This article is part of Mental Health Workforce Crisis: Effective Approaches to Improving the Pipeline
, a solutions-focused reporting series of Southwest Michigan Journalism Collaborative
. The collaborative, a group of 12 regional organizations dedicated to strengthening local journalism and reporting on successful responses to social problems, launched its Mental Wellness Project in 2022 to cover mental health issues in southwest Michigan.
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On a recent June day in Battle Creek, Matt Jones started his typical workday in a unique job that has grown to become an integral part of mental health providers’ teams: Peer Support Specialist.
First on his work to-do list: Locating housing for a person with a sex crime on their criminal record. As Jones was working on that, a call came in from someone who had bed bugs and needed to get their belongings cleaned. Then, Jones needed to leave the clinic to drive two people to the methadone clinic.
All that accomplished before 10 a.m.
Jones, 37, was hired in February as a peer support specialist at the Battle Creek SHARE Center
, a non-profit agency. (SHARE stands for Self Help Awareness & Recovery.) One of the requirements of this increasingly common position is lived experience. As in, having walked the walk.
“A peer support worker is someone with the lived experience of recovery from a mental health condition, substance use disorder, or both,” according to the federal “Value of Peers”
report from the Substance Abuse and Mental Health Services Administration.
“They provide support to others experiencing similar challenges. They provide non-clinical, strengths-based support.”
For Matt Jones, his strengths as a certified peer support worker are firmly rooted in his lived experience as a formerly homeless heroin addict, who now lives as a single father after his child’s mother died of a drug overdose. That traumatic event was his turning point. He has been through drug treatment court and mental health court. And he knows he never wants to go back to such a destructive lifestyle. He says the price is too high, and some people pay with their lives.
“Everything that I’ve learned in my addiction benefits me today in this job.”
A Response to a Growing Need
Working as a peer supporter is a labor of love. Demand is high for mental health services across many agencies in Kalamazoo and Calhoun counties, and many peer supporters are ground zero – serving communities that are marginalized, diverse, and in high need.
Integrated Services of Kalamazoo and Summit Pointe
are both Certified Community Behavioral Health Clinics (CCBHC) and are required to have peer support offered as a component of care. Other agencies in the area, such as Community Healing Centers, Recovery Institute of Southwest Michigan, and Recovery Services Unlimited, employ peer workers, and each of the agencies had peer specialist positions open as of June 2023.
Peer support work began in the 1970s and research and funding mechanisms that were evolving before the COVID-19 pandemic became a more pressing conversation as the demand for mental health services increased.
Matt Jones is Peer Support and Recovery Coach for the SHARE Center, a drop-in center near downtown Battle Creek.
“COVID helped people realize that isolation can be deadly,” says Detroit-based peer support provider Braunwynn Franklin, board president of the National Coalition for Mental Health Recovery and founder of 313 Network Solutions. “Our suicide rates went up. Our murder-suicides went up. People were stressed out.”
As behavioral health moves toward recovery-oriented models of care focused on trust-building and mutual respect, peer support work can prove to be a vital part of guiding clients through their recovery, says Margaret Ziemann, research scientist with the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University.
Employer demand for peer support positions nationally grew 17-fold from 2010 to 2020. While this data highlights the increasing need, Ziemann says there is no singular database to track and count the number of peer support workers across the United States. Ziemann and several colleagues published a report in February 2023 documenting the trend.
“Expanded use of peer support providers could help mitigate adverse mental and behavioral health outcomes by increasing individuals’ retention and engagement with behavioral health treatment and improving quality of life, among other benefits,” the report states.
The position may also go by other titles, such as peer specialists, peer recovery coaches, peer advocates, and peer recovery support specialists. The position is becoming more common as organizations are looking for innovative ways to meet mental health care needs in communities.
Almost half of the U.S. population lives in a region with a shortage of mental health care workers, according to the National Institute for Health Care Management. The COVID-19 pandemic increased rates of anxiety, depressive disorders, and trauma- and stress-related disorders.
Matt Jones is Peer Support and Recovery Coach for the SHARE Center, a drop-in center near downtown Battle Creek.
Matt Jones’ behavior while in active addiction caused him to be barred from drop-in services at the SHARE Center. But the Battle Creek-based nonprofit continued to feed him and engage him in classes to help him heal. Nearly seven years into his sobriety, Jones now serves as the first certified peer support worker for the SHARE Center, giving others hope and filling a much-needed role as the community continues to deal with the mental health workforce shortage.
“It’s living by example, living a clean lifestyle. I thought we were enabling people at first, but come to find out, we’re not,” Jones says. “We’re literally providing the bare minimum of their needs – the clothing, the food, the fellowship, water. They’re even building showers.
Stabilizing a Life Through Trust
The SHARE Center provides a mutually supportive safe space with resources for recovery for vulnerable people experiencing issues with homelessness, mental health, and/or addiction.
As Jones does the work of connecting consumers to tangible services, he’s also having conversations that make a difference. Jones says what makes him most effective is that he’s been in the streets with the people he’s serving. It’s important for him to let people know that they are loved and supported and that the SHARE Center is not giving up on them – as the center didn’t give up on Jones.
