Based on a post “America Needs Humble “Public Servants” and New Efficiency Metrics to Optimize the Welfare System.” of 3 Apr 2020
American welfare system is in a deep crisis. To emerge from this crisis, we need more peer-run recovery centers, mental hospital diversionary respites and other recovery facilities which would be operated by the people with lived experience for the people with lived experience. This implies a transfer of power that cannot occur without vigilance, solidarity and cooperation in the national movement for the people with lived experience.
In order for changes to occur, American peers need to work together, as a well-orchestrated national front and to aid each local group of active peers in pursuit of the following goals:
Peers represent themselves in a county, municipal and state and federal governments
Peers defend labor rights of peers
Peers collect their own data to support expansion of peer services
Peers create a media presence that enables
them to speak directly to the public (taxpayers) and to demonstrate positive outcomes
Fair Representation and Survivability.
In order to bring on economically and socially favorable conditions for peer support, peers need to find a way into the local governments. Many brave individuals made attempts to do it single-handedly or in very small groups, in their hometown. Yet their attempts often meet immense resistance, causing them to give up or to wait indefinitely. Such undertakings require strong peer support, as well as courage.
The National peer community has to develop a standard approach to allow peers to gain representation in their local government, without having them to rediscover the peath individually, every time. It is like crossing the Atlantic Ocean in a boat instead of trying to swim across individually.
What would it take to organize a hub to coordinate the advancement of peers in the local governments?
Peers representing peers
As people with lived experience, many of us rode in the back seat for many years. Powers at being instinctively defend their privileges and assets by retaining a parental role over weaker, traumatized people. This, in turn, works against our attempts to recover and to become fully-integrated members of the American middle class, and to propagate the idea of peer support.
This is why it is in our best interest to dismantle the old “doctor”/”patient”, professional “helper” / dependant “helpee” relationships that dominated the mental health industry for centuries, holding many thousands of clients in obedience and constraint.
Survivability is important to track down a vulnerable group that needs the most help. It would also counteract covert hostility and endangerment of minority groups by negligence, as well as by deliberate misplanning of the services.
Survivability is often used in medical brochures, when we read about the chance of recovery from a certain type of cancer within the next 5 years, after surgery and chemotherapy.
What about a chance of survival for a colored transsexual person who was diagnosed with schizophrenia, in the next 5 years, at a specific location, as a client of that location’s welfare services?
Survivability - based determination of need would allow us to protect vulnerable groups, in different areas: CSX, LGBTQ, BIPOC, refugees, PTSD veterans, or single working poor men who don’t have time to get “handouts” from the charities as they have to work. It would also help identify the most vulnerable age groups.
Survivorship bias is introduced if only grateful/ successful customers of the welfare or mental health establishment are allowed to speak about their experience with the system. The accounts of single poor men and LGBT people are commonly omitted. Tracking of survivability would also help prevent rehospitalizations and recidivism. It would decrease mortality among the patients and decrease the burden on the emergency medical services.
Diminishing role of volunteers
As the gap between rich and poor in America is increasing, the volunteers no longer represent the poor, welfare-dependent population. It takes more and more resources to dedicate oneself to uncompensated work, as the cost of living raises, particularly rent in my hometown. (The gap could be healed if tax laws favored barter over monetary trade, thus encouraging communal relationships)
In my hometown of Frederick Maryland, many volunteer — governed boards of the key welfare organizations fell into the hands of pro-gentrification forces and no longer represent the interests of the clients. Reforming the system to accommodate for the changes in the economy presents another challenge to our movement and hopefully another subject to reforms, yet it is our duty to spread awareness for this reform to occur.
Peers in the government
In order for peers to leverage reforms that would help advance the peer movement, we need to learn how to represent ourselves in the federal, state, municipal and county governments, (suggested name: “National Association for the Advancement of Peers”), In conjunction with the National School of Grant-Writing, a national umbrella organization can aid peers in sharing their experience with other local groups. Maryland State-level effort to bring peers into politics could also be improved.
What can Peers do in the local government:
Administer Local Welfare
Define the level of need.
sincere, open, negotiable priorities of who we help first, instead of traditional throttling of poor people with waiting lines, humiliation and disrespect of personal time
strive to create an objective, agreed upon, universal scale to determine levels of need
possibly prevent covert hostility, microaggression, hate towards vulnerable groups which inevitably occurs in the current patriarchal system, especially if some corrupting economic force is present. (Typically, as a political effort to eradicate a problem population to increase the real estate value in the area.)
Review complaints, provide various forms of immunity / protection to complainants (especially if they are homeless and/or completely depend on the services for survival)
Communicate with other regions about the solutions that they implement.
