ACMHA Peer Leadership Hand-out

1. Peer* Leadership:
A ‘Perfect Storm’ of Opportunity
Offered as a ‘discussion starter’ by Steve Harrington
Disclosure Statement: Steve Harrington is CEO of Recover Resources, a peer owned and operated micro-
enterprise that has pulled together some of the top peer facilitators from across the country to deliver
diverse knowledge and skill building relating to recovery for mental health and substance abuse
professionals. One of the offerings of Recover Resources is a peer leadership institute that has been
performed several times on an “open enrollment” basis. Steve has been a developer for this leadership
initiative and is using the institutes to gain information and perspectives for a book on peer leadership.
He hopes this initiative will lead to a comprehensive peer leadership endeavor that can be offered
throughout the U.S.
Background
Recent federal legislation and continuing interest in mental health system transformation has
created a strong demand for peer input. This demand has, all too often, resulted in the selection
of peer representatives on boards, committees and task forces based less on competency and
more on tokenism. Too often, peers find themselves in a foreign environment that includes an
ocean of confusing acronyms, disrespect, lack of validation and judgment.
When recognized leaders are invited to mental health policy gatherings, it is often the case where
the same individuals are seen. Unfortunately, these …these individuals are already
individuals are already spread very thin and their ability
spread very thin and their ability
to advocate for even very important initiatives is limited
by prior commitments. By inviting the same faces to to advocate for even very
such events limits perspectives and, in many instances, important initiatives is limited by
cultural diversity. In addition, the corps of existing peer prior commitments.
leaders is aging. Without an adequate “flow” of peers in
the leadership “pipeline,” we appear to be in danger of having to relearn lessons and face a lack
of efficacy.
The Consumer Affairs Division of the Substance Abuse and Mental Health Services
Administration (SAMHSA) has long recognized this vital need for new leaders. SAMHSA has
supported important leadership development initiatives but, for the most part, those initiatives
have not resulted in new faces at national and regional policy development and advocacy events.
One issue regarding leadership development appears to be a lack of understanding regarding the
unique peer leadership role and newly recognized leadership theories that are well-suited to peer
leadership. Specifically, peers are often in positions that lack authority and traditionally
recognized leadership power. Recent research and leadership development theories address these
challenges in ways that can greatly enhance peer leadership. Previous peer leadership
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2. development initiatives have relied on traditional or “legacy” leadership theories that have little
or no relevance to contemporary peer leadership.
In addition to leadership journal articles, three recent books address and offer support for peer
leadership:
In Leadership: Theory and Practicei, Peter G. Northouse describes the evolution of
transformational and authentic leadership theories. Transformational leadership, contrary
to common misperceptions, relates to transformation of leaders and followers. It is based
on listening skills, leader intangibles such as charisma and personality traits, honesty,
communication and integrity. Northouse also describes in detail authentic leadership.
Authentic leadership is similar to transformational leadership but relies more heavily on
the power of ideas. Interestingly, Northouse notes that persons who have had life-
changing experiences tend to be more adept at authentic leadership. This theory emerged
as a result of popular frustration with political and business leaders who exploited their
positions for personal gain.
Crucibles of Leadership: How to Learn from Experience to Become a Great Leaderii was
written by Robert Thomas, CEO of Accenture Performance, a leading financial
consulting organization. Thomas examined the lives of our current business, government
and non-profit leaders and came to the conclusion that great leaders often emerge after
they have experienced a significant life challenge.
A Tufts University psychiatry professor, Nassir Ghaemi, wrote A First-Rate Madness:
Uncovering the links Between Leadership and Mental Illness.iii In this book, Ghaemi
provides an historical perspective on leadership and concludes that the best leaders in
times of crisis are those who have experienced mood disorders. He examines leaders such
as John F. Kennedy, Winston Churchill, Martin Luther King and Ted Turner. He also
concludes that, as a result of society‟s stigma regarding mental illness, society is
preventing such leaders from public service at a time they are most needed.
