What is the system challenge?

Within the mental health and substance use systems, many peers have historically felt disempowered and defined by stigmatizing labels associated with their mental health status. By “peers,” we mean people who expect that their experience of mental health and substance use issues will be valued when supporting others and working to improve services. Many areas—like HIV/AIDS, violence against women, or chronic illness—benefit from the expertise of peers.

Peer experience is expertise; Peers have a unique perspective about what works and what needs improvement, but often experience tokenistic, paternalistic, and even harmful treatments from systems that, despite the best of intentions, can fail to involve peers in decisions that affect them.

Evidence:

Peer Positive has drawn lessons from these initiatives:

People Powered Health, a UK-based project that supported the design and delivery of innovative services for people living with long term health conditions.
The World Health Organization’s efforts to promote positive mental health the highlights the importance of social inclusion, freedom from discrimination, and participation and control as key concerns.
The Wellesley Institute promotes a targeted and integrated equity strategy across all social services to address the pervasive health inequities facing Toronto, including poverty and systemic racism.
The Ontario Centre of Excellence in Child and Youth Mental Health encourages the Art of Youth Engagement to help improve mental health outcomes for young people while improving the ability of organizations to make more effective and responsive decisions.

Find more evidence

Peer Positive was implemented by the Northwest Toronto Service Collaborative with help from the Provincial System Support Program at the Centre for Addiction and Mental Health.

The Peer Positive approach is committed to developing strong personal and organizational understandings of how power, privilege, oppression, and equity strongly influence all peer and professional relationships. Creating meaningful opportunities for peers to contribute to a range of decision-making processes helps organizations better respond to service user needs. Engaging peers in the design, delivery, and review of services is guided by deliberate efforts to re-balance power relationships between peers and professionals.

Peer Positive is based on three key components:

Peer Involvement: Meaningfully involving people with lived experience in the planning, delivery, and evaluation of mental health, addictions, and other health and human services is crucial to creating more responsive and empowering service experiences.
Spaces to Reflect on Power and Equity: Designating time and space for reflection on power and equity can help to create a greater awareness within the culture of the organization of how these issues impact peer involvement in decision-making.
Accountable Mechanisms of Feedback and Response: When peers can actively evaluate services through a variety of avenues, services are more likely to remain relevant and effective. Timely and transparent responses to service user feedback ensure that services are held accountable to improvement and build user confidence in the service.

Exploration
Installation
Initial Implementation
Full Implementation

?What's this?

Exploration

The Northwest Toronto Service Collaborative worked together to answer the following question: "How can we reimagine access to mental health and addictions supports in a way that strengthens, rather than undermines, the relationships, culture, and quality of living of children, youth, families, and those supporting them?"

In response to this question, the Service Collaborative focused on improving timely access to appropriate supports that meet community members where they are at, in ways that make sense for their situations.

Installation

Participating individuals received capacity building and decision-making support that included Peer Positive training, onsite coaching from CAMH PSSP staff, a toolbox of helpful practices, and support engaging individuals with lived experience who were invested in Peer Positive’s development. The implementation process was intended to encourage flexible organizational capacity building that reinforced Peer Positive’s overarching goals and expectations.

Initial Implementation

Peer Positive was initially piloted with three partner organizations: the Hong Fook Mental Health Association, York University’s Disability and Mental Health Services (YUDMHS), and Leave Out Violence Ontario (LOVE). Peer Positive helped enhance awareness of peer roles in service design and delivery, and increased commitment to involving peers in decision-making among initial implementation agencies. LOVE was able to build more meaningful connections between board members and youth involved in programming, and YUDMHS restructured their peer mentoring program to encourage more mentor ownership of how programming is determined and offered.

Full Implementation

Now at full implementation, involved peers reported that they learned new skills and knowledge, and felt a sense of participation and influence.

These experiences led to the development of the Peer Positive Toolbook as a preparatory guide for shifting the culture, values, and practices of their organization to better meet the needs of the populations being served.

How do we know it works?

“Being able to connect with peers and to opportunities. Through being part of this group I learned a lot more about the system than I had known before. I have now that perspective to add to everything I’ve learned. Being part of a group and say something that can be taken serious.”
— Peer Participant

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services providers, peers, and community members were trained in the concepts and practice approaches of the Peer Positive initiative.

It was so enriching to see people who identified as peers step into new and different roles, no matter what they were. I have seen many people change positively because they were supported to take risks and challenge themselves.
— Interview with a Service Provider

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organizations pilot-tested the Peer Positive initiative.

“Peer Positive allows a dynamic shift where those community and individuals within the communities are thought of as experts.”
— Service Provider Participant

Who is involved?

Leave Out Violence Ontario
York University’s Mental Health Disability Services
Hong Fook Mental Health Association
Elizabeth Fry Toronto
Jamaican Canadian Association
Provincial System Support Program at the Centre for Addiction and Mental Health

Next steps

Responsibility for the Peer Positive initiative has been handed over to an independent Steering Committee to explore future funding options.

Resources

Info

Peer Positive Toolbook

Link

Peer Positive Website

CAMH PSSP

Peer Positive