Recovery in Action: Peer Support as a Profession

4/7/2023

Many of us in the mental health field or helping professions are what Carl Jung described as "wounded healers", but no profession is better suited to this archetype than that of the peer support specialist. This last year, I took Peer Support 101 with Montana's Peer Network and became certified as a peer support specialist. To be quite honest, the training itself was a huge catalyst in some of the amazing steps I have taken in the past few months. In fact, I would say that being a peer support specialist has changed my life, and I think everyone should know about it.

What is a Certified Behavioral Health Peer Support Specialist (CBHPSS)?

To become a certified behavioral health peer support specialist (CBHPSS), you must be diagnosed with a mental illness and/or substance use disorder. You also have to have been in recovery for over two years (typically, this is shown by not being admitted to a hospital or rehab center for behavioral health issues, maintaining sobriety and wellness, and not being charged with a crime or serving jail time for two or more years). If a person meets these requirements, then they may go through specialized training in order to support individuals in the community that are currently struggling with mental illness and/or addiction.

Peer support training includes suicide prevention, reducing access to lethal means, crisis intervention, ethics, and diversity and inclusion training, among other vital topics. The training may include learning how to do a "recovery talk", which is a way to discuss your own story in a cohesive and appropriate manner-- a difficult, but important skill as a peer support specialist. In Montana, peer support training must be at least forty hours and include an examination. After passing the exam and completing the training, peer support specialists go through a background check with the Department of Justice. If a peer support has a history of being involved in the justice system, there is an appeal process to demonstrate that a person has been successful in following through with probation and refraining from further involvement with the penal system.

After this process, peer support specialists submit an application and fee to the state that they reside in. To maintain their certification in Montana, peer support specialists must complete 20 continuing education units per year, as well as having supervision from a licensed behavioral health professional (such as a licensed clinical social worker, licensed professional counselor, licensed addiction counselor, or psychologist). They are required to have one hour of supervision for every 20 hours of direct peer support work. They must also be aware of how to write appropriate documentation for each peer support session. Peer support specialists must uphold the code of ethics and refrain from unethical decisions when working with individuals in the community.

Here is a link to an infographic that takes a broader look at peer support across the nation, and contains information about Nationally Certified Peer Specialists (NCPSs).

What's so special about peer support?

Sure, we have therapists, psychologists, psychiatrists, and licensed addiction counselors-- so why add an extra person to the mix? Well, peer support is a wonderful addition to mental health and addiction treatment in many ways.

Peer support is a recovery and wellness-based profession.
What does that mean? Well, therapists, psychiatrists, etc. often use a medical or treatment-based model. They diagnose and treat mental illness, addiction, or co-occurring disorders. While this is highly useful and necessary for many individuals, peer support specialists take a different approach. Part of the work we do is telling our stories of recovery and what that means to us, which can communicate to those we work with that they are not alone, that others have some of the same experiences as them, and that there is hope. We see recovery as a process that is continual, because people should not feel as though something is inherently wrong with them that needs to be "cured". We work with wellness and recovery models to identify what motivates an individual and what areas of life that they need most support in to reach their goals. Then-- we give them support! We can also connect them to community resources, social programs, and other wraparound services.

Peer support provides additional social connection and support
Many studies have shown that social isolation is a factor in addiction and choices that may negatively affect an individual's mental and physical health. This has been famously studied in rats, like in this study where rats chose spending time with fellow rats over ingesting drugs such as methamphetamine and heroin. When individuals are given an option to engage in positive social connection, drug/alcohol abuse and self-destructive behaviors can be greatly reduced. This is where peer support specialists come in. Being a peer support doesn't require a fancy degree; it just requires being a person in recovery! Therefore, individuals at times may feel more comfortable spending time with a peer support specialist. They may be closer in age, socioeconomic status, gender, or education-level to their peer. This can foster authenticity, openness, and a positive connection. Sometimes, peer support specialists can even meet their peers in their communities, making peer support even more accessible and giving the peer a chance to be in a safe space, or take risks and go on a hike, to the gym, to coffee, or to other fun places!

Peer support specialists can relate to individuals with behavioral health difficulties in a way that clinicians can't due to the nature of their jobs
Although I am a peer support specialist, I am also working on my master's degree in counseling and expressive arts therapy. As a counselor, there are more limitations on what we can share with clients. Though much of the stigma has reduced in recent years, it is still somewhat stigmatized for therapists and counselors to have histories of mental illness and substance abuse. Some self-disclosure is okay, but the main focus of therapy is on the client and the treatment methods that will best help them! Though peer support specialists are coached to disclose in appropriate and positive ways, there is less restriction on self-disclosure, because disclosure is part of the profession! Though therapy, psychiatry, and addictions counseling are vital to the treatment process, peer supports simply have an advantage in this way. Peer supports can also model healthy self-disclosure, so that clients can learn how to share their own stories without affecting their relationships or their feelings of safety in a variety of settings.

