Building Resilience Through Peer Support

The Mood Disorders Association of Ontario

• The MDAO offers free support and recovery programs to people across Ontario living with depression, anxiety or bipolar disorder.

• We provide drop-in peer support groups, recovery programs, individual counselling support, early intervention for mood disorders and psychosis and online tools focused on wellness and recovery.

MDAO Values

• Recovery and self-discovery are possible• Building hope is key• Peer support based on lived experience can contribute to

recovery• We support a comprehensive approach to recovery that meets

the unique needs of each individual• Supporting families can help them play a positive role in

recovery and contributes to the well-being of the family• It is possible to reduce both stigma in society and self-stigma

Resilience• Resilience has been defined as “the process of adapting well in

the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors.”

• It means "bouncing back" from difficult experiences.

(American Psychological Association [APA], 2015)

Resiliency Capacities• Social Competence• responsiveness, cultural flexibility, empathy, caring, communication

skills and a sense of humour

• Problem Solving• planning, help seeking, critical & creative thinking

• Autonomy• sense of identity, self-efficacy, self-awareness, task mastery &

adaptive distancing from negative conditions

• A sense of purpose and the belief of a bright future• goal direction, educational aspirations, optimism, spiritual

connectedness

Fostering Resilience?

• Benefits• Manage and minimizes stress• Boosts self-esteem• Increases confidence

“Resilience flourishes when security and predictability coexist with a manageable balance with novelty and the

unexpected.”-Gabrielle Bauer

Peer Support

“Peer support is a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful. Peer support is not based on psychiatric

models and diagnostic criteria. It is about understanding another’s situation empathically

through the shared experience of emotional and psychological pain.”

(Stiver & Miller, 1998)

Traditional Power Dynamics

The Label of “Mental Illness”“To me, mental illness meant Dr. Jekyll and Mr. Hyde, psycho-

pathic serial killers, loony bins, morons, schizos, fruitcakes, nuts,straight jackets, and raving lunatics. They were all I knew about

mental illness, and what terrified me was that professionals weresaying I was one of them. It would have greatly helped to have hadsomeone come and talk to me about surviving mental illness—aswell as the possibility of recovering, of healing, and of building a

new life for myself. It would have been good to have role models—people I could look up to who had experienced what I was going

through—people who had found a good job, or who were in love,or who had an apartment or a house on their own, or who were

making a valuable contribution to society.”(Deegan, 1993)

Peer Relationship

Core Values of Peer Support

(Peer Support Accreditation and Certification Canada [PSACC], 2014).

Recovery?• Self-defined and driven by the individual• Key principles include:o Hopeo Self-determination and autonomyo Personal responsibilityo Self-advocacy and empowermento Supporto Learning, growth, and self-definitiono Fostering resilience

• Living the life you want to live, even though you experience mental health issues

Types of Peer Support• Informal Peer Support• “naturally occurring, mutually beneficial support process…

meeting as equals, sharing skills, strength, and hope…”

• Formalized Peer Support• Peers receive “specialized training” and “assume unique,

designated roles within the mental health system”(Ontario Peer Development Initiative [OPDI], 2010)

• Peers in traditional roles• Peers with job descriptions that aren’t inherently self-disclosing

(e.g. social worker, psychologist, etc.)

What did you call me?• “Consumer/Survivor”• “Service User”• “Client”• “Patient”• “Nutjob”• “Person With Lived Experience” (PWLE)• “Individual”• “Person with mental health issues”• “Peer”• “Crazy”• “Addict”• “Schizophrenic”• “Mentally Ill”

What did you call me?• “Doctor”• “Psychiatrist”• “Shrink”• “Social Worker”• “Child Snatcher”• “Peer Support Worker”• “Therapist”• “Counsellor”• “Case Worker”• “Quack”• “Mental Health Professional”• “Life Coach”• “Health Care Provider”

The Importance of Language

“There are multiple descriptions of the same real world situation. The only justification for language is to

empower yourself. If the verbal description you create of the situation you find yourself in leads to paralysis and ineffectual behaviour, then throw those damn words away and find yourself a new set. There is always some useful description of the world that

empowers and gives you choices. Your task, if you are going to use words at all, is to find that set of words.”

