NYAPRS Note: As peer support moves to the forefront of the BH dialogue in NY and at the national level, it is important to highlight the methods that offer meaningful outcomes within the work of peer specialists. Peer support begins with mutuality and a horizontal relationship, but is sustained through a trauma informed paradigm within each developing relationship, and affirmed by community supports that are self-directed. In this beautifully written article from a peer support mentor at the Empowerment Exchange in Rensselaer County, we can uncover the breadth and significance of those relationships.
Trauma Informed Peer Support at The Empowerment Exchange
Matt Hamzaoui, Peer Support Mentor
In a recent study to measure outcomes at The Empowerment Exchange (A program of Mental Health Empowerment Project, Inc.), Dr. Cheryl MacNeil at The Sage Colleges and four peer investigators used The Peer Outcomes Protocol Questionnaire to measure the outcomes of peer support within the program. They discovered that although 73% of the participants reported having experienced emotional difficulties, 75% of those participants claimed the peer support program prevented these difficulties from turning into a psychiatric crisis and 70% of the study participants reported the program helped them to stay out of the hospital. Participants reported that the program helped them by providing support whenever needed (91%), giving them someone to talk to (91%), helping them to cope with their symptoms (81%) and helping them to involve other people in their life (86%).
Mental Health Empowerment Project is a peer run not for Profit Corporation organized in 1988 in order to develop and strengthen self-help and recovery activities throughout the United States. We offer a variety of pathways to help individuals identify their strengths, gifts, and talents, and what I’d like to talk about is not only what we do, but how we do it. As a peer run and recipient served organization it is relationship that is the primary factor that informs our daily activities. How we relate with each other as a team, the people we serve, and ourselves often determine how our services evolve. What does that mean? It means most of the staff and at least 75% of the board has some experience using mental health services. Don’t we all do things with and for each other that support our own mental health? Though we all experience the peaks and valleys of stress brought on by unexpected environmental circumstances, the way we deal with that stress depends very much on what resources are available to us, we are knowledgeable about, and we choose to utilize in order to exercise personal agency. The EE seeks to educate, and advocate for people about resources in the community that are available to them.
Another perspective might be that our sense of wellbeing and connectedness; resilience and efficacy, are social issues that can be addressed in relationship and dialogue about the environments we utilize in order to structure our lives and feel safe. Many of us possess natural supports that allow us to minimize the effects of stress on our lives. For some of us, for one reason or another, these natural supports have either been worn away or never fully established, often as a result of trauma. As a trauma informed organization, peer support mentors at the EE don’t usually ask questions about what is wrong, but rather seek to assist the people we serve in discovering their own truth about what happened.
By developing one’s own personal history in a natural, safe and organic way with the intentional support of someone who is willing to relate their own challenging experiences to the alienation, marginalization, or isolation resulting from the erosion of natural supports such as family, friends and faith, it is hoped that trust and understanding arise in the presence of non-judgmental acceptance of wherever a person happens to be that moment. In doing so we do not seek to establish a particular plan for another person or determine what goals are best suited for them. Though we do support people creating their own Wellness Recovery Action Plans and have the materials on-site to accomplish that.
In supporting someone in developing their own history of what happened, it often occurs that a person expresses their own aspirations, goals, dreams or passions naturally through dialogue . At times like this, Peer Support Mentors are then able to leverage Empowerment Exchange’s partnerships throughout the community in order to affect conditions so that they might be more suitable for an individual to actualize an aspect of their lives that brings them happiness. In practice, the relationship becomes more important than the problem. In developing authentic trusting trauma informed relationships we find their efficacy is most prevalent in situations where both parties take an active role in sharing the risk of communicating some amount of experiential knowledge gained from past. As this is the basis of developing trust in natural support systems, such as friends, family, neighbors, civic groups, faith groups, etc. we seek to model natural supports in order to assist people in developing their own. In this case being a peer is not only about having a set of experiences one is willing to relate, but also about the way that we relate. We do so in a way that seeks to minimize the power imbalances sometimes experienced in the client provider relationship. While there are times this may be necessary, this perspective serves as an alternative.
While power and privilege cannot be totally eliminated as one of us is being compensated for our time, we come pretty close. In order to maintain a connected relationship in this manner a great deal of self-care is emphasized with the staff both individually and collectively, and most of us are engaged in CA practices that support ourselves and each other as we recognize that meeting the whole person where he or she is means we also have to show up as we are as whole as we are able. These practices have served us well and include meditation, music, reiki, journaling, daily affirmations, and yoga among others. For example, in 2012 I spent 70 days in silent retreats practicing meditation. While that level of commitment is not available to all people at all times, the experience taught me something about myself and the internal dialogue that relentlessly comments on everything my senses come into contact with. From this worldview, the fact that some people verbalize this inner dialogue more than others is a relatively minor point as trust is developed and sustained a worldview emerges that informs how it is we know what we know. At times these views may be similar at other times quite divergent. Neither appears to be an impediment to maintaining a connection so long as we are willing to acknowledge what we know with humility and admit what we don’t know with curiosity common ground often emerges. Having cultivated a connected relationship based in worldview and mutuality the framework of a naturally supportive human relationship is in place. Now, it may, or may not, be time to look at solution to “problems”. Now we know enough about a person and that person knows enough about us, that the possibility of offering alternatives can be introduced naturally without the hierarchical dichotomies that so often direct concepts such as compliant and noncompliant.
Sometimes people are aware of a problem right away, others want to talk, still others find the idea of dialogue challenging and prefer silence, and yet others have had their behavior directed for so long within the Mental Health system that autonomous decision making seems uncomfortable and foreign. In these situations we try to resist offering bullet point solutions and work on connection, and trust. In any case, we try to listen with present moment non judge mental awareness that validates every human beings right to make their own informed decisions about care treatment and interventions as well as connect to their passions, abilities, and aspirations. The results have been astonishing to me: hearing trust and gratitude from a man who is diagnosed as paranoid schizophrenic by giving him space to direct the dialogue wherever he wants it to go and going there with him. Watching a woman stand up for herself in a fair hearing in a calm yet firm, assertive manner after having rehearsed possible scenarios in advance. Supporting someone in their dream to perform country music in front of an audience and, while practicing for the event see her in tears because she can feel the presence of her mother in the room and supporting someone in their efforts to maintain sobriety. These “islands of clarity” are of value in and of themselves as a relief from whatever pathologies are normally present and as stepping stones to recovery.
These are just a few examples and come from only the few months I’ve been employed by this agency. If you would like to hear more about us, please call 518/434-1393 or email us at mhepinc@aol.com.