Study the Population
Conduct a study ”United Way style”, researching vulnerable population’s needs.
Analyze efficiency of services (R1),(R2), peer support to save taxpayer money on services, while presenting results directly to the taxpayers.
Work with the city transportation services to design routes that would serve the recovering population.
Advance the expansion of Peer-run services
Advocate for the interests of the peer-run programs, peer-staffed services as well as peers themselves, as workers. Develop new services, such as mental hospital diversionary respites which would be staffed by peers.
Exchange experience with other peers in other regions.
Encourage participation of peers in the local government
Counteract Gentrification and Development lobby that perceives vulnerable populations as an easy target, those who drive down the values of real estate, can be easily expelled by increase in rent and harsher policing.
We can accomplish all this if we are a strong National movement with communication between multiple, local, groups that work simultaneously. It is easy to choke one such local effort, yet if national movement occurs, the change will become more expected by the local government establishments. It would not add to their popularity of the local authority to resist such progress.
Economic Justice for Peers.
Peers and Basic Human Needs.
Peers already lost their physical and mental health due to the oppressive forces that extracted surplus labor from them and their ancestors, to the point where their life was endangered. Thus, in order to prevent further traumatization of people with lived experience, working as peer supporters, economic justice has to be made a priority.
Caseworkers and Certified Peer Recovery Specialists
When caseworkers were first introduced, they were members of vulnerable populations and many had lived experience themselves. Later, formal training had replaced the first-hand knowledge of how to navigate the system.
Currently, peers with lived experience know how to navigate the system better than many other types of specialized welfare workers, while often not being paid in accordance to their level of experience. Peers at high levels of recovery would be much more effective if they were paid enough to be able to afford rent in the municipality where they work, and not financially marginalized. It is difficult to help others for someone who remains in survival mode, despite their best efforts.
Peers and Labor Movement
People with lived experience cannot be expected to perform in an insecure, competitive environment that a typical (disposable) worker has to endure in a fully commercial business. it is also more difficult to determine the worth of a peer in a peer recovery center, compared to the efficiency of an assembly line worker. Peers tend to work as a crew and the crew has to have the right to enlist and expel members in order to function like an adaptive organism.
What may be ethical in a standard business practice, will often bring more trauma to a peer employee and will compromise their performance. People with lived experience get excited when they get the position, and become very depressed when they lose it. It undermines their self-esteem and greatly impedes their recovery. Limited funding often forces peer organization directors to fire and rehire peers in order to stay within the budget. At the same time, directors tend to receive a secure middle-class wage and this creates a barrier of understanding between the captain and an ordinary crew member, who works and lives with fear of being tossed overboard.
Such a workplace becomes very competitive, overwhelmed with envy, and fear of losing income. Relationships between peers become less fraternal and more back-stabbing.
Only worker solidarity among the peer employees, and a collective struggle for secure employment can allow people with lived experience to hold positions long enough to enable them to recover and to grow, as well as to negotiate for more funding.
Peer recovery centers are one of the rare cases where the directors would benefit from labor organization of the workplace, as there would be less pressure on them to perform under restrained finances.
School of grant writing
Understanding of grant writing by peers will heal the gap between rich and poor in the welfare sector. If peers bring money into their organizations, they would become more horizontal and peer run, decreasing the potential for manipulation through funding.
Presently, grant writing is a secretive and competitive trade. Learning it, requires a level of financial security, which is often unattainable for people in higher levels of recovery, who could otherwise do the job. Thus, they find themselves excluded from major financial decisions that affect the security of their employment and integration of peer services into the welfare sector.
It would also serve us to share our experiences of applying for grants, with the national peer movement, in order to understand how the system varies from state to state and how we can coordinate our efforts to improve it. It has been suggested that public safety grants are worth looking into, along with mental health grants, that peer support organizations typically apply for.
I would like to start a National Grant-writing School for peers, by gathering all the knowledge and experience of our National community in one place.
Perhaps, the first assignment is to find grants for interested participants to fly to one location and to hold a conference.
Can peers be hired as consultants? What are the labor laws that govern the hiring of consultants? Do they vary from state to state? What restrictions apply to hiring consultants by a non-profit? How can peers benefit from this practice? Can this allow peer recovery centers to navigate around book-keeping restrictions?
Answering those questions, as well as the institution of a National Grant Writing school would pave our way to success in the post-coronavirus quarantine economy.
Gap between rich and poor, within the welfare sector itself.
Welfare-affiliated nonprofit organizations often spend most of their budget on salaries for the staff, rent and insurance. Very little money remains for the programs themselves. Peer support organizations are not an exception.