During Jones’ toughest times as a client, the SHARE Center worked on building a trusting relationship with him while providing direct services, and that’s what kept him engaged in recovery, says the SHARE Center’s Executive Director, Robert Elchert. The organization offers case managers and recovery coaches and received grant funding to add a peer support worker.
Elchert says Jones is one of the strongest people he knows and was truly suited for the job as a peer support specialist.
“You have to be very, very strong. Like Matt. You’re dealing with your own trauma and then taking on other people’s trauma as secondary trauma,” Elchert says. “Somebody who’s in recovery for substance abuse, you’re willingly subjecting yourself to other people’s substance abuse, which could be a trigger.”
Robert Elchert is the Executive Director of the SHARE Center.
The organization received a two-year grant for a peer supporter, and Jones has stayed busy providing direct support and making community referrals. Some days, he takes clients to local mental health agencies for services that range from talk therapy to medication appointments. Even with clinical services available, some of their consumers are more comfortable speaking to a peer support worker about what’s happening in their lives.
“A lot of folks we see down here don’t trust the traditional mental health system. They’ve been hurt by it. They didn’t get the help they needed,” Elchert says. “A lot of times we see that lack of trust, where we really thrive on that trust component. That’s another key difference or way that peer support fills in the gap.”
Kalamazoo-based nonprofit ASK Family Services (ASK) has used peer support models for both family services and youth services. In the case of youth, the organization hires peers aged 18-28 to serve youth with serious emotional disturbances.
Families have access to a family support partner — a parent or caregiver of a child with developmental, mood, behavioral, or emotional challenges who have faced and overcome barriers while trying to access services for their child. Latrieva Boston, ASK director of operations, says peer service is more about personal connections and helping clients find their own voices, while a therapist is using more clinical skills.
Robert Elchert is the Executive Director of the SHARE Center.
“Not only will we talk about basic needs, but the mental and emotional,” Boston says. “The therapist or case manager is looking at it from the therapeutic lens, they went to school, they’re using their clinical skills. Well, those clinical skills don’t transfer over to the peer world, because they’re sitting in a different chair.”
Boston began her career with ASK as a family support partner, giving her first-hand experience in peer support work. Now, as a supervisor post-pandemic, she speaks with pride about the staff of family support partners and youth peer supporters she’s coaching. Many times they’re called in as part of an intensive outpatient program team, and when that level of service is no longer needed, clients will still request to keep peer support.
“The connection that our youth and our peers
have built shows that they value us to keep us in their lives for a little bit longer. For some, we have been the most stable person sitting at that table on their team because case managers and therapists, especially since the pandemic, seem to change a lot,” Boston says. “Sometimes we have been with that family through two or three therapists or case managers and we’re still the ones sitting at the table. I think that gives them [the client] a sense of security.”
Beyond the Clinical Lens
Peer support specialists can work in a variety of organizations, and may be on teams with clinical staff that include behavioral health professionals, but the specialists are not considered clinicians. However, the perspective that peers add is invaluable as part of a holistic team aiming to meet clients’ needs both individually and systemically.
“Peer workers educate their colleagues and advance the field by sharing their perspectives and experience in order to increase understanding of how practices and policies may be improved to promote wellness and resiliency,” according to SAMSHA’s “Value of Peers” report.
“This is particularly important in mental health systems,” continues the report, “where historical oppression, violence, and discrimination present significant barriers to recovery for many people. Peer workers play vital roles in moving behavioral health professionals and systems towards recovery orientation.”
Franklin of the National Coalition for Mental Health Recovery, since 2007 has dedicated her time to working as a peer support specialist and trainer, and to advocating for the advancement of the profession nationally. She has struggled with her own mental health issues, had multiple hospitalizations, and has been on and off different medications as she navigated her mental health needs. In her experience, she says peer support allows for mutuality and empathy and allows the client to figure out what they want to pursue. This philosophy is different from the clinical approach, which generally looks for a problem to diagnose and ends with providers directing clients in how to treat a problem.
“When you go to peer support and share with them ‘OK, I’m feeling down, I’m feeling suicidal.’ They don’t immediately want to ask you, ‘Do you have a plan? Do you have a purpose?’ They don’t ask that. They ask, ‘How can I support you?’ or ‘What happened?’,” Franklin says. “When you go to a professional or a doctor, that’s the first thing they’re going to ask you: ‘Do you have a plan? Do you have means? Do you have a motive?’ And then
they look at how they can fix it. But I'm a person. I’m not broken. I’m having a situation. I’m having a circumstance, but I’m not broken.”
Peer support uses a trauma-responsive lens, says Franklin, who was recognized as the National Peer Leader of the Year at the 2023 Peerpocalypse Conference, a mental health conference focused on the peer community.
“We approach the whole thing differently because we know what we needed when we were having those situations and those challenges. That’s why it has been such a help in a lot of programs,” she says.
Peer support work is rewarding, but it’s not without struggle. There’s regular secondary trauma exposure, long work hours, or being on-call, and often low wages. There’s also the risk of relapse.
