Why Not All Social Supports Are Created Equal
By Taryn Tang, MHI Research and Evaluation Lead
Twenty-five years ago, during a routine appointment with my mom's psychiatrist, I asked about other things we could introduce into my mom's recovery plan to supplement the cocktail of medications she was taking which had varying degrees of success. "What about a physical or social activity or referrals to social and psychological health services," I asked. At the time, these inquiries were swiftly shut down with a condescending reply that "mental illness is a brain disease" and, therefore, best treated with medicines that could target the brain.
Time and a substantially better understanding of mental illness have shown the fallacy of this doctor's words. These days you would be hard-pressed to find a doctor who does not believe that recovery from mental illness requires a fulsome set of tools which can include, at times, medicine, therapy, meaningful activity, and social support.
Even the most fervent medical-model doctors cannot ignore the abundant evidence that it takes a village – or at least a well-resourced and well-functioning community – to move people from merely surviving to thriving.
In his recent book, "Healing: Our Path from Mental Illness to Mental Health," Dr. Thomas Insel, former director of the National Institute of Mental Health in the United States, summarized that although mental illnesses are medical problems, the cures are not just medical but social. Too often, the focus is on drug therapies for symptom reduction rather than on plans for long-term recovery. According to Dr. Insel, the path to healing must include the three Ps – People, Place, and Purpose.
No doubt, social support is firmly situated among those three Ps. Yet, through the increasing recognition of its importance for mental well-being over the years, it has become a loose, catch-all phrase. It seems to have encompassed everything from the weekly knitting group to helpful friends and family to meeting with people who share similar lived experience for the specific purpose of recovery.
While there is value in keeping the definition of social support broad - after all, the types of interpersonal relationships and networks I have access to and find meaningful in my life may differ from yours – we may also be at the point where refinement and distinction are necessary.
Not everything is social support, and not all social supports are created equal.
One such example – peer support – is often subsumed under the umbrella of social support. While it may share more similarities with social support than drug therapy, it is also uniquely its own thing and different from what most people understand as social support in critical ways. At its best, the peer support relationship is a cross between an empathetic friend and a skilled therapist. Let me explain.
Peer support is grounded in the foundation of shared lived experience; someone who has been where you are and has gone through what you're going through. However, recovering from a mental illness or a challenging life event is a necessary but not sufficient criterion to make someone a peer supporter. In addition, one must unlearn many automatic characteristics or hold back as a peer supporter.
Like a therapist, peer supporters suspend judgment and share only relevant bits of personal stories when they are in service of the individual's recovery. Peer supporters meet the individual where they are and will find different ways to provide social and emotional support based on the stage in the individual's recovery journey. However, as much as they would like to, peer supporters do not advocate or take action on behalf of the individual. Like therapists, peer supporters create a space with hope and confidence so that the individual can walk their own path. Peer supporters judiciously maintain boundaries in their work.
Because peer supporters are not typically considered part of the healthcare system, their role is sometimes thought of as more of a friendship than a tool for recovery.
An important similarity between a peer supporter and a friend is that the power differential does not exist as it does with healthcare practitioners. However, the peer support experience is firmly focused on the peer without an expectation of reciprocation, as might be the case with friends. Even the most supportive of friends would expect to receive support back at some point. Further, as with therapists, friends may not have a shared lived experience and can only imagine what it is like for the individual.
The point is that there is a distinct role for peer support that stands apart from the other social supports needed in a person's recovery. For more insight into peer support firsthand, I encourage you to read Leslie Howard's recent blog post, "A Day in the Life of a Peer Supporter." Leslie shares her experience as a peer supporter and the importance of how a peer support relationship is rooted in trust, honesty, empathy, loyalty and mutuality.
Done correctly, the practice of peer support requires training and selection criteria to determine who would make a good peer supporter.
"The power of peer support is that lightbulb moment in your heart and soul when you feel seen, heard, and understood. It is the burden of isolation lifted and the letting go of the breath that you didn't even know you were holding. I wish I could have experienced it sooner in my journey as a family caregiver, but when it arrived, it was the true beginning towards healing."
We’re here to help.
MHI offers full turnkey service in building peer support programs for workplaces and healthcare organizations as well as virtual peer support skills training to the public in addition to first responder and workplace-specific training.
Learn more here and sign up for our Support Your People Newsletter for upcoming training updates.