For the 94th HGPI Seminar, we hosted Mr. Nobuaki Igarashi and Mr. Yohei Tanaka of the Institute of Japan Mental-health Peer-support training. They introduced the Institute’s current activities and discussed how patient organizations can get involved in the policy-making process for mental health.

Key points of the lecture

• The role of peer supporters is to cooperate with specialists and utilize their painful firsthand experiences to support people who are currently suffering.
• The FY2021 revision of the Disability Welfare Services Service Fee Schedule included a new entry for peer support. Peer support will be reimbursed at the rate of 100 points per month. In this manner, progress is being made on frameworks for evaluating peer support in the existing system.
• Empowerment, relationships of mutual respect, and the motivation to build a better system together will be important as patient organizations grow increasingly involved in the mental health policy-making process.

 

Mr. Nobuaki Igarashi (Executive Director, Institute of Japan Mental-health Peer-support-training)

■The Role of Peer Supporters
I believe the role of peer supporters is to “provide support to those who are currently suffering based on your own painful experiences in the past.” Peer support can be broadly categorized into three groups: support that occurs naturally, support that is provided for free or for a gratuity, and support that is based on employment and is provided at workplaces and other such places. None of these types of peer support is superior to the other two. Rather, each one has its own strengths, weaknesses, and values. The Institute of Japan Mental-health Peer-support training has been providing peer supporter training programs in the field of mental disorders and mental disabilities with the belief that it is effective for peer supporters to collaborate with specialists to support people with mental disorders or disabilities.

Concerning the relationship peer supporters and specialists should have while cooperating, I think it is best if they have a relationship akin to that of a commentator who provides live play-by-plays and one who provides in-depth analyses during a live sporting event. Each specialist acts like a sports commentator by explaining what they see in front of them (the external factors), while peer supporters use their own experiences to break down what is happening (the internal factors). This allows for a deeper understanding of the person with a mental disorder and makes it easier to connect them with support.

The following figure illustrates collaboration between peer supporters and specialists.

 

In this figure, peer supporters are on the left and specialists are on the right. Specialists provide support to people with mental disorders based on their past experiences after undergoing specialist education at training institutions and accumulating real-world experience based on the Code of Ethical Practice of their specialty. They work to gain new expertise while embodying their Code of Ethical Practice. Peer supporters provide support to people with mental disorders based on each peer supporter’s experiences in life and with recovery. They sometimes act as role models or examples; as casual advisors or mentors; or as coaches. In all these roles, they encourage the independent decision-making of the person receiving support. It is ideal if each specialist and peer supporter cooperates while making the most of their own expertise to provide support to the person in question so they can enjoy living.
The keywords for peer support are recovery, empowerment, and strength.

Recovery:
Recovery is not about getting back to how you were before. It is about facing your illness, your injury, and your life. Unlike colds and scrapes, chronic illnesses like mental disorders and disabilities cannot be cured completely. Rather, people can live their daily lives by taking advantage of various systems and services to live their lives their way, just like people with nearsightedness or presbyopia can live their lives by wearing glasses. In this manner, it is possible for people to live their lives while managing an illness or injury even when full recovery is not possible.

Furthermore, it is not important whether their job is full-time or part-time. What is important is that we view work as a tool for participating in society in a way that is true to ourselves. As such, people must understand and keep in mind that “finding employment” does not equal “recovery.”

Empowerment:
Empowerment means knowing your rights and exercising them with confidence.

Strength:
Strength refers to the characteristics, attractive features, and preferences of the person with a mental disorder. When thinking about the person receiving support, it is important for supporters to focus on their health rather than their illness, allow them to make choices rather than forcing them to do things, to see potential rather than problems, and to think of what to add rather than what to subtract.

Based on the way of thinking behind these three key words, peer supporters verbalize their own experiences with recovery to support the recovery of people currently facing difficulties. I think this is the specialty of peer supporters. To give an example, people can receive certain privileges if they obtain a disability notebook to certify they have a disability, but many people do not want not want to be labeled “a person with a disability.” In such situations, a peer supporter can tell them, “If you have one, you can receive benefits through the system, and as long as you don’t show it to anyone, nobody will say anything to you about it. You shouldn’t worry so much about it.” They can give advice like this based on their own experience and help improve the situation.

