Early Psychosis Intervention: A Culturally Adaptive Clinical Guide

20. The Peer Support Programme in Early Psychosis Intervention Programme (EPIP)

20 The Peer Support Programme in Early Psychosis Intervention Programme (EPIP) Suying Ang “Où sont les hommes?” reprit enfin le petit prince. “On est un peu seul dans le désert.” “On est seul aussi chez les hommes’, dit le serpent.” “Where are the people?” resumed the little prince at last. “It’s a little lonely in the desert . . .” “It is lonely when you’re among people, too,” said the snake. —The Little Prince (Antoine de Saint-Exupéry) Background to Peer Support The diagnosis of early psychosis can be a lonely experience for a young person. The illness typically strikes at the developmental stage of heightened yearnings for affiliation and intimacy. Yet, the stigma and shame of having a mental illness often results in them shunning their social support systems. Further marginalization is inadvertently caused by the medical model of diagnostic labels, which imposes a role of “mental patient”, leaving a sense of otherness and disconnectedness in their lives (Mead, Hilton, & Curtis, 2001). The provision of psychosocial interventions such as case management attempts to address this isolation through working closely with patients during the early part of the recovery process. Other adjunctive psychosocial interventions include social skills training, psychosocial clubhouses, and support groups. Peer support is a newer addition to the repertoire and emerging as a promising adjunct approach. 236 Suying Ang Peer support is essentially the process of providing encouragement, instilling hope, and sharing experiences of coping or narratives of recovery with others who are going through hardships of similar nature. The provider of peer support, by those who have gone through the process of battling the illness, has the advantage of having an “insider” perspective of what it is like to have to confront, endure, and cope with the disease. They will thus be able to show authentic empathy. This is particularly relevant in the mental health setting where self-stigmatizing beliefs are addressed through cultivating a sense of connectedness and affiliation and challenging assumptions about mental illnesses . Peer support, in other words, offers a culture of health and ability as opposed to a culture of illness and disability (Mead et al., 2001). The stigma of mental illness, unlike in other fields such as addiction, places individuals with serious mental illness in the position where their ability to effectively offer peer support is in doubt, and this has not been caught up with earlier, despite the fact that they have been providing informal support within traditional mental health settings. Peer support services have henceforth flourished only in the 1990s, after the rise of the recovery movement by mental health consumers in the West (Davidson et al., 2006). The recovery movement has greatly influenced how peer support relationships are viewed. While some place peer support services in the context of consumer-run self-help programmes (Mead et al., 2001), others define it as lying on a theoretical continuum between case management and mutual support programmes (Davidson et al., 2006). At one end of the continuum, the relationship with the service provider is of an intentional and one-directional nature. The other end is a naturally occurring and reciprocal relationship that is akin to friendship. This chapter focuses on the type of support provided by peers as paid facilitators within the context of an institutional service. Having emerged from their struggles of being struck with early psychosis and having made significant functional improvements, peers offer support that involves sharing of personal experiences from a non-professional perspective, validation of experience with authentic empathy, and provision of practical advice and coping strategies to others who are still in the earlier phases of recovery. The peer support model in the Early Psychosis Intervention Programme (EPIP) is discussed, together with the learning that transpires from its application in a Singaporean context. The Peer Support Programme in Early Psychosis Intervention Programme (EPIP) 237 Description of EPIP Peer Support Programme The Peer Support Programme, initiated by EPIP, was formally established in 2009. It is funded by the Woodbridge Endowment Fund under the Institute of Mental Health. The idea was first mooted after a participant of a support group expressed interest in helping to facilitate future support groups. Peer support groups were subsequently organized, in which a patient would cofacilitate together with a case manager. This gradually evolved to the current programme where peer support specialists are involved as paid facilitators in three main avenues of providing support, namely peer support groups, oneon...