Author, attorney and inspirational speaker Iyanla Vanzant writes, “It is important that we share our experiences with other people. Your story will heal you and your story will heal somebody else. When you tell your story, you free yourself and give other people permission to acknowledge their own story.” Whether she knows it or not, Ms. Vanzant is describing peer support. Research shows the importance of these services in the behavioral health system; but these same studies show that peer professionals are consistently underutilized. The power of sharing lived experience seems undeniable, so peer support must become an integral part of the recovery process.
Peer support is defined as “a system of giving and receiving help founded on key principles of respect, shared responsibility and mutual agreement of what is helpful.” Peer services are administered by individuals who self-identify as having lived experience with mental health and/or substance use disorders. In 2007, peer support services were incorporated into the Pennsylvania Medicaid Plan, which assures these services are available in every county/joinder in the state.
Peer services are currently available in every Pennsylvania county, so why is this amazing service not fully utilized? The truth is there are many barriers to the successful implementation of peer services into the mental health system.
The treatment of mental health and substance use disorders in a more holistic or “whole-person” way is on the rise; however, practitioners who subscribe to treatment through the “medical model” are still in the majority. The medical model assumes a physical cause for these disorders, while largely ignoring the effect of trauma and other non-medical reasons. These practitioners can resist the use of non-clinical services, such as peer support, in the treatment planning process. Clinical staff are often trained not to share any personal or lived experience, even if they share commonalities with the patients they are treating. As a result, it is my opinion that some practitioners may feel uncomfortable with the concept of peer support.
There is also evidence to show that peer professionals “seem to be discounted or not given the same weight as other staff because they don’t have a degree.”
This lack of respect for peer professionals may impede their ability to receive trust and acceptance from other members of the treatment team.
There is also the issue of stigma. Progress has been made to reduce the stigma associated with both mental health and substance use disorders, but there is still a long way to go. Both conscious and unconscious biases exist, even among clinicians working within the field. When you couple clinical discomfort, resistance, and stigma with a severe staffing shortage post-COVID-19 pandemic, the barriers to peer support become clearer.
Now that the obstacles have been named, there must be a strategy to create successful growth for peer support. As with many barriers, the ways to increase the use of peer support are through education and example. The issues listed above could be minimized by ensuring that other mental health and substance use practitioners understand the role of a peer professional as part of the treatment team.
I believe the best way to explain and understand is through example. As a peer professional myself, I have personally seen the effect of shared experience.
When I was 32, I was diagnosed with terminal cancer. My treatment was long and grueling. My mental health declined as a result. Once I was stable in both my physical and mental health recovery, I trained as a peer support specialist. One of the first people I was assigned to work with was an individual in treatment for cancer. This person was slightly resistant to the idea of peer support but allowed me to meet with her. As I listened to her story, I knew we were perfectly matched. When she finished, I told her about my own cancer journey. I watched her face soften as she said, “you had cancer?” I heard her audibly exhale and saw her entire body relax. That simple, but profound moment was the beginning of her recovery journey.
A peer supporter, like me, is the living, breathing embodiment of recovery and gives hope to those who are hopeless. And that is the power of peer support.
Stephanie Cassanese is the recovery and resiliency supervisor at Magellan Behavioral Health of Pennsylvania.
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