Candelaria Mahlke

Peer support in mental health services.

Purpose of review Considering international diversity in the implementation of mental health peer support and an increasing research interest in peer support work (PSW), this review focuses on priorities in current research and practice. With grassroots in informal services for people with mental health problems, peer support has been strengthened by the recovery paradigm in mental health policy, and there are steps towards integration in statutory services. Recent findings Current issues include benefits of peer support, its efficacy and effectiveness. The value of peer support in formal and informal settings is discussed, and organizational change processes and the challenges in peer support implementation are discussed. Recent studies have identified the need for a clarification of roles, competencies and job structure and for adequate training and supervision. Along with reported benefits for consumer and PSW involvement in care revealed by mixed method studies, destigmatization at the personal and system level is a crucial PSW component. Summary Various types of peer support merit further evaluation. Assessing the impact of peer support on service users, peer providers and organizations require complex intervention studies, using mixed methods designs with qualitative exploration of underlying processes and experiences to complement high-quality controlled trials.

Eigensinn und Psychose, Peer-Beratung und Psychotherapie

ZusammenfassungDie im Zusammenhang von Psychiatrie und Psychotherapie oft sehr engen Vorstellungen von Krankheitseinsicht und Compliance werden kritisch diskutiert, nicht zuletzt weil sie der (inneren) Dynamik einer Psychose widersprechen. Aus dem inhaltlichen Zusammenhang von Psychose und Eigensinn sowie aus den Erfahrungen von unbehandelten Patienten werden Anforderungen an die therapeutische Beziehungsarbeit abgeleitet. Die besonderen Chancen der Genesungsbegleitung durch geschulte Peer-Berater werden dargestellt und aus den Erfahrungen des Hamburger Psychenet-Projekts begründet. Dieses in Deutschland neue Behandlungsangebot ist nicht als Konkurrenz zur, sondern als Verstärkung für Psychotherapie zu verstehen. Unterschiede und Gemeinsamkeiten sowie die vielfältigen Möglichkeiten der Kooperation werden dargestellt.AbstractThe narrow concepts of illness insight and compliance in psychiatry and psychotherapy will be discussed, not least because they contradict the dynamics of psychosis. Demands on therapeutic relations will be deduced from the therapeutic relationship between psychosis and ownness as well as of the experiences of untreated patients. The particular prospects of the accompaniment of a trained peer counsellor during convalescence will be represented and explained by the experiences of the Hamburg psychenet project. This new form of treatment in Germany is conceived as a supplement and not as competition to psychotherapy.

“Irre menschlich Hamburg” – An Example of a Bottom-Up Project

This chapter highlights the advantages and importance of bottom-up approaches in the fight against stigma. Where and how does stigmatization occur? Through uneducated neighbours, colleagues or psychiatric services itself? Does the diagnostic process unwillingly foster stigmatization by creating terminological barriers? Is it the case that today’s prejudices against psychiatry reflect its failure of the past? Which concepts of mental health problems can strengthen or weaken prejudices, and which concepts can foster tolerance and sensitivity? What does successful work against stigma look like and what are the necessary prerequisites for such work? How should a field of psychiatry be constituted that allows for the natural transition between life crises and mental health problems that do not reject experiences with alienating terminology and concepts, but instead supports the assimilation of alienating experiences? Questions regarding stigmatization and in opposite regarding tolerance, sensitivity, prevention and hope are profoundly connected with the understanding of health and mental health problems, as well as the proposed concepts of support systems. Stigmatization due to mental health problems is judged as more distressing compared to stigmatization due to innate features or a minority status, given that the stigmatized person often held similar prejudices prior to their mental health problems. Whether people are stigmatized depends on the concept of human being, not merely on the idiosyncrasies of the individual. If a society propagates the picture of a successful, dynamic, eternally youthful person as the unquestioned standard, then any deviation from this can be stigmatized. A field of psychiatry that diagnoses every “deviation from the norm” and that endlessly extends its diagnostic categories is substantially responsible for the expansion of stigmatization.