Division of Behavioral Health Services

Best Practice Advisory Committee: Peer to Peer Services

Peer support is the social, emotional and instrumental support that is mutually offered or provided, by persons having a mental health condition, to others who share a similar mental health condition in order to bring about a desired social or personal change. This support may be either financially compensated or voluntary.

The development of peer-run support programs has been influenced by the growth of self-help groups that have addressed a wide range of conditions, the movement of people with special needs from institutions to communities, the mobilization of the consumer/survivor movement and the growing support of consumer inclusion and concepts of recovery. The literature defines peer support as self-help groups, Internet support groups, peer delivered services, peer run or operated services such as drop-in centers, clubhouses, crisis, vocational or employment services, peer partnerships where control of the program is shared with others without psychiatric diagnoses and peer employees hired into unique peer positions or traditional mental health positions. Within the diversity of peer support services these common elements can be found: focus on recovery and empowerment; opportunities for persons to tell their stories to peers and larger audiences; belief that recovery is possible; and the support of peers who believe in recovery.

Family support addresses the need for restoration, enhancement or maintenance of family functioning to increase the family's ability to effectively provide care in their home and community to a person with a mental illness or substance abuse disorder. These services can include education on the nature and treatment of the person's illness/disorder, how to access community and other resources, enhancement of parenting skills, navigating through service delivery systems and help with identifying and engaging social supports.

In reviews of peer support/peer-provided services the following outcomes were noted: symptom improvement, reductions in hospitalizations or shorter inpatient stays, improved daily functioning, illness management, self-esteem and social support and higher rates of employment. Benefits to being a peer provider included personal growth in terms of increased confidence in their capabilities, ability to cope with the illness, self-esteem and a sense of empowerment and hope. By participating in a peer role there was the opportunity to practice their own recovery, engage in self-discovery, build their own support system, learn positive ways to fill time and engage in professional growth through building job skills and working toward a career goal.

Research findings have also found that inclusion of families in treatment helps to engage treatment-resistant individuals, promotes treatment adherence and psychiatric stability, reduces relapse, alcohol and illicit drug use and improves the well-being of the person and family members.

A number of components are critical for successful implementation of peer/family support services. Initially, the diversity of potential roles for peers requires careful matching of peer attributes, such as interpersonal and life skills, experiences and areas of knowledge, with designated tasks. It is also essential to develop and communicate clear distinctions between the roles and functions of peer positions and those of other staff while emphasizing teamwork and the unique benefits of peer-provided services to the recovery efforts of those served. Knowledge of the characteristics of the community's self-help network promotes the development of peer roles, functions and services that compliment existing resources. Also, there is a need for peer/family support to be recognized as a professional discipline to maintain funding for a peer workforce that is eligible for career benefits.

Compensating peers for providing services while they are also receiving services requires reimbursement like other staff members. Additionally, agencies must develop internal management and documentation systems to record, monitor and manage peer activities just as they would for other services they provide. Peer access to client records must be consistent with HIPAA and State statutes and regulations. Payment rates for peer-provided services should be reasonable for the services provided and competitive with similar types and levels of services. Program and management needs, as well as the services to be provided by a peer workforce will dictate hiring practices such as full or part time, or on an ad hoc basis. Furthermore, recruitment of peers who are in a stable recovery is crucial to minimize the chance of stress-related relapses.

Finally, supervision and monitoring systems are needed to ensure that peers receive clinical guidance, managerial oversight, orientation to the work environment, sufficient training in the skills needed to perform the job and ongoing emotional/interpersonal support. Establishment of policies for managing relapse situations and supervision that addresses peer management of dual relationships and feelings about role confusion will ensure a stable workforce.