Information Update Archived Issue
Promising Practices for Social Inclusion:
The Important Role of Peers
April 2011 » Issue 29
Letter from SAMHSA
“A broad range of services and supports beyond traditional treatments for mental and substance use disorders can help people manage their recovery. The elements of health, home, purpose and community are the pillars of person-centered, evidence-based, quality-driven systems and services that support recovery from mental and substance use disorders.”
—Leading Change: A Plan for SAMHSA’s Roles and Actions 2011–2014
At the end of March, SAMHSA published its strategic initiatives paper, Leading Change: A plan for SAMHSA’s Roles and Actions 2011–2014, which provides an overview of SAMHSA’s goals, priorities, and action steps for accomplishing its mission of reducing the impact of substance abuse and mental illness on America’s communities.
SAMHSA’s goal is to ensure people with mental health and substance use problems have a high-quality, self-directed, satisfying life integrated in a community for all Americans. This life includes health, home, purpose, and community.
Woven throughout the three-year plan is the concept that achieving this goal depends on collaboration with a broad spectrum of Federal, State, Territorial and Tribal agencies, as well as consumer/peer-run organizations. The objectives in the plan invoke actions that will ensure social inclusion in all aspects of a person’s everyday life experience.
Social inclusion occurs when marginalized groups and individuals in a community have greater access to society’s resources. For people with mental health and substance use problems to recover and rebuild their lives, they need access not only to services and supports for their conditions, but most importantly to those social, economic, educational, recreational, and cultural opportunities, and physical health services that most citizens take for granted. A socially inclusive nation provides needed opportunities for individuals in recovery from mental health and substance use problems to contribute to their communities as peers, employees, parents, residents, students, volunteers, teachers, and active citizens. Social Inclusion provides a policy framework to make this vision a reality.
The Important Role of Peers
Access to peer support is a fundamental element of social inclusion for individuals with mental health and substance use conditions. The term “peers” in this context refers to individuals who are in recovery from mental health and substance use issues and have valuable knowledge to share about their journeys of recovery. Peers can be very supportive since they have “been there” and serve as living examples that individuals can and do recover from mental illness and addiction.
Peers also serve as advocates and support others who may experience discrimination and prejudice. As leaders in their communities peers promote positive change to ensure dignity and respect for individuals in recovery and full access to needed resources including health, social, economic, and cultural systems that promote recovery. By promoting a broader concept of recovery from mental health and substance use conditions that engages all aspects of community life, peers are primary drivers of a social inclusion perspective.
This informational update highlights how peers are fueling a shift toward social inclusion across the country—working with individuals and families, improving communities, and engaging health, economic, education, and social systems to better support people recovering from mental health and substance use problems.
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Teleconference Summary: Peer Support and Peer Providers—Redefining Mental Health Recovery
During the past 15 years, there have been several significant developments in the field of peer support and peer-provided services.
The SAMHSA ADS Center sponsored a free training teleconference on September 21, 2010 entitled Peer Support and Peer Providers: Redefining Mental Health Recovery. The teleconference, which featured presentations by Dr. Jean Campbell, Steve Harrington, and Shery Mead, highlighted:
- The evolution of peer support services;
- Research findings demonstrating the effectiveness of peer support in an individual’s recovery;
- The role of certified peer specialists, their certification, and Medicaid reimbursements for services;
- Issues facing peer specialists in the mental health system; and
- The education of traditional providers in peer support, self-help, and recovery principles.
If you were unable to participate in the teleconference, or would like to listen to it or view the slides again, you can access it here.
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A Personal Story: Recovery With Support From Family, Academic, and Peer Communities
Kevin Coyle opens up and shares his recovery journey beginning with a few people in college – his mom, psychiatrist and academic adviser – and continuing with a peer community of people who are deaf and have mental health problems:
“My mental illness, although unfortunate, has brought me into a warm and caring deaf community. Now I am so blessed with what I have. I am thankful for my friends who warm my heart, for my adviser who believed in me, for my family who stood by my side through thick and thin, and for the staff and doctors who work with me. Without them I would not be where I am today.”
Read Kevin’s story and support others by sharing your own.
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A Community Model: Poughkeepsie, N.Y. Peer-Run Crisis Respite Services
By, Steve Miccio, Executive Director, PEOPLe, Inc.
PEOPLe, Inc. located in Poughkeepsie, N.Y. has developed an internationally replicated Peer Crisis Respite House service, Rose House, which helps people to better manage personal crises and stay out of emergency rooms and inpatient hospitals. This innovative and unique “hospital diversion” service is designed for persons seeking temporary residential care or respite for 1–5 nights in a warm, friendly, safe, and supportive home-like environment which is vastly different from a traditional emergency room.
