The Case for Expanding Peer Support

At the beginning of every NAMI support group, the facilitators ask attendees to agree on guidelines for how those in the group will treat each other, using the 12 Principles of Support as guidance. After nearly a decade as a facilitator of NAMI Connection, the group for those who have lived experience of mental illness, I know each of them by heart. The fifth principle is a personal favorite: "We find strength in sharing experiences."

Peer support is an evidence-based best practice where a specialist uses their experience of recovery from mental health conditions and/or substance use disorders to support others in their own recovery. Combined with training, this experience and institutional knowledge puts a peer in a unique position to offer support to others.

Since fully engaging in my own recovery, I've been a Peer Support Worker, supervisor of peers and an advocate for the expansion of their inclusion in several areas, such as health care, legal and legislative environments. Essentially, I push for peer support in all the same health systems and public-policy spaces where other mental health professionals are invited.

Research speaks to the efficacy of peers. In a cross-site study conducted in New York and Wisconsin, the New York Association of Psychiatric Rehabilitation Services (NYAPRS) found an average reduction of over 43% in inpatient services for clients who received peer-support services. Similarly, they found a nearly 30% increase in outpatient treatment visits.

Simply put: People receiving peer-support services were less likely to end up in hospitals and more likely to engage with their treatment-providers.

I've experienced first-hand what both the mental health and criminal justice systems look like without peer support. I've also seen how improved these systems are with peer involvement.

The Beginning of My Journey as a Peer Worker

In 2011, before I’d ever heard of peer support, I had just gotten out of an overnight stay in jail and became a patient in an acute-care psychiatric ward. It was a small unit, fewer than a dozen of us most of the time. “J” was the youngest patient, in his late teens compared to me being in my mid-thirties. While I was in for medication management and stabilization, he was experiencing nonstop suicidal ideation. Every waking minute of every day, he was obsessed with the idea of taking his own life.

It’s never been much of a challenge to figure out everybody’s story in the places I’ve been institutionalized. There’s always a lot of chatter, and it’s usually a simple thing to piece together. J was different, though. He never spoke to anyone.

At first, I thought he was angry at being put there with the rest of us “crazies.” It was in a group therapy session where I finally realized he was fearful — not of us, but of his own thoughts.

The therapist, trying to talk about suicidal ideations and ways to work out of those thought patterns, was clearly a little taken aback when J said that he couldn't even hear what she was saying because all he could think about at that moment was suicide.

She responded with how it’s hard to be a teen, and how these thoughts can take root while dealing with the everyday stresses of teenage life. His facial expression changed to one of confusion. Her words weren’t connecting to his experiences at all. That’s when I chimed in:

“When I was a teenager, I couldn’t stop thinking of killing myself, either. It would be a few years before I found out about my bipolar disorder, so those times where my brain would get all squirrelly were scary as hell. Especially when they came out of nowhere while I was having an otherwise alright day.”

His eyes widened as he said, “That's exactly it!” He then went on to talk about how he had some struggles here and there, and he went to a doctor about it. This need to die was totally out of character, he said, and had started a few weeks prior.

The fact that his ideations were so suddenly all-consuming was different from anything I’d experienced or heard from others. I asked him, “What happened between the time things were their usual and when they weren't?”

As it turns out, he had been given a medication that can cause this side effect in teens. He didn’t really believe it at first, until I briefly shared how — again, as a teen — it turned out that a lot of my hallucinations and other psychotic symptoms were the result of getting prescribed meds that research eventually showed were risky to give to people with my diagnosis.

“You might want to talk to your doctor about this. A lot of us have to make changes to meds as we look for what works. It’s a pain, believe me, I know. But it’s a lot better than wanting to die all the time.

That was the lightbulb moment, and working with his doctor, he did exactly that. Within 24 hours, his suicidal ideations were gone. When he was eventually discharged, he introduced me to his parents. He explained that someone understanding what he was going through was what helped him open up and figure out what was happening.

Groups became my favorite thing after that. It made me feel like all my lived experience could be useful. Four years later, I’d learn there was an entire profession dedicated to that exact ideal.

Peer Bridgers

Finding mental health care is a constant uphill battle. For some, this struggle leads to brushes with law enforcement. This is where Peer Bridgers come in. Using their knowledge, training and experience, Bridgers help navigate the complexities of the behavioral health care system and criminal justice system for those struggling with their mental health or living with addiction.

For some, this starts when the certified peer specialist first meets with the individual while they are in the hospital, establishing a relationship built on mutual respect and trust. It’s there that they develop goals and plans for discharge, with the peer specialist making appointments and finding appropriate support services, like recovery groups, housing and food services.

For others, this outreach happens in the community as a form of prevention, meeting the person where they are and connecting them with services before they reach a point of crisis. This model takes mental health care from a state of crisis reactivity to a focus on whole health and wellness.

Legal Peer Supports

This form of peer support, officially referred to as “forensic peer support,” focuses on the criminal justice system, including law enforcement, initial hearings, jails, courts, reentry into society after release and probation supervision. A lot of the basics look similar to health care environments: meeting the individual, providing emotional support during a challenging and emotionally fraught time, finding and connecting them with services, etc. However, the peer can advise the system itself on approaches and different community support options for an individual.

For example: In my experience as an advocate, many courts do not wish to further institutionalize or criminalize someone as the result of a mental health or substance-use issue, but they have been limited by the options available. Frequently, I would provide options, such as community rehab facilities, that the courts were not familiar with as an alternative. I would share my personal experiences with the specific programs to both the court and the individual to argue that the option was worth pursuing. I would then follow up with the individual and connect them with said services, often accompanying them to their first appointment.

In the early days of my time with the courts, I was often asked by judges, attorneys and providers to share my perspective and provide insights into how to be better trauma-informed in our interactions with those who came before us. This allowed the court to reflect another core principle: "We will see the individual first and not the illness."

Peer support is essential for a comprehensive continuum of care. More than that, peers are essential to evolving our systems into something more effective, impactful, trauma-informed and recovery-focused. This barely scratches the surface of the potential applications of peer supports, but I hope it gives an idea of the impact peers can have on all the systems intersecting with mental health.

Micah Pearson is the Second Vice President of the NAMI Board of Directors. In 2021, Micah was appointed to and currently serves as a direct advisor to the New Mexico Governor's behavioral health council. As an artist, his art has been featured at the Smithsonian Arts and Industries Building. He has authored multiple books, the last of which was “A Peek Inside: Illustrated Journeys in Life with Mental Illness.” He has received multiple awards for his work in mental health advocacy, criminal justice reform and peer support.