play a positive role in
recovery and contributes to the well-being of the family
• It is possible to reduce both stigma in society and self-stigma
Resilience
• Resilience has been defined as “the process of adapting well in
the face of adversity, trauma, tragedy, threats or significant
sources of stress — such as family and relationship problems,
serious health problems or workplace and financial stressors.”
• It means "bouncing back" from difficult experiences.
(American Psychological Association [APA], 2015)
Resiliency Capacities
• Social Competence
• responsiveness, cultural flexibility, empathy, caring,
communication skills and a sense of humour
• Problem Solving
• planning, help seeking, critical & creative thinking
• Autonomy
• sense of identity, self-efficacy, self-awareness, task mastery &
adaptive distancing from negative conditions
• A sense of purpose and the belief of a bright future
• goal direction, educational aspirations, optimism, spiritual
connectedness
Fostering Resilience?
• Benefits
• Manage and minimizes stress
• Boosts self-esteem
• Increases confidence
“Resilience flourishes when security and predictability
coexist with a manageable balance with novelty and the
unexpected.”
-Gabrielle Bauer
Peer Support
“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.”
(Stiver & Miller, 1998)
Traditional Power Dynamics
The Label of “Mental Illness”
“To me, mental illness meant Dr. Jekyll and Mr. Hyde, psychopathic serial killers, loony bins, morons, schizos, fruitcakes, nuts,
straight jackets, and raving lunatics. They were all I knew about
mental illness, and what terrified me was that professionals were
saying I was one of them. It would have greatly helped to have had
someone come and talk to me about surviving mental illness—as
well as the possibility of recovering, of healing, and of building a
new life for myself. It would have been good to have role models—
people I could look up to who had experienced what I was going
through—people who had found a good job, or who were in love,
or who had an apartment or a house on their own, or who were
making a valuable contribution to society.”
(Deegan, 1993)
Peer Relationship
Core Values of Peer Support
(Peer Support Accreditation and Certification Canada [PSACC], 2014).
Recovery?
• Self-defined and driven by the individual
• Key principles include:
o Hope
o Self-determination and autonomy
o Personal responsibility
o Self-advocacy and empowerment
o Support
o Learning, growth, and self-definition
o Fostering resilience
• Living the life you want to live, even though you experience
mental health issues
Types of Peer Support
• Informal Peer Support
• “naturally occurring, mutually beneficial support
process…meeting as equals, sharing skills, strength, and hope…”
• Formalized Peer Support
• Peers receive “specialized training” and “assume unique,
designated roles within the mental health system”
(Ontario Peer Development Initiative [OPDI], 2010)
• Peers in traditional roles
• Peers with job descriptions that aren’t inherently self-disclosing
(e.g. social worker, psychologist, etc.)
What did you call me?
•
•
•
•
•
•
•
•
•
•
•
•
•
“Consumer/Survivor”
“Service User”
“Client”
“Patient”
“Nutjob”
“Person With Lived Experience” (PWLE)
“Individual”
“Person with mental health issues”
“Peer”
“Crazy”
“Addict”
“Schizophrenic”
“Mentally Ill”
What did you call me?
•
•
•
•
•
•
•
•
•
•
•
•
•
“Doctor”
“Psychiatrist”
“Shrink”
“Social Worker”
“Child Snatcher”
“Peer Support Worker”
“Therapist”
“Counsellor”
“Case Worker”
“Quack”
“Mental Health Professional”
“Life Coach”
“Health Care Provider”
The Importance of Language
“There are multiple descriptions of the same real world
situation. The only justification for language is to
empower yourself. If the verbal description you create
of the situation you find yourself in leads to paralysis
and ineffectual behaviour, then throw those damn
words away and find yourself a new set. There is
always some useful description of the world that
empowers and gives you choices. Your task, if you are
going to use words at all, is to find that set of words.”
