Beyond the Medical Model with Neesa

A Column by Neesa Sunar, Peer Specialist, Transitional Services for New York, Inc.

Advocating for Clients Can Require a Team Effort by Peer Workers
Many of us peers in New York City are incredibly passionate about what we do. We work at agencies where our consumers desperately need our services, giving voice to their concerns in the face of other less- or non-sympathetic psychiatric professionals. We act as a go-between, giving credibility and weight to our consumers’ needs and requests. We give their voices legitimacy, and we stand strong in the face of dissent.

Our sentiment for individual advocacy can take a natural turn towards systems advocacy as well. We as peers desire change in mainstream society regarding its awareness of mental illness. Understandably, opinions on how to achieve this differ from person to person. Some of us are of an anti-psychiatry and/or anti-medication sentiment, advocating for steps towards disavowing the traditional Medical Model altogether. Others among us take a pro-choice stance, where we figure that each person can self-determine their treatment plan and goals for wellness. Still others strive to strike a balance between the Medical Model and the Recovery Model, valuing the opinions of non-peer psychiatric professionals. There is of course overlap, and many of us embrace more than one perspective to varying degrees.

As advocates, we peers can come up against people who do not understand the scope of professional services that we provide. As we work with clients, remaining true to peer principles, our supervisors and coworkers may judge our techniques as something unprofessional. Even though principles such as mutuality and person-centered treatment are evidence-based practices, professionally corroborated by modalities such as Intentional Peer Support, we are still questioned. This resistance we run into only fuels our fire, compelling us to courageously continue staying true to our cause.

It still stands that many employers do not fully understand the roles of peers. Given that peer services are only now being integrated into service delivery programs in New York City, agencies are finding themselves hiring peers for the first time. Since peers are new, job descriptions and responsibilities are uncertain, and employers do not have the expertise or resources to provide sufficient supervision for peer staff development. It may not occur to supervisors that peers serve as agents of change, who purposely go against the grain of office culture to support consumers. On the contrary, supervisors may require peers to conform to the existing culture of the office.

This expectation can prove incredibly detrimental to peers, forcing them to compromise the integrity of their work in order to keep their jobs. Peers may be forced to use their mutuality to forge a trusting relationship with a consumer, and then use that trust to make the person comply with a top-down, Medical Model treatment plan. Or, if a peer communicates a consumer’s message to staff, that peer can be shut down and told that the person is not lucid, and therefore cannot determine goals for themself. At the very worst, a peer may find that the rest of the office does not have faith in a consumer’s capacity for recovery.

It is beneficial when a peer works with an employer that has hired multiple peer staff. Peers can support one another, and can band together to impart suggestions to employers on how their agencies can adopt a more recovery-oriented perspective. When peers work together, they can also assist one another in making sure that everyone remains true to the values and mission of the peer cause. Compare this to the peer who finds themself as the only peer at their office. It can be difficult for an isolated peer to remain motivated, especially in situations where a peer’s legitimate comment is the only voice against the unanimous voices of the rest of the office.        

Peers can find camaraderie by venturing outside of the workplace and into the community, and New York City has current initiatives that can aid in this process. There are committees with the New York City Department of Health and Mental Hygiene, including the Office of Consumer Affair’s Consumer Advisory Board (CAB), a committee comprised of peers that reviews and offers feedback on upcoming city mental health initiatives. The DOHMH also has the Regional Planning Consortium (RPC)’s peer steering group, which also allows for peers to join and offer critique on upcoming initiatives. The CAB accepts board members by application, while the RPC has an open invitation for those interested to join at any time, provided that they are a Medicaid recipient of mental health and/or substance use services.

There is also the Peer Workforce Consortium, a committee of peers who are currently making strides towards creating a professional organization that represents the priorities and welfare of peer specialists, both working and aspiring. The Leadership Committee of this group meets monthly, and large “summits” commence quarterly. Topics covered in summits will include educational seminars, presentations and opportunities for networking.
There are also annual conferences that peers regularly attend. Within New York State, there is the NYC Peer Specialist Conference typically held in mid-July at the Kimmel Center in Manhattan, and also the NYAPRS state-wide conference, typically held in mid-September in Kerhonkson, NY. The former is free to attend, while the latter requires a registration fee in conjunction with hotel and travel, depending on where one lives. 

We must recognize that the values of peers are worth fighting for. One way for us to express the effectiveness of the Recovery Model is to live it ourselves. By reaching and striving towards recovery in our own lives, we can peacefully inspire the people around us, creating within them a sense of curiosity that compels them to wonder…how did they do it? How did they achieve the impossible?

But more importantly, living a life of recovery aids in inspiring the people we work with. We create a spark within people who have been beaten down and discarded, giving them a chance to ignite it. With such chance comes the opportunity for blossom and growth, enabling a person to move not only forward but upward.