Strategic Storytelling: How Mental Health Peer Providers Describe Their Own Professional Practice

Purpose

Mental health peer providers are individuals who routinely rely on their personal lived experiences with psychiatric disabilities to help other mental health service users. The use of peers is growing nationwide and several studies have shown that peer-provided services achieve equivalent outcomes when compared to services provided by non-peer professionals. Few studies have examined the practice behaviors of peer providers. In this project, peers described how they used  their personal recovery narratives in their work with others. It also examined how they conceptualized the current challenges facing their profession and their recommendations for the future of peer-provided services.

Methods

This study used in-depth qualitative interviews with a purposive sample of 23 certified mental health peer specialists in a mid-western metropolitan area. Participants were recruited from a list of practicing peer specialists in the area. Interviews were guided by a semi-structured protocol developed with input from key informants in the peer-provider community to enhance authenticity and credibility. Thematic analysis was used to develop an in-depth understanding of how peers used their recovery narratives with other service users and their views of the status of the peer-provider profession. This process involved generating initial codes to be attached to data within and across transcripts and then comparing and contrasting these codes to generate themes grounded in the data. Trustworthiness was established through peer-debriefing, triangulation, analysis of counter narratives, and continuing interviews until saturation.

Results

The analyses revealed several themes. First, participants conceptualized recovery as a personal journey of growth and development involving hope, social support, meaning and personal responsibility for wellness. Second, peers used their personal recovery narratives strategically in their work with other consumers. They did so through a reflexive process that involved active listening to the stories of those they served, internal reflection on relevant personal experiences, strategic selection of parts of their story they would use to assist others and then sharing those selections in a therapeutic manner tailored to meet the contextual demands of the encounter. Third, peers relied on the use of fundamental clinical practice behaviors and reflexive dialogue. Fourth, peers reported a need for enhanced professionalization that involved opportunities for career advancement, professional development, improved peer supervision and the establishment of professional support networks. 

Implications

This study suggests that peers use their personal stories strategically. This requires a complex use of explicit (outside) and tacit (inside) knowledge via a continuous process of listening, reflection and action. The use of their own experiences combined with reflexive dialogical practices may assist peers in helping others while also enhancing their own recovery. Despite this practice complexity, peers struggle with poor supervision, lack professional support, experience low pay and prestige, encounter a “benefits trap” limiting how much they can work and lack opportunities for professional development and career advancement. These results suggest that enhancing peer providers’ access to greater professional development and advancement opportunities is an area in need of further exploration.