A Brief History of Peer Support: Origins
Patrick Tang, MPH
The contemporary era of organized peer support owes its success in no small part to the mental health consumer movement of the 1970s. This social movement empowered former mental health service users to help each other and advocate for themselves. From these humble roots, peer support quickly found new applications in chronic disease management (diabetes, mental health, heart disease, cancer, asthma, HIV/AIDS, substance abuse), screening and prevention (cancer, HIV/AIDS, infectious diseases), and maternal and child health (breastfeeding, nutrition, post-partum depression). As the philosophy of peer support slipped into the mainstream, public interest is reaching an all-time high.
Peer support is gaining recognition in almost sector of health and healthcare. Health researchers are continuing to build the evidence base for peer support for a variety of disease conditions, populations, and settings. Healthcare providers are seeing the benefits of peer support on their medical practices, particularly when it comes to patient satisfaction and patient outcomes. Employers and health insurance companies are increasingly implementing peer support programs to improve worksite wellness, increase productivity, promote health maintenance, and reduce costs. Policymakers see peer support as an effective strategy for community outreach, quality improvement, increasing access to primary care, and reducing health disparities. And most importantly, patients are seeking out peer support in greater numbers than ever before. With passionate endorsements across the spectrum, peer support is poised to be become a pillar of national healthcare policy.
How did this come about? Where did it all start?
This article is the first in a series that will explore the history of organized peer support and discuss what this means for health and healthcare around the world.
The Origins of Organized Peer Support
Larry Davidson, Professor of Psychiatry at the Yale School of Medicine, tracks the beginnings of peer support to a psychiatric hospital in late 18th century France.2 The governor of Bicêtre Hospital in Paris, Jean Baptiste Pussin, recognized the value of employing recovered patients as hospital staff. The chief physician at the hospital, Philippe Pinel, praised these peer staff for being “gentle, honest, and humane”, “averse from active cruelty”, and “disposed to kindness”. Hiring former patients marked a shift in the philosophy of mental health care that ushered in the “moral treatment” era. Pussin’s practice wasn’t just an isolated case either – Davidson found peer staff popping up periodically in several other inpatient settings as well.
Peer support surfaced again in the 1965 with the efforts of Robert Carkhoff and Charles Truax, in which lay counselors, trained with specific skills, were successful in helping mentally ill patients in hospital settings.3,4 Professionals in community mental health were among the first to advocate for the integration of peers into primary care settings. In 1967, Emory Cowen proposed a model of community mental health care that requires the employment of nonprofessional peers in the development, implementation, and evaluation of community interventions.5 In contrast to the system of care provided in big state hospitals, community mental health emphasized a) primary care, b) matching the needs of the population, and c) employing “indigenous nonprofessionals”, or peers, in the development, implementation, and evaluation of intervention programs.5,6
While the mental health profession was slow on the uptake of peer support, the philosophy was rapidly and widely adopted by the community of mental health consumers. The mental health consumer/survivor movement has been a driving force behind the dissemination, adoption, popularization, and growth of peer support. In the 1970s, big state hospitals across the country were being closed down, releasing patients with severe mental illnesses into the community with inadequate transitional support. Simultaneously, patients began to speak out about systematic mistreatment and denial of civil liberties while under the care of state mental hospitals. Once released, former patients sought relief through autonomous peer and mutual support groups, which helped empower individuals as well as the community.
In its most radical period, the mental health consumer movement sought autonomy and rejected traditional modes of care. However, the movement changed course in the 1980s as it reached out to governmental and professional organizations. This period of re-engagement led to improved mental healthcare practices, increased funding for technical assistance and training programs, and a subsequent boom in peer support services. Peer support specialists in the mental health field were among the first to be certified, and qualify for state and Medicaid reimbursement.
In the next part of this series, I’ll look at the spread of peer support into other health fields and chart the growth of peer support in the academic literature.
1. Davidson L, Chinman M, Kloos B, Weingarten R, Stayner D, and Tebes JK. (1999). Peer Support Among Individuals with Severe Mental Illness: A Review of the Evidence. Clinical Psychology: Science and Practice;6(2):165-187.
2. Davidson L, Bellamy C, Guy K, and Miller R. (2012). Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry;11:123-128.
3. Enright MF & Parsons BV. (1976). Training Crisis Intervention Specialists and Peer Group Counselors as Therapeutic Agents in the Gay Community. Community Mental Health Journal;12(4):383-391.
