Towards peer-led and person-centred care

Ma te rongo, ka mohio;
Ma te mohio, ka marama;
Ma te marama, ka matau;
Ma te matau, ka ora.
Through listening comes awareness; through awareness comes understanding; through understanding comes knowledge; through knowledge comes life and well-being.

When I first plunged back into postgraduate studies, I had no idea it would lead me here – to new perspectives that have unravelled not only my previous academic understandings, but also, understandings of myself, my identity, my intentions, and the world around me. From the confines of traditional, biomedical conceptions of mainstream psychology, to the emancipatory horizons of critical health psychology (CHP)… and from naïve teenage dreams to practice as a private psychologist, to the raw reality of working in a peer support role at the pointy end of public health, in the Nelson Hospital Emergency Department. Perhaps most pivotal of all, has been the congruence between my learnings and real-life examples in my working environment – to observe, encounter and critique applied healthcare interactions in motion and from a unique position at the intersection of clinical and peer-led models of practice. And within these blurred boundaries, the unwavering commitment that human-to-human, person-centred care is the only way to meaningfully, equitably adapt services and systems for individuals and communities that are currently being overlooked and underserved.

To me, this is underpinned by CHP’s emphasis on our interconnectedness as social beings (Lyons & Chamberlain, 2006), and a relational interdependence that deconstructs the prescribed roles and power imbalances of established doctor-patient relations (Buetow, 2016). As such, when I softly knock or step inside the curtains of a triage room, my first words are almost always “Hi, I’m Bella, I’m not a doctor or a nurse…” and automatically, something intangible in the air changes, and we are simply two humans able to be vulnerable and accountable to each other. Perhaps, this is the absence of Foucault’s (1963) ‘medical gaze’ that methodically searches for physical pathways of pathology, viewing the patient through dehumanising discourses that omit the complexity of situational and socio-structural factors (Decaria, 2022; Holt-Lunstad, 2021). This urgency to identify biomedical causes and courses of action is only exacerbated by the resource-intensive, time-critical nature of emergency health responses, and further embedded by popular social representations of medical professionals (Hether & Murphy, 2010). Instead, I am the one sharing a quiet cup of tea and a long conversation amidst the clinical chaos, gifted the knowledge of each individual’s passions, purpose, support systems and frustrations, of who they are beyond their diagnosis.

But within these privileged kōrero (conversations) came the realisation that so often, who people are and how they define themselves becomes inextricable from their medical diagnosis – an illness narrative that is immersed within situated cultural and social connotations. Here, I notice how dominant social processes of knowledge and power constrain and construct biographical disruptions and subsequent sense-making to integrate a new illness identity and its associated social utility (Conrad & Barker, 2010; Lyons & Chamberlain, 2006). I’ve had countless interactions with service users, whereby their chronic pain or illness colours all future aspects of their lives, including how they interpret and attend to new physical sensations; enter, the co-constructive and complex interplay between psychosocial and physiological factors that selectively frame conditions and symptom recognition (Brown, 1995). In my experience, peer-led conversations and person-centred care normalise and contextualise these behavioural expectations and embodied knowledges, whilst compassionately locating people within their unique social landscape. That is, a socially just and reflexive stance that anchors understandings, expressions of and resistance to mainstream healthcare services within the convoluted systems of power that sustain health inequalities and institutionalised oppression (Lyons & Chamberlain, 2006; Riggs & Treharne, 2017).

At their roots, both CHP and intentional peer support perspectives search for social change, that proactively addresses the power imbalances in medical practice (IPS, 2023; Lyons & Chamberlain, 2006). They apply theoretical and ethical frameworks that consider the complexity of our collective humanity and the multiplicity of social and cultural identities we carry (Crenshaw, 2016), as well as a critical lens towards the macro systems and structures that can mapped and enacted against singular social locations (Bowleg, 2012). To me, the intersections within the tāngata (people) I support are simultaneously the source of their personhood and contextual wellbeing, and the sticking point for an inflexible, biomedical system that fails to adapt to other models of health or ways of knowing. Person-centred care provides an opportunity to humanise services (Moen, 2013) and tailor healthcare experiences to meet the diverse needs of marginalised groups (Wilson & Barton, 2012). And further, an open-minded, authentic counterpoint to the inherent healthism and neoliberal undertones within public health imperatives (Hui & Robinson, 2022; Littlejohn & Kimport, 2017), that limit individual autonomy, agency and equitable care through biased assumptions and decision-making. Digitisation and overmedicalisation threaten this further, through Big Pharma-backed technologies that further divide and disengage from human-to-human, holistic healthcare (Lupton, 2014).

Therefore, I find myself in a fortunate position within the moving medical cogs as peer support partner services become more widespread (Te Pou, 2021) – to grasp a systemically endorsed empowerment that fully embraces patient-centred care within mutually led healthcare interactions. And further, to couple this with CHP’s distinct awareness of our interdependence in navigating inequitable systems of power and discrimination, that actively searches for more collaborative, holistic, and whole-person conceptualisations of health and illness… that is, to nurture life and well-being through listening, awareness and understanding that proactively supports other systems of knowledge and self.

Bella van Hattum is currently undertaking an MSc in Health Psychology at Massey University, with high hopes to continue postgraduate studies through a Doctor of Clinical Psychology from a critical health perspective. Bella also works as a Peer Support Worker in Mental Health and Addictions with COMPASS in Nelson, New Zealand, across a range of community and clinical settings. Her research interests follow women’s experiences of matrescence – specifically, childbirth and reproductive challenges, and associated public health responses from a socioecological and person-centred approach. Aside from her drive to improve and deliver sensitive interventions specific to women’s psychosocial wellbeing, Bella is a busy mother of three young children, still plays indoor volleyball (at least half as well as she used to) and enjoys time offline hiking or boating in the nearby Marlborough Sounds or Abel Tasman National Park.