Throughout California, the nation, and the world, peer specialists provide services to individuals with mental health challenges. In California, over 6,000 peer specialists are employed (Medi-Cal: mental health services: peer, parent, transition-age, and family support specialist certification, 2015). In 2007, the Centers for Medicare & Medicaid Services (CMS) guided states to create peer certifications (CMS, SMDL #07-011). Since then, more than 30 states have created statewide peer certifications, and if Senator Leno’s Senate Bill 614 goes through, so will California (California Mental Health Planning Council, 2015). Overall, SB 614 will ensure the quality of training that Peer Specialists receive and in turn the quality of care that Peer Specialists provide. The one aspect that might undermine the success of SB 614 and the peer profession is that the supervisor is not required to have lived experience or any training on the peer profession.
As SB 614 currently reads, the clinical supervision would be provided by someone who is at minimum, a mental health rehabilitation specialist, substance abuse professional, or licensed mental health professional (2015). Peer Support is its own distinct profession with specific values and a scope of practice that is different than other mental health professions. As such, new Peer Specialists should be supervised by a trained experienced Peer Specialist who can guide them in the unique role of a Peer Specialist. Peer Specialists, therapists, psychologists, psychiatrists, etc. all have their unique scope of practice. “Peer providers bring unique strengths and qualities to the integrated care team” (Substance Abuse and Mental Health Services Administration [SAMHSA]). Interdisciplinary teams are effective when they respect and understand each other’s unique roles (Nancarrow et al., 2013). These professions are not interchangeable.
Peer Specialists have lived experience with mental health challenges and self-identify as such (Solomon & Draine, 2001). Other mental health professionals do not traditionally include the disclosure of personal lived experience as a tool in treatment. Traditional mental health professionals are thus not equipped with the necessary experience to advise a Peer Specialist on how to disclose lived experience in a way that is helpful to the mental health recipient.
Peer specialists are models of hope and recovery. Self-disclose is Peer Specialists’ most distinctive and potentially impactful tool in their toolkit. As with all interventions, it must be used carefully, under the supervision of qualified individuals with experience using the intervention. For Peer Specialists to be supervised by individuals who may not have experience using this intervention has the potential to compromise the efficacy of the intervention and the peer profession in general. This oversight in SB 614 must be rectified.
Mental health peer support was created as an alternative to the traditional clinical medical model (Mead & MacNeil, 2006). Peer support is by design different than traditional mental health services (Mead & MacNeil, 2006). Phyllis Solomon wrote, (as cited in Mead & MacNeil, 2006) “Consumer provided services need to remain true to themselves and not take on the characteristics of traditional mental health services.” Traditional mental health professionals operate from a professional-client relationship; whereas, peer providers operate from a basis of mutuality where each individual is equal and helps the other (Mead & MacNeil, 2006). This is not to say that any profession is right or wrong, but only that the peer profession is inherently different. To preserve its integrity, the profession must be allowed to practice with autonomy and without oversight from other professions that do not share the same perspective. For Peer Specialists to be appropriately trained in their profession, they need to be supervised and guided by individuals with experience working in the peer profession as a Peer Specialist.
Peer support is an evidence-based practice (SAMHSA, 2011), but as with all evidence-based practices, it must be practiced with fidelity to the model, which is based on peer values and appropriate disclosure of lived experience (Mead & MacNeil, 2006). SB 614 will enhance the health care treatment of Californians with mental health challenges if amended to ensure that Peer Specialists are effective by practicing with fidelity and integrity to their profession, the model, and under the supervision of qualified individuals with lived experience.
* * * * *
- California Mental Health Planning Council (2015). Peer Certification: What Are We Waiting For Retrieved from http://www.dhcs.ca.gov/services/MH/Documents/CMHPCPeerCertPaper2015.pdf
- Mead S., & MacNeil C,. (2006). Peer Support: What Makes It Unique? International Journal of Psychosocial Rehabilitation, 10 (2), 29-37. Retrieved from http://www.psychosocial.com/IJPR_10/Peer_Support_What_Makes_It_Unique_Mead.html
- Medi-Cal: mental health services: peer, parent, transition-age, and family support specialist certification, S. 614, 114th Cong. (2015). Retrieved from https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB614
- Nancarrow, S.A., Booth, A., Ariss, S., Smith, T., Enderby, P. & Roots, A (2013). Ten principles of good interdisciplinary team work. Human Resources for Health, 11(19). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662612/
- Solomon, P., & Draine, J. (2001). The State of Knowledge of the Effectiveness of Consumer Provided Services. Psychiatric Rehabilitation Journal, 25, 20-27. Retrieved from http://www.parecovery.org/documents/Solomon_Peer_Support.pdf
- Substance Abuse and Mental Health Services Administration. (2011). Consumer-Operated Services: The Evidence. (HHS Pub. No. SMA-11-4633). Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Retrieved from https://store.samhsa.gov/shin/content/SMA11-4633CD-DVD/TheEvidence-COSP.pdf
- Substance Abuse and Mental Health Services Administration Center for Integrated Health Solutions. Peer Providers. Retrieved from http://www.integration.samhsa.gov/workforce/team-members/peer-providers
- United States Department of Health & Human Services, Centers for Medicare & Medicaid Services, Guidance Letter to State Medicaid Directors, SMDL #07-011, August 15, 2007. Retrieved from https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/smd081507a.pdf
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.