–Moshe Feldenkrais
Peer Support Works
A robust and growing research evidence base shows peer
support is associated with:
• Reductions in hospitalizations for mental health problems
• Reductions in “symptom” distress
• Improvements in social support
• Improvements in people’s quality of life
(Mental Health Commission of Canada, 2010)
• Stigmatization is negatively related to self-esteem, while peer
support is positively linked to self-esteem
(Verhaeghe, Bracke, & Bruynooghe, 2008)
Peer Support Works
Possible benefits include:
• increased self-esteem and confidence
• improved problem solving skills
• increased sense of empowerment
• improved access to work and education
• more friends, better relationships, more confidence in social
settings
• greater feelings of being accepted and understood (and liked)
• reduced self-stigmatization
• greater hopefulness about their own potential
• more positive feelings about the future
(Centre for Mental Health and Mental Health Network, NHS Confederation, 2013)
Peer Support Works
• Meta-analysis showing peer support associated with:
•
•
•
•
•
•
Reduced inpatient service use
Improved relationship with providers
Better engagement with care
Higher levels of empowerment
Higher levels of “patient activation”
Higher levels of hopefulness for recovery
(Chinman et al., 2014)
• Peer support associated with:
•
•
•
•
Improvement in empowerment, hope, and self-efficacy beliefs
Decreased hospital frequency and duration of hospital admissions
Decreased substance use and depression
Increased hope, self-care, and sense of well-being
(Davidson, L., Bellamy, C., Guy, K. & Miller, R., 2012;
van Gestel-Timmermans, Brouwers, van Assen, & van Nieuwenhuizen, 2012)
Peer Support at the MDAO
• Drop-in Peer Support Groups
• Registered Recovery Programs
• Wellness Recovery Action Plan (WRAP)
• Laughing Like Crazy
•
•
•
•
One-on-one Counselling Support
Family Programs
“Warm line” and online peer support forum
Volunteer Opportunities
Peer Support Training
Peer Support Training
• At MDAO, 4 day intensive peer support training for peer
volunteers, designed by peers and for peers:
• Days 1 & 2: Foundational peer support training
• Day 3: Group facilitation
• Day 4: Working one-on-one with peers
• Emphasis on experiential, self-reflective learning
• Exploring how peers can fit their experiences to the
framework of the training (vs. other way around)
• Training peers to make intentional choices around what
aspects of their experience they can use in offering support to
others
• Ongoing training and support provided over the course of
everyday practice
Research and Evaluation
Research and Evaluation
• For structured Recovery Programs:
• Quantitative data gathered via pre and post surveys to measure
any positive or negative changes after program completion
• Standard Likert Scales on a variety of recovery measures
• Client Satisfaction Questionnaire (CSQ-8) post-program to measure
client satisfaction
• WRAP for Families: 94% overall rating for client satisfaction
• Qualitative data gathered post-program via focus groups
• Planning 3 and 6 month follow-ups to assess more long-term
changes
• For drop-in peer support groups:
• CSQ-8 + additional questions specific to group
Peer Support Across Ontario
Systemic Change
References
American Psychological Association. (2015). The Road To Resilience. Retrieved 13 May
2015, from http://www.apa.org/helpcenter/road-resilience.aspx
Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift,
A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals
with serious mental illnesses: Assessing the evidence. Psychiatric Services,
65(4), 429-441.
Centre for Mental Health and Mental Health Network, NHS Confederation . (2013). Peer
Support Workers: Theory and Practice. London, UK: Repper, J., Aldridge, B.,
Gilfoyle, S., Gillard, S., Perkins, R. & Rennison, J.
Davidson, L., Bellamy, C., Guy, K. & Miller, R. (2012) Peer support among persons
with severe mental illnesses: a review of evidence and experience. World
Psychiatry, 11, 123-128.
Deegan, P. E. (1993). Recovering our sense of value after being labeled mentally ill.
Journal of Psychosocial Nursing, 31, 7–11.
O’Hagan, M., Cyr, C., McKee, H., and Priest, R., for the Mental Health Commission
of Canada. (2010). Making the case for peer support: Report to the Peer
Support Project Committee of the Mental Health Commission of Canada.
Retrieved from: http://www.mentalhealthcommission.ca.
References
Peer Support Accreditation and Certification Canada [PSACC]. (2015). Certification
Handbook | PSAC (Canada). Retrieved 13 May 2015, from http://www.psaccanada.com/certification-handbook/
Sunderland, Kim, Mishkin, Wendy, Peer Leadership Group, Mental Health Commission
of Canada. (2013). Guidelines for the Practice and Training of Peer Support.
Calgary, AB: Mental Health Commission of Canada. Retrieved from:
http://www.mentalhealthcommission.ca.
van Gestel-Timmermans, H., Brouwers, E. P. M., van Assen, M.,A.L.M., & van
Nieuwenhuizen, C. (2012). Effects of a peer-run course on recovery from
serious mental illness: A randomized controlled trial. Psychiatric Services,
63(1), 54-60. Retrieved from:
http://search.proquest.com/docview/1368609606?accountid=14771
Verhaeghe, M., Bracke, P., & Bruynooghe, K. (2008). Stigmatization and self-esteem of
persons in recovery from mental illness: The role of peer support. International
Journal of Social Psychiatry, 54(3), 206-218. doi:10.1177/0020764008090422