Disease model as attitude: a doxastic framework and the challenges of peer support work in mental health

The integration of peer support workers (PSWs) in mental healthcare challenges not only the prevailing medical model in practice but also its underlying attitudinal structures. This paper develops a theoretical framework based on Ortega y Gasset’s philosophy of belief to conceptualize disease models as attitudes that shape how stakeholders perceive mental health issues, and secondarily, act with regard to them. Understanding the medical model as an embodied system of beliefs allows for an analysis of resistance to PSWs, as beliefs regarding their usefulness may conflict with stakeholders’ previous attitudes and therefore force attitudinal transformation. We argue that PSW integration can foster a shift from a hierarchical, deficit-based system to a co-productive model that values lived experience and recovery and loosens fixed medical categories. However, this process may not only require structured training, institutional support, and collaborative engagement, but also necessitate professionals to self-reflect on their own attitudes and belief systems. Our proposed theoretical framework posits that attitudinal change, rather than policy reform alone, is key to making peer support a meaningful component of mental healthcare.