"I hear some people say that there’s no hope for the mental health system and we need to throw it away and start over. I don’t disagree with the “throw it away and start over” approach but guess how that happens? I think it happens from within the system. I’m seeing it happening! It’s painfully slow but—at least where I am—a clear shift is underway." --Malakia Puffer
Occasionally, I think it is helpful to extend our view beyond our state to hear from some important voices in the peer movement. I really enjoyed Malakia's blog post and have chosen to offer a blog re-post "Why I Work In the System?" from the very important site "Mad In America".
Malakia Puffer is a Certified Peer Specialist in Ohio. Malaika now lives and works in New England where she coordinates peer support services in a traditional setting, and outside of work she is involved in grassroots community organizing and advocacy.
Malakia Puffer
Her Disclaimer: I’m basically going to write about my own processing of my work as a peer support coordinator in a mental health agency. My intention is not to teach or advise but to “learn out loud” and hope that others join me in that process. Also, I’m coming from a starting place of believing that there is value in having *some kind* of system for helping people who aren’t able to find support elsewhere.
I find it to be a really difficult decision—some days more so than others—to do peer support in the traditional mental health system. I need to remind myself pretty often why I am doing this because it’s really, really hard!
Here are the reasons I go to most often:
1) If Not Me Then Who?
This job exists—for better or for worse, there is a demand for peer support in all kinds of settings. If I didn’t take this job, who else would? Would it be someone who continued the message of illness and disability? Would it be someone who was comfortable with the status quo? If someone is going to be in this role and talk about people without them there, write notes about them, restrict access to some items, and do other things that can feel a little icky to me at times, maybe it’s better that the people doing this be critical and questioning of those practices rather than comfortable with them?
2) There Are People in the System Being Harmed
Building alternatives is something I value a lot and I hope that someday we get to the point where people have access to other types of support besides what the traditional system has offered. In the meantime, there are many people every day being told devastating messages about themselves and their future, people being shamed, people being coerced,people being over-drugged or unnecessarily drugged, and people being written about, talked about, thought about in disrespectful and degrading ways. Maybe my presence will lead to a bit less of this.
3) I Don’t Want to be Sheltered or Shielded
Similar to the point above, horrible things are happening in the mental health system on a regular basis (in my opinion). It’s happening in the world. I’ve decided I can co-exist with that reality and, at least for now, I would rather be right there to see it and feel it so I can try to understand it better and perhaps change it. (There’s no implied judgment here towards people who decide that it’s better for them to have some space from consistently seeing this kind of harm up close and personal on a regular basis—very reasonable!)
There are also some really tough situations and questions to be dealt with, particularly issues around public safety and social control. I used to have a bit more black-and-white thinking about things like heavy medications, restraint, force, intervention and secretive notes/conversations. It was easier to simply think of all of that stuff as bad and not really engage with the more complex questions. For me, when I really wanted to work somewhere that I considered a “pure alternative,” I think it was in part because I didn’t want to deal with those tough, uncomfortable things that felt scary and horrible and bring up my own experiences of systemic trauma and oppression. (For the record, I still OFTEN feel that way and there are so many questions/issues I’m just not ready to tackle.) I appreciate that working in the system really compels me to consider these tough issues from multiple points of view and I’ve found that it is (occasionally, slowly) softening some beliefs or attitudes that were a bit rigid. I find this process painful and frightening but so far I’m valuing my aspiration to not be dogmatic over my desire to be comfortable.
4) I’m Gaining Some Useful Skills
I feel so very, very lucky in my job (and in the world in general) because I’m really challenged in all the ways that I want and need to be!
I get a lot of practice with things that I want to become better at. On a daily basis I feel compelled to rethink pretty much all my opinions and automatic reactions. I definitely get to work on a lot of diplomacy skills; I have to give people feedback and speak up about what I think (I wouldn’t be doing my job if I didn’t) and it has to be in a compassionate, tactful way in the context of genuine respect. I want to have consistency and integrity in what I believe and how I would like people to be treated. If I think that people are worthy of positive regard and not being reduced to anything less than a dynamic, lovable, understandable, equal human being then I need to work on cultivating that kind of attitude towards people whose actions I consider harmful or oppressive. In my opinion if I do anything less than that then I’m just handing out diagnoses and prescriptions as well.
I get to practice hope a lot. And having joy and peace despite being around a lot of very unjoyful and unpeaceful things. I’m beginning to learn a little bit about what’s mine to worry about and what isn’t. I’m learning a lot about myself, of course, and I’m (tentatively?) discovering and trying out my potential to be influential in the world around me.
I get to practice sharing difficult or unwanted information with people (like “No, I’m not going to bring you home” or “if you did that my response would be to call the police” or “I am going to call crisis now” or “in order to see your chart you have to fill out this form and wait 30 days” or “I don’t feel comfortable sharing that information with you”) in a way that, as much as possible, sends a positive message about their worth, autonomy, and capability.
I get to practice teaching people a new way of thinking and relating to others who are in distress or whose experiences they don’t understand.
I so don’t have any of this figured out—and probably won’t—but it’s really enjoyable/rewarding/not-boring to be actively in this process. There are some perks to regularly being in difficult conversations and situations.
5) There’s Actually Hope
I hear some people say that there’s no hope for the mental health system and we need to throw it away and start over. I don’t disagree with the “throw it away and start over” approach but guess how that happens? I think it happens from within the system. I’m seeing it happening! It’s painfully slow but—at least where I am—a clear shift is underway. Many people are at least aware of things like Open Dialogue, the Hearing Voices Network, Mad In America, etc. AND there is buy-in from a lot of people in leadership positions. All the awesome young leaders I see (and many of the older ones too) are open-minded and rights-conscious.
Also, it’s just not cool to use very pathologizing, disease-based language anymore. It totally happens all the time but you don’t see it happening without a bunch of people bristling at least.
I’d really like to include a few anecdotes here but I think I might get myself in trouble with some small-state politics so I won’t.
6) I’m Making a Difference
I just am.
I feel uncomfortable rambling off a list of things that I’ve done or been involved in but it’s clear to me—unless I’m feeling really discouraged—that things would be different if I weren’t here. I think my presence (like the presence of every member of our community) makes a difference in the individual experience of people receiving services, in the activities and atmosphere we provide, in treatment decisions, in program policies, in staff perspectives, and in what kind of information and ideas people are exposed to.
7) I Happen to Work With Great People
I’m not sure if I could work in the system if I didn’t have support from my supervisor, coworkers, and senior leadership. There’s openness and interest towards approaches outside the disease model and a strong push to be “recovery-oriented” (but actually, not just as a cool phrase to put on a brochure). I realize it’s not like this everywhere.
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