National Peer Certification

Jennifer Maria Padron, MEd, CPS, PhDc Public Health
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Health disparities between the seriously persistent mentally ill (SPMI) population and general population exist which are alarming (MHA, 2008).  A report issued by the National Association of State Mental Health Program Directors (NASMHPD, 2006) stated that the rates of morbidity and mortality among people living with a chronic, episodic serious persistent mental illness are increasing (MHAT, 2008).  Individuals living with an SPMI are dying, on average, 25 years earlier than a person not experiencing SPMI (Elias, 2007).  While largely preventable, physical comorbidities (e.g., Respiratory disease, CDV, Diabetes), are deemed a side-effect of using long-term psychotropic medication prescription.

The National Association of State Mental Health Program Directors (NASMHPD) issued a position paper in 1989 recognizing that mental health consumers have a unique contribution to make to the improvement of the quality of mental health services in many arenas of the service delivery system. NASMHPD recommended utilizing consumers to assist with program development, policy formation, program evaluation, quality assurance, system designs, education of mental health service providers, and the provision of direct services (as employees of the provider system).

Within the context of a peer driven workforce, NASMHPD stated that consumers should be included in meaningful numbers in all of these activities. In order to maximize their potential contributions, their involvement should be supported in ways that promote dignity, respect, acceptance, integration, and choice. Support provided should include whatever financial, educational, or social assistance is required to enable their participation.  The terminology has changed to developing peer leaders and providing peer-to-peer support and treatment.  (NASMHPD, 1989)  In July of 2003 the President’s New Freedom Commission Report on Mental Health stated that mental health care should be consumer and family driven.

Consumers working as peer service providers help expand the range and availability of services and support which professionals offer. Consumer providers also bring different attitudes, motivations and insights to the treatment encounter and overall continuum of care.  Consumers are trained and hired as mental health peer whole health coaches to join a fostering human service workforce.  Peers are trained to share their own personal experiences of recovery from mental illness and open doors that otherwise would remain closed due to the stigma and shame associated with mental illnesses.  Integrating them into traditional behavioral health programs may result in professionals experiencing firsthand the valuable contributions peers have to offer.

Well-trained peers can be a valued and important component of a treatment team.  Peers create an environment that encourages and supports healthy futures and even helps individuals in the middle of mental health crises believe that they can and will experience a healthy future.  Creating healthy futures is critical for everyone and adults diagnosed with a serious mental illness should not be overlooked.  This provides an incredible economic opportunity for disadvantaged individuals.

A peer workforce that is trained, work-ready and skilled not only effectively changes life for the peers employed but for other potential Peer Whole Health Coaches and for the providers and provider agencies they work in.  Peer Whole Health Coaches develop skills and abilities in teaching life skills including: financial literacy, housing assistance, job training, and nutritional assistance.  Working helps these individuals overcome their disability and reach and maintain recovery by providing income and motivation.  The act of giving back to the community has additional long term and lasting rewards that provide access to the basics:  food, clothing, shelter, medical care, and a social support network.  The peer workforce coaches people about accessing health care, disease prevention, health promotion initiatives, and health literacy.

Peer specialists are an untapped workforce who create an atmosphere of hope and acceptance often times working side by side with medical professionals.  Peer Whole Health Coaches provide evidence and support, demonstrating that recovery is possible. Integrating peer specialists into the workforce can and does reduce the stigma of mental illness. Peer Whole Health Coaches often completely change clinical staffs’ perceptions of their clients because they see them as people first, rather than exclusively as a person with a mental health diagnosis.

Stamping out stigma, one person at a time, occurs when peer specialists are respected members any “treatment” team. The Substance Abuse and Mental Health Services Agency (SAMHSA) hallmark and innovative 10×10 Wellness Campaign was established in 2010.  The 10×10 Wellness Campaign established the  importance of improving the eight  dimensions of a person’s life (Swarbrick 2006) with a goal to increase life expectancy for persons with serious persistent mental illness  by 10 years over the next 10 years to 2020.  Currently, where I live in the State of Texas, mental health consumers living in community mental health programs are dying on average at the young age of 52 (SAMHSA, 2011).  The 10×10 can aggressively work to increase individuals’ lifespan by ten years to age 62 years of age.

