“You need to push, and then he himself”: the “equal – equal” approach in the rehabilitation of veterans

Authors: Victoria Podvorochanska and Tina Polek, researchers Human rights center for servicemen “Princip”

More and more often, in rehabilitation centers, you can see someone who has already overcome this path standing next to a veteran who is taking the first steps after being wounded. This is a mentor who shows by his own example that recovery is possible. The “equal to equal” approach is based on natural trust and shared experience.

The approach has long been part of the veteran community. And the results research conducted by “Princip”show that the effectiveness of this tool differs depending on the scope of its application. In physical rehabilitation, it has a more obvious added value. In the field of mental health, sometimes the risks outweigh the benefits.

Physical rehabilitation: when “equal” is a practical resource In working with physical injuries, “equal to equal” support mainly has a concrete, practical content. Rivni helps veterans adapt after amputations, spinal cord injuries or vision loss, learn self-care and mobility skills, overcome fear and insecurities, find motivation for rehabilitation and establish communication with medical personnel.

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The most important principle in the “equal to equal” approach is to motivate the patient to the maximum, considering the injury, independence and a better understanding of the possibilities of one’s own future in a new body.

Mentors formulate their task as follows: “It is necessary to push [пацієнта], and then he himself“, “Do not do for him, but let him do what he can“, “Your rehabilitation depends only on you“, “You have to be able to take responsibility for yourself“, “Disability is in the head and heart, not a wheelchair or prosthesis. A cart is a means of transportation“.

By showing his own example what life can be like after an injury, the mentor does “emphasis on possibilities, not on limitations“. According to the view of the mentors – “rehabilitation is time and work“, so its success directly depends on what efforts the patient makes to change his condition. The mentor’s example becomes a positive emotional stimulus and inspiration for the patient: “I saw that the mentor can, so I can too!”.

For a person starting the path of recovery after a physical injury, the experience of someone who has already overcome the same difficulties is not a metaphor, but a working tool that strengthens the rehabilitation process. That is why the WHO and other authoritative international institutions recommend including elements of “peer to peer” support in rehabilitation services.

In physical rehabilitation, a “peer” does not replace a doctor or a psychologist. He is a role model capable of activating real behavioral changes and maintaining motivation in critical moments.

Mental Health: When Good Intentions Can Hurt In the field of mental health, the situation is different, including due to the specifics of the recovery itself. Here the work takes place inside, it is more sensitive and less visible.

Mentoring support is not only about support in depressive and anxiety states and overcoming the consequences of a traumatic experience. It’s also about “searching and finding a new self.” Reflecting on his own experience of rehabilitation after injury, survey respondents indicated to the fact that they faced basic questions related to identity, their place in the world after the injury, such as: “Who am I?”, “Who can I be?”. It was mentors who helped them find answers. By their example and support, the mentors gave the patients an understanding of what to live for and what opportunities each person may have for self-realization: “The mentor helped me understand how to live on“, “The mentor helped me find meaning”, “Mentor is about spiritual search” etc. This combination of physical rehabilitation counseling and helping patients find meaning is so valuable that some argue: “Without a mentor, I wouldn’t have made half the progress in rehabilitation”.

Psychological support for a veteran by a veteran seems natural, but in the context of an ongoing war, it can be risky. In our interviews, it was unanimous that many veterans who want to support others have unintegrated trauma themselves. In such conditions, attempts to immerse oneself in the painful experiences of siblings often lead to emotional exhaustion, aggravation of one’s own symptoms, and mutual trauma.

This does not mean that the approach is not necessary. It can work as an “entrance to a professional service”: reduce stigma, encourage the first step to a psychologist, create a safe space for communication within shared leisure time. But anything that goes beyond simple support should be the work of mental health professionals.

The common problem of both spheres: lack of systematicity Both in the field of physical rehabilitation and in the field of mental health, “equals” need quality training, supervision and their own support resources — and this is what is often lacking in practice. Despite the successful programs of individual organizations, the “equal to equal” approach in rehabilitation is still developing chaotically and fragmented. Our research identified the following key issues:

• lack of official profession and training standards for “equals”;
• short trainings are often positioned as full training;
• a significant difference in the level of competences;
• supervision and psychological support are almost not developed;
• the role of “equals” in medical institutions is not settled: there are difficulties in interaction with medical personnel, integration into multidisciplinary rehabilitation teams (MRC), access to medical data;
• funding is mostly based on grants and volunteerism, which calls into question the sustainability of the programs.

As a result, the “equal to equal” initiative in rehabilitation has no systemic support. Their effectiveness depends entirely on the enthusiasm and experience of specific people who implement them.

Our research has shown that the “equal-equal” approach is characterized by informality and flexibility. It is these traits that allow mentors to establish trust, find a common language with their mentees, and adapt support to individual needs. At the same time, they also create risks: blurring of professional and personal boundaries, lack of established ethical norms, differences in the quality of services provided by various organizations and individual specialists.

What needs to be changed? Our research identified several steps that could systematically strengthen the peer-to-peer approach:

• Professional framework. Mentors need quality training and formalized standards. An important step in this direction has already been the certification program for training consultants based on the principle of “equal to equal” on the basis of KNU named after Shevchenko.
• Supervision and interview. To make care safe for both veterans and those providing it.
• Integration in medical institutions. “Levels” should be part of the patient’s rehabilitation route. This requires mechanisms that will allow them to be involved in the work of the MRC and exchange information about the patient’s medical condition, goals and needs.
• Sustainable financing. So that the role ceases to be a volunteer feat and turns into a professional service.

Ukraine is building a rehabilitation system virtually from scratch. And right now there is a chance to lay down approaches that will make it modern, safe and effective. The “equal to equal” approach can become one of its elements, provided that we implement it responsibly, taking into account both opportunities and risks.

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