Shery Mead

This article offers one theoretical perspective of peer support and attempts to define the elements that, when reinforced through education and training, provide a new cultural context for healing and recovery. Persons labeled with psychiatric disability have become victims of social and cultural ostracism and consequently have developed a sense of self that reinforces the "patient" identity. Enabling members of peer support to understand the nature and impact of these cultural forces leads individuals and peer communities toward a capacity for personal, relational, and social change. It is our hope that consumers from all different types of programs (e.g. drop-in, social clubs, advocacy, support, outreach, respite), traditional providers, and policy makers will find this article helpful in stimulating dialogue about the role of peer programs in the development of a recovery based system.

This study explored the role of work in the recovery of employed and unemployed persons with psychiatric disabilities. Fourteen persons with psychiatric disabilities participated in semi-structured interviews. Content analysis revealed that the experience of recovery was based on six major dimensions: self-definition, empowerment, connections to others, meaning of work, vocational future, and meaning of recovery. Differences in these six dimensions led to the identification of three profiles of recovery: recovery as uncertain, recovery as a self-empowering experience, and recovery as a challenging experience. Each profile described a specific context in which participation in work or avoidance of work can be understood and vocational interventions can be designed.

To promote research and improved clinical practice, three criteria are proposed to define recovery from severe mental illness: hope, self-responsibility and 'getting on with life' beyond illness. Each of these criteria can be measured at the intrapsychic-subjective, interpersonal-behavioral,and environmental levels.The criteria were identified through cumulative experiences of a decade of clinical services research at the New Hampshire-Dartmouth Psychiatric Research Center, contributions from consumers and family advocates, and focus groups. Measures of each criterion are proposed through the use of extant assessment instruments such as the Beck Hopelessness Scale, Locus of Control Questionnaire, instrumental and social role functioning scales,and subjective ratings of quality of life. Collateral sources of information are required to assure that the measures of the criteria for recovery are reliable, accurate and valid. The criteria selected to define recovery have already instigated the use of a broad array of tools to assess the course and outcome of schizophrenia in research and clinical practice. Concentrating on the importance of self-responsibility as a criterion should have the spin-off benefit of encouraging psychiatrists to more actively involve their clients in a collaborative enterprise for pharmacotherapy, including education in disease management and shared decision-making. To promote recovery using the three component definition will require rehabilitation practitioners to provide services that should facilitate clients managing and directing their own lives with greater autonomy. Services that enable clients to develop the social and independent living skills needed for community reintegration will engender hope, self-responsibility, and the development of a functional person who has recovered from a disabling mental disorder. Operationalizing recovery should accelerate hypothesis-testing research on this construct, including determining the attributes of treatment and rehabilitation services that are associated with optimal states of recovery.

Purpose The purpose of this paper is to demonstrate how mutuality and shared power in relationship can avoid coercion and force in mental health treatment. Design/methodology/approach This is not a research design. It is rather an opinion piece with extensive examples of the approach. Findings The authors have found that using these processes can enable connection; the key to relationship building. Originality/value This paper is totally original and stands to offer the field, a new perspective.

Psychiatric interventions for crisis care lie at the center of the conflict between involuntary commitment and recovery/wellness systems in mental health services. Though crisis can mean completely different things to people who have the experience, the general public has been convinced by the media that people with psychiatric disabilities are to be feared. More and more this has led to social control but is erroneously still called treatment. This does nothing to help the person and in fact further confuses people already trying to make meaning of their experience. This paper offers a fundamental change in understanding and working with people in psychiatric crises. Rather than objectifying and naming the crisis experience in relation to illness, people can begin to explore the subjective experience of the person in crisis while offering their own subjective reality to the relationship. Out of this shared dynamic in which a greater sense of trust is built, the crisis can be an opportunity to create new meaning, and offer people mutually respectful relationships in which extreme emotional distress no longer has to be pathologized. The authors, who have had personal experience with psychiatric crises, have provided this kind of successful crisis counseling and planning and have designed and implemented peer support alternatives to psychiatric hospitalizations that support this model.

It is the era of evidence-based practices. Now more than ever, social programs are challenged to clearly describe their ideal frameworks and empirically demonstrate fidelity to their standards. In this study, the authors implemented a narrative approach to developing standards in a peer support program for people accessing mental health services. In an attempt to broaden the scope of evidence-based practices, emphasis was placed on developing standards that characterize the helping processes in peer support. Seven helping standards and their related indicators were identified. When is narrative inquiry an effective approach for developing standards? Should similar kinds of social programs have to adopt the same standards? What role do contextual factors play in the development of standards? Whose criteria should standards represent? These are but a few of the broader issues the study attempted to address.

