Unintended consequences of institutionalizing peer support work in mental healthcare
Unintended consequences of institutionalizing peer support work in mental healthcare
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DOI：
10.1016/j.socscimed.2020.113249
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发表时间：
2020-10-01
影响因子：
5.4
通讯作者：
Adams, Wallis E.
中科院分区：
文献类型：
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作者：
Adams, Wallis E.
向以康复为导向的精神保健的广泛转变导致了同伴提供服务的广泛增长。同伴支助工作人员利用精神卫生挑战和服务使用的生活经验，提供非临床支助服务。随着同伴支持服务的发展，它们也变得形式化了。这项在宾夕法尼亚州（美国）对同伴支持工作的混合方法研究探讨了同伴支持如何制度化，并确定了与该过程相关的预期影响和意外后果。在宾夕法尼亚州，除了县级关于同伴支持服务提供情况的规定外，还将同伴支持服务纳入医疗补助计划可报销服务，这有助于使该领域制度化。数据包括2016年与同伴支持工作者（n = 35）和利益相关者（n = 14）进行的49次半结构化访谈。定性分析揭示了同伴支持工作的范围和性质、同伴劳动力、同伴客户关系以及工作场所的耻辱的变化。尽管发生了这些变化，但同辈员工往往仍然薪酬过低，无法在专业上取得进步。同伴支持的制度化是工人进入和保留的障碍，并突出了消费者驱动的恢复领域和当前精神卫生保健系统之间的紧张关系。由经验专业知识定义的角色的制度化，如同伴支持，有可能降低经验专业知识的中心地位，再现社会不平等，并矛盾地影响耻辱。
The widespread shift towards recovery-oriented mental healthcare has led to the extensive growth of peer-delivered services. Peer support workers draw on lived experience of mental health challenges and service use to provide non-clinical support services. As peer support services have grown, they have also formalized. This mixed-methods study of peer support work in Pennsylvania (USA) explores how peer support has been institutionalized, and identifies the intended impacts and unintended consequences associated with that process. In Pennsylvania, the inclusion of peer support services as a Medicaid reimbursable service, in addition to county level mandates regarding peer support service availability, have served to institutionalize the field. Data include 49 semi-structured interviews conducted with peer support workers (n = 35) and stakeholders (n = 14) in 2016. Qualitative analyses reveal changes to the scope and nature of peer support work, the peer workforce, peer client relationships, and to stigma in the workplace. Despite these changes, peer workers frequently remain underpaid and unable to advance professionally. The institutionalization of peer support serves as a barrier to worker entry and retention and highlights tensions between the consumer-driven origin of the recovery field and the current mental healthcare system. The institutionalization of roles defined by experiential expertise, such as peer sup-port, has the potential to reduce the very centrality of experiential expertise, reproduce social inequalities, and paradoxically impact stigma.