Between Structural Precarity and Disruptive Innovation: Peer Support Workers in Early Psychosis Services

Background and purpose: Peer support workers are among the most rapidly growing segments within the public behavioral health workforce. In federal and state policy, rationales for expansion include cost savings stemming from the generally lower pay of peer support workers, the potential for peer support roles to address widespread provider shortages by shifting roles and responsibilities traditionally held by clinicians onto peer workers). as well as the more values-driven goal of integrating staff with personal experience of mental health challenges into services. The primary goal of the proposed presentation is to investigate the experiences of peer support workers in early psychosis settings as they navigate work environments structured by these potentially contradictory system motivations.

Methods: Utilizing participatory and service user-led research methods, we worked with a core group of current and former peer specialists to develop and refine research and interview questions and methods, interview participants and code data (total N = 30, spanning 8 states).

Results: Analyses identified cross-cutting concerns about peer specialist status and pay; reflection on the psychological challenges involved in coming to terms with roles that are at once elevated (held up as a source of “disruptive innovation”) and compensated at the lowest rates of any provider within early psychosis services; and ambivalence about the extent to which peer specialists are in fact poised to more fundamentally transform services as opposed to contributing in more incremental ways to service improvement.

Conclusions and Implications: Our findings join a small but growing literature aimed at amplifying the perspectives and concerns of working peer specialists, and seeding conversations about working conditions truly conducive to the empowerment and impact of providers with lived experience.