By Lisel Blash, MPA
After losing his job in the corporate sector, Josh was homeless and in and out of jail for several years. “Until I had my diagnosis; I thought everyone heard voices,” he said. The realization that he had a mental illness made Josh take action. After seeking treatment, he volunteered for homeless shelters and soup kitchens because he “wanted to give back.”
Eventually, a fellow volunteer gave him a job application. “You are already doing the work,” she said. “You should get paid for it.” He signed up for training to become a certified peer provider, a special type of behavioral health worker who uses lived experience in conjunction with training to help others recover from mental illness and/or substance abuse. He got a job working for an innovative program providing peer support to incarcerated and recently released individuals recovering from mental illness and seeking to transition back into their communities.
Our understaffed public mental health system cannot provide the long-term support that helps individuals learn to manage their own recovery and stabilize their lives. Peer providers like Josh can help fill that gap, meeting with individuals in hospitals, jails, or in the community, coaching them to follow up on medications and health care; helping them access housing, food, transportation, and employment; accompanying them to court, or just providing someone to talk to.
Peer providers’ lived experience helps them build rapport with others who have experienced mental illness, addiction, homelessness, and incarceration.
As one supervisor observed, “I had a peer on my team and he could go there and talk to the client on that level and he could connect in ways that I couldn’t. It was like, “I walked where you walk; I understand and I get it.”
Some states have adopted statewide policies that standardize training and allow organizations to provide peer support as a Medicaid-billable service. This provides a more reliable funding stream for these programs, which have typically depended on grants. California is one of the few states in the US that has not done so—but this may change: in January, Sen. Jim Beall introduced a bill that proposes statewide training and certification for peer providers in mental health and addictions recovery and recognition of these workers as providers in the Medi-Cal program. If passed, this bill could provide a reliable funding stream for the peer provider workforce and enhance the legitimacy and expertise of the role.
Healthforce Center has completed two studies on the emerging peer provider workforce. Our new paper in the American Journal of Preventive Medicine examines promising practices in states that have developed statewide training and certification for peer support leading to the ability to bill Medicaid for these services. Another report, funded by the California Health Care Foundation, explores the role of peer providers in California programs that help individuals transition out of psychiatric hospitalization and incarceration.
Though his job doesn’t pay well and can be stressful, Josh is grateful for his role as a peer provider. It helps with his own recovery and allows him to be “out” about his condition. Many with lived experience with mental illness face stigma in the job market and in other social interactions. Peer support may provide a gateway back into employment for many and may help alleviate the behavioral health care workforce shortage.
Lisel Blash, MPA, is a senior research analyst at Healthforce Center who focuses on innovative and emerging models of care for frontline health care workers.