In 1985, Larry K. Brendtro and Harry H. Vorrath developed the “Positive Peer Culture” treatment model, grounded on the principles of building group responsibility and incorporating group meetings, service learning and teamwork into the model.
Today, those principles are being implemented at some residential facilities and outpatient settings for individuals with serious mental illness and substance abuse diagnoses.
Wellspring & the Arch Bridge School in Bethlehem, Conn. is one such facility that has several peer support structures for its adolescent residential students, according to CEO Daniel Murray, Psy.D.
He said that Wellspring has created a strong peer culture that is passed down as new students enter the school. “There might be some passivity in the beginning, but it’s the responsibility as group leaders to make it work. There may be resistance to their own therapy, but not to the Residential Empowerment Meetings,” he said.
All 19 students and one staff member attend the weekly Resident Empowerment Meetings where residents can suggest or request changes to the physical environment.
“Residents bring an agenda to Resident Empowerment related to communal living and therapeutic programming to both make changes and organize themselves to bring agenda to other groups and meetings, including the larger community meeting where the entire staff joins the residents,” he said.
“The goal is to promote collective responsibility for the social environment. It counters what’s happening in society, in the outside world. The system is based on relationship restoration, developing social skills and friendship. A lot of these kids don’t have the emotional muscle to stay in relationships.”
Resident sponsors at Wellspring help guide the newcomer through orientation and scheduling. “This person acts as a mentor and guide to get new admissions acclimated, introduced and on the right road,” Murray said. “The resident sponsor is mostly someone engaged in the treatment process to get her life on track.”
Murray pointed out that all the peer support programs are part of a larger milieu program based on relationship building.
“The program is founded on this active milieu, recreational program integrated with multiple family and parent-based therapies, eight or nine group therapies a week, two individual sessions, 24-hour nursing and, of course, a full NEASC [New England Association of Schools and Colleges] accredited private school experience,” he reported.
While peer programs as a whole appear to be effective, determining individual outcomes poses a challenge in residential treatment, said Murray. “We know the kids value the programs and give the groups high marks. We have good outcomes for the agency. All seniors are able to graduate, but it’s hard to say how each individual is affected.”
In a broader context, peer specialists who work with adults with serious mental illness complement the work that psychologists do, noted Larry Davidson, Ph.D., professor of psychiatry and director of the Program for Recovery and Community Health at the School of Medicine and Institution for Social and Policy Studies at Yale University.
“Peers can engage people in services when they are reluctant or have had bad experiences. They offer hope and encouragement to others in the care of self,” he said.
Medication non-compliance and failure to show up at appointments is a common issue with people who have serious mental illness and peers can have a positive influence in these matters.
“There is a 50 percent no-show rate in outpatient clinics,” Davidson said. “Peer staff will get people to their appointments and encourage them to take their meds. Peers support specialists reinforce what the patient is learning and enhance the work of psychologists.”
Although the work they do is valuable, it’s important to remember that peers are not “traditional psychologists.” Davidson explained that peers do not offer counseling or cognitive behavioral therapy. “They’ve ‘been there’ and learned lessons and can show others that it’s possible to come out the other side. Peer support doesn’t cure schizophrenia or other mental illness. It’s about [having] a better life.”
Davidson has noticed a “renaissance in psychology in the last five to 10 years.” He noted that the creation of more training and certification programs for peer specialists is helping to bring more peer-to-peer assistance to those who need it.
For example, Davidson reported that the Veteran’s Administration hired more than 1,000 peer “technicians” last year and 36 states train and certify peer specialists.
One gap that exists, however, is professional oversight of these peers. “Peer specialists are making patients with serious mental illness more accessible to psychologists. There are lots of opportunities for psychologists to train in this area.”
A study published in Psychiatric Services in 2014 examined the evidence related to the efficacy of peer support services and found the results “encouraging but not definitive.”
The study authors concurred though that peers provide hope, engagement, empowerment and encouragement and helped others with self-efficacy, self-management and expanding their social networks. The creation of professional organizations, such as the International Association of Peer Supporters, lends credence to the discipline as it has developed standards of practice, training and certification.
Rob Walker in the Office of Recovery and Empowerment at the Massachusetts Department of Mental Health noted that peer specialists, unlike psychologists, have the privilege of “sharing self with individuals.” He said that shared experiences and useful advice often provide hope and differ from a clinical relationship. “Peer specialists supplement and complement other services,” Walker added.
DMH funds the organization that provides certification for peer specialists. Walker reported that more than 500 individuals have been trained and more than 400 have been certified as peer specialists and are employed by the state. “DMH employs certified peer specialists in each state inpatient facility,” he said.
Laurie Martinelli, executive director, NAMI Massachusetts, pointed out that reimbursement for peer support services, which is not yet available in the Commonwealth, will be critical as more than 1.7 million individuals will enroll in MassHealth in 2015.
Sen. James Eldridge (D-Acton) filed a bill that requires MassHealth to cover peer services for those who have completed relevant training. Martinelli estimated that a minimum of 340,000 citizens annually could benefit from peer programs.
Davidson added that the community of psychologists believes peer specialists enhance the work of psychology. “Psychologists have a lot to offer. They’ve been in the lead of partnering with peers,” he said.