Study Highlights Challenges for Mental Health Peer Specialists

Role clarity, supervisor flexibility, peer input, and professional development top list of needed supports for mental health peer specialists.


A team of researchers across the United States recently released research in Psychiatric Services in Advance detailing the best ways to support and supervise peer specialists in the mental health workforce. Through semi-structured qualitative interviews with four peer specialists and five supervisors and their personal experience with peer specialists, the authors were able to unpack a number of support and supervision strategies to best support peer specialists.

Ana Stefancic, a psychiatric researcher at Columbia University, led the study. The authors write:

As the peer workforce grows, a need emerges to develop and disseminate evidence-based approaches for supporting and supervising peer specialists,” conclude the authors. “Lessons learned and strategies discussed in this column suggest key areas that can be further explored and targeted for development to advance the reach, impact, and value of peer specialists in behavioral health organizations.”

Peer specialists are defined as those who self-identify as having a mental illness or receiving mental health services and combine their personal experience with training to support others. Studies have supported their efficacy, and the profession has grown to over 30,000 individuals. Many challenges, however, remain for the profession, including role confusion, lack of supervision, and lack of respect for the role.

To unpack these difficulties, the authors evaluated a pragmatic trial to evaluate the efficacy and implementation of a 22-session healthy lifestyle intervention for those with serious mental illness. The project was conducted by both a team of university researchers and three supportive housing agencies that double as community sites for the programming.

Before this study, an implementation study investigated each housing agency’s context, built staff support, identified key stakeholders, and developed communication protocols. The project was designed specifically to engage in co-learning via an iterative approach that received input from all partners.

Peer specialists were certified in peer-delivered services and completed a two-day Group Lifestyle Balance certification training. Sessions were delivered in participants’ homes or supportive housing offices. The project supervisors were non-peers and provided support and supervision for the peer specialists via weekly structured supervision, monthly structured supervision with the housing agency, informal texts and phone calls, and joint weekly calls with peer specialists to work through challenges. Through this process, several supervision strategies were developed, outlined below.

  1. Role clarity: despite the reasonably clear job description, confusion regarding role responsibility arose. To address these confusions, supervisors a) explicitly took responsibility for lack of clarity, b) made role negotiation an ongoing discussion topic, and c) explained the rationale behind task assignment. All parties agreed that specialists had the grounds to make on the fly decisions on a case-by-case basis, given their expertise.
  2. Supervisor responsiveness and flexibility: to rectify the perceived lack of support and supervision, strategies such as having multiple supervisors at meetings were implemented. This bolstered shared understandings of contexts and goals and made sure that specialists’ concerns were quickly addressed.
  3. Peer value and input: often, peer specialists are not treated as equal and are more generally undervalued. To combat this, supervisors sought peer input and feedback, implementing a collaborative approach to problem-solving and highlighting each peer specialist’s specific skills.
  4. Peer professional development: this project specifically sought opportunities for peer specialists to expand their knowledge and skills to make broader contributions to both the project and the field at large. To do this, specialists led the development of formal intervention adaptations (allowing peer specialists to identify problem areas and direct change), led community-of-practice calls on a rotating basis, and attended/presented at conferences and training sessions. This served to engage peer specialists in developing new competency areas, accessing mutual support, assuming leadership roles, sharing their expertise, influencing practice, and networking with others.
“These strategies may have contributed to peer specialists reporting feeling included in decision making and having their roles valued and taken seriously; moreover, we achieved high rates of staff retention, with all four peer specialists who had begun delivering the intervention remaining on the project for at least 3 years,” conclude the authors.
“These strategies also benefited supervisors, who described how the peer specialists had positively influenced their own practice. They noted having developed a greater awareness of inequitable power dynamics with service users, having greater humility and appreciation of challenges in peer specialists’ and service users’ lives, wanting to incorporate attributes that peer specialists exhibited in their daily work (e.g., patience and enthusiasm), and using more self-disclosure.”

There were, of course, challenges despite the steps above. Organizational silos tended to develop, there was a lack of integration, and supervisors were not peers, and as such, were sometimes limited in the support they were able to provide. Still, the experience was largely positive, and several key areas can be targeted for future research and betterment of the practice.



