When you might need to use advocacy

There are a lot of scenarios where advocating for peer support programs might come up. If I worked in a mental healthcare setting, maybe my employer is considering implementing one but is hesitant to make room in the budget. At legislative hearings, I might be confronted by mental health policy that de-funds peer support programs or de-legitimizes their effectiveness. In the doctor’s office, I might find myself confronted by a provider who doesn’t believe that seeking peer support is a good use of my time and wants me to abandon it in favor of more clinical treatment. In any case, these are some talking points that I can refer to during those conversations.

Three points on peers: equality, treatment adherence, and hope

  1. The value of peer support is acknowledged and appreciated for almost every other kind of health condition except mental health conditions.

    • When someone seeks treatment for their substance use disorder, their discharge or continued outpatient treatment is often contingent on participation in a peer-based support group like Alcoholics Anonymous or LifeRing. Specialists in addiction medicine nearly universally acknowledge the value of support from people who have been there. These programs have another word for peer support workers, like sponsors, but the principle is the same.
    • When someone is receiving treatment for cancer, diabetes, or another severe or chronic illness, they are often referred to peer support networks to help them cope with the lifestyle changes and emotional challenges of illness. While doctors provide valuable, life-saving interventions, they do not have the training or capacity to support their patients in non-medical areas of recovery. The limitations of their professional experience are acknowledged and supplemented with peer support.
    • While therapists, psychologists, and psychiatrists provide valuable interventions like medication, cognitive-behavioral therapy, EMDR, and a wealth of other things, they cannot provide the mutual support and understanding offered by peers. People with mental health conditions, like those with any other illness, deserve to hear from people who have experienced what they are experiencing. They deserve support in lifestyle management, social wellbeing, meaning-making, self-advocacy, and other areas of recovery that are unaddressed by traditional providers.
  2. Peer support programs improve recovery outcomes and treatment adherence when used as supplements to traditional care.

    • One 2017 study showed that supplementation of one-on-one peer support to treatment as usual significantly improved self-efficacy, which is correlated with improved resilience, task persistence, acceptance of life imperfection, and use of appropriate coping strategies. These are all characteristics that are necessary for long-term recovery.[1]
    • A 2013 study of individuals with severe mental illness who were involuntarily hospitalized in a forensic psychiatry unit showed that peer support interventions had a significant positive impact on personal recovery and a small positive impact on patient activation and service engagement.[2]
    • A 2014 study of peer support intervention targeted toward individuals with schizophrenia showed drastic increases in medication adherence and decreases in positive, negative, and depressive symptoms that held steady for months after the intervention.[3]
    • A 2011 randomized controlled trial at the Yale-New Haven Psychiatric Hospital demonstrated that assignment of a peer mentor in addition to treatment as usual results in fewer rehospitalizations and fewer inpatient bed days than in patients receiving treatment as usual.[4]
  3. Peer support workers provide hope, recovery support, and comfort in ways that traditional mental healthcare providers cannot.

    • A 2015 qualitative study of post-hospitalization peer support programs showed that peer support workers were identified by their clients as most helpful in regaining normality in daily life after hospitalization, while their traditional providers were not able to provide this kind of support. Nearly all peer support recipients reported that they got valuable emotional support that was improved by the peer support worker’s lived experience. Many said that the mutual understanding helped them to feel normal, gave them hope that they could recover, and offered them comfort in ways that their providers and non-diagnosed friends and family could not.[5]
    • A 2012 study of peer interventions in 24 mental health treatment facilities showed that people with psychotic disorders like schizophrenia and those who have had two or more episodes of psychiatric crisis are most likely to develop hopeful beliefs about recovery due to the intervention.[6] This is compared to single-episode patients with affective or substance use disorders. Many believe that peer support is only effective for people who are already “well enough,” but research shows the opposite!
    • A 2017 meta-analysis of 20 studies on peer support showed that peer support workers were equally competent to traditional healthcare professionals in providing recovery support services.[7] Considering the chronic shortage in mental health workers coupled with ongoing healthcare budget concerns, peer support workers are a good option for improving reach of services.

I hope some of these are helpful!

References

[1] C.I. Mahlke, S. Priebe, K. Heumann, A. Daubmann, K. Wegscheider, T. Bock, Effectiveness of one-to-one peer support for patients with severe mental illness – a randomised controlled trial, European Psychiatry, Volume 42, May 2017, Pages 103-110

[2] Livingston, J. D., Nijdam-Jones, A., Lapsley, S., Calderwood, C., & Brink, J. (2013). Supporting recovery by improving patient engagement in a forensic mental health hospital: Results from a demonstration project. Journal of the American Psychiatric Nurses Association, 19(3), 132-145.

[3] Boardman, G., McCann, T., & Kerr, D. (2014). A peer support programme for enhancing adherence to oral antipsychotic medication in consumers with schizophrenia. Journal of Advanced Nursing, 70(10), 2293-2302.

[4] Sledge, W. H., Lawless, M., Sells, D., Wieland, M., O’Connell, M. J., & Davidson, L. (2011). Effectiveness of peer support in reducing readmissions of persons with multiple psychiatric hospitalizations. Psychiatric Services, 62(5), 541-544.

[5] Gidugu, V., Rogers, E.S., Harrington, S. et al. Community Ment Health J (2015) 51: 445.

[6] Rabenschlag, F., Hoffmann, H., Conca, A., & Schusterschitz, C. (2012). Who benefits from peer support in psychiatric institutions? Psychiatric Quarterly, 83(2), 209-220.

[7] Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental illnesses: Assessing the evidence. Psychiatric Services, 65(4), 1.

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Kate Fitch

I've been with the Network since 2015, when I started as a volunteer. I've been on staff as the Communications Specialist since January 2017. I'm currently in college and pursuing a dual BA in Public Health and Public Administration. I'm most passionate about making sure that people with mental health conditions are fairly represented in the media, at policy tables, and in treatment system planning. In my spare time, I like to crochet, knit, and be the best cat mom ever.

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