Peer Specialists as Educators for Recovery-Based Systems Transformation

The past 3 decades have witnessed an ongoing transformation of mental health care systems around the world, beginning in the United States and followed by New Zealand and Western European countries. With decreasing enthusiasm among consumers and consumer advocates for the traditional model of care that has dominated clinical practice for about a century, the recovery model has become the centerpiece of systems transformation.^1,2 As articulated by former patients who are living a full and meaningful life beyond illness, the recovery model underscores hope, empowerment, independence, strengths, and the patient’s ability to adapt.^3,4 This notion of recovery stands in contrast to traditional views that focus on clinical outcomes such as symptom remission, an asymptomatic state, cure, and functional improvements maintained for a given duration.⁵

As the recovery model has wielded its influence in mental health care systems worldwide, there has emerged a need to develop and implement curricula focused on increasing knowledge about the model and promoting attitudes consistent with recovery among patients, family members, practitioners, and the general public. These efforts have been particularly pronounced in New Zealand, where recovery-based clinical training is incorporated into mental health education and required of service providers.⁸

A similar mandate for recovery education is not currently available in the United States. Although there is growing enthusiasm about the recovery model in treatment settings, it is not reflected in psychiatric training programs. Lacking recovery-based competencies, many US mental health care providers are unprepared to provide care in ways consistent with the recovery model or to provide recovery-relevant information that can help patients.

With the recovery model, the patient’s unique experiences and perception inform treatment and serve as a springboard for collaboration in treatment decision making. Traditional care has failed in this regard—more often than not, patients’ strengths, coping abilities, suggestions, and interpretations and attributions of their unique experiences have been ignored, devalued, and excluded in treatment planning. This may very well explain the feelings of disenfranchisement, dependence, disability, and hopelessness patients have often experienced with traditional care.⁹ Fostering a truly collaborative doctor-patient relationship requires a commitment on the part of the mental health provider to listen and attend to the patient’s perspective and expressed needs.

Project GREAT

Recognizing a need to foster recovery readiness among trainees in the department of psychiatry at Georgia Health Sciences University, we collaborated with the Georgia State Department of Human Resources to develop Project GREAT (Georgia Recovery-Based Educational Approach to Treatment)—a peer and provider endeavor to champion the recovery model. Our goal was to develop, appraise, and dispense a recovery-based educational curriculum for trainees and providers in our department as well as for providers in the community.

We envisioned a 2-tiered effort targeted toward mental health providers and patients. The Project GREAT provider curriculum is centered on teaching the Substance Abuse and Mental Health Services Administration–defined principles or elements of recovery and is currently taught in the department of psychiatry and health behavior at Georgia Health Sciences University.¹⁰ Services provided for patients and family members revolve around interactions with certified peer specialists (CPSs), who support and serve as models of recovery and provide recovery-based information and resources.

What is already known about psychoeducation and the role of certified peer specialists?

■ Traditional psychoeducation involves practitioners in the role of educators, and patients and family members as recipients of information about psychiatric illness, treatment options, coping strategies, and crises management. As part of ongoing recovery-based systems transformation, peer specialists have emerged to assume supportive roles for patients in mental health care systems.

What new information does this article provide?

■ The Project GREAT program—recipient of the 2012 American College of Psychiatrists’ “Award for Creativity in Psychiatric Education”—is the collaborative effort of peer specialists and practitioners at Georgia Health Sciences University to provide recovery-based education for both patients and providers. Project GREAT incorporates peer specialists in educational, advisory, and provider roles in an academic department, thus highlighting a changing role for people who have experienced mental illness in contemporary psychoeducation.

What are the implications for psychiatric practice?

■ Peer-led psychoeducational efforts are beneficial to providers and patients and represent a critical strategy to advance recovery in modern psychiatric practice.