Jul. 2020: Peer supporters in the workforce: diversity, inclusion, integration

A message from Thomas Lane, NCPS, CRPS, senior director, community and recovery supports

Welcome to Magellan’s July 2020 edition of eMpowered for Wellness. This month, I want to share some thoughts and insights on the importance of peer support services in healthcare, as well as other systems where peer supporters can be integrated. As the impact of the COVID-19 pandemic continues to be felt across the U.S. and around the world and folks struggle with the fallout, we are seeing an increased need for mental health and substance use disorder services and supports.

COVID-19 mental health impacts

For many, the virus has taken a terrible toll. Family and friends have been lost. Millions of jobs have been lost. Our collective and individual sense of what is “normal” has been lost.

In a May 14, 2020 news release, the United Nations called for a substantial investment in mental health services to avoid a “massive increase in mental health conditions in the coming months.”

World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus said this:

“It is now crystal clear that mental health needs must be treated as a core element of our response to and recovery from the COVID-19 pandemic. This is a collective responsibility of governments and civil society, with the support of the whole United Nations System. A failure to take people’s emotional well-being seriously will lead to long-term social and economic costs to society.”

Focus on prevention

Public health experts, media and a growing number of policy makers are urgently emphasizing the critical necessity to take a preventive approach to this crisis, urging people to wear masks in public, practice physical distancing and increase testing. If we don’t embrace prevention, we will not beat this disease.

It’s not just infectious diseases like COVID-19 that require a robust, full court press preventive public health response. We need to get serious about prevention in mental health. A 2015 research article, Preventing Mental Illness: Closing the Evidence-Practice Gap Through Workforce and Service Planning stated:

Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in policy dialogue and service delivery, the prevention of mental illness remains a neglected area.

Note the reference to “evidence-practice gap” in the article title. What does that mean? Here’s a great, succinct description from a 2014 article published in PLOS Medicine.

Health research promises societal benefit by making better health possible. However, there has always been a gap between research findings (what is known) and health care practice (what is done), described as the “evidence-practice” or “know-do” gap.

Peer support contributions

So, what are the implications to the peer support workforce I mentioned at the beginning of this article? How does prevention apply to this discussion? Why is there still an “evidence-practice” gap with regard to peer support?

There are 200+ articles published in the literature on peer support. Peer support has long been recognized as an evidence-based practice. In fact, there are several peer-developed, peer-delivered models grounded firmly in the principles of recovery and resiliency, choice and self-determination, and an understanding of a holistic approach to wellness. And these models have been shown to have a positive impact on traditional outcomes, predominantly measured in behavioral health, including significant reductions in hospital admissions, fewer re-admissions and decreased spending on high-cost, restrictive settings like psychiatric inpatient. While peer support is not a clinical service, it has been shown to impact clinical outcomes. Beyond this, folks receiving peer support services express very high degrees of satisfaction with those services and report improved quality of life.

We can all agree that peer support has had, and continues to have, a tremendous positive societal impact. Think about the foundational work of Clifford Beers who’s seminal book, The Mind That Found Itself, was published in 1908, or William Griffith Wilson’s contributions as the driving force behind Alcoholics Anonymous. Bill W., as he is more commonly known, can rightly be called the founder of today’s thriving 12-Step communities around the world. Every day, all around the globe, peer support is making better health possible. What about the small group of ex-patients from New York’s Rockland State Hospital who, in the late 1940s, met on the steps of the New York City Library in Manhattan and started We Are Not Alone (WANA), a mutual self-help group? WANA went on to be what is now known as the Fountain House clubhouse model. All of this before 1950.

Today, 70 years later, we see the rapid and disruptive growth in tech-enabled peer support. We are experiencing the evolution of a digital peer support ecosystem. Peer specialists can now be trained and certified to provide digital peer support. If you missed our e-interview with Dr. Karen Fortuna last month, take a look at our eMpowered for Wellness newsletter June feature article or our eMpowered for Learning June webinar on digital peer support in Magellan’s Recovery and Resiliency e-Learning Center. I think you’ll be fascinated with the state of the field in providing virtual peer support, especially in light of the COVID-19 pandemic.

Increasing peer support in the workforce

Yet, for all this work and progress over the last 110+ years and the 200+ published papers on peer support, there are still some states that do not provide reimbursement for peer support under state Medicaid plans. Policy makers have only recently begun to craft legislation to make peer support a Medicare benefit. Peer support as a covered benefit is in its infancy in commercial health plans. Our collective work is not done.

As demand for mental health services continue to accelerate, and as we re-think how public monies should be spent in our communities and neighborhoods to address not only public safety needs, but public health needs, peer support should be an integral part of our thinking, our planning and our funding. Peers offer a variety of preventative supports, including peer-run warmlines and peer-run respite programs. Peer support groups are, by their very nature, a preventative resource. Peer support has a huge role in suicide prevention and deterrence. Peer support focused on the unique needs of youth and young adults has awesome potential to change the long-term health trajectories for these individuals, with early education and attention to improving health literacy. Again, think prevention.

Today’s peer support workforce reflects diverse communities of color and culture, and of lived experiences along the life spectrum. Peer supporters are folks who want to give back, to pay it forward in our communities, to advance recovery and resiliency and be part of the solution to the gross inequities and disparities we see in healthcare, especially behavioral healthcare. Look at the evidence. Understand what lived experience really means. Learn about the capabilities, competencies and skills peer supporters bring to our work. Continue to create opportunities for peer support across the entire healthcare continuum and in social programs designed to help folks who experience marginalization, poor health outcomes, and who, many times, lack hope.

Please pledge today to take a look at what you can do right now to promote peer support in your communities, whether it’s at the grassroots level, in peer-run organizations, traditional provider agencies, inpatient and emergency department settings, or at the intersection of mental health and the criminal justice system. Most importantly, remember that together we can bridge the evidence-practice gap sooner rather than later.

We hope you enjoyed this feature article from the Magellan Healthcare eMpowered for Wellness July newsletter.

Access the full July newsletter

Magellan’s eMpowered for Wellness newsletter provides an in-depth look into the critical behavioral health and social issues individuals in our country are facing today. Information and valuable resources are included to help improve overall health through peer support, whole health and working toward wellness.