Demailly Lise, Garnoussi Nadia
Université de Lille, CLERSE, MESHS-CNRS.
Université de Lille III, Centre de Recherche Individus, Épreuves, Sociétés (CeRIES).
Sante Ment Que. 2015 Spring;40(1):171-87.
This series of two parent papers describes, as part of an experimental program in France, the meetings that took place between consumers of psychiatric services and peer mentors. We report on the shape, style and characteristics of these interactions. Some of their effects are also reported. The peer mentors are hospital employees who are hired through renewable contracts or, for some, on permanent contracts. The program was led by the World Health Organization Collaborating Centre for Mental Health for France, with the intention, beyond the creation of a 'new profession,' of transforming current practices and representations of public psychiatry teams towards recovery. The first paper discusses the general characteristics of the consumer/peer mentor meetings and the effects of this mechanism on the representations of the consumers about mental illness and more broadly about the health care system. The second paper reports on the therapeutic effects of these meetings. Some limitations and pitfalls are highlighted.
The program under study involved the hiring of (ex-) consumers of psychiatric services (n=29). These peer mentors are individuals 'who have had, or still have psychiatric disorders, and have experienced a process of recovery.' They were deployed in public psychiatric services after having been trainees for a year and having pursued a training of eight weeks, in parallel, that led to a peer mentor university degree. Our sample is mainly composed of patients who met at least once with a peer mentor, and who were recruited during the field survey in the sites (in-hospital, outpatient or in urban settings). We approached and spoke to patients who were likely to agree to be interviewed to share their experience and thoughts. They had to sign consent forms and thus they were told that we were working on this experimental program on peer mentors with a qualitative and inductive approach. The empirical data that is reported here comes from a qualitative sociological investigation that accompanied the evaluation of the implementation of the program between 2012 and 2014. We have conducted 74 interviews with consumers. We have a significant number of observations of the meetings between peer mentors and consumers, some of which were transcribed verbatim. We were also informed by informal discussions with consumers in every service, and through direct interviews with peer mentors, as well as through in situ observations.
We used standardized prompt questions such as: 'Did you meet X,' or 'Do you know X?' We had to introduce the terms 'peer' or 'former patient.' In effect, in interviews with study participants it appeared that this 'X' was sometimes perceived as more of a nurse, and that they were not aware that this person was a 'peer mentor' or a former patient. The insistent style of some questions and the context of what could appear to be a formal assessment of a person's work might explain why study participants seemed inclined to give positive comments. A bias was also possible when study participants were recruited and 'prepared' by the treatment team for the interview. Despite these limitations, we can highlight the quality of the data.
By the end of the experiment, 15 peer mentors were able to find and make their place in various services, despite important differences between situations with regards to their position in the institution, their degree of autonomy and responsibility, their working arrangements with other professionals, and their actual work. However, we were able to identify common determinants: the voluntary nature of the meetings; less normativity on behavior; the supply of time and availability; a distant relation to medical drugs; a blurring of boundaries between private and professional life; specific management of distance and familiarity. Concerning representations of illness and care, we found that the peer mentors actively contribute to disseminate a vision of recovery based on a positivist conception of personality. They also allow some criticism of other professionals and of the healthcare system. Consumers, in turn, evoke interactions based on the ease of contact, proximity and availability of peer mentors. This proximity can be linked to a form of camaraderie in the institutional context of care but can also lead consumers to see, in the peer mentor, a figure of 'hope.'
作为法国一项实验项目的一部分，这两篇相关论文描述了精神科服务消费者与同伴导师之间的会面情况。我们报告了这些互动的形式、风格和特点，并介绍了部分效果。同伴导师是通过可续签合同聘用的医院员工，部分人签订的是长期合同。该项目由世界卫生组织法国精神卫生合作中心牵头，目的不仅是创建一种“新职业”，还在于改变公共精神科团队当前关于康复的做法和观念。第一篇论文讨论了消费者/同伴导师会面的总体特征，以及这一机制对消费者关于精神疾病及更广泛的医疗保健系统观念的影响。第二篇论文报告了这些会面的治疗效果，并强调了一些限制和问题。
本研究项目涉及聘用（前）精神科服务消费者（n = 29）。这些同伴导师是“曾患有或仍患有精神疾病且经历过康复过程”的个人。他们在接受了一年培训并同时进行了为期八周的培训后获得了同伴导师大学学位，之后被部署到公共精神科服务岗位。我们的样本主要由至少与一名同伴导师会面过的患者组成，这些患者是在实地调查（医院内、门诊或城市环境）中招募的。我们接触并与可能同意接受访谈以分享其经历和想法的患者交谈。他们必须签署同意书，因此被告知我们正在采用定性和归纳法开展这项关于同伴导师的实验项目。这里报告的实证数据来自2012年至2014年对该项目实施情况进行评估时开展的定性社会学调查。我们对消费者进行了74次访谈。我们对同伴导师与消费者之间的会面进行了大量观察，其中一些进行了逐字记录。我们还通过与每个服务机构的消费者进行非正式讨论、直接访谈同伴导师以及现场观察来获取信息。
我们使用了标准化的提示性问题，如：“你见过X吗？”或“你认识X吗？”我们必须引入“同伴”或“ former patient”（原患者）等术语。实际上，在对研究参与者的访谈中，似乎这个“X”有时被更多地视为护士，他们并未意识到此人是“同伴导师”或原患者。某些问题的坚持风格以及可能看似对一个人工作进行正式评估的背景，或许可以解释为什么研究参与者似乎倾向于给出积极评价。当研究参与者由治疗团队招募并“准备”接受访谈时，也可能存在偏差。尽管有这些限制，我们仍可突出数据的质量。
到实验结束时，15名同伴导师能够在各种服务机构中找到自己的位置并发挥作用，尽管不同情况在机构中的地位、自主程度和责任、与其他专业人员的工作安排以及实际工作方面存在重大差异。然而，我们能够确定一些共同的决定因素：会面的自愿性质；行为规范性较低；时间供给和可及性；与药物的距离关系；私人生活与职业生活界限的模糊；对距离和熟悉程度的特定管理。关于疾病和护理的观念，我们发现同伴导师积极传播基于实证主义人格观念的康复愿景。他们还允许对其他专业人员和医疗保健系统提出一些批评。反过来，消费者提到互动是基于与同伴导师接触的便利性、亲近感和可及性。这种亲近感在护理机构环境中可能与一种同志情谊形式相关联，但也可能使消费者在同伴导师身上看到“希望”的形象。