According to UMDNJ and CSP-NJ’s Dr. Margaret (Peggy) Swarbrick (2006), eight dimensions make up a personal’s life.  The dimensions are social, physical, emotional, spiritual, occupational, intellectual, environmental and financial.  The social includes the development of a sense of connection and a well-developed support system.  The physical realm recognizes the need for physical activity, diet, nutrition, and sleep while discouraging the use of tobacco, drugs, and excessive alcohol consumption.  The emotional world includes developing skills and strategies to cope effectively with stress, challenges, and conflict.  The spiritual world includes searching for meaning and purpose in human existence in one’s life.  The occupational links the individual into deriving personal satisfaction and enrichment from one’s work.  The intellectual recognizes that there are creative abilities and the need to find ways to expand knowledge and skills.  The environmental is fostering good health by occupying a pleasant, stimulating environment that support well-being.  The financial domain includes feeling satisfied with a current fiscal climate and having a foreseeable positive future financial situation.

SAMHSA envisions a future in which people living with mental health issues pursue optimal physical and behavioral health, happiness, and recovery (SAMHSA 10×10, 2010) in their communities through integrated services, supports, and resources.  Earlier morbidity and mortality rates of individuals living with a serious, persistent mental illness urgently requires attention and programs which address largely chronic illnesses (e.g., cardiovascular disease, respiratory diseases).  Health disparities in the SPMI population is widespread. Whole health and wellness is an incorporation of mental, emotional, physical, occupational, intellectual, and spiritual areas of living (SAMHSA 10×10, 2010) which affects quality of life (Dunn, H.L., 1997). For the SPMI population, physical and behavioral whole health and an integrated wellness program(s) is directly related to the quality and longevity of life.

The Medical Directors Council (2010) of the National Association of State Mental Health Program Directors overall health findings support the SAMHSA 10×10 Wellness initiative as physical and behavioral educational interventions are essential for individuals living with an SPMI and for healthy living.  Mental health recovery includes wellness.  Recovery is a personal process in which an individual gains insight into his or her psychiatric disabilities and chooses to utilize natural supports, self-help strategies, and community resources for ‘personal liberation and wellness’ (Curtis, 2000, p. 25).  Recovery refers to the process in which people are able to live, work, learn, and participate fully integrated within their communities as opposed to living within a silo, or living isolated away and from supports.

Particular nationwide consumer provided services such as the Peer Whole Health Coach Project working jointly with the San Antonio Elder Care (SAEC) is a peer pilot project funded through OptumHealth as well as the outstanding City of New York and the New York Association of Psychiatric Rehabilitation Association (NYAPRS) OptumHealth Chronic Illness Demonstration Project (CIDP) Health Home.  Peers work as subject matter experts on the mind, body and spirit connection through actively engaging their matched consumer with whole health and wellness solutions (e.g., nutrition, exercise).

Larry Fricks, CEO and Director of Training at Appalachian Consulting Group, is the national innovator who introduced the Whole Health Training Module into the Depression & Bipolar Support Alliance’s national Certified Peer Specialist certification training.  This is one example of how COSP’s can offer the Peer Whole Health Coach Project at SAEC.  Fricks has partnered in his vision to provide a direct 1:1 peer to peer service focused on providing an integrated whole health model of wellness (Appalachian Consulting, 2011; DBSA, 2011).

The National Association of State Mental Health Program Directors  (NASHMPD) issued a position paper in 1989 recognizing that mental health consumers have a unique contribution to make to the improvement of the quality of mental health services in many areas of the service delivery system.  NASMHPD recommended utilizing consumers to assist with program development, education of mental health service providers, and the provision of direct services (as employees of the mental health provider system).

