By Taylor Knopf
There are two groups of people most familiar with mental illness: psychiatrists and those who live with it. So Cherry Hospital is hiring both.
Cherry, a psychiatric inpatient treatment facility in Goldsboro, is the first state-run hospital in North Carolina to add certified mental health peer support specialists to its staff. The hospital has five peers who are integrated throughout the hospital.
They meet with every newly admitted patient, tell their stories and answer questions. They advocate for patients, consult with treatment teams and advise on hospital administrative committees. Peers also assist with patient discharge by helping people about to return to their communities to build support systems.
Every new hospital hire, from physician to janitor, meets a peer and hears their story about mental health recovery.
Not only does Cherry incorporate the expertise of mental health peer support specialists, but the hospital also has a group of active patients who attend almost every administrative meeting, review policy changes and vet new hospital products, such as bed mattresses.
Listening to people who live with mental illness provides a unique perspective that hospital clinicians say they would otherwise not be aware of. Hospital officials said that peers assist with patient treatment because they are relatable. Patients open up to peers in a way they may not with medical staff.
A hand from the other side
At Cherry, treatment teams consisting of psychiatrists, doctors, nurses, social workers and dieticians meet regularly to discuss their patient caseload. These teams frequently request a peer support specialist.
“We truly don’t understand a lot of the experiences that our patients have had. Whereas these people really do,” said James Mayo, a physician and Cherry’s clinical director.
“Or our patients might not trust us enough to tell us,” he added.
Mayo said there’s a lot of talk in psychiatry about being “culturally aware,” and most people think of that in terms of ethnic or religious backgrounds. But he said there are other cultures that medical professionals don’t always understand, such as what it’s like to be homeless or incarcerated.
“That’s a big thing,” agreed Lesa Mutters, Cherry’s Hope and Wellness Center program director.
“The initial relationship building happens easier and quicker with peer support specialists because right away there’s someone who’s been there,” she said. “They can say, ‘I’ve been to jail, I’ve been hospitalized, I’ve been homeless, I have suffered with addiction.’”
Peers help run every new patient orientation, and it was the peers’ idea to create and hand out welcome bags with items that would make people more comfortable as they enter an unfamiliar setting.
“I knew that putting a peer right there in the beginning would help to ease anxiety and just help people feel connected,” Mutters said.
The peers worked with occupational therapists to get approval on some of the sensory items, such as stress balls. The kit also has socks, playing cards, tissues, a notebook, a welcome letter and a patient-designed calendar.
Mutters said the calendars were added later as a result of patient feedback. It features patient artwork and frequently asked questions about treatment and the hospital. Cherry has handed out 700 since they began the welcome kits last year.
Amanda Thompson has been a peer support specialist at Cherry since October and said this is the first time in her career that doctors have asked for her input. She worked in outpatient children’s behavioral health for 10 years before Cherry and said the providers wouldn’t listen to anyone without letters behind their name.
“They thought that since they had this title, that they knew everything and they wouldn’t budge at all,” Thompson said.
She said the peer involvement at Cherry is “unique” and that she thinks including different perspectives is great, especially in a hospital setting.
“I tell patients in orientation, ‘I don’t know exactly what it’s like to be you, but I have somewhat of an idea of what it’s like to be you.’”
Navigating process, pitfalls
Thompson said she has a lengthy personal story about her mental health journey. She demurred on details but said she draws on what she believes will be most helpful in relating to the patient or group she’s talking to.
Mayo said peers help him think through a lot of scenarios like a complicated living situation that might jeopardize a patient’s recovery once they go home or something as simple as taking medication. He said patients frequently agree to take their medications with little discussion. Then he finds out later they never intended to continue it once they were discharged.
Thompson said she takes medication for Attention Deficit Hyperactivity Disorder, and it’s something she talks to patients about a lot.
“I know what it’s like to not want to take medication. Most patients in here go through that struggle,” she said. “I thought medication was going to make me a zombie, and I thought it took my personality. And it did for a couple weeks, but I wasn’t patient enough. So I know what it’s like to be frustrated and have to go from medicine to medicine to medicine.”