This appears to be a cultural problem, as directors are expected to receive an upper-middle class wage with benefits, while the poor are expected to get breadcrumbs and to be grateful. Lower-level staff, often composed of people with lived experience, also receives very little pay or recognition. The gap between rich and poor within the welfare sector itself, certainly doesn’t make America’s safety net more efficient.
It is perceived as an industry standard that a typical non-profit organization spends around 60% on administration. The ratios vary from industry to industry. Different publications state ratios obtained by slightly varying methods, making them hard to compare. This makes the American welfare system very demanding and inefficient, leaving very few resources to maintain a healthy peer culture.
Two ratios to compare equity of employees and service output.
Federal law requires all construction thermal insulation to be labeled with a thermal coefficient ‘R’, in order to protect buyers from commercial trickery. Can we do the same to prevent non-profit trickery that costs us so much in taxes and in human lives, making our safety net so unreliable?
Can we measure how much money is spent on wages vs. how much money is spent on programs and mandate that each welfare-affiliated organization has to publish this ratio next to their name?
Can we also require state grant-receiving non-profits to publish the income gap ratio between their lowest-paid and their highest-paid employee?
Otherwise, pathetic pictures of cute kittens, puppies and starving children would always be used to manipulate donors, politicians and voters, while our taxes would not be used to strengthen the safety net. This tendency does not favor peer support.
Reporting Positive Outcomes.
Building a system that rewards positive outcomes
In order for peer services to gain recognition that they deserve, we need to advocate for a system of productivity metrics that reward positive outcomes, not headcount.
Grants come with Conditions of Award, which often require numbers that show how many people were served. Yet, often that creates no incentive to measure client satisfaction or positive outcomes.
Meanwhile, peer recovery centers could benefit a lot from consensual methods of documenting positive outcomes. Such organizations have a hard time proving their usefulness in the system that values easily obtainable numbers.
Despite the burden of scientific evidence that peer support helps people recover and the commitment of peers, peer support remains underappreciated and underfunded.
Eventually, there is a fear within the establishment that peer support will lead to a new Civil Rights movement. We encounter a lot of roadblocks as many traditional professionals are afraid that we would no longer not need them and that the cash flow to them, on our behalf, would end.
Many thriving welfare services resemble a cattle drive: herding clients through and counting heads becomes a priority that the services are optimized for. This marginalizes the role of peer support.
There are two more metrics that could help optimize our welfare and healthcare here in Frederick County, Maryland, as well as in the entire United States of America:
1) How many clients have given up, knowing how difficult it would be to obtain a service.
2) How many clients went on another loop, out of despair.
The latter is very important in the mental health world, if used against the regular headcount.
These may be guidelines of the World Health Organization, yet I could not confirm that. Please write to me, if you know their origin.
Such metrics would also create an incentive to help clients achieve self-sufficiency and graduate from the programs and into productive life. They can also decrease the loopiness that an average client experiences, along with the operational costs. It is in the interest of the peer supporters to push for such metrics to be used by the overall welfare system.
How can we expect people to recover if the system itself is so loopy?
User feedback survey.
I also suggested that our County could obtain vital feedback by making follow up phone calls and asking clients of the 211 phone services about their experience and the usefulness of the advice that they were given. Can 211 be made into a peer-run service?
Peer Media Presence.
As we successfully build a more peer-centered version of the welfare system in America, we need to encourage the struggling, alienated people with lived experience by showing our success in the media.
Such presence can be accomplished if our community learns how to secure specialized media presence grants and to acquire the necessary skills and equipment to record video and to publish media posts about our success.
I believe that sufficient media presence would naturally emerge from us documenting positive outcomes, after we negotiate for a better way to report our outcomes to the funders, on the terms that suit the peer support industry.
Thus, it would not require a significant diversion of resources to show some of our positive outcomes to the general public which sustains the welfare system by paying taxes; it would be a part of our job.
Local government reforms would go a lot smoother if there is a media background that presents those reforms as ever-present and simultaneously occurring across the entire Nation.
Help me bring those propositions to life!
I wrote this as I felt an obligation to all the people who “cried on my shoulder” and shared their stories with me, out of despair. My impression of the system’s faults was based on those accounts, as well as on my personal experience.
I set my mind on writing this article and addressing a national peer support community, after I found very little local support with those ideas.
The information about nonprofit economics originates from internal sources which I am unable to disclose.
My assessment of the apparently national problem is based on a network of personal sources, located in Frederick, as well as at the other, primarily Maryland locations.
Follow this link to access the Google Document with the article, which contains the original formatting.
This document will update automatically, while the post has to be updated manually, resulting in delays in the updates.
#peersupport #mentalhealth #wellness #recovery #mentalhealthrecovery