POSITION PAPER - THE MENTAL HEALTH PEER WORKFORCE TANDEM INC. Tandem began as the Victorian Mental Health Carers Network (the Network) in 1994. Four main organisations were involved Carers Victoria, the then Schizophrenia Fellowship (now Mental Illness Fellowship), SANE Australia and ARAFEMI. In addition there were numerous carer groups and individual carers. The Network beginnings were rooted in ensuring that the policies and rhetoric around family/carer involvement and participation were translated into practice and adequately resourced and funded. The Network s ever expanding membership grew and in 2008 gained status as an Incorporated Association with Charitable and Deductible Gift Recipient status. It was then able to become an independent organization with its own funding and service agreement and obtained status as the Victorian state peak body for mental health carers and families. In 2014 the name was changed to reflect the organisations commitment to working together for better outcomes better mental health involves everyone TM Tandem Inc., the peak body for families and carers of people experiencing mental illness and emotional distress in Victoria. Our mission is to: Promote family/carer involvement in treatment and care planning, and decision making Promote participation of family/carers in policy development and service improvement activities Advocate for the needs of family and carers to be met Improve the mental health system TANDEM INC. POSITION STATEMENT Tandem has adopted the National definition of the Mental Health Peer Workforce; it refers to people employed in job roles that require them to identify as being, or having been, mental health consumers or carers. The term Mental Health Peer Workforce is used to encompass the diversity of the roles and job titles undertaken by people with mental health lived experience throughout Australia Tandem strongly believes that the Mental Health Peer Workforce is an essential component of mental health service provision and makes an important contribution to the recovery and wellbeing of people, including family and carers who use these services. We consider that the Mental Health Peer Workforce is not an add on to any service or team, it 1
should be an integral part of service provision. It is also essential that the Mental Health Peer Workforce practitioners have equal status to their team colleagues so that their contribution is effective and maximized. Tandem believes that the Mental Health Peer Workforce: Must have clearly defined roles in order for successful integration to occur. Should be supported to obtain the qualification of Certificate IV in Mental Health Peer Work to provide a solid foundation for practitioners on which to expand their practice. Must be supported and sustained into the role with high-quality, ongoing training and education. Must be remunerated appropriately at a level commensurate with their skills, training and qualifications. Must have the opportunity for supervision including: o Line supervision o Consumer peer supervision o Carer peer supervision o Consumer peer group supervision o Carer peer group supervision (Example - Carer Consultant Network of Victoria has bimonthly peer group supervision) Must have a clear career trajectory. Work with governments and others to develop a Framework for the workforce that includes a national data set, key performance indicators for service contracts and programs and targets for peer practitioners in mental health related support services. SCOPE AND PURPOSE The purpose of this position paper is to deepen the understanding of the Mental Health Peer Workforce and to advocate for the continued commitment of governments, organisations, services and others in valuing the development and promotion the Mental Health Peer Workforce. This paper is intended to be used as a reference for any person, service, and organisation seeking to understand the contribution the consumers and carers peer workforce can make to the treatment, care and recovery of consumers and families/carers and also to improving the mental health service system. It will also provide value to people who make decisions about the strategies, policies, practices, and resources in mental health related support services. NOTE: Tandem values the important work and contribution that peer consumer and peer carer/family volunteers can provide. Tandem believes that volunteers complement the Mental Health Peer Workforce and can be a source of potential future employment for the workforce, however they should not be used as a substitute for the paid peer workforce. The role, expectations, training and support needs of volunteers are different to those of the paid peer workforce and should be clearly defined and properly addressed by services utilizing volunteers. It is important that volunteers receive the training and support they require to be effective in their roles, however volunteering is out of scope for this paper. Tandem supports Australia s new National Standards for Volunteer Involvement. (Launched May 2015) The new Standards incorporate significant changes in order to reflect best practice. For more information on volunteering see http://www.volunteeringaustralia.org THE MENTAL HEALTH PEER WORKFORCE CONTEXT Peer work has its origins in ideas of self-help and mutual support. People with lived experience of a physical illness, a mental health issue, or traumatic circumstances, who have faced adversity, (be it the person or their family, friend or carer) are able to provide support, guidance, advice, wisdom, mentorship, expertise and hope to people facing a similar situation (Davidson 2012 cited in Health Workforce Australia 2014a). 2
