10 October 2022
By Cassi Strauss – Mind Australia peer practitioner.
As flagged earlier, this Mental Health Week Croakey is hosting the Speaking Our Minds series of articles, featuring powerful messages from writers with lived experience, about what needs to be done to improve our mental health and mental health services.
Cassi Strauss, who writes below, is one such person. Cassi works as a peer practitioner, creating a safe, non-judgemental and non-clinical space for people who are dealing with mental health problems and diagnoses.
It’s a role that she describes as both the most challenging and the easiest thing she has ever done, and one that she believes has the potential to be even more effective, if properly understood and supported.
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Cassi Strauss writes:
Growing up in an era that did not allow space for children to express emotion or complain of physical ailments, it’s no surprise that, after a diagnosis of ovarian cancer at the age of 25, I went on to develop complex Post Traumatic Stress Disorder. With this came what I then thought was a sudden onset of anxiety and suicidal ideation.
However, with the support of a great therapist, I was able to recognise that many of my struggles came from unresolved childhood and teenage trauma – triggered by the recent health scare. The more of life I experienced, the more I recognised the things it was lacking, and the disconnect I was feeling grew.
I knew something had to change. I could no longer sit around waiting and accepting the things happening to me and my family. I decided I needed to understand us all better.
Becoming a Peer Practitioner
After four years of study, I completed my Bachelor of Psychology and graduated in the midst of COVID. I was determined to use my experiences, my pain, and my knowledge, to help others to never end up in the helpless position I’d found myself in.
I took a part time job in youth residential care on top of my full time managerial role, to gain some experience.
From there I applied for a community mental health practitioner’s role, but instead was offered to interview for a new position that had not been advertised yet – peer practitioner.
I had never heard of this title before and had no idea what to expect. I began my time as a peer practitioner working alongside other newbie peer practitioners at the local hospital emergency department.
Peer work means different things to different people, but to me it means using my lived experiences to support other people to their own self-discovery. Much of my own recovery journey has extended from understanding myself better – why I feel what I feel, and how my reactions relate to those feelings.
The value of lived experience
As peer practitioners in the ED we were able to offer alternative crisis support to people presenting in distress, while also learning and developing our own peer practice. This was both the most challenging and the easiest thing I have ever done.
I found that my practice was always going to stem from my own lived experience, however I quickly discovered that my learnt judgemental opinions had no place here and I needed to be completely open minded if I was going to be authentic in my practice.
Before practising peer work, I had very strong opinions around drug use, specifically that there was no reason why people should become addicted. Early into my work and training, I came to recognise that, for some people, the impact of life experiences may mean their best coping mechanism becomes using drugs.
I am now able to support people with alcohol and drug use effectively by embracing empathy, understanding and zero judgment.
I have had the privilege of working across many different programs during my time as a peer practitioner. This has given me great insight to the amazing support lived experience brings to the mental health system.
Through our own lived experience, peer practitioners can look beyond someone’s diagnosis and see the whole person. We are able to provide people with authentic, holistic support throughout their mental health journey by being with them, as opposed to doing things to or for them.
We take the time to learn from and about the person we are supporting so that we can co-facilitate a recovery plan, and we strive to create a safe, non-clinical environment, where people can be supported to self-discovery.
The advantage of this non-clinical environment is that it removes barriers such as intrusive paperwork and assessments – both of which add no value to support provided, and are simply a check box exercise for organisational procedure.
As someone with their own lived experience, I know that people need understanding, not fixing. People want to be heard and to feel safe, especially when exploring subjects such as suicide.
Peer practitioners are able to create a safe space where people can explore what they need to, without fear of judgement or consequence. We know we are not perfect – we won’t always get things right – but you can be sure that we will take responsibility when we get it wrong and learn from the experience. There are no egos here. And we will ask your permission, every step of the way.
Barriers to effective peer work
Currently the benefits of lived experience in the mental health system are being hindered, whether intentionally or not. Through my professional experiences, I have seen how most system guidelines, policies or procedures don’t align with peer practice and values.
This includes the expectation of unnecessary incident reporting or intrusive and unwarranted welfare checks for people expressing suicidal thoughts or ideation. These systems have been created to protect liability of organisations and have lost sight of why they were implemented in the first place – to support people who want to be supported.
As someone with this lived experience, I can recognise that not everyone who has suicidal thoughts has the intention to end their life. This has been a common theme I have come across in my peer support work – people afraid to be honest due to fear of hospitalisation or other consequences.
These include having child services involved if they are a parent, being “dobbed on” to other support services, and unwanted welfare checks by police or ambulance.
The need for understanding and inclusion
Many non-peer mental health professionals don’t know or understand what it means to be a peer practitioner. The number of times I have introduced myself and been met with the blank stare or roll of the eyes – I have reverted to introducing myself as a community mental health practitioner in some professional settings to avoid the awkward conversation or explanation.
Alongside this is the myth that people with their own lived experience are damaged, broken and fragile. They couldn’t – so the myth goes – possibly be able to help themselves, let alone anybody else.
This could not be further from the truth, and this stigma and emphasis on tiptoeing around peer practitioners creates a huge barrier.
This is evident even in some of the peer work educational framework – where there is a massive emphasis on safe disclosure but nothing about how to utilise lived experience in a practical way. Without advice around this, peer practitioners are thrown into practice without all the tools they need to provide the best support possible.
A powerful tool
Of the many great outcomes achieved by people I’ve supported, one in particular has held a special place for me: supporting someone with a recent diagnosis of BPD (Borderline Personality Disorder) who was feeling lost and hopeless around their ability to manage their daily symptoms.
At the start of our support they were hyper focused on the diagnosis and all the barriers this created for them. As we would find out, many programs, organisations and mental health professionals will not support someone with BPD directly.
This is due to the lack of understanding around the diagnosis and the wide breadth of symptoms that can accompany BPD. This lack of awareness has created a stigma around BPD, felt immensely by people seeking support through long wait times and inappropriate support options.
I was able to be flexible in my role and create space for both self-discovery and education for others supporting this person. Together we explored the whole person and how their symptoms were affecting, and intertwined with, every part of their life – work, social, family etc.
Our collaborative care approach allowed a safe space for this person to explore their self-harm and suicidal ideation to a point where they began to feel somewhat safer with themselves, as their understanding of themselves had changed.
At the end of our support, we were both able to reflect on the growth we’d each experienced. We learnt a lot from each other and we were able to create some trust in the system again for this person. They were able to detach themselves from their diagnosis and recognise that they were a whole person outside of their BPD.
Seizing the opportunity to empower peer practice
This person’s story and my experience point to an opportunity.
The idea of peer work has become the flavour of the month, but organisations need to provide the right support and awareness across all service providers, for peer practitioners to ensure their impact is felt.
Without proper understanding and acceptance of the peer workforce, lived experience will not be utilised to its fullest effect but, if done correctly, peer work will be the way forward for mental health support, providing a trustworthy pathway for people to access the support they want.
This article was originally published on Croakey’s website as part of the Speaking Our Minds series on 10 October 2022. Find the Croakey story here.
If this article raises concerns for you, please call Lifeline on 13 11 14. Aboriginal and Torres Straits Islanders can also call 13 YARN (13 92 76) a 24/7 national crisis support telephone service staffed by Aboriginal and Torres Strait Islander peoples
If you would like more information, please contact us via Mind Connect or phone: 1300 286 463