The Emergence and Utilization of Peer Support in Mental Health Treatment

In 2007, The Centers for Medicare and Medicaid Services (CMS) recognized peer support services as both an evidence-based mental health model of care and an important component in a state's delivery of effective mental health and substance use disorder treatment.  In 2009, SAMHSA recognized peers as important service providers and designated the International Association of Peer Specialists (iNAPS) among the five mental health professional organizations charged with developing recovery-oriented educational materials and training thousands of traditional and peer staff providing mental health services.  On October 1, 2015, New York became the 33rd State to implement a certification process for peer specialists.

         Peer support is a form of self-help and mutual aid exchanged in diverse settings to address a broad range of physical, mental, and emotional issues (Davidson, Bellamy, Guy, & Miller, 2012). Peer support literature across various disciplines identifies theoretical concepts such as social support, experiential knowledge, and social learning theory (Solomon, 2004). These concepts are universal to peer support specialists, individuals who use their lived experience with a particular issue, challenge, or situation to assist others in communities or settings ranging from issues of serious mental illness and addiction to the care of returning veterans (Ault, 2006).

         The use of peer specialists in mental health has been researched and demonstrates that peers providing conventional mental health services can be effective in engaging people into care, decreasing the use of emergency rooms and hospitals, and reducing substance use among persons with co-occurring substance use disorders (Davidson, et al., 2012). Given these potential benefits, it is prudent to explore some of the complexities involved in hiring and sustaining peer employees.

         Despite the increasing visibility of peer specialists and their recognition as important service providers in mental health treatment settings, many organizations that either employ peers, or indicate interest in expanding their workforce to include peers, continue to face challenges related to: (1) Lack of opportunities that promote social support for peer employees; (2)The dearth of experience supervising individuals who are transitioning their role from patient to worker; (3) Poor compensation and lack of career advancement opportunities for peer staff; and (4) Prevailing attitudes of skepticism among both traditional and peer staff regarding readiness and stability of peer specialists to adapt and function effectively on the job.  If these issues remain unaddressed, hiring, integration, job satisfaction, and retention among peer staff will be severely compromised.   

         Identifying and replicating promising practices for hiring, integrating and sustaining peer employees in delivery systems providing traditional mental health services can ultimately help improve the care experience for individuals receiving services, increase population health outcomes, and deliver care more efficiently by integrating the lived experience paradigm in traditional treatment.  These intents parallel the Institute for Healthcare (IHI) Triple Aim objectives, which are part of the Affordable Care Act.

         As a potential presenter, I would use this platform to share my professional experience developing a peer program within a major hospital system, and share recommended practices for integrating peer staff in mental heath treatment settings.