Over the past several years, New York City has increasingly shifted toward community-based responses to behavioral health crises. In the past, individuals experiencing psychiatric emergencies were often limited to hospital emergency departments or interactions with law enforcement. While those systems still play an important role, there has been a growing effort to develop alternatives that meet people where they are and focus on stabilization within the community. Mobile treatment models such as Intensive Mobile Treatment (IMT) and Assertive Community Treatment (ACT) are central to this approach, providing ongoing support to individuals with serious mental illness who may struggle to remain engaged with traditional outpatient care. Within these teams are our talented Peer Specialists, who are individuals with lived experience of mental health recovery. Peer Specialists play an important and critical role in engagement, stabilization, and long-term support.
In my role as Senior Vice President of Care Management at the Institute for Community Living (ICL), I have had the opportunity to see this dynamic play out across several programs. ICL currently operates six Intensive Mobile Treatment (IMT) teams and seven Assertive Community Treatment (ACT) teams across New York City. These programs rely on multidisciplinary teams that include clinicians, nurses, case managers, and peer specialists, all working together to support individuals in the community. While each discipline brings important expertise, peer specialists often serve as a bridge between clinical treatment and personal recovery.
ACT teams in particular rely heavily on relationship-based work. Participants served by ACT programs typically require intensive, long-term support to remain stable in the community. Staff meet individuals where they live and help address a wide range of needs, from medication management to housing stability and daily routines. Within this structure, peer specialists frequently focus on helping participants reconnect with a sense of purpose and autonomy in their recovery.
During a conversation with several of our ACT teams, they shared that peer specialists often become the person participants feel most comfortable talking to. Participants may initially see clinicians as authority figures or representatives of the system, while peers are often viewed as people who genuinely understand their experiences. Because of that connection, peers frequently help open the door to deeper conversations about recovery goals, medication concerns, or frustrations with treatment. Once that trust is established, the rest of the team can often engage more effectively as well.
IMT teams share a similar philosophy but often work with individuals who experience frequent crises or repeated hospitalizations. The work can be fast-paced and unpredictable, with staff responding to urgent situations in supportive housing programs, shelters, or other community settings. In these moments, peer specialists can be particularly valuable in helping to de-escalate tense situations.
One incident that stood out to me happened in the lobby of one of our Health HUB sites. A participant became increasingly agitated and began loudly threatening staff members while visitors and other clients were present in the space. Several staff members attempted to calm the situation, but the participant continued pacing and yelling. The tension in the room was noticeable, and it was clear that the situation could escalate further. What ultimately shifted the interaction was the voice of one of our peer specialists. Instead of approaching the situation from a clinical or directive standpoint, the peer spoke calmly about understanding what it feels like to feel overwhelmed and unheard. The tone was more personal and less authoritative. The participant paused, focused on the peer, and gradually began responding directly to them rather than escalating toward the rest of the staff. Within a few minutes the intensity of the situation had noticeably decreased, and the conversation shifted toward what the participant needed in that moment. Experiences like this highlight something that is difficult to quantify but easy to observe in practice. When someone in crisis feels seen and understood, the emotional intensity of the moment can shift. Peer specialists often help create that shift because their presence signals that recovery is possible and that the person in crisis is not alone in their experience.
Another important part of crisis response is what happens after the immediate situation has stabilized. De-escalation is critical in the moment, but long-term recovery requires ongoing support. Without that support, many individuals end up cycling through repeated crises or hospitalizations.
To help address this gap, ICL has piloted a step-down program known as STEPS. The goal of this program is to support individuals transitioning from intensive services such as IMT to a more sustainable level of care. Recovery rarely happens in a straight line, and the period following a crisis can be especially vulnerable. Programs like STEPS provide continued support while individuals rebuild routines, strengthen coping strategies, and reconnect with community resources.
Peer specialists are particularly effective during this transition period. After a crisis, many individuals feel discouraged or uncertain about their ability to maintain stability. Having someone who has personally navigated recovery can help normalize those feelings while also offering practical encouragement. Within programs like STEPS, peers often work with participants to develop wellness plans, recognize early warning signs of relapse, and explore goals that extend beyond simply avoiding another crisis.
From my perspective, integrating peer services across ACT teams, IMT teams, and step-down programs reflects an important shift in how behavioral health care approaches crisis intervention. Stabilization remains essential, but recovery involves more than managing symptoms. It also requires hope, trust, and meaningful connection. Peer specialists bring those elements into the work in a way that complements the clinical expertise of the rest of the team.
As community-based crisis services continue to expand in New York City, programs that combine professional training with lived experience will likely remain central to effective care. Time and time again, I have seen how the presence of a peer specialist can change the dynamic of a difficult situation. Programs like ACT, IMT, and STEPS demonstrate that combining clinical expertise with lived experience creates a more balanced and responsive system. By meeting individuals where they are (both geographically and emotionally) mobile crisis teams can move beyond short-term stabilization and support the larger goal of sustained recovery.
Laura Savino, LCSW-R, is Senior VP of Care Management at Institute for Community Living (ICL).
