Peers are not Medical Professionals

Marvin RossBy Marvin Ross

When it comes to people with illnesses helping and providing support for those newly diagnosed with the same illness, I am supportive. It makes perfect sense for people to have a support network of their peers. Many disease groups have some variation of this. When I was involved with the local chapter of the schizophrenia society, there was an excellent buddy program. Family members with newly diagnosed offspring were matched with an experienced family member who could give advice, support and comfort.

It is only in mental illness where lay peer support people are becoming quasi professionals and involved with all aspects of the illness. This, despite the research that shows that their therapeutic role is of little value. The Mental Elf Blog reported on the most recent evaluation of these programs and found that:

“there is currently little evidence to support the clinical effectiveness of this intervention for people with severe mental illness.”

So, imagine my surprise to find that there is a social worker from Quebec described as a psychiatric survivor who has developed a program called  Gaining Autonomy & Medication Management (GAM) Training for Peer Support Workers. This program was held in Toronto on December 11 but it has been given in a number of other locales throughout North America.

According to a paper written on GAM, “the approach was developed to take into account the many perspectives and relationships that users have with their medication, their knowledge and practices, their experience of mental health workers, and a thorough analysis of the current knowledge of psychotropic medications both in the field of biomedical research and in the human and social sciences.”

GAM also “recognize(s) the symbolic aspects of medication and require(s) recognition of its multiple, and at times contradictory, meanings in the lives of users and various individuals involved in psychiatric treatment.”

Now I have no idea what this means, particularly the symbolism medication may have. If you have a headache, you take an analgesic. Is that symbolic?

The only paper that I could find on Pub Med or on the internet is the one that I quoted from above. It is claimed that this strategy qualifies as best practices in Quebec but the reference link is dead. Many of the references are not there. They did mention research with 26 people with serious mental illnesses and provided a table to demonstrate the results of their research. That table shows that there was a decline in the number of medications taken at the end of the program. Is that good or bad? No idea. They may think so.

If you have a serious mental illness, your doctor will prescribe medication. That doctor is usually a psychiatrist who has six years of medical school, one year of internship, and five years of residency training to qualify as a psychiatrist. He or she should be well aware of what to expect from what is prescribed and should discuss the effects of that medication on you including side effects. The prescription will be dispensed by a licensed pharmacist with five years of university training who will pick up any drug-drug interactions that the doc may have missed.

Both the doctor and the pharmacist have ethical obligations and responsibilities to you as well as legal responsibilities dictated by their regulatory colleges. Your buddy, the peer, has none of the above education, ethical or legal responsibilities. They might say by way of support, “that sounds like a side effect. I had something similar but it went away in a few days. If it doesn’t, better see the doctor or talk to your pharmacist”. Perfectly legitimate. But you really should not be talking to him about the legitimacy of the prescription or whether you should even take it. To be perfectly pragmatic, you can sue your doc for malpractice and/or report him to his regulatory body, but what of your lay peer?

If you had diabetes, would you learn from a peer how to manage it or would you work with your endocrinologist, dietician and other regulated health professionals?

Why, when it comes to mental illness, is it considered alright to get your pharmaceutical and treatment advice from a lay person?

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2 thoughts on “Peers are not Medical Professionals

  1. I’ve noticed that the Ontario bureaucrats who plan mental illness systems can be too easily taken in by unscientific social presumptions. Acceptance of the necessity of “”peers” in services for the seriously mentally ill (SMI) is one example. Too many professionals lack the scientific education to acquire the knowledge or acceptance of the biological nature of SMI.

    And the money spent by consumer groups in sending these new peer employees down to American treatment centers to be further indoctrinated into anti-psychiatry beliefs is not only unhelpful and expensive but it undermines the work of Ontario’s own system. And we pay for this?

    We understand and commiserate with those with brain diseases but we expect reason and common sense from our governments and bureaucrats.

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  2. In one large publicly funded housing organization for people with mental illness, nurses were required to be hired and were responsible for the overseeing of medication administration to residents. The tone of voice of the CEO when he spoke of this arrangement was disparaging.
    It seemed like any arrangement that is remotely connected to the medical model is a bad thing, even if it ensures that people get their medication administered safely. The provincial government pours millions and millions of dollars into this organization, that has never, to my knowledge, had any external review of the quality of its services. This is one reason why I and other parents and supporters have gotten together to attempt to develop safer housing which is also family friendly.

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