Peers Partnering with Clinicians: Inpatient Care
On any single night in the United States there are around 170,000 people in the hospital due to a mental health disorder (National Association of State Mental Health Program Directors, 2017). The rate of hospitalization has dropped dramatically in the past 20 years, with the result that the only people who are admitted to the hospital have severe symptoms, such that they are usually a risk to their own safety or the safety of others.
For most, hospitalization it is a very dark time. Besides the severe symptoms, they typically lose control of their freedom and are staying in a program that is somewhat chaotic due to the symptoms of other residents. If the client previously had started the process of recovery, hospitalization can often be a challenge to their hope – they may feel discouraged or even hopeless about their ability to recover. If the client has not started recovery, they may feel confusion about what the hospitalization means for their life.
Inpatient psychiatric care can be challenging to provide:
· Most patients are not feeling physically or emotionally well. They may be trying new medications that are not fully helping or that have difficult side effects. They may be facing difficult realities that they’ve not faced before such as the reality of having a mental illness that they didn’t see, having functional problems at work or school caused by their illness, having problems in relationships with family and friends caused by their illness. Hospitalization can be a time of facing up to the damage that symptoms have been causing – and that realization can be overwhelming.
· Many people are hospitalized against their will or at least reluctantly. This can translate into anger and distrust toward the people providing inpatient care including the clinicians but also the Peer Support Specialists. You may find that many clients don’t want to talk with you or if they do, they don’t trust that what you say reflects your genuine interest for their welfare.
· For many, inpatient hospitalization is a time of very low hope. Many people are hesitant to even think about how they might recover or if they can recover.
Peers have a critical role on inpatient mental health teams.
1. At a time of low hope, Peer Support Specialists are concrete evidence that clients can and will recover. Ideally, the Peer Support Specialist has personal experience with being hospitalized. They are now in recovery and are working to help others. They are living evidence that people recover after hospitalization and build successful lives. By talking about this openly as part of the treatment, Peer Support Specialists can do a great deal to address the hopelessness many will be feeling.
2. The clinical staff on inpatient psychiatric units also often experience challenges to their hopefulness about their clients. They may see people who are repeatedly hospitalized. They typically do not see those who recover successfully come back to share their success. Like the clients, the clinical staff can start to feel that their clients are not likely to recover. Having a Peer Support Specialist on the clinical team reinforces to the staff that clients can and do recover.
3. Peer Support Specialists can help interpret the hospital experience for the client. People are often confused during hospitalization – confused about what they are supposed to do and why others treat them the way they do. They are surrounded by other patients, most of whom are in the middle of a psychiatric crisis. Peer Support Specialists can help clients understand what is happening and why. That explanation can go a long way to reducing their anxiety and building their sense of how to best participate in treatment.
4. Peer Support Specialists can help remind clients that the goal of inpatient treatment, like that of all treatment, is for the client to return to a happy, rewarding, full life in the community. Clinicians on inpatient units are often focused on very short-term goals (e.g. find the right medication, reduce the symptoms). Clients need someone to remind them that they are headed back to a full life in the community, and that all of their efforts are really in the service of that goal. Who better to do that than a Peer Support Specialist who is living that goal.
5. Similarly, Peer Support Specialists can remind clinical staff of the long-term recovery goals of the clients. That helps the entire team to maintain a focus on the full life and functioning of their clients.
6. Peer Support Specialists also represent the community of recovered people and their care and concern for those in the hospital. This is a symbolic role, but an important one. Clients often feel that they are very different than the clinical staff – different in their background and their interests. They are likely to feel that Peer Support Specialists are like them. The Peer is a stand-in for the community of people in recovery. Clients can see them as representatives of the large group of people who have recovered and are rooting for others who are in the early stages of recovery.
7. Peer Support Specialists can be powerful advocates. There are disagreements between clients and in-patient clinicians around strategies for care. In some situations, clients need help in advocating for their needs. Who better to advocate than a team member who has personal experience with the same challenges as the client.
8. Peer Support Specialists can help clients see the potential benefits of their treatment. Because of their symptoms and confusion, clients often focus on frustrations or what they have to do to get discharged. There are typically good opportunities for them to improve their lives if they fully engage in treatment. Peer Support Specialists can help them see the added benefits that come from full engagement.
9. Peer Support Specialists can answer questions about the experience of leaving the hospital, including challenges related to returning to work, how to explain hospitalization to friends and family, how to ask for accommodations, and how to apply for disability income.
10. Peer Support Specialists can encourage patience and persistence. This is key to all of recovery, but Peer Specialists are particularly persuasive when it comes to encouraging clients to take the long view of recovery and so to remain patient.
11. Peer Support Specialists can have a powerful role in nurturing continuing collaboration with clinicians. Clients often see them as standing between the clinicians and the clients. From that position, Peer Support Specialists can help troubleshoot any conflicts between clients and clinicians, and can encourage trust and open communication.
What peers can and can’t do:
1. They can talk about their own experience with inpatient care, mental illness and recovery.
2. They can talk about the value that inpatient care can play in recovery.
3. They can encourage clients to talk to providers directly and collaboratively. They can listen for issues of trust and anger that are inaccurately pointed at the clinicians, and help redirect those.
4. They can organize, and be part of recovery groups during the inpatient programming. These groups provide peer support and peer feedback, which play a key role in most people’s recovery.
5. They can help spotlight people in recovery who successfully used inpatient care. They can use their stories to build further hope.
6. They can talk with clients about challenges the clients are experiencing in working with inpatient clinicians.
7. They can’t provide clinical care specific to other providers.
8. They can’t get pulled into conflict with the staff in a way that hurts the clinical team and/or the treatment being provided.
9. They can’t contradict the clinical guidance of trained clinicians.
REFERENCES
National Association Of State Mental Health Program Directors (2017). Trend In Psychiatric Inpatient Capacity, United States And Each State, 1970 To 2014. Alexandria, Virginia.
KEY WORDS: Peer Support Specialist, Peer Support Training, In-Patient Psychiatric Care, Peer Support Jobs, Recovery