4. Carkhoff RR & Truax CB. (1965). Lay mental health counseling: The effects of lay group counseling. Journal of Consulting Psychology;29:426-431.
5. Cowen EL, Gardner EA, and Zax, M. (1967). Emergent approaches to mental health problems. New York: Appleton-Century-Crofts.
6. Newbrough JR. (1969). Community mental health: A movement in search of a theory. In J.J. Bindman and A. Spiegel (Eds), Perspectives in community mental health, Chicago, Aldine Pub. Co.
"Patrick Tang, MD, PhD, anasema: ""Nguvu ya kisasa ya msaada wa wenzao uliopangwa inapaswa mafanikio yake kwa sehemu kubwa kwa harakati ya watumiaji wa afya ya akili ya miaka ya 1970.""" Harakati hii ya kijamii iliwapa nguvu watumiaji wa zamani wa huduma za afya ya akili kusaidiana na kujitetea. Kuanzia mizizi hii ya unyenyekevu, msaada wa wenzao ulipata haraka matumizi mapya katika usimamizi wa magonjwa ya muda mrefu (ukimwi, afya ya akili, ugonjwa wa moyo, saratani, pumu, virusi vya Ukimwi, matumizi mabaya ya dawa za kulevya), uchunguzi na kuzuia (kansa, virusi vya Ukimwi, magonjwa ya kuambukiza), na afya ya mama na mtoto (kunyonyesha, lishe, unyogovu baada ya kuzaa). Kadiri falsafa ya utegemezo wa wenzao ilivyopanda, ndivyo upendezi wa umma unavyoongezeka sana. Msaada wa wenzao unapata utambuzi katika karibu sekta ya afya na huduma za afya. Watafiti wa afya wanaendelea kujenga msingi wa ushahidi kwa msaada wa wenzao kwa hali mbalimbali za ugonjwa, idadi ya watu, na mipangilio. Wataalamu wa afya wanaona faida za msaada wa wenzao katika mazoezi yao ya matibabu, haswa linapokuja kuridhika kwa mgonjwa na matokeo ya mgonjwa. Waajiri na makampuni ya bima ya afya ni zaidi ya kutekeleza mipango ya msaada wenzao kuboresha mahali pa kazi wellness, kuongeza uzalishaji, kukuza matengenezo ya afya, na kupunguza gharama. Watengenezaji wa sera wanaona msaada wa wenzao kama mkakati mzuri wa ufikiaji wa jamii, uboreshaji wa ubora, kuongeza upatikanaji wa huduma za msingi, na kupunguza tofauti za afya. Na muhimu zaidi, wagonjwa wanatafuta msaada wa wenzao kwa idadi kubwa kuliko hapo awali. Kwa utegemezo wa shauku katika wigo wote, msaada wa wenzao uko tayari kuwa nguzo ya sera ya kitaifa ya huduma ya afya. Jambo hilo lilitokeaje? Yote hayo yalianza wapi? Makala hii ni ya kwanza katika mfululizo ambao utachunguza historia ya msaada wa wenzao uliopangwa na kujadili nini hii inamaanisha kwa afya na huduma za afya ulimwenguni. "Larry Davidson, profesa wa Psychiatry katika Yale School of Medicine, anafuatilia mwanzo wa ""msaada wa wenzao"" katika hospitali ya akili mwishoni mwa karne ya 18 Ufaransa. ""Msimamizi wa Hospitali ya Bicêtre huko Paris, Jean-Baptiste Pussin, alitambua thamani ya kuajiri wagonjwa waliopona kama wafanyakazi wa hospitali." Daktari mkuu wa hospitali hiyo, Philippe Pinel, aliwapongeza wafanyakazi hao kwa kuwa "wenye fadhili, wanyoofu, na wenye fadhili", "wanaopinga ukatili", na "wana mwelekeo wa kuwa wenye fadhili". Kuajiri wagonjwa wa zamani kulionyesha mabadiliko katika falsafa ya huduma ya afya ya akili ambayo ilianzisha enzi ya "matibabu ya maadili". Mazoezi ya Pussin hayakuwa tu kesi ya kutengwa ama Davidson alipata wafanyakazi wenzao popping up mara kwa mara katika mazingira kadhaa mengine ya wagonjwa wa ndani pia. Msaada wa wenzao ulijitokeza tena mnamo 1965 na juhudi za Robert Carclough na Charles