Currently, the model used for a peer workforce utilizing a Medicaid reimbursable funding mechanism with local mental health authorities, state hospitals and COSP’s demand collaborative efforts publically/privately.  National managed care organizations throughout the U.S. currently offer triage treatment units for a peer to perform psychosocial rehabilitation services.  Additional services and areas of subject matter expertise through a peer can be provided such as:

  • Physical fitness wellness action plans.
  • Wellness Recovery Action Plan (WRAP) ® Wellness Plans with Daily Maintenance Plan.
  • Assume the role of being a WRAP PAL ® with matched mentorship provided.
  • Perform whole health screenings.
  • Offer information & referral services.
  • Financial literacy training.
  • Housing assistance and referral services.
  • Job training.
  • Nutritional coaching.
  • Life skills training.
  • Enhancing sleep hygiene.
  • Personal life change agency.
  • Community integration.
  • Educational rehabilitation counseling and referral services.
  • Vocational rehabilitation counseling and referral services.
  • Trauma informed care resiliency skill building.
  • Treatment team capable.

 I support a national peer certification and peer registry to be built by peers, consumer/survivor/ex-patients (c/s/x), Certified Peer Specialists (CPS), advocates, MH/SA stakeholders, our leadership and other interested individuals.  A state by state Medicaid reimbursable peer workforce is often folded into the state mental health and/or public health social service system.  Imagine a peer workforce managed and operated via a cooperative c/s/x, peer, CPS driven and c/s/x, peer and CPS led organization?  To name a few, a national peer workforce would invigorate cause for action to implement public/private MH/SA CPS specializing in, and but not be limited to:

  • Psychosocial rehabilitation, recovery and integration.
  • Be hope based.
  • Whole health, wellness and resiliency.
  • Be trauma informed care recovery and resiliency based.
  • Substance abuse/Dual Diagnosis.
  • Housing.
  • Information referral & resource providers.
  • State and federal disability benefits service provision.
  • Independent living.
  •  Veteran Americans.

A national peer certification is supported broadly by national leadership, c/s/x, CPS, peers, advocates, and other MH/SA stakeholder individuals and organizations that are publically and privately funded.  I welcome an invitation to the 2012 Pillars of Peer Support in order to participate, offer programmatic options and support the peer, CPS, c/s/x voice.

 

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18 COMMENTS

    • Dear hogwash,

      Excellent analysis. This article made me literally sick in that it’s the same deadly stigmatizing and forcing lethal torture treatments of drugs or ECT involuntarily with the pretense of doing it in an egalitarian, healthy way. This is Orwellian doublespeak by the BIG PHARMA/PSYCHIATRY/GOVERNMENT totalitarian dictatorship trying to cover up their latest evil eugenics targeting of certain groups to justify robbing them of all human rights and plotting their latest euthanasia projects that are getting too obvious now, requiring a positive spin of “concern” about their health, which was the nightmare lie used in the first place about “mental health” to perpetrate this and other crimes against humanity.

      I have no doubt this blogger has good intentions, but I also have no doubt that any government agency has no good intentions when it comes to so called “mental health” due to their horrific actions and laws to date.” This type of program would just give would be victims a false sense of security to make them more willing sheep to the slaughter that is biological, mainstream psychiatry.

      George Bush, some experts have labeled a psychopath, and his father had huge family ties to Ely Lilly, which is why he created the Orwellian “NEW FREEDOM COMMITTEE” with psychiatrist Sally Satel bent on robbing all Americans of their civil and human rights with bogus labels and forced drugging. Bush colluded to push all the horrific “mental illness” screening from the cradle to the grave for the sole, souless purpose of pushing more toxic psych drugs on the majority if not all citizens with the pretense of the nobel aim of funding/promoting “mental health.” Along with starting the bogus IRAQ war to collude with the military industrial complex and power elite to rob more wealth from one more country preyed on by the U.S. for self serving reasons, George Bush also has the dubious honor of ensuring our children would be subjected to the worst medical catastrophe and betrayal ever with psychiatry’s fraud labels and poison drugs guaranteed to permanently disable them to make them the good, docile, apathetic sheep ready to do the bidding of the 1% power elite including the Bushes as they have been plotting for decades.

      SAMSHA is the agency the censored Bob Whitaker, making their true “mission” all too horribly clear.

      • Seems like they think they can develop a cheaply paid version of their own system using psychiatrized “Kapos” to run it without changing anything but the veneer.

        “Physical fitness wellness action plans” for those with practically irreversible weight gain and severe metabolic damage from the drugs.

