A Conversation About Peer Work in Suicide Prevention

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September 09, 2021

People Lady thinking

Lucy: Jo, you and I work in the same suicide prevention program, but as a Peer Worker you obviously have the lived experience of being a consumer in this same space. I'm just interested in what you've noticed, or if you’ve noticed, any changes in the area and what hope this bring you as a worker.

Jo: Thinking back when I first started with Next Steps, peer work was quite new, and I remember using the word pioneering quite a few times. In fact, peer work wasn’t really a part of suicide prevention programs and I guess there was a bit of pressure in that as well.  We were trying to make sense and understand what this new thing (peer work-led suicide prevention programs) was I think, as were others. It created a fair bit of curiosity as well. So, the curious questions about how this will work and if it's been tried before and what does a peer worker know and how will they move in this space. So yeah, it came with its challenges at the start, but I guess in that too, we could kind of do that learning together in the space.

Lucy: So, from the sounds of things, peer workers weren’t around when you were a consumer?

Jo: No, I was never offered a peer worker and looking back now with what I know, I don’t believe there was a peer worker available in the service. I had a small amount of support with community mental health, so a few weeks, and then I was referred out for clinical support. At the time, to be honest, that's not where I wanted to head (engaged in clinical support) and I knew that wasn't the space that I needed. What I did do that was helpful, was work with the clinician at Community Mental Health to have a big deep and look at my values and what was important to me. It's like somebody had finally given me permission to make some changes, and I did. And making those changes to my own life was enough to have me feeling a lot better and move to me out of that space of suicide. That was enough for me to make those changes and consistent goals and look at what was important.

Lucy: I think it’s interesting, I guess what you’ve said expresses to me that it doesn’t necessarily matter where you go to get help, but that wherever you go, you can be met as a person with ideas and solutions about your own problems. And the package that is presented in can be a community service, a clinician, a peer worker, things like Safe Haven and SPOT (Suicide Prevention Outreach Teams). I guess you can argue there’s no special knowledge or skill necessarily needed to work with someone who is suicidal other than a capacity to meet them as they are and work with what’s important to them.  

Jo: I think an acknowledgement that not all people that come to suicide prevention services will also have co-existing mental health conditions.  In the example of what happened for me was very much that some very overwhelming things happened in my life that I thought I had no control of. And being able to acknowledge and give myself some space to think about that and recognising that there were choices in there, even though I felt like there were none at this time, was enough for me to start feeling better. And I think that's where lived experience can fall into this space really well. Saying I know what it feels like to feel lost, I know what it was like to forget those things that were important to you and feel like you have no choice. Its good having somebody to support you while you take a first ginger step out and try something different.

Lucy: Sometimes there’s the idea that the more unwell someone is, or the more complex their situation, then their more clinical their care and support needs to be. But from your experience, I’m hearing that what made the biggest difference for you was to talk about the life you wanted to lead, to open discussion about some of the choices and options you did have, and to gently make some changes towards that. Even though there were some suicidal thoughts hanging around, you didn’t need much more than that to open to some hope. What do you see, now working in suicide prevention, that makes you feel good about the way things are going?

Jo: I think there's a lot of recognition of the work people with lived experience can do in that space and the benefits of peer work. It’s good to see that acknowledgement in things like Safe Havens and SPOT, peer work is an integral part of those things. We're acknowledging that need to have that lived experience lens in helping people move from that space of suicide. So that's really exciting. There was some curiosity to start, around peer work in suicide prevention, like how will you assess risk and what will you do. Sometimes the work we do in a peer work session doesn’t result in tangible output, like a risk assessment but that doesn’t mean there hasn’t been growth and movement. It works around the connection and sharing of experience. It's about being able to say “Hi, I know what it's like being in that space and also know what it's like to feel better”, being able to create a safe space to talk around suicidal feelings and have no judgement.

