The Use of Peer Providers in Involuntary Outpatient Commitment: Roles, Responsibilities and Perceived Benefits

Background and Purpose: Involuntary Outpatient Commitment (IOC) provides court-ordered community treatment, targeting individuals with a serious mental illness and a history of non-adherence to mental health care. Therefore, by nature, this program is charged with engaging a difficult-to-reach group of consumers. A novel strategy for increasing engagement of court-ordered individuals is to include peer providers on the treatment team. Across the mental health system, peer providers are increasingly being utilized to provide essential support services, such as health education, advocacy and community outreach. A growing body of literature supports the effectiveness of peer workers, particularly among vulnerable populations such as individuals with a serious mental illness or substance use. While there is existing literature on the overall efficacy of peer-provided services, there has been almost no research conducted to investigate what unique skillsets this emerging workforce can offer to mental health programs provided in an involuntary treatment context.  The present study examines how peer providers are being used in 6 newly implemented IOC programs. The objective of this study is to explore what roles and responsibilities peer providers assume, and how staff and consumers view the unique benefits of these workers.

Methods: As part of a larger parent study, in-depth qualitative interviews were conducted with 31 IOC consumers and 31 staff members, including 5 peer workers, across 6 IOC programs. Interviews covered a number of domains, including questions relating to the role of peers within the programs, and the perceived utility of their function within IOC. Analysis was completed using a constant comparative technique, a method commonly associated with grounded theory in which two research team members independently code each interview, compare findings, and resolve differences by consensus. The resulting themes were developed through inductive approach refined through multiple stages of coding, synthesis, and discussion.

 

Results:  Findings from this qualitative analysis indicate that peers served two primary functions: clinical case management and advocacy. Programs varied in how they deployed peer staff, based on differences in their staffing needs and the geographically-determined needs of each consumer population served. Overall, however, peer providers offered unique engagement skills in two distinct ways. First, peers were reported to be effective at breaking down power dynamics that are particularly present in involuntary settings, especially during the critical early engagement period.  Second, because peers had experience with both mental illness and the mental health system, they possessed a unique credibility that made their advice or feedback particularly influential among consumers. In this way, peers were often able to motivate consumers to continue their recovery process in ways non-peer staff could not.

Conclusions and Implications: These findings support existing research suggesting that peer providers can be valuable assets to mental health programs, and offers the additional insight that peer services may help to reduce the coerciveness inherent in involuntary services.  Input from both staff and consumers perspectives offer important insight into how the unique skills of these workers can be optimized, even with difficult-to-reach populations.