–Moshe Feldenkrais

Peer Support Works

A robust and growing research evidence base shows peer support is associated with: • Reductions in hospitalizations for mental health problems • Reductions in “symptom” distress • Improvements in social support• Improvements in people’s quality of life

(Mental Health Commission of Canada, 2010)

• Stigmatization is negatively related to self-esteem, while peer support is positively linked to self-esteem

(Verhaeghe, Bracke, & Bruynooghe, 2008)

Peer Support Works

Possible benefits include:• increased self-esteem and confidence• improved problem solving skills• increased sense of empowerment• improved access to work and education • more friends, better relationships, more confidence in social

settings• greater feelings of being accepted and understood (and liked)• reduced self-stigmatization• greater hopefulness about their own potential• more positive feelings about the future

(Centre for Mental Health and Mental Health Network, NHS Confederation, 2013)

Peer Support Works• Meta-analysis showing peer support associated with: • Reduced inpatient service use• Improved relationship with providers• Better engagement with care• Higher levels of empowerment• Higher levels of “patient activation”• Higher levels of hopefulness for recovery

(Chinman et al., 2014)

• Peer support associated with:• Improvement in empowerment, hope, and self-efficacy beliefs • Decreased hospital frequency and duration of hospital

admissions• Decreased substance use and depression• Increased hope, self-care, and sense of well-being

(Davidson, L., Bellamy, C., Guy, K. & Miller, R., 2012; van Gestel-Timmermans, Brouwers, van Assen, & van Nieuwenhuizen, 2012)

Peer Support at the MDAO• Drop-in Peer Support Groups• Registered Recovery Programs• Wellness Recovery Action Plan (WRAP)• Laughing Like Crazy

• One-on-one Counselling Support• Family Programs• “Warm line” and online peer support forum• Volunteer Opportunities

Peer Support Training

Peer Support Training• At MDAO, 4 day intensive peer support training for peer

volunteers, designed by peers and for peers:• Days 1 & 2: Foundational peer support training• Day 3: Group facilitation• Day 4: Working one-on-one with peers

• Emphasis on experiential, self-reflective learning• Exploring how peers can fit their experiences to the framework

of the training (vs. other way around)• Training peers to make intentional choices around what aspects

of their experience they can use in offering support to others• Ongoing training and support provided over the course of

everyday practice

Research and Evaluation

Research and Evaluation• For structured Recovery Programs: • Quantitative data gathered via pre and post surveys to measure

any positive or negative changes after program completion• Standard Likert Scales on a variety of recovery measures• Client Satisfaction Questionnaire (CSQ-8) post-program to measure

client satisfaction • WRAP for Families: 94% overall rating for client satisfaction

• Qualitative data gathered post-program via focus groups• Planning 3 and 6 month follow-ups to assess more long-term

changes• For drop-in peer support groups:• CSQ-8 + additional questions specific to group

Peer Support Across Ontario

Systemic Change

ReferencesAmerican Psychological Association. (2015). The Road To Resilience. Retrieved 13 May 2015, from http://www.apa.org/helpcenter/road-resilience.aspxChinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift,

A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental illnesses: Assessing the evidence. Psychiatric Services, 65(4), 429-441.Centre for Mental Health and Mental Health Network, NHS Confederation . (2013). Peer Support Workers: Theory and Practice. London, UK: Repper, J., Aldridge, B., Gilfoyle, S., Gillard, S., Perkins, R. & Rennison, J.Davidson, L., Bellamy, C., Guy, K. & Miller, R. (2012) Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry, 11, 123-128.Deegan, P. E. (1993). Recovering our sense of value after being labeled mentally ill. Journal of Psychosocial Nursing, 31, 7–11.O’Hagan, M., Cyr, C., McKee, H., and Priest, R., for the Mental Health Commission of Canada. (2010). Making the case for peer support: Report to the Peer Support Project Committee of the Mental Health Commission of Canada. Retrieved from: http://www.mentalhealthcommission.ca.

ReferencesPeer Support Accreditation and Certification Canada [PSACC]. (2015). Certification Handbook | PSAC (Canada). Retrieved 13 May 2015, from http://www.psac-canada.com/certification-handbook/Sunderland, Kim, Mishkin, Wendy, Peer Leadership Group, Mental Health Commission of Canada. (2013). Guidelines for the Practice and Training of Peer Support. Calgary, AB: Mental Health Commission of Canada. Retrieved from: http://www.mentalhealthcommission.ca.van Gestel-Timmermans, H., Brouwers, E. P. M., van Assen, M.,A.L.M., & van Nieuwenhuizen, C. (2012). Effects of a peer-run course on recovery from serious mental illness: A randomized controlled trial. Psychiatric Services, 63(1), 54-60. Retrieved from: http://search.proquest.com/docview/1368609606?accountid=14771 Verhaeghe, M., Bracke, P., & Bruynooghe, K. (2008). Stigmatization and self-esteem of persons in recovery from mental illness: The role of peer support. International Journal of Social Psychiatry, 54(3), 206-218. doi:10.1177/0020764008090422