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The Power in Peer Support for Mental Illness: An underutilized tool

When we talk about closing the treatment gap in mental health, there are many approaches that come to mind, one that stands out and is evidently an effective and favoured intervention is Peer Support. Many people look at mental illness lesser as a biological disorder, and more as a social disorder, one that is caused by social circumstances, and this is partly correct. This has prompted researchers to study interventions in low and middle income countries from a more psycho-social approach, rather then a bio-medical one. In low and middle income countries, as a matter of fact even in high income countries, when people find themselves struggling with a mental illness they mostly approach a priest, faith healer, friend or someone in the community whom they trust. Approaching a psychiatrist is one of the last thing on their minds, and its way out of their capacity, as it's not a financially viable option for most. That's when researchers proposed "What if we can train peers, those who have had a lived experience with mental health, to deliver evidence based interventions? and deliver them in their communities?"


Disclaimer: We don't possess any rights to the content below. The 6th, 7th, 10th paragraph and further has been written by Nicola Davies, PhD for the Psychiatry Advisor



Project LETS, a national grassroots organization that works on peer-support defines it as an abolitionist offering, where people with lived experience of Disability, mental illness, madness, and/or neurodivergence support each other and offer a form of accessible, competent, non-carceral, mutual, mental health care. Where peer supporters are there to hold people, be present with them, and hear them. They do not judge, cage, coerce, force, or challenge people’s autonomy and self-determination as human beings. Many power dynamics that exist in the traditional therapeutic model and mental health system are reduced.


They professionally train peer mental health advocates with specific skills in: peer counseling, advocacy, crisis response skills and much more.


Here are some examples of what PMHAs do:

  • Backend logistics: making appointments, doing research, calling insurance companies

  • Being present: during meetings or appointments

  • Crisis moments: crisis response support

  • Skill Building: goal planning, building our toolbox with new resources, skills, and strategies

  • Sense-Making: exploring how Disability, trauma, mental illness, madness, and/or neurodivergence (and ableism) impact our lives, sense of self, communities, etc.

  • Regular peer counseling sessions: A safe place to keep coming back to

Systematic reviews have confirmed that, while peer support and clinical practice typically perform fairly equally on traditional outcome measures like rehospitalization and relapse, peer support scores better in areas related to the recovery process. In particular, peer support tends to offer greater levels of self‐efficacy, empowerment, and engagement. This mechanism of benefit could come from the social connectedness experienced from interacting with peers, with one study showing that people with serious mental illness such as schizophrenia, bipolar disorder, and other psychoses value the sense of group belonging that comes from sharing personal stories. The mutual exchange of strategies to cope with the everyday challenges of living with a mental illness is also an important aspect of the peer-to-peer community.


“There is a lot of value in sharing with people who have overcome similar mental health challenges,” says psychotherapist Hilary Jacobs Hendel, author of the award-winning book, It’s Not Always Depression. “Peer support builds confidence and hope for healing.” Indeed, in a meta-study, Dr Daniela Fuhr and colleagues found that peers have the potential to deliver care to persons with serious mental illness that can result in improved quality of life as a result of such increases in hope. Furthermore, there is some evidence that interventions delivered in an individual format work better than group interventions. However, for depression, the team found no effect on improvements in clinical and psychosocial outcomes. Still, the study concludes that peer interventions are an untapped resource in global mental health.


Rayshell Chambers used to be scared to talk about her mental health challenges. The first time she was hospitalized was at 14. She was a straight-A student and cross-country runner, but she felt isolated and nervous all the time. She didn’t know how to ask for help, so she took some pills. “I don’t know if I would have went to a counselor and said, ‘Oh, I’m feeling sad,’ because I don’t know if they would have told my mom” she said. “I wasn’t ready to tell my mom that I was feeling depressed because I just wanted to seem normal.”

She said she was lucky that her mother took care of her and put her in therapy, but looking back, she thinks she would have benefited from talking to a peer, someone with lived experience with mental illness who had learned how to cope. Chambers is co-founder and chief operating officer of the peer-run mental health nonprofit Painted Brain. Now she tells everybody about her PTSD and multiple hospitalizations. It’s part of her job. ”We tell people if you need somebody, to talk to us,” said Chambers. “We’ve been through it. Most of us have been hospitalized and been in board-and-cares. And now we have full-time jobs. We’re functioning. Most of us are taking our medicine or finding other ways to cope.”