        “Perform whole health screenings” in order to do absolutely too little too late or nothing at all once a “SPMI” starts to become chronically sick from the drugs and maybe even has diabetes going on.

        “Offer information & referral services” such as making crafts in the mental health center basement or going to NAMI and DBSA meetings to get brainwashed into complying with the early death regimen.

        “Financial literacy training”, so the “SPMI” know exactly how to spend their meager incomes of $700 a month that mostly gets turned over to the agencies running their lives.

        “Housing assistance and referral services” on how to find and rent a hovel from a slumlord.

        “Job training” to prepare the “SPMI” to work in sheltered wage-slavery workshops.

        “Nutritional coaching” so that the “SMPI” know how best to shop for food if they could afford anything other than pre-packaged, high-calorie, carb-laden garbage.

        “Life skills training” so the “SPMI” know how to do their laundry.

        “Enhancing sleep hygiene” for the “SPMI” who rarely get their own bedrooms and usually have to share with someone who is ranting or snoring in the group home or hospital. These are called “ear plugs”.

        “Personal life change agency” for the “SPMI” who have almost no control over their lives and have to get approval from someone else for just about everything, including when to pee.

        “Community integration” for those “SPMI” who have been drugged and quieted enough to live on the outside in the “community” but in settings that are worse than most people provide for their dogs.

        “Educational rehabilitation counseling and referral services” to provide jobs for state employees and newly graduated college students while crowding the “SPMI” into little “classrooms” and teaching them they they too can someday be a janitor at McDonalds if they can stay awake on the drugs.

        “Vocational rehabilitation counseling and referral services” where “SPMI” can go to get interviewed by people who don’t really believe that they can benefit from an education and instead would like to send them to a workshop to learn how to assemble and package junk for minimum wage.

        “Trauma informed care resiliency skill building” is a bone that SAMHSA is throwing out there to make this pig of theirs look nice.

        “Treatment team capable” “peers” are “peers” that promote the psychiatric agenda. Some call them “traitors”.

        • Dear Unimpressed,

          Again, superb analyis and exposure of the latest “veneer” promoted by the mental death profession otherwise known as dangerous BS!! Very witty but sad exposure of the truth behind their bogus pretense of improving health or the lives they destroy with impunity by a known eugenics demolition enterprise to profit all the more from the massive human suffering they create from their insatiable greed, lust for absolute power and control over every human on the face of the earth to inflict global slavery, pathological lying and lack of any conscience. Per Dr. Robert Hare, these are the traits of psychopathy, which may also be applied to corporations. See book and DVD, THE CORPORATION, in which the creator does make this claim with insights from Dr. Hare.

        • What you said is damn true it is actually horrifying. I have been there and done that and I damn well refuse to do it again. You forgot the clubhouse model where you either sit all day and do absolutely nothing or you attend life skills classes (which I did after even receiving a college degree and working) where the teacher believes in tough love and hollers at you and makes you stand up in class when you fall asleep from the side effects of your meds. She felt you were attacking her competency. I was forced into a sheltered workshop in the 1990s by vr because they wouldn’t send me out on a job without knowing how I worked! Then, at the workshop, they put me in with developmentally disabled on meaningless tasks at so much less than the regular rate of pay demoralizing both me and the developmentally disabled involved. As far as peer counselors; I will never trust them. They, unknowingly, are involved and brainwashed by the evil system, also. I saw one once and she was old as my mother; about eighty. I have nothing against those who are “elderly” They, too, have been much tortured and disregarded in America. She told me to get on some blood type which in addition to the withdrawal I was undergoing almost killed me. I am so sorry sometimes I get so filled with rage at what has been done to me in the name of false mean-spirited goodness to really keep me in little place as an allegedly sick person. This is a tragedy that needs to be righted soon. What more can I say?

      • Peer certification? Spare me the condescending garbage. ‘Consumer’? Are you kidding me?

        Interesting how she uses the unfortunate choice of words ‘certify’ when talking about people who in the past have been labeled as ‘certifiable’.

        So this is what psychiatry has come to? first they make people disabled and unemployable by creating learned helplessness and drug induced brain damage, and then they offer them a fake job palling around with psychiatrists and psych nurses in mental hospitals.

