From Isolation and Despair to Engagement and Activation: The Peer Support Specialist’s Role in the Behavioral Health Care System

Peer coaches are individuals in recovery from a behavioral health condition who are trained to use their lived experience to help others on their journey to recovery. They do this by offering support, promoting engagement and facilitating activation. Optum’s Whole Health Peer coaching program is one of many programs emerging across the country that give new hope to people living with behavioral health conditions. These programs offer community-based Peer Support Services and promote recovery. For example, when Optum implemented the Peer Bridger model, first created by the New York Association of Psychiatric Rehabilitation Services (NYAPRS), in its Tennessee and Wisconsin PeerLink programs, the support of peer coaches helped consumers reduce the amount of time spent in inpatient care due to acute symptoms:

  • Enrollees in the Tennessee Peer Link program showed a significant decrease of 39% in their average number of acute inpatient days
  • Enrollees in the Wisconsin Peer Link program showed a significant decrease of 34% in their average number of acute inpatient days

A recent testimonial from an Optum Whole Health Peer Coach illustrates the type of services provided and the important role that these individuals are able to have in the lives of others.

I was asked to meet with Mr. West (not his real name) who was deeply depressed. Mr. West lives daily with severe pain. He was often negative in perspective and irritable in attitude. Mr. West permitted me to briefly introduce myself and the Optum Whole Health Peer program. When I asked him if I could come to see him in person he barked back, “If you can do something about my pain, come on over.” I reminded him that I am not a doctor or a nurse, but I would commit to work hard with him to help him find ways to improve his pain.

During our visit, I asked Mr. West to describe to me what life was like with such severe pain in his leg. He described himself as hopeless and often felt that there was no purpose for living. He wondered if he could ever walk again. I discovered that beneath Mr. West’s gruff presentation, he had a wonderful sense of humor. We have a motto that we share and talk about often “We will never give up”!

Through Whole Health Peer strategies and support, Mr. West developed a willingness to talk about his condition and schedule appointments with specialty physicians. After careful consideration, Mr. West elected to have leg surgery. He is recovering and has realistic hopes of walking again. With renewed hope and a less self-centered focus, Mr. West began to share with me his successful career as a skilled auto mechanic. He is enthusiastic about someday becoming a mentor for high school students learning auto mechanics. Mr. West is choosing life and wants to share his talents with others. He has developed relationships with neighbors and has a network of friends who enjoy sitting on the porch talking every evening.”

– From the Optum Whole Health Peer Coaching program

In the case described above, Mr. West felt isolated and was experiencing a number of physical and psychological challenges. The Whole Health Peer Support Specialist who worked with him was able to provide outreach and engage Mr. West in a recovery-focused approach to his care that addressed both his physical and emotional well-being. This helped Mr. West achieve activation, which occurs when an individual has the necessary knowledge, skills, hope, and confidence to proactively manage their own health. As a result, Mr. West experienced improved mental and physical well-being as well as a renewed sense of hope for the future. Greene et al (2012) have shown a direct link between patient activation and improved quality of life and health outcomes. People who are activated are more likely to have received preventative health services. They are also less likely to smoke or have high a high body mass index (BMI). Also, they are less likely to have been hospitalized or have received services from a hospital emergency department.1

Peer services can benefit a wide range of consumers and have been included as part of behavioral health treatment throughout the country for many years. Family-to-family coaches or navigators have been used to help families of children with emotional difficulties manage the often confusing and confounding health care system. Addiction Recovery coaches have been used both in person and over the phone to support sobriety. The Veterans Administration has used peer coaching as part of its behavioral health treatment program since 2006. The Substance Abuse and Mental Health Services Administration-Health Resources and Services Administration (SAMHSA-HRSA) Center for Integrated Health Services has also deployed the Whole Health Action Management program, a peer-coaching model that supports both health and behavioral health created by Larry Fricks, in integrated behavioral health and primary care settings.

The Centers for Medicare and Medicaid Services (CMS) has issued several advisories to states highlighting the value of peer coaching in all its forms. Its most recent letter from May 2013 clarified the viability of peer coaching for family-to-family peer partners and for addiction recovery coaching. Thirty-nine states have set guidelines for the training, certification and use of peers within their mental health workforce systems

Optum recognizes that peers in recovery are uniquely positioned to promote engagement, foster activation, and support recovery. They can help overcome the stigma, fear, shame, and lack of hope that often gets in the way of activation simply by being a listening, caring exemplar of the reality that people do recover. As one person recently said to an Optum peer coach, “If you did it, I know I can, too.” The peer can share tools, resources and services to fit the unique needs of the individual and connect them with local or online support groups, smartphone apps and other e-tools. They can also help the individual prepare for conversations with their provider by thinking through their questions and encouraging them to share their concerns and potential barriers to treatment.

The use of laypeople (Community Health Workers, Promotores) in promoting health and managing illness within non-behavioral health has been recognized by the Centers for Disease Control and Prevention (CDC), and they note that their roles “have been extensively documented and recognized for a variety of health care concerns, including asthma, hypertension, diabetes, cancer, immunizations, maternal and child health, nutrition, tuberculosis, and HIV and AIDS. Evidence supporting the involvement of community health care workers in the prevention and control of chronic disease continues to grow.”2

With growing evidence of the positive impact of Peer Support Services, more individuals with behavioral health conditions are benefiting from their work with peer specialists. By promoting engagement, reducing isolation, and supporting hope, Peer Specialists are able to help individuals foster activation and take an active role in their own health and wellness. Or, as the Optum peer helping “Mr. West” recently stated, “The Whole Health Peer Specialty program has assisted Mr. West to look beyond depression and pain, to remember his strengths, to aid in future planning and to have hope.” From despair to hope, from uninvolved to activated — all it took was a peer!

If you are interested in hiring a Peer Specialist, contact your local consumer-operated program or your state behavioral health authority to connect with peers who have gone through the state-approved training and certification process.

If you’re interested in becoming trained as a Peer Specialist, connect with your state’s behavioral health authority to learn which training program is preferred in your state. Depression and Bipolar Support Alliance, Recovery Innovations, and Mental Health America (MHA) of Southeastern Pennsylvania have well-regarded training programs for adult mental health peer coaching that is offered across the country. The Federation of Families for Children’s Mental Health has a certification and training program for Family Partners. The Connecticut Community for Addiction Recovery (CCAR) has a well-regarded training program for Addition Recovery Coaches.

  1. Greene J, Hibbard JH, “Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes,” Journal of General Internal Medicine, published online Nov. 30, 2011.

2.            National Center for Chronic Disease Prevention and Health Promotion. Addressing chronic disease through community health workers: A policy and systems-level approach. Policy brief on community health workers. Washington, DC: Centers for Disease Control and Prevention; 2010.

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