Image courtesy Texas A&M University, flickr creative commons


By Rose Hoban

Dona Allen is not a woman who looks as if she could have been a crack addict. Tall and elegantly dressed with matching jewelry, Allen is calm as she describes several years in the late 1980s and early ’90s when she smoked crack, traded sex for drugs and sold her six children’s food to support her habit.

“I was out on the streets, having sex behind abandoned houses … just doing ugly stuff,” Allen admits. She lost custody of her children, overdosed and was homeless for months.

Map courtesy the Peer Support Specialist Program at UNC-Chapel Hill
Map courtesy of the Peer Support Specialist Program at UNC-Chapel Hill. Click on map to see updated map of county peer counselors.

Allen, 52, eventually found sobriety in a renewed faith augmented by Bible study and frequent 12-step meetings, like Alcoholics Anonymous and Narcotics Anonymous. Now she’s doing well. She’s been sober and working for more than 15 years, and all but the youngest of her six children have finished school. Several have gone on to college.

That’s why in the fall of 2011, Allen was back in church in Greensboro. Along with several dozen others, she attended a training aimed at helping others get off of drugs and manage their mental health problems.

Allen and the others are now certified peer-support specialists, a designation of counselors who help people with mental health disabilities get well and navigate North Carolina’s mental health system by drawing on their own experiences. Peer-support specialists play a relatively new role in the mental health system, but they’re becoming increasingly important. And there are more of them.

“A ‘peer’ is someone who has experience of managing their mental health challenges,” said Sarah Bobo, who led the training. Bobo is a director of supportive services at the Mental Health Association in Greensboro (She has since left the agency.) Bobo lead the training for the group, many of whom will go on to get jobs as peer-support specialists at mental health agencies around the state.

“Every person is capable of recovery from their mental health problems,” she said. “but that looks different for everyone.”

And that’s where peer supporters come in, Bobo said, because people who are actively struggling with mental health problems often need someone who can relate to what they’re going through to help them navigate both the feelings and the system.

“I think peer support has been a missing piece in the mental health and substance-abuse system,” said Cynthia (Syd) Wiford, coordinator of the Behavioral Healthcare Resource Program at the UNC School of Social Work. The North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services contracted with Wiford’s center to run peer-support certification around the state.

“I’m a licensed counselor, but a lot of times a professional has to work pretty hard to establish a relationship of trust with the person in crisis,” Wiford said. “But with the peer, the rapport is instant. Give me a good peer on my team, someone who has experience with recovering from a mental health problem themselves, and we’re unstoppable.”

photo of someone listening to another person
Peer counselors can give support because they have had experience with many of the issues people with mental health issues face. Image courtesy of Alan Cleaver, flickr creative commons

The idea of people with mental health problems helping one another has been around since the 1960s, but the concept really took off in Georgia in the 1980s with the creation of a peer-support network. Now peer supporters work in about half the states, and the model is considered to be a “best practice.”

North Carolina initially applied to Medicaid to have peer-support specialists reimbursed by the federally funded program. But the Centers for Medicare and Medicaid Services said no, even though peer-support specialists are relatively low-cost workers.

Then the Division of Mental Health asked mental health agencies around the state to propose ways of using peers in their programs, made money available to pay for them and made it easier for people to get certificated.

“And it just exploded,” Wiford said. “We had days when there were 20, 30 applications coming in a day.”

In 2009, North Carolina had only about 250 certified peer-support specialists. By August 2014, that number had reached to more than 1,370, and peers are employed in mental health agencies throughout the state, working as advisers, members of community crisis teams and one-on-one supports to people struggling to get their lives together after a mental health crisis.

People with mental health problems get paired up with someone who has a similar problem but who is managing well and is more integrated into the mainstream. Peers help by encouraging their clients to stay on their medications, for instance, or by helping them to navigate an often-complicated social service system to get the treatment they need.

“They can give out their phone numbers and say, ‘Call me,'” Wiford said. “The value of that voice on the phone, or someone willing to see how you’re doing … so many times, that’s what these huge systems are missing. It’s not just the counseling technique; it’s knowing that there’s someone there to go through it with you.”

That’s how it is with Anthony Pugh, 58, who finished the certification training in Greensboro. Pugh spent a decade living on the street in Winston-Salem, bedeviled by symptoms stemming from a combination of schizophrenia and bipolar disorder. Now he’s married and living with his wife, Lois, in Asheboro. Lois also finished the certification program.

When asked what prompted his recovery, Pugh said, “A voice just came to me: ‘You gotta take your medication, you gotta take your medication.'”

That was the start of a decade-long process that’s put Pugh in the center of the mental health-advocacy movement in North Carolina. He now sits on several statewide boards and was named Advocate of the Year by the state chapter of the National Alliance for Mental Illness.

“I can talk to people because I have experience,” Pugh said. “Not only do I have an illness, but I’ve educated myself on my illness. I know the ins and outs of the mental health system, and I’ve been able to effect change through NAMI.”

Bobo said one of the most powerful aspects of the peer-support model is that people who are currently struggling can see that it’s possible to recover from even serious mental health problems. Mental health recovery isn’t a clean, linear process with a set outcome, like the process of healing a broken bone. Instead, it’s often filled with setbacks.

Bobo said that can be hard for people who have never experienced a mental health issue to understand.

“In the mental health-recovery model, relapse is part of the process,” she said. “Peers help clients identify their own early-warning signs and take steps to avoid an impending relapse. Or they help them develop a crisis plan to help them get help and recover if they do relapse.”

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