I’ve just read this article 20 Ways to Combat Rankism, by Robert W Fuller, and it resonates with me. I’ve been talking about this issue of what I’ve called a class divide in mental health. I’ve watched organisations that started as peer based, consumer-led, with a lot of flexible cross over between the service users and service providers become dramatically divided into distinct classes. The service users and providers become totally different from each other in dress, language, culture, attitudes, expectations of behaviour, and places they are permitted to access. Most of the power in this unequal relationship resides with the providers, who also bear responsibility for ensuring good outcomes to justify funding. These groups become rapidly polarised when mutual relationships are not holding them both aware of their shared humanity. The roles of provider and user can each be rigid and dehumanising. Those of us who are service providers find ourselves trying to achieve two contradictory aims – preserve the system of professional divide between users and providers, and build and strengthen communities.
Please don’t misunderstand me. We’ve created our therapeutic distance for very important reasons. Whether the system actually works is another conversation, but the needs and challenges are very real. I don’t have simple answers. But I am deeply disturbed by the divide. When I started working as a peer worker, I thought this was an answer, that we would be able to bridge this divide, those of us who are both service users and providers. That we would bind the two communities back to one whole. But that’s not what I’m seeing. What I’m seeing is a whole community of peer workers who are paralysed by their basic human need to keep their own job. Who are being asked to be braver and wiser than everyone else in the system who has more voice, more power, more status, and more money. I’m also noticing the change of the idea of what a ‘peer’ is. I’ve sat in meetings where Peer Work was described as a career path. As it’s fitted to the mental health model and turned into a job, it’s being torn away from its roots; a place of shared humanity. Back when Soteria was running, the peers who supported people having psychotic experiences did not themselves have to have experienced mental illness. They were peers because they were people.
I wrestle with all of these things because I’m no more immune to their influence than the next person. Do you not think that after years of being poor, bullied, marginalised, and homeless that I cherish having a voice? An income? That somewhere inside I laugh when people who ignored me as a patient pay money to listen to my ideas now that I’m refashioned into a public speaker? I keenly feel the paradigm and the tension of my place within it, allied to both groups and refusing to rescind my membership with either. I was told by my PHaMs worker once that my attempt to insist on my right to maintain the friendships I had with other service users was pointless as it was clear that I was nothing like them and would “leave them all behind” as my career developed. The last time I sat talking with a friend who works at a local NGO mental health org, a staff member popped their head around the door to inform us we needed to leave as we were the last people present and it was now against organisational policy for a staff member and a consumer to be alone on the premises. I had not until that moment considered that I was in that context classified as a service user. I have tried to create change within these systems as a service user, but the total lack of power and voice, the constant dismissal by those who could make changes but do not have any comprehension of the subtle violence their systems do to people finally convinced me that it was not possible to do what I was trying to do. The system does not accept dual citizenship – I may train all I like and create and maintain as many services as I wish but if I fight for my right to make friends with whomever I choose and if I regard service users as my peers I am never to be one of them.
So we have two groups of people, disconnected from each other. They do not use the same entrances to the buildings. They do not share the same toilets. They do not lunch together. One usually arrives by car, the other by bus. On one the burden of healing the sick is placed. On the other, the burden of recovery. There is often conflict between the two, sometimes subtle, sometimes open abuse or violence. Those who seek to bridge the gap are often alienated by both groups and exhausted. Many leave the system. The culture is fatally flawed.
