From Physical Wellness to Cultural Broker: Unpacking the Roles of Peer Providers in Newly Integrated Health Care Settings

Background: The Patient Protection and Affordable Care Act has positioned an expanding cohort of individuals living with mental disorders to become leaders in the delivery of integrated health services.  These individuals, known as peer providers, have personally experienced mental illness and have received training in mental health service delivery. Previous studies have documented potential roles for peer providers in delivering integrated mental health and primary care services to improve the physical health of persons living with mental illness. However, less is known about the large-scale implementation of this role in a system wide effort to deliver integrated care to a culturally diverse consumer base.  This qualitative study explored the experiences of peer providers delivering integrated care in newly integrated pilot programs within Los Angeles County Department of Mental Health. These pilot programs were implemented using the final funds of California’s Mental Health Services Act.

Methods: Peer providers were recruited from 17 integrated pilot programs to participate in a semistructured interview, which focused on their experiences delivering care on their integrated teams, their professional backgrounds, and their program-related responsibilities.  Qualitative interviews were audio recorded, professionally transcribed, and analyzed with Nvivo software using constant comparative methods informed by grounded theory.

Results: Nineteen peer providers participated in a semistructured interview. Peer providers reported having various experiences in common with clients including a shared cultural background, history of chronic disease, and recovery from mental illness.  Peer providers reported substantial variation in their program-related responsibilities, and discussed three primary roles: (a) encouragement of physical health self-management, in which peer providers had received formal training in health navigation, or drew from their experiences managing their own chronic diseases to motivate their clients to improve self-management;  (b) use of recovery expertise to educate program staff about the realities of having a mental illness; and (c) evoking of shared cultural identity to reduce stigma and engage clients. Some peer providers were uninvolved in physical health promotion of their clients.  Although these peer providers reported understanding the importance client physical health, they reported feeling unprepared and unskilled to support clients in accessing and managing client health care.

Conclusion: It is feasible to involve peer providers in the delivery of integrated care using a culturally competent approach.  However, integrated settings need ongoing support from public health and mental health authorities to ensure successful implementation of culturally competent peer-based services. These supports, including the formal training of peer providers on matters related to physical health and wellness from a cultural perspective, are needed so that agencies can continue enhancing peer-based services to improve the physical health and wellness of people living with mental illness.  Sharing of implementation successes and challenges through learning collaboratives can also facilitate knowledge transfer between mental health programs and systems.