Troubling Peer Support Institutionalization: A Mad Institutional Ethnography; Or, Everyday Documentation, De/Valuing, & Values Work in Institutionalized Peer Support

Abstract

This study explores how the everyday work of peer supporters working within institutionalized settings are shaped by institutional forces (“ruling relations”), through a series of four (peer support) focus groups and interviews with five peer support workers in Ontario. I explore peer supporters’ approaches to writing, reading, and verbally sharing information about their peers (“documentation work”), and reveal how their experiences and “felt troubles” relating to documentation are shaped by ideas of (clinical) confidentiality constructed in the Personal Health Information Protection Act (2004). I also explore how both lived experience and peer support are devalued through the ways organizations and clinicians determine and describe the value of healthcare roles (“de/valuing work”), and reveal how peer supporters’ experiences of being (de)valued are shaped by discourses of “professional/ism” which equate being a professional to having a post-secondary education and working through clinical frameworks. I describe the work that peer supporters, clinicians, and organizations (can) engage in to ground peer support workers within peer values and approaches (“values work”) through accessing peer community and fostering environments of peer culture. I draw on these suggestions and the findings of the study to provide recommendations for peer support workers, organizations and clinical workers, the peer support sector as a whole, and research/ers.