        I can’t wait to be locked on the ward and have one of these ‘peers’ point me in the direction of the suggestion box when I complain I have no human rights.

        What are the chances of a ‘peer’ network being allowed on psychiatry’s turf if they don’t take psychiatric drugs and believe in psychiatry’s lies?

        My peers are the people who believe I deserve rights, not some Uncle Tom ex mental patient who is still drugged to the nines and such a model of recovery that they are on disability for life, who have a part time ‘make work’ job handing out pamphlets full of empty rhetoric ready-made and pre-packaged from SAMHSA spin doctors.

        God grant me the serenity to comprehend how lucky I am that I can see through the lies. In another version of this life, I might actually be leaving comments of praise on this sad, sad ‘peer certification’ paper.

  2. I wholeheartedly agree with unimpressed, but want to specify: people supposedly suffering from “SPMI” die on average 25 years earlier than the general population. The 10 x 10 Wellness Campaign can potentially, according to this post, take 10 years off those 25 years lost. What’s wrong with the campaign that it can’t take 25 years off those 25 years???

    All that these campaigns, which we also see massively touted here in Denmark as THE solution to the problem of the drugs killing people, do is rearranging the deck chairs on the Titanic, while of course they can make those who label others with “SPMI”, and then tell them they can’t live without life-shortening drugs, feel better about their mistreatment of the labelled, and allow them to, continuedly, avoid having to face reality.

    • Also, claiming this should be family/consumer oriented means drug front funded groups like NAMI AND CHADD helping BIG PHARMA/PSYCHIATRY/GOVERNMENT push more life destroying stigmas and torture treatements that these horrible narcissistic groups falsely claim those unfortunate or ignorant enough to see a psychiatrist are a danger to the public and themselves to pass more totalitarian laws to rob more and more citizens of their civil and human rights. The fact that so called family members could do this to their so called families and society at at large shows most if not all are narcissists and/or sociopaths who drove their so called families crazy!! Beware of BIG BROHTER since 1984 has come with a vengeance!!

      • What good is it to gain 10 or 25 years back if psychiatry has destroyed your life and made it a living hell, which is their true purpose as instruments of social control in our growing police state. Many of these deaths are suicides caused by psychiatry’s demolition enterprise against their so called patients, which is maybe an additional number needing to be added to those who die due to their poisoning and deliberate brain/body damage. See article on the harm of DSM stigmas posted here today by Dr. Paula Caplan as an example of how psychiatry destroys constant lives by medicalizing normal life stressors for their own greed, profit, power and status. “What good is it to gain the whole world and lose your soul?”

  3. The words “support and acceptance” make me shiver because it means “brain-washing” into believing biop-sychiaty’s mental illness and broken-brain theories by already brainwashed peers. We were at the receiving end of that one in Britain

  4. I’d be interested in getting certified and participating as a peer counselor but, as posters above have noted, I would have a great deal of difficulty working in an environment where biopsychiatry reigned and medication regimens were regarded as having come down from God.

    (FYI, see http://onlinelibrary.wiley.com/doi/10.1002/hec.1737/abstract — they really don’t know what they’re doing! It’s not just a few bad apples.)

    Since my area of specialty is safe withdrawal from psychiatric medications, which in a rational world would be valuable expertise, I don’t expect to be very popular in conventional mental health settings.

    I imagine being a peer counselor would be in a similar situation to ethically conflicted doctors, but without the remuneration. I’d be very interested to hear of people’s experiences as peer counselors.

  5. I really don’t have the energy to write a treatise on all the reasons I find this article objectionable – although I agree with the critiques offered by several other posters, above. The only thing that I’ll add is that I find it reprehensible when a person who defines him or herself as a “peer” uses the system’s pathologizing language to refer to people with psychiatric histories. It’s dreadful enough to refer to people as “seriously and persistently mentally ill,” but to refer to them by the horrific acronym “SPMI” is just beyond comprehension.

