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.
- 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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