Stressors and Challenges Faced by Peer Workers
Several subthemes of stressors and challenges in peer work were identified by focus group participants. These themes and subthemes are summarized in Table 3 and presented sequentially in more detail below.
In cases where the survey data for a particular theme from the focus groups was available, they are presented below (see Tables 4 and 5 in the appendix).
- “Scrape up money… to just get by”: Financial Insecurity
Poor financial situation of workers was consistently mentioned by participants as a key stressor. As one participant stated: “Honestly, my biggest hurdle is trying to do my job and then try and scrape up money outside of work to just get by.” This sentiment reflects the severe financial hardships and often ‘hand-to-mouth’ situation many peer workers are faced with.
Similar to focus group participants, survey participants also indicated financial insecurity as a key stressor. When asked to choose from a list of 16 potential stressors (see appendix), overall 72% of participants listed financial situation as one of their top three stressors (Table 4). This perception varied between the four cities (ranging between 62.5% and 88.9%), however was not significant p=0.71. There were also no statistically significant differences in the perception of financial situation as a one of the top three stressors across the different age groups, genders and ethnicities.
Inequitable Pay
Several focus group participants attributed their financial insecurity to the inequitable pay they received. Participants spoke about getting paid much less than other support staff employed by their organizations, despite doing the same work. This is apparent in one participant’s words: “[Support workers] are making one amount. [Peer workers] are making another, doing the exact same job.” This highlights the inequities between staff doing the same kind of work.
Some participants suggested that the pay inequity stems from the higher value that organizations place on formal education and certification over expertise acquired though lived/ living experience. As one participant mentioned: “We’ve got people that […] took an eight-month course […] with two months of addictions training and somehow that certification is valued above lived experience.” This quote illustrates that there is a lack of recognition of the value of lived/ living expertise as an important source of knowledge.
The idea of pay inequity was also echoed in survey responses When asked if individuals feel they get paid a fair amount, 45% of the participants disagreed and 14% were neutral (Table 5). The proportion of participants that disagreed ranged between 14% to 69% in the four cities.
These findings suggest that ongoing pay inequities contribute to the financial insecurity faced by peer workers. The sub-theme of inequitable pay is suggestive of a larger issue related to lack of respect and recognition of lived/ living expertise, which is discussed as a separate theme below.
Job Instability
Job instability compounds financial insecurity faced by peer workers. Many peer workers mentioned that their jobs rely on unstable funding and lack formal long-term employment contracts. As one focus group participant described, “There’s only so much money in this ‘well’, because this is government funded. Now if they pay us what they’re paying the people over there, how much sooner is our well going to run dry? When am I unemployed? That scares the hell out of me. […] Am I going to be here next year?”. The use of the metaphor of a ‘well’ indicates that peers work in a precarious environment, often characterized by job instability and lack of job security. The quote also highlights that lack of funds is often used to justify inequitable pay for peer workers and that invokes fear of unemployment, which is a significant stressor for peer workers.
- “Sets us apart”: Lack of Respect and Recognition at work
One of the top stressors that emerged from the focus group data is the lack of recognition and respect for peer workers. Several peer workers felt that they were not taken seriously or given due respect by their work colleagues and by other professionals they encounter in their work.
Many peer workers expressed that the use of the term “peer” is not an adequate job title as it sets to define the work of peer workers solely by their history of substance use, rather than by the important work they do and the lived/ living experience and context they provide. As such, it is considered stigmatizing and derogatory. As one peer worker mentioned, “This term “peer,” I’m really quite uncomfortable with [it]. […] It divides us. […] It sets us apart from normal society.” This quote highlights that term ‘peer’ can be othering and leads to differential treatment of peer workers by others. Thus, the lack of respect seems to stem from stigma against PWUD.
The differential treatment of peer workers is apparent in the lack of basic resources for peers, which are generally provided to most working professionals, such as photo IDs or business cards. As one peer worker mentioned, “We don’t have the exact same things as the other support staff”.
Focus group participants also pointed out the absence of formal job descriptions and contracts for peer workers, leading to lack of role clarity among supervisors as well as their support worker colleagues. Several focus group participants mentioned that they are often assigned to menial tasks and are looked down upon despite their extensive expertise and skillset. As one participant described:
“Sometimes when I get [to work] and I’m barely even in the door [support workers are] like, ‘you gotta go upstairs and go clean the kitchen. You gotta go in here and clean the staff room’”.