Australian national policies and strategies over the past decade acknowledge the importance and value of mental health peer employment in the mental health sector due to the expertise they bring to the role. Successive National Mental Health Plans, the Council of Australian Governments (COAG) National Action Plan on Mental Health, the National Mental Health Workforce Strategy and the recent Report of the National Review of Mental Health Services (National Mental Health Commission volume one) all focus on the development of the Mental Health Peer Workforce as a critical factor for improving the outcomes for people and families or carers accessing mental health services in Australia. Evidence of the major benefits of the Mental Health Peer workforce to mental health outcomes in relation to recovery, wellbeing and positive organisational change has developed rapidly in the last decade. Substantial Australian and global literature outline these benefits. Victoria has taken significant steps in recent years to transform its mental health services to promote recovery, wellbeing and positive organisational change through policy and practice. This includes funding and other support for the emerging profession of the Mental Health Peer Workforce. Mental Health Peer Workforce practitioners are now widely employed in the state of Victoria and perform many roles in diverse settings. DEFINITION OF THE MENTAL HEALTH PEER WORKFORCE The Mental Health Peer Workforce are people with lived experience of mental illness, co-occurring mental healthaddictions, or have/are caring for a person who is, or has had, experience of these issues. They use their lived experiences to help others in their journey of recovery in meaningful ways. The Mental Health Peer Workforce practitioners serve as powerful role models and demonstrate that recovery and wellbeing is real for everyday people noting that carers and families are part of a person s recovery and have their own recovery and wellbeing journey. The Mental Health Peer Workforce offers an authenticity and trustworthiness based on experiences that are directly relevant to the people they support. The skills and empathetic perspective of this workforce informs and complements the work of other mental health, health and allied professionals. WHAT THE MENTAL HEALTH PEER WORKFORCE DO Mental Health Peer Workers work across diverse mental health related sectors and service settings. They work within services or organisations locally, regionally and at the state or territory and national level. They are working with professional bodies, academic bodies, peak bodies, educational bodies and Mental Health Commissions at both state and national levels. Practitioners work is diverse depending on the work setting, thus job titles, responsibilities and related tasks will vary. Consequently a single definition of the workforce is not possible or useful. Although work does not adhere to any one program model it has a dynamic and flexible approach to mutual understanding based on a set of core values and principles. These values and principles have been developed by consensus over the years by people who have been directly involved in peer work as participants, practitioners, researchers, and writers. The core values of peer support focus on mutuality, reciprocity, being non-judgmental, and sharing power in non-hierarchical ways. It is also about challenging the status quo of people, service providers, governments and communities to develop new ways for positive experiences for people and families/carers. WHAT THE MENTAL HEALTH PEER WORKFORCE DO NOT DO They do not give medical advice or advice about medications. They do not make diagnoses or tell people what they should do. They are not a substitute for a doctor or counsellor, and they do not provide psychotherapy. 3
WHERE THE MENTAL HEALTH PEER WORKFORCE ARE LOCATED DEFINITION OF A MENTAL HEALTH PEER WORKFORCE - PRACTITIONER A peer practitioner is a person who uses his or her lived experience of recovery from mental illness and/or addiction or caring role, plus skills learned in formal training, to deliver services in mental health settings to promote mind-body recovery, wellbeing and resiliency. Roles of a practitioner may involve - Individual advocacy; Peer support; Systemic advocacy and representation; Health promotion; Education and training; Quality and research; Coordination and management. Names of positions may include, consumer consultant; carer consultant; family consultant; peer specialist, peer support person, peer advocate; recovery coach, peer advocate, indigenous worker; Commissioner; Director; Manager; CHALLENGES AND BARRIERS OF THE WORKFORCE There remains widespread confusion regarding The Mental Health Peer Workforce and the core competencies of peer practitioners. This is seen in hiring practices that focus solely on lived experience and fail to address skills necessary to performing the job. Many peer workers have been hired into positions with vague job descriptions and are supervised by individuals unfamiliar with the supervision needs of the Mental Health Peer Workforce or with peer support practices and peer workforce competencies. As a result, Mental Health Peer Workers have been asked to perform tasks that are inconsistent with professional competency training that is now available in Australia. Nationally endorsed qualification Certificate 4 in Mental Health Peer Work. Poorly defined jobs and range of jobs poorly defined The roles and responsibilities of peer practitioner can be vague. Job descriptions and associated structures such as supervision can be lacking. Skills, knowledge, values and attitudes required for quality performance; Technologies used; Standards of quality performance are all important components for role clarity. How the peer practitioner position is integrated within the organisation, service and team can cause success or failure for the peer practitioner and the service. 4
