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Peer Providers and Professional Colleagues: Powerful Partners for Recovery
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Rene’ Buchanan shares her own lived experience, rich with insight into how peer providers can be powerful partners in the recovery process. This essay was part of Rene’s presentation in the session “How Can Peer Providers Complement Professional Colleagues as Powerful Partners for Recovery?” at SAMHSA’s 2012 Homeless Programs Annual Grantee Conference in Washington, D.C.
Peer Providers and Professional Colleagues: Powerful Partners for Recovery

Every morning, before I start my day, I look in the mirror, and I see my many faces.

I see a woman, a daughter, and a sister.

I see an employee, a volunteer, a dog lover, and a friend.

I see a brunette with at least as many hidden gray hairs as the years she struggled.

I see a person who is, at long last, truly in recovery—a person on a journey that I began as a disheartened client, but now travel as an empowered woman.

I certainly didn’t always feel powerful, though. In fact, I long ago bought into a mental health system that encouraged compliance to norms dictated by many who had never actually walked in my shoes—by many who had never even been on a similar path.

…and as they dictated my path for me, they never asked me what I wanted. They never asked me what I needed. And they certainly never asked me what I thought.

Instead, they diagnosed and prescribed according to what they thought I should want, what they thought I should need, and what they thought I ought to think.

Initially, I was diagnosed with major depression. At some point, “with psychotic features” was added. Later, after I told a psychiatrist that I sometimes felt like I was being forced to do things, I was told I was schizophrenic. When they realized that schizophrenia didn’t really fit, they changed my diagnosis to schizoaffective disorder, which at that point was just a fancy way of saying they weren’t really sure what was wrong. Next came bipolar disorder, then bipolar disorder depressive type; eventually, we went full circle back to major depression.

Ultimately, in spite of what I know today to be a multitude of best intentions, I was rendered manageable; and this was because, quite honestly, I was rendered helpless.

It is no wonder then that, for over 12 years, I was trapped in a revolving door of hospitals and institutions as I blindly submitted to several series of electroconvulsive therapy treatments and swallowed an endless pharmacy of prescribed cures.

That is, until one cold December morning in 2001 when I was no longer welcome even in the system with which I had been colluding for years. A prominent psychiatric hospital literally threw me out, loaded me into a taxi, and dumped me in the parking lot of OPCC, a social service agency in Santa Monica, CA.

Ironically enough, though, this seemingly horrible circumstance—becoming homeless—would be the beginning of my transformation. For it was in that moment, standing in that parking lot among people into whose eyes I had never looked, and among people I had never wanted to be, that I finally understood. Mental illness, addiction, homelessness—they are not choices people make. Just as I didn’t wake up that cold December morning and decide I wanted to start sleeping in alleys; just as I didn’t suddenly decide I wanted to stop showering, to start wearing dirty clothes, and to begin worrying about where I’d get my next meal; just as I didn’t decide that today was the day I was going to become invisible to everyone who passed me on the street—I realized that no one in that parking lot had decided those things, either. Mental illness, addiction, and homelessness—they’re opportunistic thieves and will steal one’s dignity and crush one’s soul. They do not discriminate, and their causes are as unique as their victims.

Now, it has been over ten years since that hospital dumped me in that parking lot, and I haven’t been back to a psychiatric hospital since—not as a patient, anyway. I live in a beautiful apartment by the beach. I have the honor of working for the agency that helped me save my life. I am involved in my community as a volunteer and housing commissioner. I have two beautiful dogs that remind me every morning at 6:00 am that it is definitely not all about me. I no longer engage in any of the self-destructive behaviors that, for years, ironically gave me a purpose and a reason (albeit a somewhat twisted one) to face each new day. I no longer binge. I no longer purge. I no longer cut myself. Next month, I will celebrate 22 years clean and sober…and 2 ½ years ago I finally managed to stop smoking.

It seems like perhaps the ideal recovery, wouldn’t you say? Well, earlier this year, something happened which rocked my recovery to its very core and left me re-evaluating whether or not I even understood the real meaning of recovery.

On March 20, my best friend, Linda, took her own life. Like me, she had struggled with mental illness for years. She had wound up homeless on the streets of Santa Monica after her depression drove her from her home in Oregon. We met at OPCC, became fast friends, and, for ten years, shared our lives. In spite of how close we were, however, her suicide was a complete surprise. I had absolutely no idea she had returned to such a dark place, and I wondered what, as her friend, I had missed. More importantly, I wondered what, as someone who worked where she still received services, I had missed. I wondered what it was that none of us had seen.

Even though I know that when a person is intent on killing herself, there is little anyone can do to stop her, I realized something. I realized I had fallen into a trap—a trap which gauges recovery in terms of how well a person’s illness appears to be managed rather than in terms of how well the person actually is. I had begun concentrating on milestones, on outcomes, rather than on the person behind the outcomes. And while I know that outcomes are important indicators of recovery, they do not tell the whole story. I had clearly missed a huge part of Linda’s story.

It was a lesson learned, a bittersweet lesson that reminded me of what my passion really is, and of why I do what I do. It is why I believe we all do what we do. It is why it is important that we recognize that we are all vulnerable and that we must construct a world that allows us all to live our dreams—a world in which, together, we stop the thieves.

