A guideline prepared over the 2013-2014 term by Sue McLean, Librarian at the Gender Issues Centre with edits and notes by George Brunklaus, Assistant and Jayal Chung, Coordinator.
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Peer support has always been around and growing with a shift to the consumer/survivor movement in the mental health field. Some mental health patients have realized the limitations to one-on-one therapy with a professional and also there has been a lot of controversy about some people being over-medicated.
The “Mad Movement” says that more information needs to be available to patients in regard to these matters, in order to make the best choice in treatment. This is where the option of “peer support” comes in, as no one knows better what works and what doesn’t other than the patient themselves.
Peer support only requires a desire to share what one has been, or what a person is going through, and the desire to help oneself and others who want to be helped.
How to get started
The first thing needed to begin a peer support group is to advertise to a group of like-minded people who wish to share experiences such a things like addictions, depression, LGBT issues, stress of school, etc.
It is best to meet organize a group and get everyone in the group to participate in writing a and coming to an agreement for “Statement of Purpose”.
An example might be something like, “This groups meets to support those people working through challenges, being a trans person on campus…”. The group can come up with a name to call the group if they choose.
Everyone in the group needs to take ownership of the responsibilities of the group as much as possible.
Although it might turn some people off if you have too many rules, it is best to have at least a few.
These, except for a few which are necessary, such as keeping confidentiality, are made for the stability and building the sense of trust within the group. Sometimes a person can be disruptive to a group, for example by dominating the space when talking and making it difficult for other folks in the group feel they can participate and share.
Some of rules that you might want to consider for the group are:
- confidentiality (most important)
- no gossip about other members outside the group. If you have a problem with someone, it is best to try to talk to them later and work it out (a peer support worker might be able to help you with this – you will feel more empowered if you can work out issues if at all possible)
- be on time
- no cell-phones going off (unless absolutely needed for emergencies, etc.)
- having a “talking stone or feather” – this is very important – the person who is talking/sharing holds the stone and no one can interrupt until they are finished. There should be no “cross-talk” e.g. interruption or telling the person what they should do. The best peer support workers are those who “listen” and only respond when the person is finished. At this point you can validate what the person has said but only offer suggestions (of what has worked for you) – only do this if it is asked for – don’t assume what worked for you, will always work for another.
- any other rules which the group wants – and these should be visual (on a poster, or paper) at every meeting – the rules (except for confidentiality) are not written in stone and can be
Re-visit the group agreements, if necessary.
Someone can volunteer to chair if the need is expressed by the group. The role of the chair is to help ensure everyone gets an equal chance to participate.
Discussions can bring up challenging feelings and memories to work through and can be very upsetting and unexpected.
If someone is triggered by something and gets really upset, rather than let it take over the group, you can offer to have a one-on-one with the person afterwards to help them and evaluate if they should pursue professional help.
Another idea is to agree on an object e.g. a stress ball that one can grab to mean you are triggered and need to leave if you can’t or don’t feel comfortable to talk about it.
It is ok and important to state that a person can step out if triggered; consider and discuss the procedure that works for the group when this happens.
Another suggestion is to have a list of trigger words and ask the group to try to remember and warn for these topics before speaking about them.
Options for an individual who is triggered:
- sit out in a quiet space
- talk/explain why it is a trigger for you if you feel comfortable
- step away from the group and with a peer if necessary/wanted
Active listening and facilitating the conversation
The most important aspect I have found in groups is to have a “Check-in”. This is done at the beginning of the group as you go around the circle and each person shares what they want to.
This is usually how their week has been going and whatever they need to talk about. You can make suggestions, such as asking people to share something positive they did, or how their holiday weekend went, but they can also talk about what they feel they need to. It may take a while to get to this point as people need to build up trust and be assured of confidentiality.
Another benefit of a check-in is that people who are shy are encouraged to come out of their shell and share what they can. People have the option of “passing” once in a while, but not every week. Participants will get more out of the group, the more that they can share, but this takes longer in some people and we must be patient with them.
If time allows, it is also good to have a quick check-out at the end of the group. This gives you an idea if everyone is in a good space before leaving the meeting. For example, you can ask them to give one word to express how they are feeling about the group that day. Even using a negative word, (eg. tired, pissed off, etc.) is not necessarily bad, but use your intuition here to decide if they are okay or not – sometimes a call later to see how they are is appropriate).
Listen carefully to the feedback of the group (which should always be encouraged – people need to have input to feel it is really a peer-support group. Everyone has equal ownership in the group.) The feedback could be an occasional survey or verbal.
Other planning considerations
Although the sharing circle is a vital part of the group, there is also usually room for discussions on a chosen topic, a guest speaker, an artsy craft (eg. Art journaling). Participants should be encouraged to come up with desired topics and also, some could be encouraged to look after this part of the group for a meeting.
It would be a good idea to have the group located in an area where there are no interruptions – no phones ringing, no one walking into the room unexpectedly. This can have the effect of shutting down the person who is trying to share personal feelings. I would keep the group at about a two hour limit with a break for those who need to use the washroom or have a smoke break. If budget allows, it is nice to have a light lunch (eg. Soup) or a healthy snack, with tea and coffee and water available.
Peer Support Workers
Some agencies, such as mental health groups, hospitals and police stations have begun to hire peer support workers – people can also make an appointment to see this worker one-on-one. They are often paid much less than a professional. It is very important to let people (eg.in a group) know that you are not a professional counsellor and to know the signs when a person needs to be referred to someone like this.
At the very least, anyone working or volunteering as a peer worker should take a workshop in suicide prevention. There are occasionally courses offered in the community in peer support and also may be some online. Local CMHA offers one occasionally.
A peer worker may also be required to accompany someone to an appointment or to a court proceeding – but only as a support, and not in a professional capacity.
Remember that peer support is an important job, but one must realize that you can only help as much as you yourself have been helped! For example, although I think that some people are over-medicated, I would never tell someone to go off their medication. I would, however, encourage them to learn as much as they can about the meds they are being prescribed, by asking the Dr., Pharmacist or going online. I would suggest, if possible, and with the Doctor’s approval to only try one new med at a time to see what the side effects are. If they want to reduce some of their medication, only do this slowly and of course with a doctor’s approval.
Supporting each other
There will be a variety of people in each peer support group – some will be further along in their goals, recovery, etc., than others. It is important not to judge where someone is, as you have not walked in their shoes.
We all have our strengths and weaknesses, and what is important to one person, may not be so important to another. We are all trying to work towards an optimum level of health, (both physical and mental), and happiness and peer support can be very beneficial in providing a safe space to do so. Sometimes, the other members become like your extended family, although the purpose of the group is not to make friends or start relationships. Each person needs to be recognized and accepted for where they are “at”.
It is good to have a lot of resources around to offer people too – services which are available in the city, access to a “warm-line” number – such as in Sudbury – a warm, friendly line that anyone who needs to talk after hours can call. This is a 24 hr. free service where peer support workers are paid to be available to offer support to anyone who has any mental health issues.
For the facilitators, after a challenging or very emotional session, it might be a good idea to have a debriefing session.
Starting a Peer Support Service or Group
Peer Support Group Facilitation Skills by New England MIRECC Peer Education Center Good 2 Talk 1-866-925-5454