Negative attitudes, discrimination and stigma Some of the environments in which the Mental Health Peer Workforce work devalue the practitioners experience, skill and practice. This is particularly evident when working in settings in which non-peer professionals with their own lived experiences with mental ill health or caring roles are not valued or supported to disclose their lived experiences. This can send the message to peer colleagues that there is shame in having a history of or caring for a person with a mental health diagnosis. Uptake in minimum training requirements and job training The Certificate IV in Mental Health Peer Work was endorsed by the National Skills Standards Council to provide a solid foundation on which to expand the practice of the mental health peer workforce. Services employing peer practitioners are not routinely ensuring that their staff are supported in minimum standards for a peer practitioners or that other staff and managers are supported in education of the Mental Health Peer workforce and peer support via Mental Health POD training. http://www.mhpod.gov.au/assets/sample_topics/combined/supporting_a_mental_health_peer_workforce/objective2/index.html Salary range not well defined The Mental Health Peer workforce is mostly low paid and not compensated at the same level as comparable non-peer jobs. Support Supervision is an important support to peer practitioners; when it s not taken seriously, peer practitioners can flounder. Peer practitioners need support as they transition to the new roles. They need both internal and external peer support networks. Ethics and Boundaries To date, there is no authorized authority to guide and ensure effective and ethical practice. In addition, some employers fail to ensure education in Peer Work, thereby compromising the quality of the peer workforce and perpetuating misconceptions about the value of the role. Policy and practices regarding ethics and boundaries need to be clarified. Other professionals codes of ethics do not apply to peer practitioners and the services they provide. Human resource Human resource staff should be skilled in understanding value and contribution of the Mental Health Peer Workforce. Best practice in human resource for the recruitment and development of all staff affords robust foundations for recruitment and development of peer practitioners into the organisation. OPPORTUNITIES FOR THE WORKFORCE Taken from Health Workforce Australia Mental Health Peer Workforce Study five domains - 2014 Workforce reform National guidelines are needed to support the adoption of peer practitioners in Australia. More systematic and more extensive use of peer workers in Australia will be facilitated by the establishment of National Mental Health Peer Workforce Development Guidelines. 5
Guidelines must cross a range of settings and be inclusive of: Key roles and functions; Guiding principles and a code of ethics; National capabilities for peer workers and supervisors (including diversity); Principles for employment and reasonable adjustment; Training and support; Practical resources Supervision, coaching, and mentoring. Capacity and skills development Working effectively in mental health requires adequate and appropriate training. The Certificate IV in Mental Health Peer Work offers an opportunity to move towards nationally consistent training for peer practitioners. Mentoring and supervision are important elements of support for peer practitioners. Career pathways for peer practitioners, particularly multiple entry and exit points, and stackable education and training outcomes are valuable components to a well-functioning workforce. Supporting practitioners to work to their full scope of practice by supporting practitioners education and development is vital. Leadership The Mental Health Peer Workforce leaders are at service or organisational levels, locally, regionally and at the state or territory and national level. They are across sectors and service settings and working with professional, research and educational bodies and mental health commissions at both state and national levels. Leadership, both of the peer practitioners and the organisation is needed to overcome barriers to the peer workforce and support organisational change. Workforce planning Development of a national mental health peer workforce, dataset, data collection and public reporting approach across employment sectors to measure progress and support evaluation is required. Currently it is not possible to say with any precision how many peer practitioners there are currently employed in Australia or where they are located. Funding and regulation Policy levers available to governments and organisations to shape the mental health workforce include education, occupational regulation, and healthcare funding. Using these policy levers can play a part in promoting uptake of the workforce and this can assist in addressing the substantial variation in wage levels, depending on service, sector of employment and jurisdiction. Julien McDonald Executive Director Tandem Inc Helen Lococo Chair Carer Consultant Network Victoria 6