Lucy: And I guess we both come from the perspective of l working in a program that, you know, does focus on the contribution of the lived experience lens on support and, you know, I guess we both see the impact that can have on dismantling that power dynamic that can exist within mental health. All those constructs of power that are often in the health system and in the mental system that we try hard to address and make smaller. When I think about lots of clients’ stories now, control over their own experiences and lack of power over their own lives is really the heart of what's going on for them, the heart of what's driving that suicidality. And a peer work model kind of speaks to that straight away, right. Like, by just meeting a peer worker, are you are introduced to someone who is not claiming to have special skills of knowledges, someone who can use their power to help you feel better, but instead someone who can tell you a story of how they found their own power. I think that's quite beneficial for everyone involved, client, peer worker, clinician.  And its what they represent, which is the fact that lots of people live with suicidal thoughts and also lead very rich and meaningful lives. The two aren’t mutually exclusive.

Jo:  Yeah, absolutely agree and I think when you have the experience of coming through a system, you feel like you're in the system, not of it. There are constructs built on how a person would move through a particular system. I think about my experience, I kind of took other people's advice and didn't really know that I had much choice. I'm thinking of sitting down and doing safety plans for instance. And one of the things that we might look at it in a safety plan is “means reduction”, removing means.  And I remember sitting with one of the clinicians and we're talking through safety planning. I notice a bit of a change when we get to means reduction. I remember what it was like to have my medications removed and other things, and feeling like, well that's one less choice I have, that my choices are continuing to be taken away even as I'm trying to get better.  I think there's some power in being able to reflect on that experience as a consumer and it can change the way that we approach it. So, I talk to people about adding things to their home, as well as removing means, to keep them safe. I think it gives people choice and power and makes them feel like they’re not just stuck in the system, going through the motions.

Lucy:  I can relate to that feeling of being stuck feeling powerless in a system as a clinician.  When you spoke of moving through the motions or occupying a certain space because that's what you're told or conditioned. I think the same can sometimes apply to workers in the system especially in suicide prevention when the stakes can be high. Personally, I think the introduction of the lived experience voice to suicide prevention has reiterated that, as a clinician, I’m just one part of a greater model of care. And I like directing people to things like co-design processes and peer support groups. I find opening that conversation, it centres lived experiences and the client in that process. Centring the client is something that is much more complicated and difficult than is given credit when you’re working in a system that traditionally centres specialised knowledge.

Jo: Now people have choice, to be able to choose. This is one way to engage and get support, then here's another.  I wonder, even before they step in any door, just the impact of having that choice on which door they step into and what that door will look like. It helps services also look at what they are offering in and, you know, maybe it gives us all permission to be able to look back on that and make changes when we see more boldness within the system. Learning from one another and gaining confidence from one another.

Lucy: And drawing a client’s attention to things like co-designs, can bring hope I think. That they can be involved in designing their own care and the care of future clients. Client also get that hope from peer work, this idea that what they are going through now can help them connect and relate to others. It can make people feel connected to their community, being useful.

Jo: I think it’s kind of facing that mirror every day, I mean it's also a reminder of that space of mutuality. I talked to somebody recently and wholeheartedly my day was better off speaking to them. You know, those little things around hope that I lost touch with. The small things that you lose sight of that makes you remember you know you're your own person in recovery.

Lucy: See in narrative therapy, we talk about how a client’s story transports a worker and letting them know how they’ve done that. So Jo, what are you hopes for suicide prevention?

Jo: I would love to see peer work used at different levels of contact, so like, a peer worker being the first person you talk to when you go to emergency. I've heard of this approach being used and Sydney and it just makes so much sense, because there's nothing lonelier than sitting in those rooms by yourself.

Lucy: I guess we work in a model that uses both peer worker and workers with clinical skills and experience to support and I think that that's a model that works well. I think some really meaningful conversations come out of those meetings when the three of us meet. I think when the three of us get together, we don’t just shift into gear and occupy the roles that we think we are meant to occupy. I’m constantly learning from the peer workers and clients in those meetings, professionally and personally, and I think that just speaks to the meaningfulness. I think it would be great if this just becomes the norm. And that clinicians and peer workers, obviously with their own skills and knowledges, maintain these common ways of being with people.


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