Peer Specialists in the Mental Health Workforce: A Critical Reassessment

By Darby Penney & Peter Stastny, MD: For More Info, Go Here…Since its origins during the late 1980s, the use of peer specialists in traditional mental health agencies has grown tremendously. There are now an estimated 30,000 people with psychiatric histories employed in such positions across the country.1 The term “peer specialist” was coined nearly 30 years ago in a federally funded research and demonstration project in the Bronx, New York. 2 The position was created for workers with a psychiatric history who were trained to provide peer support and to assist people in developing self-help skills, support systems, and strategies to deal with emotional distress and extreme states.3 The goal of establishing this role was to bring genuine peer support to people receiving traditional community-based mental health services. “Peer support” was defined as a “reciprocal process through which people with shared experiences support each other’s healing and growth in the context of community.”4

The Bronx Peer Specialist Project came about at a time when the US federal government invested considerable funds to demonstrate that bringing “consumers” into the mental health workforce and supporting “consumer-operated projects” would have a transformative impact on the wider system and that service recipients would benefit from this type of engagement. While some of the projects showed that former psychiatric patients could provide support services like any other staff, the Bronx Peer Specialist program was first to demonstrate that peer workers’ personal experience directly correlated with certain improved outcomes for people receiving services.

Following this early enthusiasm,5 states began to implement a variety of programs for hiring peer specialists in various mental health settings. Based on our experience in the Bronx, New York became the first state in the nation to approve a non-competitive civil service position under the title “Peer Specialist” in 1993, based on an analogy with counselors who had relevant personal experience in the substance abuse field.

Over the intervening years, it became clear that being trained and hired as a peer support worker/peer specialist offers opportunities for people with psychiatric histories who might otherwise not have found their personal career path, as well as for those who benefit from participating in peer support. And yet, the inherent difficulties of working as a former patient in the system became apparent early on, but this did not result in serious consideration of how to address these issues. Recent research on peer workers suggests that these staff are often used to carry out paraprofessional and even menial tasks within traditional mental health programs, rather than provide genuine peer support. In most situations, relationships between peer staff and service users are construed hierarchically, in contradiction to the horizontal relationships of grassroots, user/survivor-developed peer support. Staff based in traditional mental health agencies are seldom exposed to the principles and practices of peer-developed peer support, nor do they usually receive supervision from seasoned peer experts. Cooptation of peer staff, where peer support values directly conflicted with the practice and beliefs espoused by the people in charge of those work settings, was frequently mentioned by peer workers, but never led to substantive changes in hiring and employment practices.6

One of the key concepts of peer support is that it must be voluntary, and such voluntariness is anathema to many, if not most, mental health services.7 There are indications that peer workers are increasingly being employed in situations where people are being coerced into “treatment,” secluded and restrained, and forcibly medicated.

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