  7. My 5th blog will be a treatise on Texas political duplicitousness. While I appreciate the commentary, I must also assure you of my ongoing intererst and intent to speaking to the facts. Keep reading and posting here. I’m learning about the boundaries pushing outside the middle. Your feedback is helpful, but inasmuch as I’m a peer and c/s/x, keep it clean. Address the topic and not the author.

  8. Many of the remarks of others replying here I agree with. The one point that strikes me is that the article seems to reflect the position of people who just don’t understand the word “recovery” in a helpful sense: the article states for example; “Peers are trained to share their own personal experiences of recovery from mental illness and open doors that otherwise would remain closed due to the stigma and shame associated with mental illnesses”.
    That is the definition used by those who buy the medical model. The “recovery” used by former psychiatric inmate’s means not recovery from “mental illness”, but recovery from the “treatment”.
    The existing drive for peer certification has become a strategic thrust on the part of those advocating the status quo to divide and conquer the current and former psychiatric inmate population and its efforts to restore their civil rights and lives.

  9. I just found this article. I agree with the comments here. Jen, were you being sarcastic? I am shocked. I would never ever want “training” to be a peer. I had over three decades of the best training ever. I spent time in institutions. I was inpatient over 50 times, used up my 190 Medicare days, and I guess they wanted to squeeze out all they could get. I think I need MORE training! Maybe I should rob a bank, no, I don’t mean to pay college tuition or to pay for said “training,” but so that I would get caught and spend time in a criminal prison. That would add stripes to my already overloaded uniform.

    When I first saw how the “peers” were being trained, I found that their training had no relevance to eating disorders, which were my problem. They failed especially to address the restrictive aspect. I was so put off that I told myself there was simply no point in attending their “retreat” since I’d have nothing in common with anyone there. Many, of course, defined “health” as “losing weight and exercise.” I would have dropped dead had I lost any more weight at the time. I was rather bewildered.

    I had state “services” which meant they sent this completely clueless person to visit me once a week. This proved to be a total nuisance. The state people knew nothing about what I was experiencing. This seems to be true for many people in my position who had these “state services.” A non-service for sure!

    One of these service people did know about ED. I only had her briefly. I liked her. She actually disappeared one day and then when she reappeared she was taken off my case. I can say in the long run she wasn’t that helpful, serving to urge me to stay in the same system that was killing me, not only killing my soul, but killing my body too.

    The best thing I ever did was to ditch these services. The coordinator of that team harassed me after that. I had to put blocks on my phone and email even. Finally, I received a snail mail. I threatened to take action since this was clearly uncalled for as I had already canceled the “service.” They kept calling me, trying to lure me back. I owe a lot to myself for making this smart decision. With no one to track me down, free of their babysitting, I was able to successfully walk out of the USA a free person and no one back there even noticed I was gone for two months.

    If anyone out there REALLY wants to ditch diagnosis and get free, ditch the “services” and you’ll be one giant step in the right direction. Show them you don’t need them. Dependent and needy no more! Who needs that?

    Julie Greene

  10. Oh my goodness that awful clubhouse. That was supposed to be the new great thing. Why the babyish name “clubhouse”? Well, it was just that. I remember being told to count about 500 pennies, then to count them again “because you might have made a mistake.” No more than anyone else might make a mistake, I should have said. Then, I mentioned to them that I’d like to go to school. They said, “Okay, we have sheltered classes.” I told them I had like 15/16ths of a bachelor’s degree which was most likely more than any “staff” had. They seemed to think I wasn’t very smart and wouldn’t let me near the computer. I finished my bachelor’s degree summa cum laude in 2003, went on to grad school (the shrinks objected) and then graduated without “accommodations” and no way did the school grant me a master’s degree out of tokenism for a “disabled” person. I am extremely lucky that I was born with high intelligence and I always enjoyed using it. I thrived in academic environments. That went over the clubhouse’s heads, apparently. When I had state “services” they couldn’t understand why I would write and study at the library all day. They assumed I was sitting at home watching the tube, wasting my life. The usual expectation, that we are useless, stupid, incapable, lazy…all the things that for sure I never was before I entered the MH system. Leaving the System entirely meant rekindling all that, using my REAL skills again, and feeling loved and wanted and happy and peaceful, and very much a rebel…the way I really was all along.