Training and hiring persons in recovery to provide peer support represents a win-win situation for resource-strapped systems. Patients receive support from trained peers who instill hope, model self-care, and help navigate the health care system. Peer support providers are gainfully employed in a role that supports their own recovery by allowing them to do personally motivated work. Systems gain a trained, effective workforce that pushes providers beyond the basic outcomes of decreased homelessness, incarceration, and hospitalization to include other outcomes that also matter to patients and their loved ones, ie, those associated with reclaiming a meaningful life.
To aspire to help persons with mental illnesses to establish meaningful lives is not to overlook or minimize the need to address homelessness, incarceration, and hospitalization. Because many have walked in their shoes, peer-support staff are especially expert in forging caring relationships with people who are overcome by the direst of circumstances and who have not responded to traditional approaches. Peer-support staff can effectively engage patients because they understand how they live (all too often on the street or in shelters) and offer practical help with basic needs and everyday living. In contrast to coercive measures that further erode patients’ sense of self and basic dignity by focusing solely on illness, peer-support staff can earn patients’ trust by providing assistance with day-to-day struggles, offering a more effective and sustained pathway to needed care than 2-week involuntary inpatient stays.
The evidence for peer support
It should be no surprise that the CMS study Jaffe references found that deploying peer staff increased the use of crisis services while decreasing hospitalizations.5 This increase in service use was a positive outcome for persons who otherwise were disconnected from all outpatient treatment. Perhaps it is on this score, above all, that the effectiveness of peer services has been shown most consistently.
When reviewing this evidence, it is important to recognize that neither peer nor non-peer non-clinical staff “treat” mental illness, that is not their role. Peer-support staff complement clinical care; their role is to instill hope, engage patients in self-care and health services, help them navigate complex and fragmented systems, and promote their pursuit of a meaningful life. When assessed on their ability to do these jobs for which they have been trained, peer-support staff clearly demonstrate effectiveness. The Table provides examples of the roles peer-support staff have played that have garnered consistent evidence in improving patient outcomes.6 To date, over multiple studies have found that peer staff who are working in peer-specific roles are better able to engage people in caring relationships7–8; improve relationships between clients and outpatient providers, thus increasing engagement in non-acute and less costly care9–17; decrease substance use, unmet needs, and demoralization8,11,17–18; and increase hope, empowerment, self-efficacy, social functioning, quality of and satisfaction with life, and activation for self-care.8,11–13,16,18–30
Dr Davidson is Professor of Psychiatry, Yale University School of Medicine; Dr Chinman is Research Health Scientist, VA Pittsburgh Healthcare System and Senior Behavioral Scientist, RAND Corporation; Dr Farkas is Professor, Center for Psychiatric Rehabilitation, Boston University; Dr Ostrow is CEO, Live & Learn, Inc, Morro Bay, California; Dr Bellamy is Associate Professor of Psychiatry, Yale University School of Medicine; Dr Cook is Professor and Ms Jonikas is Program Director, University of Illinois at Chicago College of Medicine; Mr Rosenthal is Executive Director, New York Association of Psychiatric Rehabilitation Services; Ms Bergeson is Principal, Recovery, Resilience, Engagement and Activation Partners, LLC, Lake, Michigan; Dr Daniels is Senior Study Director, Westat, Cincinatti, Ohio; and Dr Salzer is Professor of Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania.
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