Because of the enormous obstacles confronting individuals with behavioral health conditions who have been incarcerated, many peer-run organizations have risen to the challenge and have created programs to help these people rejoin the community.
What follows is the Executive Summary of a report entitled Reentry and Renewal: A Review of Peer-run Organizations That Serve Individuals with Behavioral Health Conditions and Criminal Justice Involvement. This report was the result of a collaborative effort by the College for Behavioral Health Leadership’s Peer Leader Interest Group, Mental Health America, the National Mental Health Consumers’ Self-Help Clearinghouse, and the Temple University Collaborative on Community Inclusion.
Executive Summary
There is an enormous need for peer-led programs that serve individuals with mental health conditions who have criminal justice system involvement. The United States has less than 5 percent of the world’s population, but it has almost a quarter of the world’s prisoners. And more than half of them have a mental health problem, according to the Bureau of Justice Statistics. People who live with mental health challenges are less likely to be released on bail, and have longer jail and prison terms. Even when they are released, they are more likely to incur technical probation violations. And this doesn’t even take into account how difficult it is for people coming out of jails and prisons to get jobs and housing, which are essential to finding their way back to normal lives.
Because of the great need, a survey was developed to identify peer-run programs/services that serve individuals with behavioral health conditions who are returning to the community from jails and prisons. Peer-run organizations have been, and continue to be, leaders in providing cutting-edge, recovery-oriented mental health services and supports; so there is much to learn from their experience. In addition, studies have shown that peer support services are effective in reducing hospitalizations.
There were 132 responses to the survey (of which 59 were incomplete). A compendium has been developed that includes the 41 most substantive replies, representing 15 states. The respondents offer a mix of day, residential, mobile and prison-/jail-based services and supports. They serve anywhere between six to 900 individuals, with budgets ranging from zero to $300,000.
Some programs are just getting off the ground; few have been open for more than a year or two. All of them are on the cutting edge and represent some of the best practices in facing the challenge of the skyrocketing numbers of people with behavioral health issues who come into contact with state and/or federal criminal justice systems.
Peer-run programs that serve individuals with mental health conditions and criminal justice involvement provide both direct programming—including case management services, vocational training and placement, housing resources, and other services—to help the individual returning to community life from incarceration find his or her balance; and ongoing support of their peers.
Following are snapshots of services provided by the programs covered in the report:
- Communities for Recovery, in Austin, TX, has developed a peer recovery coach program in the Travis County State Jail.
- Ellis Medicine Forensic Peer Mentor Project, in Schenectady, NY, helps clients access mental health and substance abuse treatment, housing, benefits, employment, and connection to 12-step groups and other supports, among other services.
- 1st Day Out, in San Luis Obispo, CA, works with clients on a one-to-one basis in jail, and then continues to follow them in the community, linking them with “all of the steps necessary to be successful.”
- Hands Across Long Island, in Central Islip, NY, also begins working with people while they are still incarcerated, and helps them try to identify those “people, places and things” that were not good influences, and also the opposite: people and places that provide support in the community.
- Haven House, in Juneau, AK, operates a housing program for women who have been incarcerated, as well as providing “recovery/reentry coach services” that have served hundreds of people since it opened nearly two years ago.
- Hope Lives/Vive la Esperanza, in Phoenix, AZ, includes forensic peer support and community-based suicide intervention and prevention programs. It helps clients with competitive employment and supported employment, education, community resources and referrals, social and community integration, and applying for benefits.
- The International Association of Peer Supporters, based in Victor, NY, incorporated the Alternatives to Violence Project training into its Substance Abuse and Mental Health Services Administration (SAMHSA)-funded Recovery to Practice initiative to offer workshops to “build affirmation (strength-based perspectives), communication, cooperation, conflict transformation, collaboration, and community.”
- The Northern Regional Center for Independent Living in Watertown, NY, provides peer-supports—both one-on-one and support groups in the jail—and continuation groups for those who have been released from jail.
- The services offered by PEOPLe Inc., Poughkeepsie, NY, include employment, financial management, and rep payee. Also offered are social inclusion activities, including support groups.
- REACH-Up, in Middletown, CT, is a peer-run pilot program created by REACH (Re-Entry Assisted Community Housing). REACH operates scattered-site housing in nine Connecticut cities for clients with criminal justice involvement. The clients also receive case management. In REACH-Up, a random sample of the REACH population receives additional support through peer involvement. REACH-Up clients have shown statistically significantly less early recidivism and a higher level of engagement with treatment and case management services than has been true of the other REACH clients.
