People with mental health struggles can support others in mental distress in ways that are very different from how a counselor or therapist might interact with them. For example, peers intentionally talk about their own mental health challenges and build rapport with others based on a shared recognition of suffering. In addition, by sharing their stories of navigating complex traditional and alternative mental health care systems, peers can speak to systemic barriers, the limits of professional care, and the need for structural change. In this way, peers can use their first-hand knowledge to advocate for communities that use mental health services.
While academic disciplines such as urban planning, nutrition sciences, and the anthropology of mental health have improved our understanding of community mental health, the recognition that we do not need to be “experts” to support each other lies at the heart of U.S. peer movement. By definition, peers are not required to hold a degree in counseling in order to serve others, and historically they have held an explicitly informal, “non-expert” position.
During deinstitutionalization, in which underfunded community mental health care systems replaced state asylums, mental health activists organized to provide free mutual aid for fellow psychiatric consumers and survivors— many of whom had lived in state asylums for several years and needed support to secure stable housing and other social services. By coming together— finding small workarounds to build informal networks of care, activists formed the peer movement in the 1970s and 1980s.
In recent decades, peers have “professionalized,” and state and national certifications to become a peer support “specialist” have come about in order to facilitate their inclusion and employment within U.S. community mental health systems. Moreover, the “peer” label has continued to shift and expand: For example, street medics and community health workers often receive basic training in peer mental health support, in addition to training in physical health care. Even at HHCI, our title “peer mental health coach” refers to people from faith-based organizations who have received our Gateway to Hope training in mental health, regardless of whether or not they “identify” as someone with lived experience of mental distress. Over time, this shift— to both standardize peer training and to expand the use of the term “peer” to include people without lived experience of mental health struggles or psychiatric histories— has resulted in some confusion about who can be a “peer” and what it means to be “trained” as one.
As a person with lived experience, a caregiver to family members with mental struggles, and as a scholar in community mental health, I believe there is power in both recognizing the historical origins of the term “peer” and in embracing the expansion and diffusion of the label as well. Moreover, the identity politics of whom ought to be considered a “peer” should not distract us from larger political and economic issues that threaten community mental health today. And if we are all “peers” in the sense that we have all experienced periods of intense emotional, mental, and existential crisis at some point in our lives, we all ought to act on our shared recognition of vulnerability and our shared responsibility to support collective mental wellbeing. By recognizing our own “peerness,” we can gain better attunement to the strengths and needs of communities and work to cultivate a politics of mutual aid over charity. For these reasons, when someone asks me if I am a peer, I typically respond, “Yes, we all are.”
Erica Hua Fletcher, Ph.D.
Zorich Fellow in Mental Health Policy
Hope and Healing Center & Institute