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Schedule:
Thursday, January 11, 2024
Marquis BR Salon 6, ML 2 (Marriott Marquis Washington DC)
* noted as presenting author
Background and Purpose: The National Suicide Hotline Designation Act of 2020 (9-8-8) is a monumental social policy that aims to create a robust mental health crisis care system as an alternative to 9-1-1. Social workers have historically been utilized as an effective and affordable role in mental health crisis settings, but due to 9-8-8’s significant systems expansion goals, mental health peers are rapidly being hired as an additional cost-effective and culturally competent resource. Despite the increasing utilization of peers, there are substantial gaps in research on mental health peers in crisis settings. This study sought to understand how states define mental health peer roles, peer credentialing requirements, and what inter/multidisciplinary crisis care settings peers are named to work in. This study team was led by a community leader in mental health crisis peer work, and a social welfare policy scholar.
Methods: This study utilized qualitative data from state-level 9-8-8, Medicaid reimbursement, and peer certification legislation that had been passed between July 2020-February 2023. States were included if they had enacted 9-8-8 legislation that identified peers or a synonymous role. We utilized discourse analysis to analyze the relationship of these three policy types for each state and compared states’ peer policy landscapes.
Results: We identified 23 states that had enacted 9-8-8 legislation. Of those 23 states, 14 named peers and/or 5 synonymous roles (e.g., community mental health navigators). Those 14 were analyzed in order of enactment date to identify how each state defined peers, and eligible roles or crisis care spaces for peers (e.g., call centers, mobile crisis teams). All states that defined peers in their 9-8-8 legislation and identified Medicaid as at least one funding method for mental health peer services also had pre-existing peer certification legislation. Within each state that had peer certification legislation, language from this policy type at times conflicted with 9-8-8 language regarding peer definitions or required experience. Significant variation also existed across states regarding recovery requirements for peer certification. Some states did not include periods of recovery, while others included stipulations such as no hospitalizations for mental health related issues for at least two years.
Conclusions and Implications: Despite 9-8-8’s significance, only 23 states have successfully passed legislation to meet federal requirements. Of these states, significant discrepancies exist across states regarding how each defines mental health peers, as well as how they are being operationalized. This creates potential complications in the future regarding implementation and evaluation of peers across states. Additionally, variability also exists regarding hiring eligibility based on the prevalence or absence of credentialing legislation, as well as what credentialing requirements that at times conflict with that state’s more recent 9-8-8 legislation. These significant differences within and across states pose potential equity issues in peer roles and hiring practices. Further research in social policy is required, as well as the significant need to engage mental health peers across states in research and policy spaces.
Methods: This study utilized qualitative data from state-level 9-8-8, Medicaid reimbursement, and peer certification legislation that had been passed between July 2020-February 2023. States were included if they had enacted 9-8-8 legislation that identified peers or a synonymous role. We utilized discourse analysis to analyze the relationship of these three policy types for each state and compared states’ peer policy landscapes.
Results: We identified 23 states that had enacted 9-8-8 legislation. Of those 23 states, 14 named peers and/or 5 synonymous roles (e.g., community mental health navigators). Those 14 were analyzed in order of enactment date to identify how each state defined peers, and eligible roles or crisis care spaces for peers (e.g., call centers, mobile crisis teams). All states that defined peers in their 9-8-8 legislation and identified Medicaid as at least one funding method for mental health peer services also had pre-existing peer certification legislation. Within each state that had peer certification legislation, language from this policy type at times conflicted with 9-8-8 language regarding peer definitions or required experience. Significant variation also existed across states regarding recovery requirements for peer certification. Some states did not include periods of recovery, while others included stipulations such as no hospitalizations for mental health related issues for at least two years.
Conclusions and Implications: Despite 9-8-8’s significance, only 23 states have successfully passed legislation to meet federal requirements. Of these states, significant discrepancies exist across states regarding how each defines mental health peers, as well as how they are being operationalized. This creates potential complications in the future regarding implementation and evaluation of peers across states. Additionally, variability also exists regarding hiring eligibility based on the prevalence or absence of credentialing legislation, as well as what credentialing requirements that at times conflict with that state’s more recent 9-8-8 legislation. These significant differences within and across states pose potential equity issues in peer roles and hiring practices. Further research in social policy is required, as well as the significant need to engage mental health peers across states in research and policy spaces.