The traditional goals of psychopharmacology stem from the medical model. Rehabilitation interventions attempt to improve aspects of functioning in patients with chronic illnesses that are not responsive to biological intervention. Recovery is a concept emanating from the consumer self-help movement. It describes a move away from the patient role defined by a diagnostic label toward community membership defined by relationships and responsibilities in the community. Comprehensive care for people with psychotic disorders can include attention to each realm. This article provides an overview of the 3 models of care and describes a role for the psychopharmacologist in each as well as his or her unique potential to incorporate all 3. We outline potential synergistic benefits of integrating recovery-, rehabilitation-, and medical-model thinking into the practice of psychopharmacology and explore implications for the goals and outcomes of treatment for people with psychotic disorders.

We consider the value of dialogue between healthcare professionals and mental health service users with severe mental illnesses. Discussion with the service user before, during and after a psychiatric crisis should help services to offer choice even to individuals under compulsory detention.

In this paper, we will describe the core themes behind the practice of Intentional Peer Support (IPS), offering a unique perspective on what has commonly been described as "mental illness" and the power dynamics inherent in traditional helping relationships. Through intentional conversations that explore "how we've come to know what we know" and challenge the naming of our experience by others, we begin to find new ways of understanding and responding to our own and other people's experiences. In addition, we emphasize the importance of mutuality in relationships. Both people share responsibility for the relationship, and no one is assumed to be the sole holder of "truth". Mutuality becomes harder but even more critical to practice when we begin to fear for "safety" of the other. It is our belief that as we practice IPS across all relationships in our lives, we can begin to tackle some of the complex ways in which language, roles, power and culture have contributed to our own sense of internalized oppression in any form.

Les interventions psychiatriques en situation de crise sont au centre du conflit entre traitement non volontaire et systèmes de rétablissement et de bien-être dans les services de santé mentale. Bien que la crise puisse signifier tout autre chose pour les personnes qui la vivent, la population en général a appris à y répondre avec une crainte alimentée par les médias. Un contrôle social accru, appelé par erreur « traitement », s'en est suivi. Cela n'aide en rien la personne et, en fait, contribue à confondre davantage celle qui tente de donner un sens à son expérience. Cet article propose un changement fondamental dans la compréhension et le travail en situation de crise psychiatrique. Au lieu d'objectiver et de nommer l'expérience de la crise en relation avec le construit du trouble, l'objectif est de développer une façon de penser plus relationnelle et contextuelle relativement à la réaction ou à la réponse à la crise. En ce sens, les auteurs explorent les concepts de réciprocité, de planification proactive, d'élaboration d'un pouvoir négocié et d'une définition commune, des risques et de la sécurité, de «»ré-écriture ou de re-construction » (re-storying). Finalement, ils présentent une discussion sur l'élaboration de stratégies de recherche appuyant les nouvelles façons de penser au sujet de la crise. Les auteurs, qui ont vécu des expériences personnelles de crises et d'hospitalisation, ont été impliqués dans l'élaboration de programmes de soutien entre pairs depuis 1990. Dave Hilton a été l'un des premiers directeurs à rendre des fonds accessibles pour l'implantation de programmes de soutien entre pairs à la grandeur de l'État. Shery Mead est ex-directrice de trois agences de soutien entre pairs, dont une ressource alternative gérée par les personnes utilisatrices. Elle est consultante pour les programmes de soutien-conseil entre pairs et pour les programmes traditionnels en santé mentale aux États-Unis.

Hamilton and Shery Mead spoke with each other over the course of 2019. They had been united through their connection to intentional peer support (IPS), of which Shery is the founder and Hamilton a practitioner. Narrative therapy and IPS have both proposed meaningful alternatives to clinical ways of work with people. More recently, Hamilton has attempted to use both of these skills together. You can read about this more in the accompanying article, 'Narrative practice and peer support' (Kennedy, 2019).

Psychiatric interventions for crisis care lie at the center of the conflict between forced treatment and recovery/wellness systems in mental health services. Though crisis can mean completely different things to people who have the experience, the general public has been taught a unilateral fear response based on media representation. More and more this has led to social control but is erroneously still called treatment This does nothing to help the person and in fact further confuses people already trying to make meaning of their experience. This paper offers a fundamental change in understanding and working with psychiatric crises. Rather than objectifying and naming the crisis experience in relation to the construct of illness, our goal is to develop a relational, contextual way of thinking about crisis response. In that we will explore the concepts of mutuality, proactive crisis planning, the development of negotiated power and meaning, risk and safety, re-storying and finally we will offer an argument for creating congruent research strategies that support new ways of thinking about crisis. The authors, who had personal experience with psychiatric crisis and hospitalization, have been involved in the development of peer programs since 1990. Dave Hilton is the director of the Office of Consumer Affairs in New Hampshire and was one of the first OCA directors to access funds for statewide peer support program implementation. Shery Mead is the past director of three peer support agencies including one peer run crisis alternative. She currently consults with peer support and traditional mental health programs nationwide.