How to increase the visibility and availability of peer support services—an evidence-based practice—is an important topic during any discussion on mental health care reform. CFYM will be discussing this topic over the next few weeks. On Wednesday, April 29, look for a recap on a congressional briefing hosted by DBSA to educate congressional staffers on this critical component of mental health care.
Larry Davidson, Ph.D.
Director, Program for Recovery and Community Health
Department of Psychiatry, Yale University School of Medicine
Stories of frustration and sorrow from family members who watch a loved one live with an untreated mental health condition are well documented. It is not uncommon for family members to express concern about how a loved one is spending their time, or the appearance that the individual has given up and is no longer trying to engage in life. Often even more frustrating is living with the misconception that the loved one does not believe they have a problem.
Much success has been realized in recent years, however, by acknowledging that individuals do have insight and that taking the time to understand these insights can lead to better outcomes than a traditional medical-only model. The evolution of this practice has led to a recovery-oriented or person-centered approach. Core to these practices is meeting people “where they are at.”
Most people with mental illnesses do have insight that their life has become derailed, that something has gone terribly wrong. The gap that often exists is between well-meaning individuals, who attempt to define lack of insight as an unwillingness to access mental health care, and the person’s own view of his or her predicament. Equally, while it may appear to an outsider that sitting alone in a chair all day is proof that the individual has given up, that behavior can actually represent quite the opposite. The Individual may have an entirely different perspective—a perspective of self-preservation and survival from yet another crushing disappointment.
When an individual is in a self-preservation or survival mode, being exposed to a clinical setting where they feel devalued and scrutinized can understandably lead to defensive behavior. Additionally, clinical settings that rely on a medical-only model can miss an important opportunity to support the individual in reaching self-acceptance about their mental health.
Peer support services
Evidence shows that tapping into an individual’s own experiences and perspective on the gaps of what is working and what is not working in their life leads to a place of trust where healing can begin. Delivering mental health services around meeting people where they are at both mentally and figuratively is central to person-centric and recovery-based models of care. This means meeting people in their own homes when a clinical setting triggers symptoms. It means allowing the individual to define their own goals and aspirations and identifying ways in which their current circumstances are a hindrance.
Participating in person-centric care only requires a desire to improve one’s life and a willingness to explore whether or not someone else can assist them in navigating this journey. And who better to provide this support than someone who has been there and walked this road before—the peer specialist, an integral part of the mental health care team.
Professional peer specialists and peer support services work because they tap into the potential of the individual’s own personally defined goals for a more meaningful life. Consider how these principles differ from medically defined goals that are centered on symptom mitigation. A clinician may tell their patient that they are experiencing suicidal ideation because they have an imbalance of chemicals in their brain, while the peer specialist, on the other hand shares that they too have experienced these feelings. They may ask the individual “How can I best help you?” or, share with them tips on how they personally navigated difficult times in their own life both pre- and post-recovery.
Peer specialists share their own experiences, gaining the trust of the individual. Once this trust has been established, individuals may be more open to examining treatments that may assist in achieving their own identified life goals. But this process takes time. It is not a quick fix.
Addressing the workforce shortage
Much has been written about the shrinking workforce among mental health clinicians, but research indicates peer specialists are just as effective as non-peers in producing outcomes for the same delivered services. It is time to elevate the role of the peer specialist to a critical member of the mental health care team. With improved training and quality tools that measure efficacy this profession has the potential to take pressure off of overburdened clinical caseloads and improve outcomes.
An individual with a mental health condition may have spent months, even years, building a structure of self-preservation that excludes letting in outsiders or persons of authority. Peer support staff that build trust through sharing of common experiences and uncovering an individual’s self-defined areas of distress can lead to acceptance and ultimately successful treatment. By bringing hope to the person living with a mental health condition, peer support opens opportunities for self-directed care enabling long-term engagement that leads to a life of recovery.
- What has been your or your loved one’s experience with peer support services?
- What are the benefits of incorporating peer specialists as a critical part of the delivery of mental health care?
- What questions or reservations do you have about relying on a person with lived experience to support your mental health care?
Larry Davidson, Ph.D., is a Professor of Psychology and Director of the Program for Recovery and Community Health at the Yale School of Medicine. His research has focused on processes of recovery in serious mental illnesses and addictions, the development and evaluation of innovative recovery-oriented practices, including peer-delivered supports, and designing and evaluating policies to promote the transformation of behavioral health systems to the provision of recovery-oriented, person-centered, and culturally-responsive care.