Knowledge and expertise in care practices : the role of the peer worker in mental health teams

TLDR: This research examines how different forms of knowledge and expertise are increasingly important in caring for people experiencing mental illness and points to how the situated nature of subjective knowing is uniquely embedded in time and space and allows for the alignment of embodied knowledge with trajectories of care.

Abstract: Our research examines how different forms of knowledge and expertise are increasingly important in caring for people experiencing mental illness. We build on theoretical developments regarding multiple ontologies of knowing about illness. We examine how experiential knowledge of mental health problems, learned by being subject to illness rather than through objective study, is enacted in mental healthcare teams. We focus on Peer Workers (PW), individuals who have lived experience of mental health problems, and who contribute knowledge and expertise to mental health care within multidisciplinary healthcare teams. Our longitudinal study was undertaken over 2 years by a multidisciplinary team who conducted 91 interviews with PW and other stakeholders to peer support within a comparative case study design. We show how workers with tacit, experiential knowledge of mental ill health engaged in care practice. First, we show how subjective knowing is underpinned by unique socialisation that enables the development of shared interactional spaces. Second, we point to how the situated nature of subjective knowing is uniquely embedded in time and space and allows for the alignment of embodied knowledge with trajectories of care. Third, we provide insight into how subjective forms of expertise might be incorporated into multidisciplinary care.

Frequently asked questions

Q1. What are the contributions in this paper?

The authors examine how experiential knowledge of mental health problems, learned by being subject to illness rather than through objective study, is enacted in mental health care teams. Their longitudinal study was undertaken over two years by a multidisciplinary team who conducted 91 interviews with PW and other stakeholders to peer support within a comparative case study design. The authors show how workers with tacit, experiential knowledge of mental ill health engaged in care practice. First the authors show how subjective knowing is underpinned by unique socialisation that enables the development of shared interactional spaces. Third the authors provide insight into how subjective forms of expertise might be incorporated into multidisciplinary care. 

Q2. What is the role of the peer worker in the therapeutic relationship?

The peer worker embodies (Kontos and Naglie 2009) therapeutic change as they enact the PW role – the recovered, productive self (Gillard et al 2015b) – while a sense of alignment between peer worker and supported person imbues their relationship with therapeutic potential in three important ways. 

Q3. What is the powerful thing about being with feelings?

You sit with feelings and somebody else, like, acknowledges them, like, to me that’s the most powerful thing, like being with a feeling and not trying to hide it. 

Q4. What is the contribution of subjective knowledge?

The contributory potential of this knowledge lies in it being embodied in time and space, highlighting the importance of its situated nature. 

Q5. What does Collins and Evans suggest can work to normalise the experience of care?

The authors suggest this can work to normalise the experience of care in a way that renders it less alienating, knowing that their experience is affirmed and acknowledged. 

Q6. What is the importance of a holistic approach to mental health?

their findings suggest the importance of an integrative approach which recognizes that PW, as past recipients of care, had gained experiential knowledge through socialisation in the practices and culture of mental health before subsequently becoming service providers. 

Q7. What is the main source of connection in peer support?

(Manager 081)That sense of connection – shared experiential knowledge of mental health – seemed to apply even where there were other differences between people, suggesting that it might be shared tacit knowledge of living with mental ill health, rather than wider social knowledge, that is the primary source of connection in peer support.