Peer Run Services Playing Pivotal Roles in Promoting Health, Recovery and Full Citizenship

In the words of one of our greatest peer support leaders Shery Mead, “In peer support we come together with the intention of changing our patterns, getting out of ‘stuck’ places, building relationships that are respectful, mutually responsible and potentially mutually transforming. We validate each other for our ‘personhood’ rather than our ‘patienthood’… [We] see each other’s behavior through the lens of personal experience rather than through the lens of illness.”

Judi Chamberlin’s seminal 1978 book about “Patient-Controlled Alternatives to the Mental Health System” galvanized the self-help and advocacy movement and led to the rise of peer support, whose key elements include:

  • Sharing, validating and normalizing similar experiences
  • Building empathy, sharing opportunities for connection and knowledge
  • Building honest mutually responsible relationships
  • Based on the intention to change patterns and get unstuck
  • Full respect for each person’s unique process of change
  • Willingness to challenge each other

Peer support offers people an alternative to traditional treatment relationships which peers have often found pathologizing, distancing and alienating, judgmental and/or artificial, culturally unaware and/or insensitive, controlling and/or rescuing, infantilizing and disempowering.

Too often, people’s “story” is defined and mirrored back by our system as a “snapshot of me at my worst moment” and one that neither promotes hope, dignity and full citizenship or healing and spirituality.

Peer support has been seen as a different way of forming relationships and sharing power. It offers a new way of thinking about help and helping that is open to new ways of thinking about our experiences and ourselves. In peer support, we teach and learn from each other, we challenge our status quo and move towards what we want, in an atmosphere of full respect for the individual process of change.

At its purest, peer support is about the quality and integrity of relationship, often unconnected with service models. Peer support values do, however, drive the nature of peer-run services like:

  • Peer Drop-in centers: A safe haven for peers to combat isolation and loneliness, meet others and participate in social, educational and vocational activities.
  • Peer Crisis Diversion services: Warm, home-like environments where peers can learn to manage stress and find compassion and understanding from a trained peer staff, as well as learn new skills to cope and prevent relapse, such as Mary Ellen Copeland’s Wellness Recovery Action Planning (WRAP).
  • Peer Advocacy services: Helps peers become more aware of mental health policies and issues, and encourages them to become more involved in planning and delivering mental health services and developing mental health policy.
  • Peer Employment supports: Helps peers obtain and keep jobs.
  • Peer Bridger services: Helps ease the transition from the hospital into community life and to significantly decrease people’s need for readmission.

NYAPRS has helped pioneer the Peer Bridger model: Over the past decade, our trained peer bridgers have helped over 1,000 individuals to successfully transition from 6 NYS state hospitals to well supported lives in recovery in home communities. Our motto has been, “We support each other to get out of the hospital, stay out of the hospital, and get the hospital out of us.”

Peers are poised to play yet another major role in emerging new responses to help those with complex medical, mental health and substance abuse conditions.

A 2006 report by the National Association of State Mental Hygiene Program Directors concluded that, “Persons with serious mental illness are now dying 25 years earlier than the general population,” and that, “Their increased morbidity and mortality are largely due to treatable medical conditions that are caused by modifiable risk factors such as smoking, obesity, substance abuse, and inadequate access to medical care.”

In 2008, the NYS Department of Health found that 20% of NYS Medicaid beneficiaries account for 75% of the program’s expenditures and that those individuals shared multiple medically complicated conditions for which they currently received fragmented, uncoordinated and duplicative care. A significant number were found to have “chronic conditions” including psychiatric disabilities and substance abuse disorders. In response, in coordination with OptumHealth, NYAPRS is developing a NYAPRS Peer Health Care Coaching initiative that builds on our successful peer bridger model and incorporates innovations from several nationally recognized approaches. Our coaches are about to undergo a 6-week 6 college-credit approved Peer Wellness Coaching certificate program associated with the University of Medicine and Dentistry of New Jersey and the Institute for Wellness and Recovery Initiatives (CSP-NJ).

Our coaches will offer their unique ability to form unique trusted relationships, promote hope in ways that foster motivation and follow through and support enrollees on a broad range of topics including lifestyle factors for health & wellness, metabolic syndrome, smoking cessation, nutrition, exercise, oral health and medication side effects.

They will also help to encourage and reinforce improved self-health management, encourage each enrollee to complete a Wellness Recovery Action Plan that will help them anticipate difficult times, help enrollees self-identify and engage with a broad range of valuable supports, including family and friends, religious institutions, support and 12 step groups and social, health or mental health service organizations.

Finally, they will also play a uniquely valuable role in providing input to the treatment team that reflects an up-to-date and personal knowledge of enrollees’ current status and motivations and will support enrollees to advocate for themselves with various systems of care, support or entitlements.

Peer services are an approach whose time has surely come, whether it be to promote recovery, empowerment and employment or to provide timely interventions to help people avoid crisis and improve their health and wellness!

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