Peer support may be more culturally appropriate for some individuals
Some individuals may have grown up in a culture that stigmatizes going to a therapist or psychiatrist. These individuals may feel more comfortable going to alternative professionals or traditional healers. Though peer support specialists are associated with the behavioral health profession, some individuals may feel more comfortable with a peer support specialist than a therapist due to the associated stigma of "needing therapy" or going to a "shrink". These individuals still deserve and need care, and it's possible that a peer support specialist with a similar background could reach them in a way that others cannot.

It is also important to note the diversity present in the peer support profession itself. As opposed to therapists, who, as a whole, are made up of 74% white individuals (Zippia, 2023), peer support specialists in the US have slightly more diversity, being made up of 67% white individuals (Zippia, 2023). This makes the peer support specialist profession actually MORE racially diverse than the United States as a whole (~76% white).

As people of color are over-represented in areas such as incarceration, especially for substance-related crimes, (Black individuals represent up to 5 times the amount of white individuals in jails and prisons, and more in some states), this number is significant. Studies have also shown that "56% of state prisoners, 45% of federal prisoners, and 64% of jail inmates were determined to have a mental health problem" (Geller, 2020). Therefore, because peer support specialists are more diverse, they can better serve the previously-incarcerated population and prevent recidivism by giving individuals culturally appropriate support and reducing the systemic barriers that prevent people of color from accessing care and funnel them back into the prison system.

Barriers in the Peer Support Profession

Organizational influences
A study noted that organizational influences can be a barrier to peer support. Organizations that are based on a more hierarchical structure, such as acute units that favor nurses and psychiatrists over mental health workers, tend to do more poorly in organizing and maintaining peer support specialists as part of their workforce. Organizations that fully accept the roles of peer supports as part of their system or peer-led organizations tend to function much better! (This is not to say that hierarchical organizations can't learn a thing or two!)

Legislature
In Montana, efforts to create a credentialing process (similar to a license) for peer support was tabled. This is just one example of how progress in the peer support profession can be stalled or halted by legislative processes. Legislators may table bills for a number of reasons, including what they believe it will cost the state. Many peer support specialists are part of the advocacy process, down to drafting bills themselves! Reach out to your local behavioral health advisory committee or peer support committee for more information on this process.

Role confusion
An important part of the workplace is having a clearly defined role. Organizations that give peer support workers unclear instructions or overload them with responsibilities function poorly. Due the potentially distressing nature of their job, peer support specialists need jobs that have good work-life balances, that teach healthy boundaries, and that clearly state their roles and give them appropriate training. This includes training on patient confidentiality and appropriate disclosure

Working with others
In larger organizations, some people are prejudiced towards peer support specialists (shown in this study), and therefore may be resistant to hiring them or working with them. That is why it is so important to teach about peer support so we can reduce stigma. Though we can't change everyone's minds, by creating a more well-informed public overall, we can influence policies and enact change.

Socioeconomic factors
Some larger organizations may not pay peer support specialists as much as some might argue that they should get paid! In part, this is due to the fact that some states have restrictions on what type or organizations can hire and bill for peer support services. In Montana, mental health centers (MHCs), licensed substance use disorder clinics, Indian Health Services and other organizations listed here can bill for peer support through Medicaid. When searching for a job as a peer support specialist, make sure that you are satisfied with the pay you will be receiving. It is up to us to advocate for better pay as a whole!

Some peer support specialists, once certified, can work as independent contractors, and therefore may have some part in negotiating their own pay. However, know that you must have a supervisor either within that organization or on your own, as well as being able to complete the appropriate documentation, and regularly pay income taxes quarterly or annually. You must also have your own liability insurance. You may be required to license yourself as an LLC (which, depending on the state, is surprisingly affordable). If you want to pursue this path, do plenty of research, and be sure to have people on your side to help inform you about your financial and legal obligations!

Conclusion

People with mental illness and substance use disorders so often face stigma and discrimination in the workplace. However, in the peer support profession, our experiences are actually appreciated and rewarded, and can be utilized to help others that are at different spots in their recovery or are in the same dark places that we've had to claw our way out of ourselves.

Peer support specialists have amazing communities amongst themselves. In fact, I recently attended a webinar with Montana's Peer Network, made some new connections, and again got to be a part of the wonderful, vulnerable, and resilient spaces that peer support specialists create wherever they go!

If you have experienced mental illness, trauma, or addiction and are in a place of recovery (or are getting there!), I highly recommend thinking about becoming a peer support specialist. There are so many opportunities, and not just as a peer support! You can be a public speaker, a writer, an advocate, and a peer educator. There are endless possibilities! If you choose this path, you will meet some amazing people along the way, and have many opportunities to grow as a person and be exposed to a community filled with love, hope, and empowerment.

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