The peers listen to patients and also help them express their thoughts to providers. They have a level of confidentiality with patients.
Thompson said she reminds patients that they have rights, and to always ask questions.
“They feel more comfortable talking or asking us questions because we shared an experience about ourselves that they can relate to, as opposed to thinking that people are,” she paused, before continuing. “I don’t want to say looking down on them, but sometimes it feels like that.”
Peers also go through all the questions the treatment team will ask so patients have answers prepared.
“It can be overwhelming because it’s a room full of people and all eyes are on you: the doctor, social worker, psychologist, nutritionist, the treatment planning coordinator, and they don’t even know who that is,” Thompson said. “And all these people just staring at you, then talking, then writing, then talking, then they’re writing.
“It’s very intimidating.”
Because there aren’t a lot of peer support specialists in communities, especially in rural areas, the peers at Cherry are always looking for natural community supports for patients when they leave.
“We know they need clinical services. We know they need a psychiatrist appointment,” Mutters said. “Peers are thinking about what church they might go to. Where the AA group is, stuff like that.”
The median length of stay at Cherry is three weeks, and the hospital receives 65 to 90 admissions per month. But there are some patients who will stay for months, or years.
Thompson and other peers help every patient create their own Wellness Recovery Action Plan (WRAP) before they leave.
To create the plan, peers walk a patient through a few stages, starting with describing what life looks like when the patient is feeling their best. Then the patient describes the order in which things start to break down before they end up in the hospital. They also list the triggers and stressors that can cause life to unravel.
The idea behind the plan is to notice signs and symptoms of an impending crisis so the person can get help or intervention before winding up back in the hospital. Thompson said the signs can be small things like maybe the patient hasn’t showered in several days or the trash in the house is piling up.
The plan includes designating trusted people to watch for these signs and reach out to ask if the patient is OK. It also includes creating a crisis plan.
“Who are the people you trust to handle you when you can’t handle yourself?” Thompson said.
“What medications you like and do not like? Do you have allergies or medication side effects? What facilities would you prefer? Maybe you don’t want to go to a hospital. Maybe you want someone to come stay with you for two weeks,” she said.
“If you are going to treatment, have someone lined up to watch your dog. What’s the plan when you come home? If you use substances, is there someone to go in and remove them from your house?”
The peers at Cherry also created a discharge packet specifically for anyone who has ever used substances before called Recovery Lifeline. It has harm reduction materials, advice for staying safe if they find themselves using again, and community resources by regions.
Listening to patients
Not only do officials at Cherry seek advice from certified peer specialists, but they also rely on input from active patients as well.
Cherry has a “quality council” of eight to 10 active patients who have daily meetings led by a peer specialist and a social worker. The administration runs everything by them, from new programs to policies. The group plans events and special dinners for the hospital. They also help make purchasing decisions. For example, when the hospital needed to buy new mattresses, the quality council tested several brands and picked one.
Mayo said he thinks this model is unique. He noted that many hospital boards have a former patient or family representative, but he didn’t know of any with an active patient group giving feedback directly to the administration.
The quality council also helps solve problems. Recently, the hospital had a safety concern because patients were bringing large bags and suitcases full of their belongings from the housing units to the treatment mall where more than 100 groups of classes meet on a 12-week rotation. So the staff asked the council for suggestions.
They came back with the idea to issue small bags to patients that only hold a certain number of items. That way patients could still bring a few belongings to class without lugging around suitcases.
There are no criteria to join the quality council. It’s based on patient interest.
“Someone that’s passionate and wants to make a difference, that’s who we want to hear from,” Mutters said. “We want them to help us do things better.”
The group has created surveys for their peers to get feedback and suggestions. Recently, patients have asked for more technology in the classes. So Mutters will request money for iPads.
She sees the quality council as another form of treatment.
“It helps them learn how to advocate,” Mutters said. “I tell people, think about how hard the mental health system in the community is to navigate. I would hate to be a service recipient with mental health treatment in North Carolina.”