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Your Peer Specialist Will See You Now

States are increasingly pairing mental health and substance abuse patients with peer specialists -- people who have experienced some of the same problems themselves.

A patient listens to a peer specialist at an organization in Chicago.
(TNS/Alex Garcia/Chicago Tribune)
Dealing with any mental health or substance abuse issue is tough. It can often feel like no one really understands what you’re going through. But there’s a growing movement to change that by employing people who can better empathize with patients.

Peer specialists are people who have personally struggled with mental health or substance abuse problems but are now in recovery and helping others. They work for community behavioral health centers, psychiatric inpatient facilities and other health-care providers. 

“These programs are proliferating everywhere you look. There’s a lot of evidence to show that peers can support and acclimate someone to a new life of recovery,” said Kim Nelson, the regional administrator of the Substance Abuse and Mental Health Services Administration for Iowa, Kansas, Missouri and Nebraska. She worked as a peer specialist for a decade before landing her current job. 

In Nebraska, peer specialists are saving providers' money and reducing readmission rates. 

“Thirty day readmissions for mental health patients is usually around 30 percent nationally. We had been hovering around 20 percent before implementing the program. Now we’re down to about 13 percent,” said Linda Knudsen, education coordinator of the Bryan Medical Center, a nonprofit health center in Lincoln, Neb.

At least 38 states have developed some sort of certification for a peer specialist program. Training and programming vary from state-to-state, but Medicaid requires employers to supervise peer specialists' first 2,000 hours of work. They also must complete at least 30 hours of continuing education training in mental health every two years.

Peer specialists are a supplement -- not a replacement -- for licensed mental health professionals. 

“It’s totally voluntary -- patients don’t have to meet with one if they don’t feel comfortable. It’s just a way for peers to sit down and minimize anxiety. They aren’t asking about their medical history. They’re just chatting with them to say ‘I’ve been there, and it’s going to be OK,'” said Knudsen. 

But even after people get all the training, they aren't guaranteed a job as a peer specialist. In fact, they often struggle to find one, said Sue Abderholden, executive director for the Minnesota chapter of the National Alliance on Mental Illness. Since it’s a relatively new field, providers can be reluctant to hire peer specialists. Plus, she said, “some of them have a criminal background because they were picked up by the police while having a mental health episode."

Right now, 36 states' Medicaid programs reimburse peer specialists. In 2007, the Minnesota Legislature was one of the first to not only require peer specialists to be reimbursed but also to create a state program model. In 2013, the state set up separate program requirements for family peer specialists to better serve children.  

Peer specialists don't just affect their patients. They ultimately help themselves in their own recovery and help alleviate the shortage of mental health-care providers.

"It benefits everybody because we are already woefully short on people in a behavioral health setting," said Nelson.

According to the U.S. Department of Health and Human Services, there were 96.5 million Americans living in areas with insufficient mental health care in 2014. For every 790 people in the U.S., there's just a single mental health provider, according to Mental Health America.

For mental health care experts, peer specialists are also a smart investment for the field's new approach. 

“For so long, we saw addiction and mental health issues as episodic illnesses," said Nelson. "Now we’re starting to look at is as a recovery process. The peer specialists system is one that focuses on wellness instead of sickness."

Mattie covers all things health for Governing.

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