- Westchester Independent Living Center (WILC), in White Plains, NY, operates a Partners for Success class based on personal awareness, personal responsibility and personal empowerment. WILC is the hub for social services assistance for employment training, anger management, domestic violence, health care/mental health care resources, self-empowerment, substance use treatment, and re-entry into the community from the criminal justice system.
- Wishing Wellness Center, in Cortland, NY, helps people find housing, connect to services, set and achieve goals, and find recreational opportunities and music and art lessons. “We also engage people in treatment services for mental health and substance abuse (both inpatient and outpatient), support services beyond the treatment process, and [assist with] connection to residential treatment services.”
It has also been demonstrated that, to help individuals with both behavioral health conditions and involvement in the criminal justice system, it is important that the peer staff members have had criminal justice involvement themselves. As the director of a community behavioral health agency within the Optum Pierce County, WA, Regional Support Network was quoted in a U.S. Department of Health and Human Services report:
We see that putting peers into situations where they have no lived experience is not helpful. For example, when we put peers without criminal justice experience into the criminal justice system it didn’t work. So then we decided to staff the peer support services with peers who had been arrested, been in jail or prison. Ta da! It was amazingly effective!
(For more information about the Optum Pierce County, WA, program, see pages 35-40 of An Assessment of Innovative Models of Peer Support Services in Behavioral Health to Reduce Preventable Acute Hospitalization and Readmissions.)
The survey was not conducted according to rigorous scientific principles, and the choice of a dozen programs to identify as exemplary was subjective. We have tried to select some of the best and most thoughtfully developed programs in the field. However, there are, undoubtedly, excellent programs that are not included, either because they did not respond to the survey or because their responses did not capture the programs’ details in a way that made them stand out.
The survey indicates that there is an ongoing expansion in the roles played by individual peer specialists and by peer-run programs in addressing the needs of individuals with both mental health conditions and criminal justice involvement. The results suggest a need for effective training programs for peer specialists interested in this important work.
The survey also indicates a need for sound research in this arena to tell us more about what strategies work best in assuring that people leaving jails and prisons receive the support they need to lead active and fulfilling lives in their communities.
This publication is based on the survey results. We hope that it will help stimulate the creation of hundreds or even thousands of peer initiatives that will assist millions of Americans with behavioral health conditions to avoid—or to get out and stay out of—our courts, jails, and prisons, and to instead pursue lives of recovery in the freedom of their home communities.
Note: A free webinar on Peer-run Organizations That Serve Individuals with Behavioral Health Conditions and Criminal Justice Involvement will be hosted by the National Mental Health Consumers’ Self-Help Clearinghouse and the Temple University Collaborative on Community Inclusion today: January 19, 2017, at 2 p.m. EST. The presenters will be Rita Cronise of the International Association of Peer Services (iNAPS), Ellen Healion of Hands Across Long Island, Steve Miccio of PEOPLe Inc., and Noelle Pollet of Peace Work. Harvey Rosenthal of the New York Association of Psychiatric Rehabilitation Services will moderate.
To register for the webinar, click here. To download the free report—Reentry and Renewal: A Review of Peer-run Organizations That Serve Individuals with Behavioral Health Conditions and Criminal Justice Involvement—click here.
Nice list, Susan. I always appreciate the passion you bring to these articles.
I assume you may have also noticed come studies have coming out recently that show that peers are very effective in helping with emotional problems in other, poorer countries, such as with feelings of depression in India. Countries like India could be a place for peers to gain a stronger, quicker foothold than in the USA, given that psychiatric treatments are fewer and less entrenched at the start in developing nations.
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Thanks, Matt! Yes, I do know that! Please see an article by Shankar Vedantam at the link below. I have also seen (and tweeted) other articles on this subject:
http://www.washingtonpost.com/wp-dyn/content/article/2005/06/26/AR2005062601091.html
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Once when I spent some time in jail I was told to tell them (the authorities), if I wanted them to go softer on me, that it had to do with a drug problem, because that was where the money was, in drug courts and that sort of thing. I think they’re sort of doing the same thing with “mental health conditions” these days and, of course, that’s going to mean more of this sort of use of “the insanity defense”. That said, I’m not saying it’s all a bad thing. There is so much that is wrong with the situation people who have been through the criminal justice system face that you need more options, such as ‘peer-run organizations’, to serve them. People who have been incarcerated, and have done their time, should be re-enfranchised (my view), and have their citizenship rights, their voting rights, restored to them. When even attaining purposeful work is difficult, due to prejudice more than anything else, it’s can be a real uphill struggle when it comes to putting “time served” behind a person.
