Reflections on Peer Support: Visions of Opportunity for 2030

Holly Harris MA & Sophie Soklaridis PhD | Centre for Addiction and Mental Health

Introduction

We were honoured to be invited guests of Imroc’s event entitled Peer Support: Visions of Opportunity for 2030. We were deeply moved by the overwhelming passion of the 180 participants representing diverse organizations, groups, identities, approaches, experiences, and expertise. These voices contributed to fruitful discussions about the nuances of advancing peer support and lived experience agendas in the United Kingdom (UK). While creating space for and celebrating differences, the event fostered a shared vision, understanding, and approach forward, informed by diverse perspectives.

The event consisted of engaging presentations by thought and practice leaders in peer support as well as interactive workshops exploring the following topics:

1. Approaches to influencing policymakers, commissioners, and managers so that far more peer support workers (PSWs) are commissioned and employed across all sectors in the system

2. Approaches to disrupting hierarchies in formal peer support and opportunities to learn from those with diverse and historically marginalized perspectives

3. The importance of spirituality frameworks for understanding and supporting people through challenging times

4. Opportunities for increasing the reach of peer support

5. Perspectives on the value of a peer support body that could represent PSWs and develop occupational standards

6. Organizational approaches to supporting PSW employees

This invited report highlights our Canadian perspectives on the event and its outcomes through the lens of equity, diversity, and inclusion (EDI). In this report, we explore the questions raised across the interactive workshops, our reflections, and considerations for future directions. Specifically, we explore the nuanced conversations regarding the expansion and diversification of peer support, the possibility of an oversight body, and mechanisms for supporting PSW employees.

It is important to note that our positionalities influence our interpretation and valuing of different practices and ideas. As such we have included positionality statements and invite readers to consider the perspectives represented, how they influenced the writing of this report, as well as the voices that are missing (see Table 1).

Expanding Peer Support

There was a palpable energy surrounding the widespread recognition of the value of peer support for people experiencing mental health-related challenges, as well as its potential benefits for other communities. For example, participants believed that peer support could be helpful for those who identify as neurodivergent, those experiencing physical health conditions, and those navigating post-secondary studies. However, participants expressed varying levels of support for expanding the profession within the current mental health system.

On one hand, some participants expressed concern that the number of peer support workers in the UK had plateaued over the past five years. These participants suggested that we need more PSWs, in general, and PSWs with strong advocacy skills, in particular, to advocate for the continued expansion of resourcing to support peer roles. On the other hand, some participants indicated that we must proceed with caution when considering expanding the peer support workforce, recognizing the misalignment between the values of peer support and the structures and processes within the mental health system more broadly.

Current structures and processes impacting PSWs health and well-being were highlighted through a consciousness-raising activity. Participants were asked, “what makes us sick?"

Participants highlighted systemic injustices such as capitalism, patriarchy, racism, and poverty. Participants also noted that what makes us sick is being constructed as sick. This is a counternarrative to dominant biomedical conceptualizations of “mental health problems” (Prince et al., 2007) which situates them as an objective individual reality. Through this workshop, participants considered a different school of thought- that “mental health problems” are social constructions that are rooted in an unjust and uncaring society (Barnes, 2020) and that people who navigate wellness in ways that diverge from norms of the dominant group are pathologized, problematized, and othered. By individualizing and medicalizing “mental health problems”, proponents of this stance would suggest that we misplace the onus for addressing these problems from the systems and structures that construct individuals as sick. Consistent with this school of thought, participants shared that the goal of peer support is to recover from systemic harm rather than “mental health problems”. This poses important questions: 1) How can we interrogate the often unquestioned existence of “mental health problems” as existing within an individual?; 2) How can we honour diverse ways of knowing and alternative conceptualizations of “mental health problems”; and 3) What is the role of peer support in systems that construct individuals who experience mental illness as sick?

Participants were also invited to reflect on what makes them feel safe, held, and whole. They named connection, choice, and community. It was striking how many of the elements that participants indicated make us sick are deeply embedded in mainstream mental health services while what makes us feel safe, held, and whole are largely embodied, community-oriented, and relational. This led to interesting conversations about the role of mainstream biomedical mental health services in the future of the peer support movement and prompted consideration as to whether the goals of peer support can be realized within the current mental health system.