I go and give big presentations in front of important people in big shiny buildings and I feel the lure of power. As a young peer worker, some of my work was being done while at night I slept at the local backpackers. The divide in my world, and in my mind, was overwhelming. One moment I would be treated as a loser, a failure, a pathetic social parasite by a bored, tired, angry worker at the local welfare office. The next I would get a standing ovation and a hundred hugs from an audience. My life flickered between being nobody and somebody. The experience was agonising and illuminating. I also felt the structures, the hierarchy, the expectations and the culture, set itself up in my head. I started to see people through this lens of nobody or somebody, to try and attract the somebodies, to give less time and attention to the nobodies. And to panic that this would cost me, that success in my goals, of employment in mental health, would undermine my values and turn me, slowly, into somebody I do not want to be. I’m not strong enough. Some people are, but I imbibe the cultures around me. I sink into them and they into me and years and years later I’m still crashing into them into my mind. I adored my local Hearing Voices group because I walk into that space full of people without power or voice or money and we would be kind to each other – nothing more, and I would feel like a human again. Not a nobody or a somebody. Just a person like them. It was like being able to breathe again after coming off some hideous drug. It makes me cry to think of it. They became my grounding point, a place where I felt real again, somewhere to return to after debasement or accession.
Now I’m in the NEIS scheme, working to set myself up as a freelance artist/writer/poet/community builder… And I don’t know what I am. I’ve investigated my insurance options as a freelance mental health worker and it’s possible. Mind blowingly expensive but yes I could set up privately to do my talks, workshops, groups, even one to one support. It’s about 3 times the cost for me than for someone who has a degree in the field. And for awhile I wondered if I should go and finish my psych degree to make life easier. Then I realised, I don’t want to be a psychologist, or a psychiatrist, or a counsellor. I never really have. I want the information, the access to materials, but I don’t want to practice the way they do. I don’t want to do therapy. In fact, I’ve been fighting for the right not to have to for years. I don’t want to take my place in this hierarchy presented me. I don’t want to choose between being a user or a provider. I don’t want to pick which side I’m allowed to find my friends from. I want to be an artist. I want to help people be more free, more informed, and more connected. I want to be a peer worker. I want to be a member of any group I help to run. I’m tired of the roles and being dehumanised by them. I don’t want to be a somebody or a nobody, I really just want to stay myself. I want to help other people be their own selves. That’s probably not very useful to write on my professional indemnity insurance application. But I guess I don’t want to be a professional. On the other hand, I do need to make a living. And there’s the clash. I do need to understand and work within the legal and cultural frameworks I’m presented with. I haven’t found a path yet. I’m still hacking at the jungle and hoping there’s a way through. I’m still trying to get out from under the paralysis that trips me up when I feel like success is as much a threat to me as failure.
Sarah K Reece 
Reblogged this on Chrys Muirhead and commented:
@sarahkreece “But I guess I don’t want to be a professional. On the other hand, I do need to make a living. And there’s the clash. I do need to understand and work within the legal and cultural frameworks I’m presented with. I haven’t found a path yet. I’m still hacking at the jungle and hoping there’s a way through. I’m still trying to get out from under the paralysis that trips me up when I feel like success is as much a threat to me as failure.”
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well said Sarah!
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Thanks Chrys 🙂
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The only way I see out of this division is, as you have hinted at, to be a member of both AND neither. The most good I have found being done for people, by people, is for “lay persons” to become equipped, but not do “helping” as an actual CAREER, per se. Then those boundaries are much less rigid, and much less patrolled by higher-ups, and the helpers do not have to choose between their “career” and their compassion. Just my 2 cents’ worth. 😉
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I hear you, and that’s the road I was going down with a lot of hours of unpaid work until a wonderful relationship and the chance to have kids diverted me… now it’s essential that I try and provide for my family, and if I get a job outside of mental health that’s thousands of hours I can’t offer any support for people… I used to run several groups locally but I don’t have the time when I’m not getting paid for any of my work. My inbox is constantly overflowing with people crying out for resources so I well know the need, and I’m very limited in how many hours a week I can work with my health issues. I do want to reach out to more than just my (current) personal friends. It’s a challenge!
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You have a wonderful way of expressing yourself. I completely relate to this sense of divide. I think, perhaps, you should start working on a book, give talks, help others to see that we are all human, and as such, all worthy of respect and love regardless of our socio-economic status. We are all walking around with wounds to lick.
I am not in the mental health industry, but have received sevices, and I am wary, because so many forget to see that they may have training,, but they still have their own past to work through!
