Ideas for Certified Peer Support Specialist

By Melissa McKinstry, Board Member for the Right Door for Hope, Recovery and Wellness & Serves on Board of Directors for Community Mental Health Association

Following Melissa McKinstry’s first writing, posted here on CMHA Connections, she continues sharing her experience saying, “I have been thinking about some of the changes I have seen in the public mental health system in my forty-eight years as a person served. Certified Peer Support Specialists are a special member of the treatment team, straddling both the world of clinician and person served.”

This morning, I was thinking about some of the changes I have seen in the public mental health system in my forty-eight years as a person served. I was trying to decide which change was the most noticeable and had the most positive effect on my life. Was it DBT, changes in how I wrote my PCP, Drop-In Centers or Clubhouses, the closure of sheltered workshops, CBT or something else? While the specific items listed each had a notable impact on my life, it was something else that was the most influential. That change was the introduction of Certified Peer Support Specialists. Master’s Level Social Workers have been and are very important to my treatment and recovery – I would not have survived without their expertise and support. Certain aspects of what I need to grow are out of their realm, however. Exercise classes, money management, writing for recovery, gardening: all enrich my life, and the lives of other persons served, but Social Workers do not provide such services. We depend on Certified Peer Support Specialists for them.

Very few social workers are also persons served. Certified Peer Support Specialists, on the other hand, have, by definition, lived experience with a mental illness. Many continue to deal with behavioral health issues. Unlike the majority of social workers, they can offer suggestions for coping with symptoms that they have actually tried and found to work. They know what it is like to be presented with a diagnosis, to take medications with unpleasant side-effects, and, perhaps, to know what it was like to have to take medications they felt were unnecessary. They have a special relationship with others of us served by the public mental health system because of our shared experiences. Along with that, the Peer Supports are living proof that it is possible to cope with symptoms and the rigors of treatment, and that recovery is possible. When they work with social workers and other clinical staff, we – the persons served – win.

In my CCBHC, Peer Supports meet people one on one to teach interpersonal skills, encourage community engagement, act as emotional supports, help the person served run errands, help with scheduling appointments, make sure the person served keeps appointments, find housing, and fill out paperwork, among other things. They accompany persons served to medical appointments. The Peer Supports lead groups to teach skills such as cooking, money management, and real-life math; various exercise groups; groups to encourage creativity. They put on community events such as the Back to School Bash and the 5-K Walk, Run, Roll,  and many other activities. That is a lot. They are a very important part of the agency.

Certified Peer Support Specialists perform different duties in various areas around the state. I have a few ideas that I would like to see universally employed throughout our public system. I believe some of them are being used already in some places, but I don’t know about the others.

The first two places I would like to see Certified Peer Support Specialists in universal use are mobile crisis units and Emergency Departments when pre-screens for inpatient admissions are being conducted. I believe both of these are practiced in some places. I advocate for Peer Supports in Mobile Crisis Units because the person is in crisis and being surrounded by strangers asking questions and perhaps law enforcement, can be very frightening in the best of times. When in a mental health crisis, the fear is often exaggerated. Having a person there who has been in a similar situation and can understand the feelings of the person everyone is trying to help in a way that only experience can provide, would, I think, often be useful.  I would like to see Peer supports in the ED because, looking back, I would really have liked to have someone who had experienced what I was going through to talk to and to tell me what to expect. Being in an ED with the commotion and noise, doctors, nurses and sometimes the police all milling around and asking personal questions is bewildering at best and frightening otherwise. I would have appreciated having had someone who had been through it available to inform me as to what was happening and what I could expect.

Related to an admission pre-screen is the Assessment for receiving services at a CMH, CCBHC, OHH, or BHH. I do not know whether anyone does this or whether it is allowed, but I would like to see Peer Supports involved in the Assessment processes. The CPSS would be there as a guide. He or she would introduce themselves, welcome the prospective person served to the facility and then describe to the person what is going to happen to them during the assessment. If more than one examiner is involved in the process, the Peer Support would tell the person who they would be seeing and why they had to see more than one person. The Peer Support would also explain that some questions may be asked more than once, that that is necessary, and instruct the person to simply answer the questions to the best of his or her ability. I think this would be helpful to the person being assessed and would possibly reduce some of his or her anxiety, thereby resulting in more consistent answers to questions and better data.

Finally, I think Certified Peer Support Specialists could be useful in the Person-Centered Planning process. I have read a number of my friends PCPs over the years and wondered how in the world they got away with stating their goals as they did. The one that amazed me the most was, “I don’t want to be depressed.” This is not a PCP-worthy goal, in my opinion. None of my friends’ goals were S.M.A.R.T.: Specific, Meaningful, Achievable, Relevant, and Time-bound. This is a small sample, but I do not think it is exceptional. I think PCPs would be more effective if people were trained in how to write goals before the day of their PCP. I also think it would be helpful if they, and, if possible, their supports, were asked to think about what they believe ought to be addressed before the day they get together to write the PCP. The CPSS would be responsible for teaching the person served to write S.M.A.R.T. goals, encourage them to consider what they think is important in life and to begin to form aspirations for the coming year or six months, It also would be helpful if the Peer Support could contact the supporters who will be attending the person’s PCP meeting, perhaps via a letter or an email, to explain the PCP process. These actions by the Peer Support Specialist would speed along the actual planning meeting, save the case manager/supports coordinator time, and I hope, result in more meaningful plans.

Certified Peer Support Specialists are a special member of the treatment team, straddling both the world of clinician and person served. I think we should take advantage of all they have to offer.