Diversifying Peer Support

When discussing the diversification of peer support, participants warned that focusing on getting “diverse faces into spaces” fails to consider how existing spaces may lack readiness to meaningfully integrate their perspectives and expertise, and thus have the potential to cause harm. Participants highlighted the need to be thoughtful and careful when seeking engagement from marginalized communities so that the benefits of engagement do not only benefit systems but also the communities.

This is consistent with recent critiques of inclusion which invite us to consider how the concept of "inclusion" can be extractive and based on a model of assimilation whereby marginalized groups are expected to assimilate into spaces and systems that are controlled by, and ultimately serve, dominant groups (Ferdman, 2017). The concept of inclusion in its current application, perpetuates the status quio as it remains with the dominant group to decide how and when to “include” marginalized communities. The group proposed two paths forward: 1) The mainstream mental health system could support communities by providing resources without exercising control; or 2) The mainstream mental health system will need to transform through engaging communities to co-design spaces that fit community needs. Both paths would involve unlearning and challenging notions of paternalism that are deeply rooted in the psychiatric system. Through this workshop, it was very apparent that there are complex barriers to equitable and inclusive futures for peer support and mental health systems.

Peer Support Oversight

The conversations regarding the development of an overarching peer support regulatory body and certification process were nuanced. On one hand, some appreciated the credibility that a regulatory body and certification process could provide within the mental health system. This credibility could lead to material benefits such as funding, resources, and support for PSW roles. Increased support for PSW roles could create valuable opportunities for career progression—something that is currently lacking for PSWs. Additionally, some participants felt that a regulatory body could ensure peer support is practiced with fidelity. However, while people recognized the power of a collective voice, they expressed concern about the potential for a regulatory body to "suck the soul" out of peer support, forcing the homogenization of the diverse approaches needed to address contextual needs and assimilation into traditional psy regimes of power. This raised the following questions: What would a regulatory body undo, produce, and uphold (Voronka & Costa, 2019)?

Participants expressed concern that transforming peer support into a regulated profession could result in losing its organic, political, and radical roots. Originally established to challenge the oppression of psychiatrized individuals and provide alternatives to clinical treatment (Leamy et al., 2013), regulation risks shifting peer support from a "movement" to a "model," becoming absorbed into dominant mental health practices (Voronka, 2017). It is important to consider that if we focus on regulation as a means to make peer support more palatable to mainstream mental health services, we reinforce psy regimes of power and succumb to the political apparatuses that produce, manage, and sustain dominant pathological constructions of mental distress and neurodivergence that peer support originally sought to challenge. Without carefully rethinking and reforming the traditional approaches to the regulation of professions, we risk limiting the possibilities of what can be thought and said, and the political implications of this. (Sinclair et al., 2023; Herrington Group, 2005). Specifically, by assimilating peer support into systems that are rooted in pathological constructions of mental distress, we limit the ability of peer support to offer alternative perspectives and problematize the structures that constitute people as “mentally ill”. By assimilating into the discourse of credentialism, we risk perpetuating the legitimization of particular voices to the exclusion of others (Lancaster et al., 2017).

To address some of these concerns, rather than focusing on a regulatory body, there was interest in exploring the possibility of a body that provides legal and occupational support. There was discussion about the possibility of a peer support union, but apprehension arose when discussing that this would only be available to PSWs who were formally employed. After much discussion, the group seemed to tentatively land on the idea of a peer support alliance in which people could get support, collaborate, and engage in multi-directional learning (Soklaris & Harris et al., 2024). An alliance would support a balance between fidelity and contextual adaptation, allowing peer support to preserve its integrity while honouring its deeply relational values.

Supporting Peer Employees

Although participants had varying perspectives on the future of peer support within mainstream mental health services, they were able to provide recommendations for how organizations could best support PSW employees. Specifically, participants identified that, to realize the transformative impacts of peer work, organizations must employ multiple PSWs with representation across levels of governance but cautioned that the value of peer support can't be realized through a “add a PSW and stir” framework. Rather, organizations must establish readiness to meaningfully integrate the perspectives of PSWs and demonstrate a willingness to amend their structures and processes accordingly. In establishing readiness, several participants described the importance of engaging in capacity building for healthcare professionals to understand the value that PSWs bring, the scope of their role, and their unique skill set. Without capacity building, participants expressed concern that if a PSW voiced a perspective that contrasted with that of a healthcare professional, the privileged perspective of the healthcare professional might overshadow the PSW's viewpoint, potentially leading to the PSW's perspective being dismissed or even pathologized.