Just a few weeks ago, Jones found a syringe of heroin at work. He immediately took the drugs to his boss for proper disposal. They both say that the work they do requires a great deal of trust and communication. Elchert checked in with Jones to be sure he was OK.
“There are a lot of things in place to keep me safe. I do have the open-door policy with all of my bosses. I’m not afraid to talk. There’s a reason I’ve been able to stay sober as long as I have,” Jones says.
Jones maintains a relationship with his own therapist and values the support among colleagues. Elchert says the SHARE Center offers paid time off and mental health days and encourages staff to take the time they need.
At ASK, Latrieva Boston says the organization also keeps an open-door policy so staff can talk anytime, and they offer time off, plus one day each week to work from home. The office strives to have a comforting feel, she says.
“We have potlucks. We love coffee so we have all kinds of coffee in our office. One morning, I stood at the stove making a special, strong coffee, and it only makes one cup at a time, so I stood there for an hour just making coffee while we talked about cases,” Boston says, laughing. “There’s nothing wrong with that because we’re getting work done.”
Assessment of Effective Care
At the agency level, the SHARE Center collects its own data about the work it does. The Center currently relies solely on grant funding for its peer support program and is collecting data with hopes to obtain more funding to continue the work.
At ASK Family Services, the agency measures success through both informal satisfaction surveys with clients as well as clients’ scores on a functional assessment scale. It also uses a state survey that captures data about clients at different intervals of service. Because ASK currently relies on Medicaid funding to maintain its peer support programs, this limits whom it can serve. The organization did have grants before that allowed it to serve a wider variety of people.
Many organizations with peer support programs use grant funding, Medicaid reimbursement, or a combination of funding types to run a peer support program. But the cost of completing Medicaid documentation alone can outweigh the benefit of the low reimbursement rates, noted Clese Erikson, deputy director and lead research scientist of the Health Workforce Research Center at Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University.
Also, the uncertainty of grant funding can also make people hesitant to accept a job with a lack of security for long-term opportunities. That, combined with the time commitment, location, and expense of peer support worker training, can steer some agencies away from pursuing such a position on staff.
“There are a lot of barriers that could potentially be eliminated for this profession. Those are other factors that come into play that prevent people from entering the field or becoming certified,” Erikson says.
Both Erikson and Ziemann say training locations, criminal history restrictions and the lack of upward mobility in the career path can make it harder to obtain diversity in the field as well. Training clinicians on how to engage peer support workers will also improve outcomes, the researchers say.
“It’s not that you necessarily need to provide training for the peer support specialist to fit into the system as it is, but what would be helpful is if you provided training to those clinical leaders and other health professionals so that they better understood how having a peer support specialist on your team can better optimize care of your patients,” Ziemann says.
As for Braunwynn Franklin, she is using her national platform to continue to advocate for more peer-run services, like respite. She will continue training people on “Emotional CPR
” – which stands for Connecting, emPowering, and Revitalizing – a way to deepen listening skills and help instill safety for a person in crisis. The training takes some “unlearning” of typical clinical responses to “fix” a person who is having a mental health crisis through medications and hospitalizations, and instead listen closely to their needs.
Training and Certification
The average pay for a peer supporter in the Midwest region is about $16 per hour, according to the National Survey of Compensation Among Peer Support Specialists report published in 2016.
Michigan offers a state certification for peer support specialists, and a quick glance at job listings shows most agencies are looking for staff to become certified soon after hire. The application process for training includes a written application, two professional letters of reference, and a peer-to-peer telephone interview. The state currently requires five days of online training and a $300 application fee, then applicants must pass a test to be certified.
An applicant must be at least 18 years old, have a high school diploma or GED, have a primary diagnosis of a mental health condition, and have received mental health treatment for at least one year to be certified. There’s a code of ethics to be followed and certified peer support specialists have to complete at least 32 hours of approved continuing education/training during the two-year period prior to renewal of certification.
Family and youth peer supporters have different certification training through the Association for Children’s Mental Health. There are also other recognized training and certification programs both online and in-person, as well as supplemental training that might help peer support specialists on the job.
A Beautiful Thing
But Jones of the SHARE Center says the most important training as a peer supporter is lived experience. That, and learning to expect the unexpected.
“Don’t get into it unless you truly have the heart for it,” Jones says. “It’s the most selfless thing I’ve ever had to do in my life.”
Jones has already navigated obtaining services through systems he’s helping consumers use, but he also received training in cognitive behavioral therapy and substance abuse recovery, as well as in administering Narcan.
“I’ve lost my freedom. I’ve lost a child. I’ve lost relationships. I haven’t been able to get a lot of those things back. There’s been things I can’t reverse. And I paid my debt to society,” Jones says. “There were courses I had to go to, but being here and helping people and living it has been the best training I’ve gotten.”
Jones says during an interview that he was looking forward to taking two people to drug rehab the next day. He was in preparations to help them get the aftercare needed to stay sober.
“Sitting down, talking to these people, and getting them into rehab, they’re all ecstatic because now there’s hope. And anytime you have hope, it’s a beautiful thing,” Jones says.
“We didn’t come this far to only come this far.”
Photos by John Grap.