Sending you a virtual hug from across the pond. Keep moving forward 🙂
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Thanks Sharon, there are certainly things I can do that don’t trigger the ‘proffessional distance’ issue, like writing books and delivering talks. If I stay away from group facilitation and any kind of paid one to one contact such as phone support I may not even need professional indemnity insurance… having said that, groups and direct public contact are passions of mine and areas I’ve spent the last several years training in, which is distressing to walk away from. It may be that I start where things are most easy for me to navigate and see if I can find a better path through the more controversial areas as things progress. Thanks for the encouragement! Hugs 🙂
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Whoops, again I forgot mark notify me of follow up posts. D’oh! Lol! 😀
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😛 😉
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Boy can I relate to this. Our system in the United States is different of course, at least where I live. There are no peer workers at all. Just mental health professionals….therapists, psychiatrists, social workers. I have a Masters degree in counseling though and was very close to being fully licensed before my psychotic break and being put on disability because I was fired from my counseling position, and there was no way anyone else was going to hire me after that. It disgusts me that in this country you are not really allowed to experience the symptoms of a mental illness and be a mental health provider. That the system is that segregated. I mean who else is better equipped to help someone else who experiences these types of issues than someone who can totally empathize because they’ve been there? I was not treated good at all while working within that system, even when it became clear that I needed some assistance myself, especially then. I am so glad it didn’t work out though. I don’t want to be a therapist. It is a sucky, stressful and rotten job. You aren’t paid well for it, the work is piled on you and supervisors and co-workers often have just as many unresolved problems as their clients, they are just blind to them and don’t deal with them, unlike the people they are trying to help. It’s very unhealthy and part of the overall mental health care system problem in this country, along with funding for programs. So I feel a lot less stressed and therefore more emotionally well being an artist, even though I don’t really make any money from it. It’s frustrating not being able to make any money, but at the same time, it’s a lot saner for me. Well, except for the stress of not having much money. Sigh. It’s always something. Your last sentence really hits home though. I felt that way for a long time. I finally just gave up and decided that if society wants to view me as a failure, so be it. I am a success in my own mind, just for surviving and finding a way to thrive in my own world, even if my type of success doesn’t at all match with the society I live in, and that people, when they find out I’m on disability and have mental health problems, tend to see me as a failure because I don’t hold a job. Not to mention fearing me due to the fact that I have these mental health problems they don’t understand, but that’s another issue altogether. I wish you luck on your journey with this. May you find the clarification in your mind of what you want to do and be able to do it well, so that you can feel successful, even if you have to define what successful means to you, placed apart from what it means in your society. Nice post, as always thanks for sharing your thoughts. 🙂
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Ohhhh I’m so sorry to hear you were do poorly supported and so badly treated! Every time I hear about another ‘anti-stigma campaign’ where the mental health sector is going to tell the rest of the world how we should be treated I’m just so taken aback that one of the bastions of the highest and most entrenched level of stigma thinks it’s in a position to lecture anyone else! Wow.
I guess I know what you mean about feeling that in some ways you’re glad things didn’t work out. My original goals several years back were to fix up my resume, find housing, finish my psychology degree, and get a job in the NGO sector… now I’m glad that didn’t work out. I’m grateful for all the awesome people out there who ARE working in a very imperfect system, so grateful. But I think we also need people outside of the system, or at least with one foot outside of it. Hoping I am that, on some level.
The issue of defining success for ourselves is so desperately important! I’ve done a lot of looking at that since my friend Amanda killed herself. I think feeling like a failure can be lethal. I’m not all tied up in knots about success or failure at the moment so much as I’m stalled and struggling to go forwards when I don’t have a clear framework about how I’m going to prevent the more destructive results of success. It’s like my brain takes out my starter motor when I think I’m under some kind of threat to my personal ethics. Everything becomes super difficult when I’m pushing the car instead of driving in it… So I have to wrestle and try to come up with something I feel more comfortable engaging, or this is going to be a really long, difficult process. 😦 Hoping to work some things out on the fly and learn from others – I know I’m not the only one wrestling with these things!
Thanks for writing, I appreciate your thoughts and sharing 🙂
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