Employing PSWs without the intention to shift the organizational culture to make space for ways of knowing that diverge from the status quo is a recipe for tokenism and co-optation. The inclusion of PSWs without a willingness to integrate their perspectives obscures and perpetuates harmful power dynamics that privilege professional expertise over other ways of knowing. By obscuring these hierarchies, it hinders the ability to see, name, and address injustices and harms, leaving oppressive structures, and practices intact. By adopting compassionate and collaborative leadership models, along with shared decision-making, co-production, and power-sharing, we can transform mental health systems into peer-capable and liberating environments.

Conclusion

As we reflect on the event, it is clear to us that the peer support movement is vibrant in the UK. Participants laid the groundwork for the future of peer support through discussions on expanding and diversifying peer support, supporting peer employees, and exploring the value of an oversight body. The event honoured diverse perspectives and approaches, mutual support, and nuanced discussions about power; an embodiment of peer support’s core values. While participants shared an understanding of the role peer support can play in challenging the oppression and marginalization of people with lived experience of mental health challenges, their perspectives on how to actualize these goals varied. Opinions differed on whether system transformation should occur from within mainstream mental health services, from outside, or by straddling the boundary. Despite these differences, participants recognized the value of addressing system transformation from all angles, recognizing that complex challenges require complex solutions. This gives us hope.

Centreing lived experience within healthcare systems is not a simple process. In fact, it is a deliberate process meant to introduce complexity into homogeneous systems and structures (Soklaridis, 2024). Transformative change requires complex thinking, while simple solutions tend to obscure power and perpetuate tokenism. While the steps forward for peer support may be wobbly and tentative, there was a consensus on one overarching principle to guide this journey:

solidarity.

As a first step in fostering solidarity, participants advocated for a needs assessment to understand the full scope of peer support initiatives, practices, and approaches as well as an asset mapping exercise to explore the collective strengths of the peer support community across the country. With this in mind, the UK will forge a path forward for the peer support movement, with other countries continuing to look to its leadership for guidance.

This event added fuel to the fire of the peer support movement, reigniting its transformative potential and reinforcing the strong ties amongst this community. Consistent with the principles of peer support, through leveraging strengths and engaging in mutual support, the peer support movement will move towards its goals, more equipped and well-informed than ever.

Table 1. Authors' positionality statements.

Holly Harris

I acknowledge the intersectional privilege/oppression that I experience on account of my identity. I am a white, middle-class, cisgender female, born and raised in Canada with Western European ancestry. I identify as someone who is neurodivergent and as someone who has accessed the psychiatric system for most of my life. Academically and professionally, I leverage my lived experiences as a source of strength, resilience and expertise to highlight the voices of those who have been historically silenced.

Academically, I have a Master’s degree in Critical Disability Studies and am pursuing a PhD in Gender, feminist, and women’s studies at York University in Toronto, Canada.

Professionally, I have been working in community-engaged mental health research and programming for the past 7 years with roles in peer support, research ethics, and research. I currently work as the Research Coordinator for the Collabroative Learning College

(operating on the Recovery College Model) at the Centre for Addiction and Mental Health. My research interests include Recovery Colleges, peer support, co-production, lived-experience engagement, and mad studies.

I acknowledge that my lived, academic, and professional experiences influence the value I place on specific ideas as well as my interpretations.

Sophie Soklaridis

I am a Canadian-born scholar and the daughter of Greek immigrant parents. I offer this report as only one possible interpretation based on my constructivist/interpretivist standpoint and as someone who has done research in the area of co-producing mental health education research through equitable partnerships among scientists, people with lived experience, healthcare providers and the intersections of these identities.

I hold a PhD in Public Health Science with a specialization in Gender and Feminist Studies. I am an Associate Professor at the Department of Psychiatry at the University of Toronto, Temerty Faculty of Medicine. I am also a Research Chair in Recovery and Equity Focused Mental Health Education Research. I acknowledge that my positionality influenced the writing of this report to some extent.

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