Over the past decade, several of us in Marcellus have sought counselling from psychologists to deal with the pressures of our job alongside personal upheavals such as losing a loved one to trying to settle down in a new country. However, people like us our fortunate at multiple levels – we have the money to hire professionals to help us cope with stress and we belong to a strata of Indian society where seeking counselling is no longer seen as a taboo. Elsewhere in the world, most people are not as fortunate as us. So, how do they deal with mental stress?
In this long essay in Aeon, Arjun Kapoor – a lawyer & a psychologist at the Centre for Mental Health Law & Policy, Indian Law Society, Pune – and Jasmine Kalha – a researcher at the same Centre – explain how they have created a system to help less privileged people deal with stress. They say that “…in India, where we work, between 70 to 92 per cent of people with a diagnosable mental health condition don’t have access to any form of mental health care.”
Using examples from other countries, Mr Kapoor & Ms Kalha explain how their system for seeking counselling works: “In the context of mental health, peer support is a process through which people who share similar lived experiences or social backgrounds support others experiencing mental health problems or emotional distress. One of the earliest recorded instances within psychiatric settings can be traced to the late 18th century at the Bicêtre Hospital in Paris where recovered mental health patients were employed as staff members to take care of patients who were in treatment. Other earlier manifestations of peer support emerged as self-help groups providing informal support in the community. For instance, in 1845, a group of men who had experienced treatment violations while in an asylum, set up the Alleged Lunatics’ Friend Society in England, which fought for protection from ‘unjust confinement … [and] from cruel and improper treatment’.
Another early example was Alcoholics Anonymous (AA) set up in 1935 in Ohio in the United States to support people struggling with alcohol addiction. AA is now present across the world and is widely regarded as one of the most successful peer-support groups specifically for addiction recovery.
However, it wasn’t until the 1970s that peer support as a formalised and systemic approach emerged out of the service-user/survivor movement, which, along with the anti-psychiatric movement, challenged mainstream and formal mental health services driven by the psychiatric model. This was alongside other social movements for civil rights, women’s rights, LGBTQ+ rights and disability rights during the 1960s and ’70s, which also influenced the development of peer support in the context of emerging discourses on human rights and resistance against oppressive systems. In particular, peer support began to embed itself in the ‘recovery movement’, which foregrounded the voices and agency of persons with lived experiences and service-users to shape and pursue their own idea of recovery, hope and functioning, without reducing their identities to their diagnostic labels and symptoms.”
The authors then give examples of how their Centre in Pune helps provide peer support: “Take, for example, a student volunteer providing psychosocial support to a classmate who belongs to an oppressed caste community and is confronting institutional caste-based discrimination; a member of an LGBTQ+ collective providing affirmative support to a person coming to terms with their sexuality; a survivor of domestic violence providing crisis support to a young woman who has been physically assaulted by her husband; a volunteer providing referral resources over a chat-based app to an adolescent having thoughts of ending their life; a peer supporter helping a person with schizophrenia admitted to hospital to develop their own recovery plan; or a group of individuals listening to and sharing each other’s journey of recovering from substance use addiction.
These are examples of the myriad ways in which peer support can be provided across settings ranging from community spaces, educational institutions, psychiatric hospitals and rehabilitation homes to online support groups, phone-based helplines or even chat-based apps. Peer support also comes in many different forms, ranging from emotional support, problem-solving and crisis support to providing information resources, advice and specific mental health services within hospital settings. The term ‘peer’ is used to describe individuals providing such support to others. Peers are most often laypersons who belong to the same age groups, specific communities or identities, or share lived experiences of distress, mental health problems or oppression. Peers can also be workplace or academic colleagues, community volunteers,….”
The authors cite academic research which has measured the effectiveness of peer support: “Studies have demonstrated benefits for both peer supporters and persons receiving peer support. In a systematic review published in 2013, of 11 randomised controlled trials involving close to 3,000 people in the US, the UK and Australia, researchers found that patients showed equivalent outcomes, in terms of quality of life, mental health symptoms, satisfaction and use of mental health services, when their care needs or group therapy were managed by a peer supporter, compared with a mental health professional.
Furthermore, in 2011 another review of studies into peer support in professional mental health services suggested that peer support can help reduce admission rates and re-hospitalisations; increase the sense of empowerment and independence…”
We would urge you to read the entire piece in Aeon to understand why peer support in so effective. Here is a glimpse of why, as per Mr Kapoor & Mr Kalha, peer support works so well in India: “To be told by someone, in whose narrative we identify parts of ourselves, I understand what you’re going through. Things can get better, they did for me can be deeply affirming and liberating. A peer’s ‘experiential knowledge’ can therefore serve as an inspirational model for living and coping with adversity, and a boosting reassurance that this is possible for me also.”
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