Staying a person within the mental health sector

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.