Shaping the Contour of Psychiatric Intervention. Peer Support's Contribution in the at Home Project, Montreal

To what extent does the integration of peer support workers (former service users) in mental health services contribute to the renewal of clinical intervention among homeless people with severe mental health illnesses? This presentation is an analysis of the integration of three peer support workers in two intensive case management teams and one assertive community treatment (ACT) team of the At Home project, Montreal, Quebec, Canada (2009-2013). This housing first project (also conducted in four other Canadian cities) compares clinical and housing support services to conventional services. An important feature of the project is the participation of service users in the governance and the clinical intervention.

We’ll discuss the clinical practices developed within the teams by the peer workers in collaboration with the clinical staff, placing a particular emphasis on two of their contributions : 1) bringing their experience of severe mental illness and their broader experiential knowledge into the understanding of the service users’ situation and the thoughtful application of coercive measures, contributing to the improvement of the existing services ; 2) challenging the classical definition of clinical distance with the service users, contributing to the redefinition of the clinical posture in the At Home project. These two contributions will open the debate on the professionalization of peer support workers and their ability to shake the professional psychiatric hierarchy and the traditional practices.

The qualitative data was collected during a PhD field work through observation and 40 individual and group interviews conducted during the year 2012 with 25 peer support workers, clinical staff, managers and psychiatrists of the At Home project in Montreal.