Peer Support vs. Clinical Support


A distinction is often made between peer support and the clinical support roles. “What’s nice about peer support is that all group members are equal,” she explains. “Sometimes having a ‘professional’ in the group can be experienced as diminishing, especially if the professional is condescending. In contrast, a peer group leader or guide who knows how to build people up and build on their strengths is a great asset.” In this respect, peers can often form a stronger therapeutic bond with the people they counsel because they have experienced mental health struggles themselves. Not only do they have genuine empathy, a key component of successful therapy, but they are also able to promote treatment engagement through personal empowerment and provide a role model for recovery.

What if the peer group doesn’t share the same mental health experience? They can still be a valuable asset, says Jacobs Hendel. “They can all learn together how to recognize their defenses, calm anxiety, work with child parts and shamed parts, practice sensing emotions in their body, and build a tolerance to positive feelings.” It is important to note that peers who are nonclinical staff never “treat” mental illness, and this is not their role. Peer counselors complement clinical care — often in a big way.


One of the biggest challenges to receiving quality psychotherapy is the cost: it’s expensive. Peer support is a great option for people who can’t afford therapy, or who live in rural communities where it’s not available. However, even for those already in individual therapy, peer input can be a substantial additional support, according to Jacobs Hendel. “People really feel better when they know they are not alone and that other people understand and share their experiences,” she says. “One of the main causes of psychopathology is experiencing overwhelming emotions in the face of too much aloneness. Good therapy and good peer support strive to eliminate aloneness, as well as to provide other benefits.” Peer support can be given in a person’s home or in a public place away from clinical locations, and the process is usually more equal and intimate than clinical treatment.


From patient to peer counselor

The Substance Abuse and Mental Health Services Administration (SAMHSA) has conducted research to identify the critical knowledge, skills, and abilities needed by anyone providing peer support services to people with, or in recovery from, a mental health or substance use condition. The core competencies, such as establishing collaborative and caring relationships, providing support by conveying hope and celebrating accomplishments, and personalizing support should be acquired by a person aspiring to help others as a peer counselor.


Alan Schmidt struggled with addiction from a young age. “I was an alcoholic by 11 and addicted to opioids by 13,” he shares. Now he is a substance abuse counselor intern at the Riverside University Health System Medical Center in Moreno Valley, California. “You must be honest, sincere, and authentic with your clients,” says Schmidt. “Never go beyond your scope of practice… ever. Our words can have a lasting effect and if we are out of our area of practice, the harm we could do could have fatal effects. I am conscious of everything I say to a client.”


It is a win-win situation if those in recovery are trained and hired to provide peer support to those currently struggling mentally. The client receives support from peers who can model self-care and help them navigate the health care system, while the peer counselors are gainfully employed in a job that supports their own recovery by providing meaningful work.


The future of peer support

Peer support has matured significantly over the years and agreement about a common set of practitioner competencies and a set of national guidelines for peer support services in behavioral health have been implemented by SAMHSA. The American Psychiatric Association issued a position statement in 2018 noting, “The Association supports the value of peer support services and is committed to their participation in the development and implementation of recovery-oriented services within systems of care.” The statement also stipulated, “Peer support personnel should have training appropriate to the level of service they will be providing.” To this end, there are state and national certification programs available for individuals wanting to become peers in the United States.


According to Mental Health America, “Although they go by many names, like peer support specialist or recovery coach, all model recovery, share their knowledge, and relate in a way that have made this evidence-based practice a rapidly growing field.” Indeed, today, peer support is available in all 50 states. It is reimbursable by Medicaid in 35 states and is considered a best practice by SAMHSA.


References:



Psychiatry Advisor. Exploring the Value of Peer Support for Mental Health by Nicola Davies, PhD :

https://www.psychiatryadvisor.com/home/topics/general-psychiatry/exploring-the-value-of-peer-support-for-mental-health/


Bellamy C, Schmutte T, Davidson L. An update on the growing evidence base for peer support. Mental Health and Social Inclusion. 2017;21(3):161-167.

Farkas M, Boevink W. Peer delivered services in mental health care in 2018: infancy or adolescence? World Psychiatry. 2018;17(2):222-224.

Naslund JA, Aschbrenner KA, Marsch LA, Bartels SJ. The future of mental health care: peer-to-peer support and social media. Epidemiol Psychiatr Sci. 2016;25(2):113-122.

Substance Abuse and Mental Health Services Administration. Core Competencies for Peer Workers. https://www.samhsa.gov/brss-tacs/recovery-support-tools/peers/core-competencies-peer-workers. Updated December 19, 2018. Accessed May 1, 2019.

US Department of Health and Human Services. What Are Peer Recovery Support Services?https://store.samhsa.gov/system/files/sma09-4454.pdf. 2009. Accessed May 1, 2019.

Mental Health America. Peer Services.https://www.mentalhealthamerica.net/peer-services. 2019. Accessed May 1, 2019.








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