This quote indicates the constant struggles that peer workers face at work and how they are given minimal respect due to their perceived position in the organization.
Peer workers also expressed that they do not feel respected by other professionals they encounter in their work. One peer worker described a situation that they faced with the police:
“Today, for example, a guy was O.D.’ing just across the street here. [We] went over, we had our Narcan kits and we had everything under control. We were doing our job. Next thing you know we got eight cop cars there and they’re telling us we’re going to be arrested if we don’t leave.”
This quote shows how police officers and other service providers may not understand the life-saving work peer workers constantly perform which illustrates lack of recognition and respect for their work. A similar sentiment was expressed by another peer worker who recounted their experience with paramedics:
“I think there’s a little bit of stigma from the ambulance people [and] from the first responders. […] I find that they can come in, take over and kind of push the peer aside. I think that there is a lot of stigma against peers.”
This quote indicates that the lack of respect for peer workers is rooted in deeper societal stigma that uniformly characterizes peer workers by their substance use and is indicative of a broader system built to further marginalize PWUD.
Similar to focus group participants, survey participants feel that they don’t always get the recognition that they deserve for their work. For the question, “when I do a good job, I get the recognition for it that I should receive”, half of the participants (50%) disagreed or were neutral (Table 5). The proportion of participants that disagreed ranged from 12% to 78% in the different cities. Furthermore, more than a third of the survey participants (40%) listed “work situation (including working conditions)” as one of their top three stressors (Table 4). This ranged from 12.5% to 77.8% in the four cities (p=0.03). The differences across genders, ages and ethnicities were not statistically significant.
These results highlight how much importance peer workers place on being recognized and respected at work; lack of respect can be a stressor for them.
- “My shithole”: Housing Challenges
Another stressor identified by peer workers was housing challenges which in turn impacts the ability to sustain work. Several participants expressed that they would like to have “somewhere [they] can call a home”. Having a safe place one can call ‘home’ is crucial for peer workers’ productivity and ability to help others. As one participant explained:
When you’re able to look after yourself financially and physically and mentally and emotionally, then you’re able to do so much more for other people. Because you’re together. You’re not worried about that. Stressing out, [worrying] about [how] after this, I got to go home to my shithole and try to figure out what I’m going to do for […] dinner. You’re together and you’re in a position where you can actually help.
Several focus group participants mentioned that their housing situations jeopardized both their security and their health. For example, participants mentioned being assaulted in their buildings, having accommodation infested with bed bugs, and having small quarters that felt like a “jail cell”. For peer workers, the conditions of their homes seem to add stress rather than offer a respite to alleviate it.
Some participants mentioned that they felt helpless and were unable to move because they often encounter problems in acquiring housing. BC is known for its exorbitant housing rental prices [59–61], which makes safe housing unaffordable for peer workers with meager wages. One participant mentioned: “I can’t move anywhere else. I can’t afford to move.” This quote indicates that many peer workers are forced to endure poor living conditions due to a housing market that favours the wealthy and privileged.
Some peer workers described that they find it difficult to find a home within their communities, surrounded by people that they feel safe with. One participant mentioned: “I don’t want to leave my community. […] I still want to stay in [my community]. It’s where my friends, my family is.”
Like focus group participants, survey participants also listed housing challenges as a common stressor. More than a third (38%) of the survey participants listed housing-related issues as one of their top three stressors (Table 4). Perception of housing situation as one of the top three stressors ranged from 12.5% to 66.7% (p=0.31) in the four communities. Differences across ages, genders, and ethnicities was not significant.
When asked if individuals faced housing challenges due to their substance use in the last 30 days, almost a half (48%) of the participants indicated that they ‘always’, ‘often’, or ‘sometimes’ faced such challenges (Table 5). Although not the majority, 48% is a large percentage of respondents that faced housing challenges in such a short amount of time (30 days). In some cities, almost all participants reported having faced housing challenges in the last 30 days (Table 5). Clearly, acquiring acceptable housing is a challenge for peer workers and this can add considerable stress to their lives.
- “Not enough social support”: Inability to access or refer individuals to resources
Many focus group participants indicated that a lack of social services for PWUD is a key stressor in their lives. Participants described that they often serve as a bridge connecting PWUD to social services and other supports. Inability to do so, despite a genuine desire to help adds to peer workers’ stress and dissatisfaction. This sentiment is expressed by one participant who mentioned, “I’m not as worried about myself as the clients, but there’s not enough social support… in all aspects.” Several examples of resources which PWUD find hard to access were provided by focus group participants, including ‘detox’, legal services, welfare and income assistance, and civic services such as government identification.
