Peer support is based on a simple definition from the medical world: it is “mutual aid between people who are suffering or have suffered in the past from the same illness, whether somatic or psychological“. It includes the sharing of the experience of the illness and the recovery process. These elements constitute the two fundamental principles of peer support. This peer support (for an alter-ego suffering from the same illness) can take several forms:
✅Participation in discussion groups within users’ associations,
✅Meeting in mutual aid groups (GEM),
✅Or the integration of volunteer or professional peer carers into care services.
Alain Bonnami, a specialist who has worked extensively on this concept in France and abroad, gives us his definition of a peer helper: “The peer helper is a user who accompanies other users because he has experienced a similar situation (e.g. Alcoholics Anonymous). To do so, he or she must be in complete remission and/or socially integrated”. Peer support first developed in the health sector with the appearance of peer health mediators (a university degree was created for this purpose). It is now emerging in the social and medico-social sector (disability, inclusion, mental health).
Developing the various degrees of peer support
In France, this practice is very successful in the self-help circles of Alcoholics Anonymous. This new form of accompaniment and support for people in difficulty is identified as a crucial step in the recovery process. It is based on “the valorisation and sharing of experience” (p. 755). The Anglo-Saxon psychiatric world is responsible for the concept of recovery. Indeed, any mental illness, regardless of its degree of severity, is considered to always have the potential for remission for the patient. The latter is achieved through the work of mental health professionals, i.e. “recovery”, i.e. the significant improvement of one’s mental state through this lever. Consequently, teaching patients to manage the undesirable effects of their illness is central to the notion of recovery. Teaching the patient to manage his or her own “social rehabilitation” through activities is also central. In the world of mental health, providing the patient with “skills” thus enables him or her to bypass the illness and acquire better well-being, easier social integration and skills to achieve this goal. Michel Rhizome explains that recovery, at the heart of health policies, is based on three key dimensions identified by the London College of Mental Health Psychiatrists:
“Hope is central to the concept of recovery because it opens up the field of possibilities;
Power / agency”; self-determination, choice and responsibility of the patient who is seen as a subject;
“Social inclusion/opportunity” non-discrimination and inclusion in the dimension of active citizenship and city services;
Recovery therefore has a double interest, for the users: more autonomy and control over their lives despite the disease, and for the professionals: more enthusiasm and satisfaction with their work by seeing the patient take charge and change their life by themselves.
The patient, included in a recovery process, is therefore a peer helper for himself. Once autonomous or even cured of their sequelae and/or illnesses (effective recovery), they can become a qualified person or peer worker for the professional.
Peer work is defined as a form of peer assistance in which intervention based on experiential knowledge is remunerated. Today, peer workers can be found in various sectors of intervention, both in the health field (e.g. peer health mediator) and in the social field (peer worker, experience expert in Belgium, peer social worker, etc.). While peer support appears to be a widespread practice, peer work is an innovation in the field of support.
In the medico-social sector, organisations have relied on professionals with experience acquired through a life course similar to those of the beneficiaries. Challenging and stigmatising experiences such as extreme poverty, life on the streets, mental health problems, addiction, disability, etc. are gradually transformed into skills and know-how.
In contrast to the labour market, which values a diploma, a qualification and classic professional experience, the peer worker is identified rather by experiential knowledge and the skills acquired in the “crossing” of this difficult life path. The acquisition of soft skills and know-how with former peers also makes the peer worker a remarkable resource person. The peer-worker then acquires specific skills that are sometimes acquired in different worlds (prostitution, addiction, disability, etc.) and based on technical knowledge that can be duplicated, communicated and mobilised. Formerly ill or beneficiaries, the “future” peer worker must have stabilised their state of health, well-being and recovery.
According to the article by the Délégation interministérielle à l’hébergement et à l’accès au logement (interministerial delegation for housing and access to housing), peer work is defined as: “a form of peer assistance in which intervention based on experiential knowledge is paid for. Today, peer workers can be found in various sectors of intervention, both in the health field (peer health mediator in particular) and in the social field (peer worker, expert on life experience in Belgium, peer social worker, etc.). While peer support appears to be a widespread practice, peer work is an innovation in the field of support. The CARE field (medico-social and social sector) aims to mobilise peer workers to promote the development of skills and empowerment of the people supported in the socio-professional field.
According to Amartya Sen, empowerment is “the power of individuals and groups to act on their social, economic or political conditions. While groups of associations have taken it up, urban policy and social work are more timidly experimenting with it”. In the social and medico-social sector, it is a device or process by which a person significantly increases his or her range of possibilities and capacity for action to improve health and illness. According to the same author, this process can be multidimensional: social, cultural, psychological or political. Empowerment enables the individuals or social groups who benefit from it :
✅Boost their impact on decisions and actions in their health ecosystem
✅to develop a structured expression of their needs and concerns and thus to better defend their rights,
✅develop political, social and cultural strategies to meet their needs
William Ninacs proposes a typology of the three variants of empowerment:
✅Individual empowerment “the transition from a powerless state to one where the individual is able to act on their own choices”;
✅Community empowerment is when an unorganised community decides to act “on its own choices and where it promotes the development of the power to act of its members. Participation, skills, communication and community capital are the four levels on which it takes place. Individual empowerment contributes to achieving community empowerment.
✅Organisational empowerment: this is the process by which an organisation develops the power to act of its stakeholders and creates a dedicated space to do so.
In France, we find a variation of peer support through the work of the Mouvement et action pour le rétablissement sanitaire et social (MARSS) team in Marseille. Their interventions are based on street work and consist of putting a peer worker in contact with long-term homeless people with psychiatric disorders.
Then with the experiments “Un chez soi d’abord” in 2011 and the “Programme de médiateurs de Santé Pairs” in 2012, combining peer workers and a research programme.
The Association pour le Logement des Sans-Abri – ALSA (Association for the Housing of the Homeless) works with people living on the margins of society in the Mulhouse Alsace Agglomeration and the Sundgau region. ALSA has a very low admission threshold and a high tolerance threshold. The objective is based on adapted social support, face-to-face and on collective actions, in order to allow people to become permanently anchored in a time and a place in order to regain a social belonging (also called recovery). In 2016, as part of the call for projects on “social innovation in the field of accommodation and access to housing” led by the Interministerial Delegation for Accommodation and Access to Housing, this structure recruited a peer helper to work in tandem with a monitor educator to co-facilitate a community space with other professionals.