Experts by Experience: Peer Support

Adolescent me. At the library. Looking at a bulletin board. It had been a rough year for me and my mental health with hospitalizations, intensive outpatient, medications, and therapy. I often wondered if this would be my life moving forward. I saw a bright orange flyer, showcasing a "Wellness and Recovery Action Planning" group. I looked closer. Recovery? The messages I'd gotten from professionals up until that point told me nothing about recovery. I need to accept I have an illness. Check. Accept I need medication. Sad check. Need to adjust my life goals. No check, just tears. I was intrigued.

Upon arrival at the group, I found myself greeted not by social workers or nurses but by three people living with conditions like mine. And thriving. Those classes marked a real turning point in my healing. Without that night and the connections I made, I do not know that I would have rediscovered my sense of hope that guided me through those dark days eventually leading me to a path of becoming a therapist. Created through Mary Ellen Copeland's recovery journey and the insights gleaned from others seeking wellness with mental health conditions, wellness recovery action planning (Copeland, 2002) groups represent a peer-led class that inspires an idea that was new to me at the time, that a person with my condition could live well. This was my first introduction to peer support.

Peer Recovery Support

Peer support is the provision of mental health services by individuals who have lived experiences with a mental health condition and/or addiction. While many therapists have their own lived experience, peer recovery support specialist roles are set apart by their focus on self-disclosure and recovery focus on the part of the practitioner. Peer recovery support specialists are in a sense living hope, showcasing recovery in action.

The role of peer support varies and can include entirely peer-run services and those held within traditional mental health agencies. What this looks like runs the gamut, including support groups, "living room" programs for individuals in crisis, community support, "warm lines" for phone support, and advocacy groups.

One randomized controlled trial found that when receiving services from a peer, individuals felt a higher sense of self-efficacy (Mahlike et al., 2017). Other research has found that peer support improves reported hope and perception of belonging among people living with serious mental illness (Davidson and Guy, 2012).

Experts by experience's ability to share their insights is empowering, both for the worker and others seeking recovery. Interactions with a peer support specialist of a mental health team can also encourage a culture that values the journeys of individuals served and the reality of recovery. The specialist can offer to team a kind of wisdom that can only really be gained by having been there.

One research study examined the effectiveness of a peer-ran respite service, a place where people experiencing a mental health crisis could stay as an alternative to hospitalization. Those who stayed at the respite center had fewer hospitalizations in the subsequent 11 months than would be expected (Bouchery et al, 2018). Other research has shown that although levels of symptoms did not change among those receiving peer support, other aspects affecting quality of life, such as social functioning, have been shown to improve (White et al., 2020).

A Conversation With a Recovery Support Specialist

The training to become a peer recovery support specialist varies significantly from state to state. In some states, this involves a weeklong training and certificate. In other states, the requirements are more rigorous, mirroring those for clinical licensure. In Illinois, for example, to become a Certified Recovery Support Specialist (CRSS), a candidate must receive 100 hours of training, 2,000 hours of work experience, and 100 hours of supervision. They must complete a written examination. This is all in addition to the greatest accomplishment of achieving one's recovery and willingness to share. Pathways to this credential vary widely, and it is a process.

I spoke with Bobbie Willis, a crisis engagement specialist who utilizes her lived experience in this peer-specific position at an Illinois community mental health center. Bobbie is an expert by experience, someone who is working toward the CRSS credential. Bobbie meets with individuals in a mental health crisis alongside a clinician as part of a crisis team. She is the one to make first contact, and her role is key in creating a space where someone can feel safe enough to receive help in a time of chaos. When asked about her particular role she shares, "It really tends to help with people opening up and not being scared."

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Regarding peer support as a whole, Bobbie clarifies, "We bridge the gap between the therapist and the professional setting and the client." Bobbie holds an understanding of crisis and recovery from the inside out. Often someone deep in addiction or mental health challenges will lament about no one being able to understand. "I do understand, at least some. I've been down that road," Bobbie expresses.

Fighting for her recovery has been an incredible journey for Bobbie. She can tell others her story, listen, and hold hope for those struggling to find such in a nonclinical way. Bobbie states, "Peer support roles are just as vital as clinical roles, but they need to come together. It's all about mutual respect." Bobbie regularly attends training on peer support, addiction, and mental health. Her work is highly skilled.

Looking Forward

While peer support is often offered in the public mental health system, it is rarely offered in private settings. Despite growing research on its efficacy, private insurance companies do not often cover services provided by peers. When asked about this, Bobbie states, "I think it's doing a disservice for the client and also hurting their bottom line," pointing out how the cost of peer support is significantly less than that of hospitalization and other rigorous medical care. With evidence that ongoing peer support may decrease the need for hospitalization for individuals with repeated hospitalizations (Sledge et al., 2011), her point is clear. Investing in recovery is an ongoing process, and peer support can be an important part of that.

In addition, recovery support specialists have historically faced resistance in a mental health system that has followed a primary medical model. This is slowly changing as peers and clinicians build respect for each other's unique roles. In time, it can be hoped that robust peer support will be made available to anyone who could benefit.