The Rose House philosophy is based on the belief that recovery is not only possible, it is expected. Guests are engaged at the house by peer companions who are trained to listen and validate issues or concerns in an empathetic and supportive manner. All peer companions working in the Rose House Service have themselves experienced crisis and bring that experience and strength to the healing environment of the house. Guests can choose activities and wellness tools to focus on. And many guests learn new ways of managing crisis that lead to a vision of hope and a better quality of life.
The Rose House also offers a 24-hour warm line and peer companion visits to an individual’s home as part of its service options which offer engagement on levels that are comfortable for people to use. The house has been very successful in keeping people out of hospital emergency rooms and inpatient settings, and it has given people the tools to maintain recovery and a vision of hope.
PEOPLe, Inc. now operates two Rose Houses in the Hudson Valley area of New York and has replicated the service in Lincoln, Nebraska and Eindhoven, Netherlands. Other organizations throughout the United States, Iceland, and Japan are consulting with PEOPLe, Inc. to replicate the service. For more information, please contact Steve Miccio, Executive Director at 845–452–2728 or via e-mail. You can also visit PEOPLe Inc.’s Web site 
.
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In My Experience: A Peer Specialist Shifting Health Services by Training Medical Students
By, Gareth Fenley, Certified Peer Specialist with Medical College of Georgia
I’m a certified peer specialist who trains health care professionals for a living. My students are used to encountering people like me as patients. Doctors, nurses, therapists, and their colleagues spend every working day evaluating and treating people like me. It's a turnabout for them to find me standing at the front of a classroom, instead of sitting in the waiting room of a medical office or wandering in a hospital unit.
What’s unique about this situation is not that a person who receives mental health services can teach doctors. Plenty of us are doing every job there is. It's unusual that I talk openly about my mental illness while on duty, and it’s unique that I’m employed specifically to do that.
Most days, average folks who get out and about—working, shopping, worshipping, walking the dog, filling up the car or taking the bus, eating out—are mixing with people who live in recovery with serious and persistent mental illness. People like me. We are everyday people. But most days, most folks do not think about that fact or even know it. They don't realize how common it is for their fellow free citizens to have mental illness.
Doctors are no different. They are accustomed to seeing patients come in when things are going seriously wrong. They typically see people like me as different and sick. And sometimes I've fallen into the trap of seeing it that way, too.
My initial training and continuing education as a certified peer specialist have truly changed my outlook on life. I've learned how to share my personal recovery story with insight and intention. I've gained skills to see what's right about me and my peers, instead of obsessing on what's wrong. I can fully acknowledge illness and problems while envisioning and facilitating movement toward goals and promise beyond.
At the Medical College of Georgia (which is re-naming itself Georgia Health Sciences University this year), the Department of Psychiatry and Health Behavior has a program intended to change attitudes in just this way, and to build recovery knowledge and skills. It's called Project GREAT, which stands for Georgia Recovery-based Educational Approach to Treatment. I'm the one who actually came up with the name shortly after I was hired to be a charter member of the project team in 2006. Today the team includes a psychologist, a psychiatrist, a postdoctoral fellow, and two full-time certified peer specialists: me and Denise Noseworthy.
It's our job to teach the recovery approach right inside the ivory tower—in medical school. Denise and I train medical students, residents, interns, and even the faculty. I mostly work with psychiatrists and psychologists, because that's the specialty of my department, but I also work with students and professionals in fields including family medicine, nursing, occupational therapy, social work, and more.
With the Project GREAT team, I develop curriculum, publish papers, and make presentations at local, regional, national, and international conferences. I participate in faculty committees and task forces. I assist in the clinical supervision and evaluation of our resident trainees. They make referrals to me and I offer peer support on a group and individual basis, both in the outpatient clinic and in the hospital, documenting my work in the health system’s paper and electronic medical records.
Sometimes I call it "fixing the doctors before they're broken." That line gets a laugh because it’s silly. It's kinder and much more realistic to say that Project GREAT aspires to influence professionals toward a recovery approach in mental health care.
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Training Opportunity: An Introduction to Peer Support Whole Health and Resilience
By, Larry Fricks, Director, Appalachian Consulting Group
Peer Support Whole Health and Resilience (PSWHR) is a person-centered planning process that:
- looks comprehensively at a person’s health lifestyle
- focuses on a person’s strengths, interests, and natural supports
- stresses creating new health lifestyle habits and disciplines
- provides peer support delivered by peer specialists to promote self-directed whole health
The purpose of the 2-day PSWHR training is to provide peer specialists with the skills needed to help another peer set, get, and keep a whole-health goal that can be inserted into an individual treatment plan. The training was developed by a SAMHSA-funded National Association of State Mental Health Program Directors (NASMHPD) Technology Transfer Initiative (TTI) grant awarded to Georgia’s Department of Behavioral Health and Developmental Disabilities.