■Past Activities of the Institute of Japan Mental-health Peer-support-training
Around 2010, there were many reports of difficult situations regarding the employment of peer supporters in Japan. Some people were given little pay and were denied official employment contracts, while others were forced to work for long hours until they burned out. To help people like that, people with mental disorders and specialists from various fields came together and, with permission from the National Association of Peer Specialists in the U.S., created a Japanese version of National Practice Guidelines for Peer Supporters called the “Textbook Guide on Training Peer Supporters for People With Mental Disabilities.” (The textbook guide is currently on its third edition. It can be found here.) We then developed and began conducting training programs.

We incorporated as the Institute of Japan Mental-health Peer-support-training in 2015. We then began revising the textbook guide and making improvements to the training program while conducting specialist training seminars. Then, from FY2016 to FY2018, we have been cooperating with research initiatives such as the “Research Study on Training to Enhance the Expertise of Peer Supporters for People with Disabilities” (Comprehensive Research Project on Disability Policy, Health and Labour Sciences Research Grants; Representative: Kaori Iwasaki, Waseda University).

When looking back on our past activities, instead of trying to see what we have accomplished on our own, I prefer to recognize that our current results were achieved because we had the baton passed to us. The many people before us gave their all to establishing our current systems. They include peer supporters and people with mental disorders who served as staff who actively contributed to providing support to others. I would like for us to take on any challenge we can until the time comes for us to pass the baton to the next runner.

 

Mr. Yohei Tanaka (Assistant Director, Institute of Japan Mental-health Peer-support-training; Mental health Social Worker)

■Past research on and existing systems related to peer support
I would like to introduce some of the major studies and systems for peer support that have started or have been introduced since the enactment of the Comprehensive Support for Persons with Disabilities Act.

As mentioned earlier, we were involved in the “Research Study on Training to Enhance the Expertise of Peer Supporters for People with Disabilities” (Comprehensive Research Project on Disability Policy, Health and Labour Sciences Research Grants; Representative: Kaori Iwasaki, Waseda University) which was conducted from FY2016 to FY2018. The purpose of that research was to develop a training program to build expertise on peer support for people with disabilities. It was unique in that it was centered on people with physical, mental, and intellectual disabilities; intractable diseases; and higher brain dysfunction; and was conducted together with specialists and researchers in welfare and medical services. Training provided by the Institute of Japan Mental-health Peer-support-training served as the basis for the model training and members of our staff also collaborated in the research project. In addition to efforts to implement, monitor, and evaluate the training programs developed during that project, an initiative called the “Research on Training and Dissemination of Human Resources Who Serve as Instructors for Training Programs on Building Expertise Regarding Peer Support for People With Disabilities” was conducted from FY2019 to FY2020. The purpose of that research was to develop training programs for instructors and facilitators qualified to provide training and to encourage the dissemination of those programs nationwide.

Based on this research, the “Peer Support Training Program for People with Disabilities” started in FY2020 as a voluntary program to be implemented by the governments of prefectures and designated cities as part of Social Rehabilitation Support Services and with funding from the Community Living Support Project Subsidy. When positioning peer support in new systems, collaboration with specialists is essential. Building a better society requires mutual understanding among specialists regarding each other’s expertise and the underlying concepts to that knowledge, and achieving this requires an environment in which all parties can engage in mutual learning. From that perspective, this training program targets both people with disabilities employed at places like disability welfare service centers and consultation support offices as well as managers of disability welfare service centers and others providing support alongside peer supporters. The effects of stationing peer supporters at disability welfare service centers have been reported in the Comprehensive Welfare for Persons with Disabilities Promotion Project (which was implemented in parallel to the training program) and construction is underway on systems for evaluating peer support. This includes the addition of new items in the FY2021 revision of Disability Welfare Services Service Fee Schedule like the “Peer supporter system premium,” which reimburses peer support at a rate of 100 points per month. It is also noteworthy that the findings of these efforts have been reflected in systems for various fields of disability, including physical, mental, and intellectual disabilities; intractable diseases; and higher brain dysfunction.