Taken together, these books (and a stack of professional journal articles) lend credence to the
value of peers as leaders. At the same time, peer leaders (as concluded by Ghaemi) are rendered
ineffective by society‟s view of persons diagnosed with psychiatric conditions. This situation, it
appears, also applies to the mental health and substance abuse leadership community where peers
find themselves “tokenized” due to internal and/or
external misperceptions about the value of peer Relatively new leadership
leaders. theories and models have
emerged that are extremely
Relatively new leadership theories and models have well-suited to peers.
emerged that are extremely well-suited to peers. These
theories and models are based on diversity of thought resulting from serious life challenges one
experiences on a personal level. New organizational structures are being increasingly
implemented to change human service organizations from “top down” to “bottom up”
management.
These lessons have been learned well by successful businesses of all types. Consider, for
example, OptumHealth Behavioral Solutions. That for-profit managed care organization has
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3. employed two peer leaders in the business‟ quest to provide quality and effective services. Those
leaders have proven remarkably effective in changing the way mental health and substance and
abuse services are provided by OptumHealth.
These factors make it apparent that the time for addressing the issue of lack of capacity of peer
leadership in the context of new leadership theories has arrived. The questions remaining are: 1)
Who are these new leaders? 2) How can potential leaders be motivated? 3) How can these new
leaders become informed and develop requisite skill sets?
Pushing Doors Open
Incumbent peer leaders can and should open doors to leadership opportunity to potential peer
leaders. Increasing the number and diversity of such leadership will bring new perspectives on
advocacy and analyses. Peer leadership involves not only policy leadership but leadership in the
fields of mental health research, education and organizations, including service provider
organizations.
Unfortunately, incumbent peer leaders are often among the least able to initiate peer leadership
development. While such leaders can play a valuable mentoring role, these leaders generally lack
1) a broad understanding of organizational theory and structure, 2) an understanding of external
factors that can affect leadership roles and styles in different contexts, 3) the skills required to
inspire and motivate peer leaders, and, perhaps most significant, 4) the time necessary to
facilitate the necessary learning and skill building for new peer leaders. The absence of any one
of these can doom a peer leadership initiative.
With this expanded corps,
If all these factors are present and applied, however, an
policy and advocacy
effective peer leadership corps can flourish. With this
initiatives—so often the sole
expanded corps, policy and advocacy initiatives—so
domain of other mental health
often the sole domain of other mental health leaders—
leaders—can involve peers in a
can involve peers in a meaningful and effective manner.
meaningful and effective
If we broaden our message to other mental health
manner.
leaders to include such recovery/wellness components
as lack of poverty, access to education, employment, quality psychiatric and medical services,
and true social inclusion, then we can open more doors for such initiatives as more and better
peer support.
Repeated emphasis on peer support poses the risk of being cast as “single-minded.” We have
made the case for more peer support and, too often, it has fallen on deaf ears. An approach that
legitimates our roles as leaders in healthcare will logically lead to listening ears that will allow us
to not only advocate for peer support but a broader range of issues affecting us.
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4. ACMHA Summit
The ACMHA leadership summit offers us an opportunity to make our case for a full place at the
table where mental health policies are considered and determined. At this event, we have an
opportunity to speak out and say, “We‟ve proven ourselves. It‟s time to „walk the talk.‟”
A message of action must be presented to incumbent mental health leaders. Ours is a true
“grassroots” endeavor and our message at this time of change is vital.
What is that message? We should expect:
Financial and administrative support for a comprehensive peer leadership development
initiative designed and delivered by peers.
A meaningful place at the table where peers are listened to and respected (including
financial compensation at the rate of other meeting participants).
Input to (if not control of) mental health policy meeting agendas.
Majority participation in decision making.
Control over financial allocations for mental health services.
Increased involvement in selection and funding of psychiatric rehabilitation research
initiatives.
A major role in the education of all mental health professional disciplines.
Funding priorities set by peers.
*
For the purposes of this background document, “peer” refers to those who have been diagnosed with a psychiatric
condition or substance abuse disorder and have embarked on a recovery journey. A “peer perspective” is drawn
from one‟s experiences with serious life challenges (usually involving major losses) and is based on empathy,
respect, trust, honesty, integrity, collaboration and sense of purpose.
i
Northouse, P.G. (2010). Leadership: Theory and Practice. (5th ed.), Sage Publishing, Thousand Oaks, CA.
ii
Thomas, R.J. (2008). Crucibles of Leadership: How to Learn from Experience to Become a Great Leader, Harvard
Business Press, Boston, MA.
iii
Ghaemi, N. (2011). A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness. Penguin
Press, New York, NY.
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