Truax, ambapo washauri wa kawaida, waliofundishwa na ujuzi maalum, walifanikiwa kusaidia wagonjwa wa akili katika mazingira ya hospitali. Katika mwaka wa 1967, Emory Cowen alipendekeza mtindo wa huduma za afya ya akili za jamii ambazo zinahitaji kuajiriwa kwa wenzao wasio wataalamu katika maendeleo, utekelezaji, na tathmini ya hatua za jamii.Kinyume na mfumo wa huduma zinazotolewa katika hospitali kubwa za serikali, afya ya akili ya jamii ilisisitiza a) huduma ya msingi, b) kukidhi mahitaji ya idadi ya watu, na c) kuajiri <unk> wenyeji wasio wataalamu, au wenzao, katika maendeleo, utekelezaji, na tathmini ya mipango ya uingiliaji. Harakati ya watumiaji wa afya ya akili imekuwa nguvu ya kuendesha nyuma ya kueneza, kupitishwa, kuenea, na ukuaji wa msaada wa wenzao. Katika miaka ya 1970, hospitali kubwa za serikali nchini kote zilifungwa, na wagonjwa wenye magonjwa makali ya akili waliachiliwa katika jamii na msaada wa mpito usiofaa. Wakati huohuo, wagonjwa walianza kusema juu ya kutendewa vibaya kwa utaratibu na kukataliwa kwa uhuru wa kiraia wakati wakiwa chini ya utunzaji wa hospitali za serikali za akili. Baada ya kuachiliwa, wagonjwa wa zamani walitafuta msaada kupitia vikundi vya kujitegemea vya wenzao na vikundi vya msaada wa pamoja, ambavyo vilisaidia kuwezesha watu binafsi na jamii. Katika kipindi chake cha kimkakati zaidi, harakati ya watumiaji wa afya ya akili ilitafuta uhuru na kukataa njia za jadi za utunzaji. Hata hivyo, harakati hiyo ilibadilika katika miaka ya 1980 ilipofika kwa mashirika ya serikali na ya kitaaluma. Kipindi hiki cha ushiriki upya kilisababisha mazoezi bora ya huduma za afya ya akili, kuongezeka kwa ufadhili kwa msaada wa kiufundi na programu za mafunzo, na kuongezeka kwa huduma za msaada wa wenzao. Wataalamu wa msaada wa wenzao katika uwanja wa afya ya akili walikuwa miongoni mwa wa kwanza kuthibitishwa, na kuhitimu kwa serikali na Medicaid malipo. Katika sehemu inayofuata ya mfululizo huu, nitaangalia kuenea kwa msaada wa wenzao katika nyanja nyingine za afya na kuchora ukuaji wa msaada wa wenzao katika fasihi ya kitaaluma. 1. Uwe na mtazamo wa kweli Davidson L, Chinman M, Kloos B, Weingarten R, Stayner D, na Tebes JK. (1999) na Msaada wa wenzao miongoni mwa Watu Wenye Ugonjwa Mkubwa wa Akili: Mapitio ya Uthibitisho. Saikolojia ya Kliniki: Sayansi na Mazoezi;6 (2): 165-187. 2. Uwezekano wa kupata Davidson L, Bellamy C, Guy K, na Miller R. (2012). Msaada wa wenzao miongoni mwa watu wenye magonjwa makali ya akili: ukaguzi wa ushahidi na uzoefu. Ugonjwa wa akili wa ulimwengu;11:123-128. 3. Uwe na mtazamo wa kweli Enright MF & Parsons BV (1976) Mafunzo ya Wataalamu wa Uingiliaji wa Mgogoro na Washauri wa Kikundi cha Peer kama Mawakala wa Matibabu katika Jumuiya ya Mashoga. Jamii ya Afya ya Akili Journal; 12:3 (4) 83-391. 4. Uwe na uhakika Carkhoff RR & Truax CB. (1965), na Ushauri wa afya ya akili ya lay: Athari za ushauri wa kikundi cha lay. Jarida la Ushauri wa Saikolojia; 29:426-431. 5. Uwe na mtazamo mzuri. Cowen, EL, Gardner, EA, na Zax, M. (1967) Njia za karibuni za kushughulikia matatizo ya afya ya akili. New York: Appleton-Century-Crofts. 6. Uwe na uhakika Newbrough JR. (1969). Afya ya akili ya jamii: Harakati ya kutafuta nadharia. J.J. Bindman na A. Spiegel (Eds), Maoni katika afya ya akili ya jamii, Chicago, Aldine Pub. Co.