The PSWHR training is built on three beliefs which are as follows:
- People cannot be forced or coerced to change their unhealthy lifestyle habits. Therefore, participation in the PSWHR training is voluntary, with participants acknowledging that they have health issues they are thinking about dealing with.
- People are more likely to create a healthier lifestyle when focused on their interests, strengths, supports, and possibilities; therefore the PSWHR training helps people focus on what they want to create in their lives, not on what they need to change.
- People find it easier to create new habits than to change or stop old habits. Therefore the PSWHR training focuses on creating new habits or disciplines on a weekly basis, monitoring how well they are doing and accepting support from their peers.
PSWHR is emerging as an exciting new program for peer specialists that demonstrates how they can promote self-directed resilience and whole health in a way that is transforming mental health systems. For more information about this training, please contact Larry Fricks, Director, Appalachian Consulting Group via e-mail or by phone at 404–375–1813.
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More Information: Social Inclusion Programs, Technical Assistance Tools, and Research
Please note: The descriptions below are pulled from or based upon the language provided on the organizations’ Web sites.
Promoting Systems Transformation
National Mental Health Consumers’ Self-Help Clearinghouse, a SAMHSA-sponsored national consumer technical assistance center, promotes and helps to develop consumer-run self-help groups across the country. They offer technical assistance and educational materials on the following topics: organizing groups; fundraising; leadership development; and incorporating public relations, advocacy, and networking into activities. To learn more, visit http://mhselfhelp.org or call 1–800–553–4539. Visit http://cdsdirectory.org to access their Directory of Consumer-Driven Services.
National Empowerment Center (NEC), a National Technical Assistance Center sponsored by SAMHSA and run by behavioral health consumers/survivors, offers technical assistance to individuals and groups involved in consumer empowerment activities. The Center also distributes recovery-related publications and sponsors education and training activities. For more information, including access to NEC’s Directory of Statewide Consumer-Run Organizations and Directory of Peer-run Crisis Services , visit http://www.power2u.org/ or call 1–800–769–3728.
New York Association of Psychiatric Rehabilitation Services, a coalition of behavioral health consumers and providers from across the State of New York, advocates for the rights of people with behavioral health problems and spreads the message that recovery is possible. The coalition’s holistic approach seeks to influence public policy, transform services, assist with community and economic development, and promote cultural competence within systems of care. To learn more, visit http://www.nyaprs.org/index.cfm or call 518–436–0008.
The Mental Health Association of Southeastern Pennsylvania Institute for Recovery & Community Integration works to increase communities’ understanding of behavioral health recovery, peer support, and community integration as the catalyst for transforming individual lives, communities, and behavioral health systems in a culturally competent manner. The organization provides technical assistance to agencies, service providers, and municipalities. To learn more, visit http://www.mhrecovery.org or call 1–800–688–4226 ext. 265.
Key Ingredients of Peer Programs Identified provides research-based recommendations for those building peer-support programs or managing community systems of care. To learn more, visit http://www.power2u.org/downloads/COSP-CommonIngredients.pdf [PDF format - 264 Kb] .
Position Statement 37: The Role of Peer Support Services in the Creation of Recovery-Oriented Mental Health Systems, from Mental Health America, promotes the use of peer-provided services and calls on behavioral health professionals to incorporate peer support in community-based services. To learn more, visit http://www.nmha.org/go/position-statements/37 .
Personal Assistance in Community Existence Series includes resources and training materials to help consumers and providers develop recovery-oriented services and promote peer support. For more information, visit http://www.power2u.org/mm5/ merchant.mvc?Screen=CTGY&Store_Code=NEC&Category_Code=pace .
Changing Community Perceptions and Influencing Local Systems
Georgia Mental Health Consumer Network, Inc. (GMHCN) promotes recovery through advocacy, education, employment, empowerment, peer support, and self-help and hosts one of the largest statewide annual consumer conventions in the Nation. For more information, visit http://www.gmhcn.org/ or call 1–800–297–6146. Visit http://www.gmhcn.org/wellnesscenter to learn more about the Georgia Peer Support and Wellness Center, a peer-run alternative to hospitalization and mental health day programs operated by GMHCN.
Peers Envisioning and Engaging in Recovery Services is a consumer-run, recovery-oriented organization that advocates for social inclusion, operates a social inclusion campaign, and empowers behavioral health consumers to pursue their personal recovery. For more information, visit http://www.peersnet.org or call 510–832–7337.
The Transformation Center provides recovery-oriented peer-support services, offers certification for peer specialists, and sponsors a leadership academy to help consumers be the voices for change in their communities. To learn more about this organization, visit http://transformation-center.org/index.shtml or call 1–877–769–7693.
