Encounters between peer workers and users of psychiatry in France: general characteristics and effects of the device on the representations of users. Part 1
Objective: This series of two parent papers describes, as part of an experimental program in France, the meetings that took place between consumers of psychiatric services and peer mentors. We report on the shape, style and characteristics of these interactions. Some of their effects are also reported. The peer mentors are hospital employees who are hired through renewable contracts or, for some, on permanent contracts. The program was led by the World Health Organization Collaborating Centre for Mental Health for France, with the intention, beyond the creation of a “new profession,” of transforming current practices and representations of public psychiatry teams towards recovery. The first paper discusses the general characteristics of the consumer/peer mentor meetings and the effects of this mechanism on the representations of the consumers about mental illness and more broadly about the health care system. The second paper reports on the therapeutic effects of these meetings. Some limitations and pitfalls are highlighted. Methods: The program under study involved the hiring of (ex-) consumers of psychiatric services (n=29). These peer mentors are individuals “who have had, or still have psychiatric disorders, and have experienced a process of recovery.” They were deployed in public psychiatric services after having been trainees for a year and having pursued a training of eight weeks, in parallel, that led to a peer mentor university degree. Our sample is mainly composed of patients who met at least once with a peer mentor, and who were recruited during the field survey in the sites (in-hospital, outpatient or in urban settings). We approached and spoke to patients who were likely to agree to be interviewed to share their experience and thoughts. They had to sign consent forms and thus they were told that we were working on this experimental program on peer mentors with a qualitative and inductive approach. The empirical data that is reported here comes from a qualitative sociological investigation that accompanied the evaluation of the implementation of the program between 2012 and 2014. We have conducted 74 interviews with consumers. We have a significant number of observations of the meetings between peer mentors and consumers, some of which were transcribed verbatim. We were also informed by informal discussions with consumers in every service, and through direct interviews with peer mentors, as well as through in situ observations. Results: We used standardized prompt questions such as: “Did you meet X,” or “Do you know X?” We had to introduce the terms “peer” or “former patient.” In effect, in interviews with study participants it appeared that this “X” was sometimes perceived as more of a nurse, and that they were not aware that this person was a “peer mentor” or a former patient. The insistent style of some questions and the context of what could appear to be a formal assessment of a person’s work might explain why study participants seemed inclined to give positive comments. A bias was also possible when study participants were recruited and “prepared” by the treatment team for the interview. Despite these limitations, we can highlight the quality of the data. Conclusion: By the end of the experiment, 15 peer mentors were able to find and make their place in various services, despite important differences between situations with regards to their position in the institution, their degree of autonomy and responsibility, their working arrangements with other professionals, and their actual work. However, we were able to identify common determinants: the voluntary nature of the meetings; less normativity on behavior; the supply of time and availability; a distant relation to medical drugs; a blurring of boundaries between private and professional life; specific management of distance and familiarity. Concerning representations of illness and care, we found that the peer mentors actively contribute to disseminate a vision of recovery based on a positivist conception of personality. They also allow some criticism of other professionals and of the healthcare system. Consumers, in turn, evoke interactions based on the ease of contact, proximity and availability of peer mentors. This proximity can be linked to a form of camaraderie in the institutional context of care but can also lead consumers to see, in the peer mentor, a figure of “hope.”