Now, we talk a lot about evidence-based and exemplary practices, one of which is consumer integration. However, as funding dwindles and the requirements for those dwindling funds become more stringent, truly valid consumer integration often seems to be the first practice that we choose to eliminate. It is as if we have this idea that we will get more bang for our buck if we hire only people with advanced degrees. Experience, especially life experience, becomes the least important factor in the recovery process. Now, please don’t misunderstand me. I have the utmost respect and admiration for my colleagues and friends with advanced degrees. But the person with the MFT or the LCSW or the Ph.D. will play but one role in the recovery process—one supporting role in a process that belongs solely to the person who comes to them for help.

It may be fairly natural to think that what we learn in our pursuit of higher education trumps life experience because, after all, a lot of time, effort, and money goes into obtaining that advanced degree. But we need to stop this trend before we lose the hard-fought ground we’ve gained. Besides, if we look at all of the evidence-based and exemplary practices employed as we seek to help those we serve, we need to ask: Where did all those practices actually originate in the first place?

Housing First, used by many providers long before it even had a moniker, embraces the fact that shelter is a basic human need and an inalienable human right. But it really came from the knowledge that people’s health improved much faster once they were living indoors. It’s common sense. Mollie Lowery, Executive Director of Housing Works in Los Angeles, describes Motivational Interviewing as really just a way of being with people. The secrets to healthy relationships have been harnessed and named ‘Motivational Interviewing.’ Harm reduction—well, parents have practiced harm reduction for years. Rather than keeping children from swimming, they put flotation devices on them until they learn to swim. They preserve their well-being until they can teach them to preserve their own. In sports, we insure safeguards are in place to prevent injuries to athletes. Each of these practices has since been supported by studies and research. But in reality, we had the evidence of their effectiveness long before we named them, and that evidence came from the very people on whom we now use these practices.

So then, what better way is there to empower someone who is just beginning their journey of recovery than by putting together a team which includes—legitimately includes—people who have already walked down that road? Peer support staff, recovery specialists, whatever you want to call them—people with lived experience who are now in a position to pass on the lessons they’ve learned.

Sounds pretty simple, right?

Well, it isn’t always.

Even though engaging peers in complementary relationships to elicit the best outcomes for the people we serve makes perfect sense, actually putting this into practice can be challenging. Providers may feel uncomfortable as they surrender control and accept that their expertise is necessarily only part of a much larger knowledge base. They may even feel a bit threatened when faced with the fact that the life experience of someone who has lived on the streets for twenty years is as valuable as their own educational experience.

Consumers who become providers are equally challenged. We often find ourselves overwhelmed by our newfound power as we begin to navigate a system that has not always welcomed our independence.

That we are even called ‘clients’ denotes dependence and predisposes us to being the less powerful in any professional relationship. In fact, one definition of the word ‘client’ is ‘one that depends on the protection of another.’ This dependence, therefore, when built into a professional relationship, automatically precludes partnership because there is the assumption, even if unspoken, that we are clients because we did not know what was best. Instead of being part of the solution, we are usurped by the solution and told we must comply.

When we move from consumer to provider, this power differential does not automatically dissipate. The cloak of ‘clienthood’ often follows us into our new roles and leaves us doubting that we can help stop the thieves.

Collaboration must therefore begin not when consumers become providers, but rather, when consumers first walk through our doors in search of help. It is at that moment that providers must recognize that, in spite of our circumstances, consumers bring valuable knowledge and insight to the table. In that way, the power differential will never develop, and we will be colleagues from the outset. Partnering will then not be just the next step. It will be the foundation—the foundation from which recovery can be holistically approached, and the foundation from which a recovery’s evolution can be acknowledged, allowed, and encouraged.

On that cold December day in 2001 when I was rejected by the mental health system that had held me hostage for so many years, I felt completely invisible. To be honest, to this day, I sometimes feel that the years I spent in hospitals, institutions, and shelters still render me invisible to a certain degree. It’s a stigma, a brand, and this type of stigma is perpetuated, albeit unintentionally, in service delivery systems that do not embrace the concept of holistic recovery. Recovery belongs to the people doing the recovering, and it must be centered around their hopes, their dreams, their wishes, and their goals. And we must make sure that we never stop asking what they want.

When peers are part of a complementary collaboration, we set in motion a system in which we are able to have proactive conversations where every voice is heard and valued. This system allows everyone to come to the table not as individual experts, but as a collective of expertise where everyone’s knowledge base is equally important, and where everyone’s perspective is considered. And built into such a system is the freedom for providers to ask the important question: What do you want? And the freedom exists for consumers to answer that question.

Given that the causes of homelessness are as unique as its victims, we must recognize that there is no ‘one-size-fits-all’ solution. Recovery is certainly not linear, so we will certainly not stop the thieves by being rigid. The dynamic equilibrium which arises from a truly complementary service delivery system will ensure that our approaches remain fluid. This, in turn, will ensure that we stop allowing diagnoses and limitations to blind us to the possibilities of holistic recovery.

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