Talking Clearly About Peer Support vs. Peer Support Specialists

As services that involve peer support continue to evolve, it is important that we are all clear on what terms we are using to talk about them.   Consider the following key terms:

Peer support services can be found in healthcare around the world.  They can take different forms and can be provided in a range of settings including inpatient, outpatient, digital, and community-based services.  They are available in developed countries and in undeveloped countries.  These services most commonly target people with mental health and/or substance use disorders, serving individuals who identify as experiencing similar lived experiences with those conditions (Mead, Hilton, & Curtis, 2001), but they are present in a much broader array of clinical settings (Chinman et al., 2014; WHO, 2017).  

 Formal peer support services originally started as mutual support/ self-help groups.  Kessler and colleagues (1997) conducted the last large national survey of self-help groups in the United States. They found that more than 25 million adults (14% of the adult population) in the US had participated in a self-help group during their lifetime and 10 million (6%) in the past year.  They also noted that participation rates had been steadily increasing for at least 30 years – a trend that has likely continued.  The size of this network is surprising to most clinicians, as the clinical world and the self-help world have not always worked together or even been aware of each other.  Peer support groups do not have a financial incentive for anyone, which is also a part of why they are typically not publicized and the public may not know the extent of the supports available.

A huge number of people are involved in providing peer support groups.  There are more than 100,000 weekly meetings of AA alone, which means at least that many facilitators.  Another 30 organizations facilitate peer support meetings for substance use and other problem behaviors.  At least another 15 organizations facilitate meetings for other mental health conditions, 20 for other medical conditions and at least another 16 for life challenges that don’t qualify as medical problems (Drebing, 2016).   

Peer Support Specialists:  In the past thirty years, there has been rapid growth in the number of paid positions designed to provide 1-way peer support to clients.  These positions have been part-time and full-time and in some situations, volunteer.  These positions are often called Peer Support Specialists, but may also be referred to as: “peers”, “peer providers” “peer specialists”, “peer supporters”, “peer mentors”, “peer navigators”, “certified peer support specialists”, and “peer support apprentices”. 

There are currently more than 30,000 Peer Support Specialists employed in the United States (Cronise, Teixeira, Rogers, & Harrington, 2016) and many more working around the world.  They provide support in a variety of settings.  These positions started in mental health, moved to related medical fields that have clear links to mental health, and are now expanding to other areas of medical care – building on existing peer support resources.   The Veterans Health Administration was an early adopter of these positions and is the largest single employer of Peer Support Specialists, with well over 1,000 full-time peers.  At the time I am writing this, there are more than 100 open jobs for full time peer support providers in the VA alone.  Peer Support Specialists have at least one professional organization – NAPS, and state certification organizations in more than 40 states. 

Peer Support Specialists are defined as “non-clinical”.  They often work with clinicians but are not considered to be clinicians despite the fact that many work in clinical settings.  There is a growing number of interventions designed to be administered by Peer Support Specialists.  That trend reflects the valuable role of Peer Support Specialists and the opportunity for that role to help solve key problems in healthcare.

Peer Support Groups and Peer Support Specialists: Peer Support Specialists provide peer support -- but may or may not have any involvement or experience with peer support groups.  Peer support groups are designed specifically to provide peer support to anyone who attends, but they do not typically have any explicit involvement of Peer Support Specialists.  Most peer support groups involve no work that is paid – everything is volunteer and roles are always part-time.  Peer Support Specialists are almost always paid positions and most are full-time. 

KEY ISSUES/SUBGROUPS TO KNOW ABOUT: 

Do Paid Peers Lose Something by Being Paid?  One of the great advantages that Peer Support Specialists add to clinical teams is the trust and credibility that they have with clients.  Clients often assume Peer Support Specialists have fewer conflicts of interests and are more focused on the client’s welfare than clinicians.  Some advocates have raised the question of whether that trust is undercut by Peer Support Specialists getting paid by healthcare organizations.  This is a valid question, as it is plausible that many paid peers may be less independent and outspoken in order to preserve their employment.  It is in the interest of the employers and the Peer Support Specialists to make extra efforts to protect the independent voice that paid Peer Support Specialists bring to their work. Those efforts will ensure they continue to have a high level of trust and rapport with clients and have a true advocacy role in those organizations.

Intentional Peer Support:  There is a sub-movement within peer support called “Intentional Peer Support” (intentionalpeersupport.org).  This organization takes the perspective that peer support work should centrally involve building interactive relationships in which everyone uses dialogue to better understand their experience including their experience of illness, treatment and recovery.  Intentional Peer Support does not take a problem-oriented approach or a healthcare-oriented approach to understanding that experience.  Instead, they focus on a broader understanding of what factors contribute to the experience of patients.  The Intentional Peer Support organization offers education and group activities and can be seen as a means of protecting peer support from the tendency to be co-opted by the agendas of professional organizations in the healthcare field.

Consumer-Run/Peer-Run Organizations:   In the last 30 years in the field of mental healthcare, there has been significant advancements in the development of consumer-run organizations that provide services to consumers of mental health care (Brown, 2012; Segal & Hayes, 2016).  These organizations are defined as programs or services that are developed, administered and delivered by consumers of mental health services.  They are governed by consumers and involve staff who are consumers and supervisors who are consumers.  They take the stance that traditional mental health providers and services have subtle and not so subtle messages that create barriers to recovery. These programs may involve a range of services including drop-in centers, warm-lines, and even fairly traditional mental health services. 

 REFERENCES

Brown, L.D. (2012). Consumer-Run Mental Health: Framework for Recovery. New York: Springer.

Chinman M, George P, Dougherty RH, Daniels AS, Ghose SS, Swift A, Delphin-Rittmon ME. Peer support services for individuals with serious mental illnesses: Assessing the evidence. Psychiatr Serv. 2014;65(4):429–41. https:// doi. org/ 10. 1176/ appi. ps. 20130 0244.

 Cronise R, Teixeira C, Rogers ES, Harrington S. The peer support workforce: Results of a national survey. Psychiatr Rehabil J. 2016;39(3):211–21. https:// doi. org/ 10. 1037/ prj00 00222.

 Drebing, C.E. (2016). Leading Peer Support and Self-Help Groups: A Pocket Resource for Peer Specialists and Support Group Facilitators. Holliston, MA: Alderson Press

 Kessler, R. C., Mickelson, K. D., & Zhao, S. (1997). Patterns and correlates of self-help group membership in the United States. Social Policy, 27(3).

 Mead S, Hilton D, Curtis L. Peer support: A theoretical perspective. Psychiatr Rehabil J. 2001;25(2):134– 41. https:// doi. org/ 10. 1037/ h0095 032.

 Segal, S. P., & Hayes, S. L. (2016). Consumer-run services research and implications for mental health care. Epidemiology and psychiatric sciences, 25(5), 410-416.

 World Health Organization. Promoting recovery in mental health and related services. World Health Organization. 2017.

KEY WORDS: Peer Support Specialist, Peer Support Training, Peer Support Certification, Peer Support Groups, Self-Help Groups, Peer Support