Another issue is the number of ‘criminally inclined’ people in the mental health system. Violence on the wards is not de-escalating. I read Kenneth Donaldson’s Insanity Inside Out (1976) recently. In that book, those people who came out of the criminal justice system were found better equipped to manipulate the system, and where others, thought to be “more sick”, were held for longer lengths of time. Some of those who were in the institution for homicide, at least back then, were out on the street ahead of many of those who had not committed any crime. Anyway, it gives a person pause to consider the complexity of the issues involved.
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This report was the result of a collaborative effort by the College for Behavioral Health Leadership’s Peer Leader Interest Group, Mental Health America, the National Mental Health Consumers’ Self-Help Clearinghouse, and the Temple University Collaborative on Community Inclusion.
I think the above speaks for itself.
“Behavioral health” is an even more Orwellian term than “mental health,” if that’s possible.
While I’ve never spent more than a night in jail (though I’ve done that more than once) I think it’s obvious that it helps to have friends from the hood in lockup, and friends from inside around on the outside once released from longer term confinement. I can’t see how it could be help to have “professional homies,” i.e. “peers,” validating for ex-inmates of any variety that they have a “behavioral health” problem. Talk about mystification.
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I would be interested in what studies establish that “Peer-run organizations have been, and continue to be, leaders in providing cutting-edge, recovery-oriented mental health services and support ….” given that virtually every mental health clinic and provider organization has long asserted the same. (I did follow the links you provided.)
Sadly, our local Wellness Centers (nee’ Self Help Centers, nee’ Drop In Centers) are peer run largely in name only and despite almost a decade of data collection they can’t provide any evidence that they apply the Principles of Recovery or foster recovery.
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Joe, I agree, I’d like to see the proof of that as well.
“Sadly, our local Wellness Centers (nee’ Self Help Centers, nee’ Drop In Centers) are peer run largely in name only and despite almost a decade of data collection they can’t provide any evidence that they apply the Principles of Recovery or foster recovery.”
We have a local “drop-in” place that is supposedly a peer run organization. When I found out about it, I had visions of a welcoming environment with couches and games and people to talk to – mental stimulation and that kind of thing. I showed up and found a single room in a strip mall shopping center filled with folding card tables and folding chairs and full of old people in diapers who were barely aware of the presence of other humans around them. I would have been the youngest person there by a couple of generations and also the most lucid by far. It seemed like a last resort type of place for families who couldn’t afford adult day care to dump mentally challenged relatives during the work day. It became quickly apparent that if I spent any time there, I would be helping the staff far more than my “peers”.
I keep hearing about ‘peer support’ but there doesn’t appear to be any cohesive definition that can be applied to that term so I’m not sure how useful any statistics are that emerge from it’s use anyway.
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Oh, my, isn’t that a very pretty and interesting re-arrangement of deck chairs on the Titanic!
All you do-gooders and reformers are just going around in circles.
You can “Mental Health America”, and “Change Direction”, and NAMI all you want….
You’re either rotating clockwise, or else engaged in counter-clockwise rotation.
Either way, you’re going in circles, at best.
As long as you believe in so-called “mental illness” or “mental health condition”, or “dual diagnosis”, or
whatever nonsense du jour, you’re going nowhere.
It’s a process-centered process, and a system-centered system, and money RULE$!
The “gold standard” is “HE who has the gold makes the rules”….
It’s the Capitalist Patriarchy on psych drugs and steroids….
Until you make it a PERSON-Centered Process, and a SERVICE-Centered System, you’ll get nowhere.
I know you’re all good people, and mean well, but I will NOT help you re-arrange Titanic deck chairs….
Psychiatry is a pseudoscience, a drugs racket, and a means of social control. It’s 21st Century phrenology, with potent neuro-toxins. Psychiatry, and it’s Frankenstein “medical model”, has done, and continues to do, far more harm than good. So-called “mental illnesses” are exactly as “real” as presents from Santa Claus, but not more real. The DSM-5 is nothing more than a catalog of billing codes. ALL of the bogus “diagnoses” in it were invented, not discovered. There IS a difference. Real people have real problems, but imaginary “diseases” should NOT be part of that. So-called “dual diagnosis” is just the latest SCAM, to $TEAL MONEY, and further enslave folks. And $ELL DRUG$ for PhRMA….
Why do you REALLY THINK so-called “peer support” always gets the $hort end of the $tick????….
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