|
Article Excerpt
Both the Veteran's Affairs Action Agenda Work Group (2003) and the National Consensus Statement on Mental Health Recovery (Substance Abuse and Mental Health Services Administration, 2004) endorsed the concept of peer support and peer provided services as an important component of mental health transformation endeavors. Peer provided services are considered an indicator of a recovery oriented service delivery system (Dumont, Ridgeway, Onken, Dornan, & Ralph, 2005). The belief that a person living with a mental illness can provide services to others with similar mental health problems appears to be growing in acceptance within the traditional mental health system. The addictions field has a long tradition of viewing persons in recovery as providers or counselors. The mental health peer provider, like the peer addictions counselor, brings a unique perspective based on 'life experience' that is believed to enhance the peer provider's sense of empathy, insight, and offers hope for recovery.
Peer providers are persons who identify that they are living with a mental illness and provide services to assist others in their recovery. Peer providers typically work in one of two service settings: consumer operated or traditional mental health programs. Consumer operated programs are organized, administered, and managed by consumers of mental health services. Traditional mental health programs in contrast are operated and administered primarily, by non-consumers (Solomon, 2004; Mowbray & Moxley, 1997). There are two broad types of peer roles within the traditional mental health system: 1) peer or consumer designated positions and 2) conventional positions. Peer specialist positions are generally designated for a person living with a mental illness who is considered further along in their recovery than those to whom they will be providing services. An example is the peer advocate role on an assertive community treatment team. Persons in recovery may also occupy traditional mental health positions, for example, case manager, staff psychologist or social worker. These individuals, while recovering from mental illness, may or may not have disclosed their personal experience. In either case, the person is paid a competitive wage for their services.
There is a small but evolving body of research indicating that consumer providers (1) (CPs) can be as effective as or more effective than traditional providers in professional settings. Since the mid 1990's there have been a series of research endeavors examining the impact of services delivered by CPs. There have been at least three randomized control trials (Clarke et al., 2000; O'Donnell et al., 1999; Solomon & Draine, 1994; 1995a; 1995b; 1995c) and three quasi-experimental studies (Chinman, Rosenheck, Lam, & Davidson, 2000; Chinman, Weingarten, Stayner, & Davidson, 2001; Felton et al., 1995; Klein, Cnaan, & Whitecraft, 1998) comparing outcomes of CPs' services to traditional non-consumer provider services. The studies with CPs assigned to an intensive case management team tended to show outcomes favoring consumer providers.
Rowe and associates (2007) demonstrated that early in treatment CPs may possess distinctive skills in communicating positive regard, understanding, and acceptance to clients, and a facility for increasing treatment participation among the most disengaged. These findings suggest that peer providers serve a valued role in quickly forging therapeutic connections with persons typically considered to be among the most alienated from the health care service system. The hastened establishment of this relationship may lead to greater motivation for further treatment and use of peer-based community services. Schmidt and her colleagues (2008) recently demonstrated that consumers with life experience but little formal training can work together successfully with professionals to provide case management services for people with a serious mental illness. This research adds to the growing body of evidence that consumers can deliver services as effectively as other providers within conventional case management programs (Schmidt, Gill, Solomon, & Pratt, 2008).
Peer Services within the VA
In 2003 the VA developed a plan to implement the recommendations of the President's New Freedom Commission. The Veterans Administration Mental Health Strategic Plan endorsed the use of peer support within the VA. The goal was to hire veterans as peer mental health paraprofessionals, referred to as CPs. In 2005 funding became available for CP positions and by April 2008, 123 had been hired (Chinman et al., 2008). Peer providers in the VA deliver services "from...
|