However, our achievements up until now are nothing more than a checkpoint which has taken several years and the thoughts and efforts of many people to reach. It is important that we pass the baton down to the next generation while maintaining mutual respect for each other’s positions based on the principle of “No one left behind.”

 

Mr. Igarashi

■The pursuit of cooperation in the policy-making process
In the future, the Institute of Japan Mental-health Peer-support-training will continue activities under three pillars: 1) human resource development; 2) dissemination and awareness-building; and 3) network building.

Human resource development:
We will work to propagate our peer support training program for people with disabilities nationwide. We also plan to keep revising and improving our training program and textbook guide content.

Dissemination and awareness-building:
While there have been some positive developments in dissemination and awareness-building, such as the addition of information regarding mental disorder prevention and recovery to high school curriculum guidelines starting in FY2022, prejudice and discrimination toward mental disorders still exist. We want to keep building awareness and generating recommendations until it becomes the norm rather than the exception for people with mental disorders to recover and enjoy life.

Network building:
Many workplaces only have a single peer supporter, which tends to lead to isolation. We want to build an impartial network to support peer supporters and prevent isolation at each workplace.

I believe empowerment, relationships of mutual respect, and the willingness to cooperate on creating better systems developed through these activities will be important when we engage in the policy-making process for mental health in our capacity as a patient organization.

Once, when my illness prevented me from continuing work, I felt that life had no meaning. However, among the basic human rights granted by the Constitution of Japan, we are guaranteed the right to happiness. This applies even when we cannot work. The Constitution represents a promise between the people and the state that the people will be protected. Although this interpretation may be a bit of an exaggeration, it is important we return to that starting point and consider that right. Also, when we feel that something is wrong with the system, we must keep in mind that it is possible to change the system if we follow the correct procedure. Until now, even when I felt something was wrong with the system, I thought there was nothing I could do because I viewed myself as an outsider. However, we can change the system for the better. I realized this after being empowered by those who passed me the baton.

Even if we are empowered and understand that we have options, the system cannot be changed unless multi-stakeholders, including people with mental disorders, enter into relationships of mutual respect. Because respect is the foundation of these relationships, we must develop respect by building experience listening and participating in discussions where everyone has peace of mind. Such experience will teach us each other’s individual depths, insights, and charm, and this will lead to good relationships.

When building such relationships, it will be important for us to stay aware that we are working together to create a better system. When we find that we have become part of a structure we are uncomfortable with, we tend to mount personal attacks on those who are directly responsible for its existence. Instead of attacking individuals, it might be possible for us to reduce the rate of tragedies if we can join with specialists to examine and change that uncomfortable structure. This is the kind of attitude we want to have. We want to look at the structure of the system in its entirety, discuss it with people with mental disorders and specialists, and work together to improve the system by creating a better structure. After all, I am certain that first-rate specialists are well aware of weaknesses in the system’s current structure and want to improve it. I have met many people like that. I believe that it is of utmost importance that we transition from relationships in which people are reliant on others to relationships in which we build our capacities together.

 

■Profile
Mr. Nobuaki Igarashi (Executive Director, Institute of Japan Mental-health Peer-support-training)
Mr. Nobuaki Igarashi was born in 1970. He graduated from Miyagi University of Education. Due to depression, he retired from a teaching position at an elementary school in Fukushima Prefecture. After attending a training program for peer supporters in the field of mental health in Fukushima Prefecture, he joined the Takeda General Hospital Mental Health Center and began participating in outreach programs. In 2020, he assumed his current position as Executive Director of the Institute of Japan Mental-health Peer-support-training.

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[Event Report] The 93rd HGPI Seminar—Universal Health Coverage and UHC2030 After the COVID-19 Pandemic (March 19, 2021)>