Some peer workers expressed that certain services do exist, but tend to be inaccessible for PWUD, either directly by prioritization of more privileged groups, or indirectly through stigma and judgement which makes PWUD hesitant to use them due to past negative experiences. Healthcare is one such resource; many peer workers feel that the stigma against substance use often clouds healthcare providers’ ability to provide compassionate care. As one participant noted, “I feel like a real asshole, like, trying to convince anybody to go to the hospital because I know why they don’t want to go”. Albeit subtly, this quote communicates a powerful message; it indicates that peer workers, along with PWUD, often do not want to access healthcare because of stigma and are left to navigate their own physical and mental health challenges.
In some cases, although resources do exist, peer workers often do not feel equipped with the skills and credibility to make referrals to those services. Sometimes this lack of credibility is due to lack of institutional authority to make referrals. This often leads to a sense of powerlessness adding stress and frustration to peer work. The following quote highlights the desire of a peer worker to be able to do more:
“If you want to help somebody you don’t want to turn them away […] without getting an answer or resolving their enquiry. You want to help them and it bothers you ‘cause you’ve been on that side where nobody’s helping you and it’s frustrating.”
The powerlessness felt by peer workers is rooted in a point discussed earlier – inequity in the workplace. Peer workers do not have access to the same resources as other staff at work, including skill development opportunities. These findings indicate that inability to refer PWUD to the services they need, either due to lack of those resources or due to lack of skills and credibility to make referrals, causes significant stress for peer workers.
- “Living through our losses”: Constant exposure to death and trauma
Several peer workers mentioned that the constant exposure to trauma and loss of lives is emotionally taxing and stressful. Like other first responders, peer workers can get stressed and burnt out from working in overdose response settings. As one peer worker described, “Being a first responder can drain you after a day, after a few of them”. In addition, unlike most other first responders, peer workers have a unique understanding of the lives of PWUD, and can relate deeply to stories of trauma, which can amplify the stress they feel. In this same vein, peer workers are not supporting mere clients but often clients who are friends and family members. Losing a client, therefore, is so much more difficult. As one participant mentioned, “I lost a couple of my best friends in the last couple of years and it’s just been really friggin’ hard.”
For peer workers, personal and professional lives are heavily intertwined because they are part of the community they serve. Unlike other professionals, their work is a 24-hour job. Peer workers often do not get to unwind after a stressful day because they are constantly working to support community members in need, even outside the work environment. Peer workers also worry about their friends and members of their community. As one participant stated:
“I just get worried about people that I know, like, friends that [are] still doing the same old thing. You like worry about [whether] they [are] going to […] OD or if they’re going to be okay.”
This constant worrying and the inability to unwind can eventually take a toll on peer workers’ mental health and well-being. As one peer worker illustrates: “I am running myself ragged. The burnout.”
Peer workers live and work in an environment so often punctuated by loss. This idea is summarized by a focus group participant who mentioned that the most stressful thing for them was:
“Living through the bad days. Living through our losses. Living through somebody [going] to jail. Living through somebody [getting] beat[en] up down on the corner and [having] their head bashed in, [spending] six months in the hospital. Living through […] we found a dead body in the garbage. Living through those things together. I think that is a lot. I think that’s it, really.”
Consistent with the focus group findings, two-thirds (68%) of the survey participants that responded were at least sometimes “affected by the traumatic stress of those they help”, i.e. the sum of those that stated ‘always’, ‘often’ and ‘sometimes’ (Table 5). Furthermore, almost half (47%) of the respondents reported that they “feel worn out because of their work” (Table 5). A similar proportion of respondents (47%) reported that they “find it difficult to separate their personal lives from their lives as peer workers” (Table 5).
Despite the traumatic stress and burn-out peer workers report, only slightly over a quarter (28%) of the survey participants indicated “caring for others” as one of their top three stressors (ranging from 0% to 44.4% across the four cities). Differences across ages, genders and ethnicities were not statistically significant. The vast majority (98%) of survey respondents reported they “have happy thoughts about those they help and how they could help” and 94% of respondents “feel a sense of pride in doing their work”. Furthermore, 94% and 95% of respondents respectively report that their “work makes them feel satisfied” and that they “make a difference through their work”. This clearly indicates that even through their work can be emotionally draining and stressful, peer workers genuinely care for their community and like to help others.