Consumers in the Mental Health Workforce: A Handbook for Providers, which can be accessed through the National Council for Community Behavioral Healthcare Store, includes tips and strategies for hiring and retaining consumer employees. Visit https://store.thenationalcouncil.org/catalog/show/15 to order this handbook.
Supporting Personal Wellness and Recovery
National Association of Peer Specialists is a non-profit organization dedicated to promoting peer specialists throughout the United States. To learn more about this organization and its annual conference for peer specialists, visit http://www.naops.org/ or call 616–676–9230.
CHOICES: Consumers Helping Others Improve their Condition by Ending Smoking employs behavioral health service consumers to work with smokers with behavioral health problems to make them aware of local tobacco-cessation resources and to motivate them to quit. To learn more about CHOICES, visit http://www.njchoices.org/ or call 732–235–8232.
Stepping Stone Peer Support and Crisis Respite Center provides a comfortable, nonjudgmental environment where people who are experiencing behavioral health problems can become empowered and move toward recovery and wellness. For more information, visit www.steppingstonenextstep.org or call 603–543–1388.
The Key Assistance Report: Focus on Certified Peer Specialists explains the important role peer specialists play in behavioral health recovery, steps consumers can take to become certified peer specialists, and the types of support peer specialists can provide to help others in their recovery. To learn more, visit http://www.mhselfhelp.org/pubs/view.php?publication_id=195 .
Certified Peer Specialist Training Program Descriptions describes certification programs in several states and is another helpful reference for behavioral health consumers who are interested in becoming certified peer specialists. For more information, visit
http://tucollaborative.org/pdfs/ Toolkits_Monographs_Guidebooks/peer_support_consumer_run_services_ peer_specialists/ Certified_Peer_Specialist_Training_Program_Descriptions.pdf [PDF format - 215 Kb] .
The Office of Technical Assistance Center for Peer Networking connects peer specialists with each other, allowing them to share experiences and lessons learned about working with other behavioral health consumers. For more information, visit http://nasmhpd.org/consumernetworking.cfm .
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Information and Research
Campbell, J. (2006). Federal multi-site study finds consumer-operated service programs are evidence-based practices. Missouri Institute of Mental Health, Program in Consumer Studies & Training.
Copeland, M., & Mead, S. (2004). Wellness Recovery Action Plan and Peer Support . Brattleboro, VT: Peach Press.
Daniels, A., Grant, E., Filson, B., Powell, I., Fricks, L., & Goodale, L. (2010). Pillars of peer support: Transforming mental health systems of care through peer support services. The Carter Center: The Pillars of Peer Support Services Summit, Atlanta, GA.
MacNeil, C., & Mead, S. (2005). A narrative approach to developing standards for trauma-informed peer support . American Journal of Evaluation, 26, 231-244. doi: 10.1177/1098214005275633
Mead, S. (2010). Intentional peer support as social change. Retrieved from NYAPRS E-news February 22, 2011.
Molls, S., Holmes, J., Geronimo, J., & Sherman, D. (2009). Work transitions for peer support providers in traditional mental health programs: Unique challenges and opportunities. Work: A Journal of Prevention, Assessment and Rehabilitation, 33 (4), 449-458. doi: 10.3233/WOR-2009-0893
Rogers, E.S., Teague, G., Lichtenstein, C., Campbell, J., Lyass, A., Chen, R., & Banks, S. (2007). Effects of participation in consumer-operated service programs on both personal and organizationally mediated empowerment: Results of multisite study. Journal of Rehabilitation Research and Development, 44 (6), 785-800. doi: 10.1682/JRRD.2006.10.0125
Salzer, M. S. (2002). Consumer-delivered services as a best practice in mental health care delivery and the development of practice guidelines. American Journal of Psychiatric Rehabilitation. 6 (3), 355-382.
Salzer, M.S., Schwenk, E., & Brusilovskiy, E. (2010). Certified peer specialist roles and activities: Results from a national survey. Psychiatric Services, 61 (5), 520-523. doi: 10.1176/appi.ps.61.5.520
Schutt, R. K., & Rogers, E. S. (2009). Empowerment and peer support: Structure and process of self-help in a consumer-run center for individuals with mental illness. Journal of Community Psychology, 37 (6), 697-710. doi: 10.1002/jcop.20325
Solomon, P. (2004). Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal, 27 (4), 392-401. doi: 10.2975/27.2004.392.401
Vergaeghe, M., Bracke, P., & Bruynooghe, K. (2008). Stigmatization and self-esteem of persons in recovery from mental illness: The role of peer support. International Journal of Social Psychiatry, 54 (3), 206-218. doi: 10.1177/0020764008090422
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ABOUT SAMHSA ADS CENTER
This update is from the SAMHSA ADS Center (Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health). SAMHSA ADS Center is a program of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services, Office of Consumer Affairs. We encourage you to share this information with others and to post it in your own newsletters or email lists.