Stefancic, A., Bochicchio, L., Tuda, D., Harris, Y., DeSomma, K., & Cabassa, L. J. (2021). Strategies and Lessons Learned for Supporting and Supervising Peer Specialists. Psychiatric services (Washington, D.C.), appips202000515. Advance online publication. (Link)

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Gavin Crowell-Williamson
MIA Research News Team: Gavin Crowell-Williamson is a Research Assistant at the University of Washington studying addiction-related suicide prevention. He is interested in researching how to provide opportunities for mental health care in communities that lack access, as well as understanding systemic factors that either facilitate or prevent getting help for mental health. He is currently pursuing a graduate degree in Community Development and Action from Vanderbilt University.


    • Well, how about dispensing with the “survivor” concept as well (which is a product of psychiatric oppression) and work towards us all getting back to a more tribal consciousness, where providing support is just another natural human capacity? (And where less alienation leads to less distress?)

      PS I am attempting to add to your idea, not contradict it.

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      • Survivor works for me, tyvm. It is a triumph over oppression and systematic harm. I don’t quite understand the recent shitting on that term as a concept. I am sorry for those who are still struggling within the system or with their anger at the system. I agree that not everyone who has left psychiatry has become a survivor and I think the anger that a lot of us experience when we do get out and off the drugs successfully is simply grieving all that was lost. But you can’t unpack and live in grief forever. This is something I know a lot about. It will eat you alive. Forward motion is healing. Every forward motion, no matter how small.

        There’s nothing wrong with being a victim. Grieving is necessary. But I am proud of all I have survived and I’m not giving up the term psychiatric survivor. I am ok *most* of the time. That’s significant and my triumph to own. Other folks’ mileage may vary.

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        • It’s acceptable and I understand how and why it became the go-to term. But I think inmate and outmate are more descriptive.

          In terms of self-empowerment, there’s a difference between recognizing that objectively we have been (or are being) victimized by something, and adopting “victim” as an identity.

          My larger point is that All people need to reclaim their stolen humanity.

          FWIW before I discovered MIA in 2014 I did pride myself on being a “survivor” but I thought of it in terms of being a survivor of the system in general; I spent almost zero time thinking about psychiatry. I didn’t even realize that “survivor” had become the prevailing term among the remnants of the AP movement.

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          • I don’t see how viewing oneself as a survivor who was once victimized by something is akin to adopting a victim identity. I DO think that not allowing for the reactions that occur when someone HAS been victimized and calling those reactions a “victim identity” is victim blaming and that it is so deeply entrenched in the culture that we don’t give space for current victims to heal. People who have been victimized often act like it at least for a time. I identify this as the grieving process. A loss of innocence. It takes working through. Not everyone survives. I have, for the most part survived and have written extensively about the factors that facilitated that. I am no longer a victim, I am a survivor. I am also at risk of being victimized by the system again, and I think we are all keen to remember that when we talk about victimization and it’s short and long term effects.

            You may have the luxury of reclaiming your stolen humanity as your experience with the system was decades before electronic medical records, among other things. Those of us more freshly out of the system live in a different world. Neither ‘inmate’ nor ‘outmate’ would be appropriate for someone like me. May ‘21 will mark five years since I saw a psychiatrist. Survivor fits and I encourage others not to fall into the trap of denigrating this concept before fully thinking about what it means.

            There are people writing in these comments sections who truly haven’t made it to ‘survivor’ yet. They are still victimized by the system and trying to find their way out and to something resembling wholeness again. Where they are at is ok too and they deserve support and hope to see what is possible and not to be shit on because they are still responding like the victims they are. It’s not a victim mentality or a victim complex, it’s what victimization looks like for a depressingly long time for far too many people who’ve been badly abused by the system for an extended amount of time.

            As I wrote before, I see the term ‘survivor’ as a triumphant one. YMMV

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      • Being a “psych survivor” is by definition a product of psychiatric oppression. Psych survivors have survived the regime that at times forcibly drugged, jailed, and electrocuted them. Without psychiatry declaring that a group of people are genetically inferior and therefore are second class citizens who lose their rights, wealth and life there would be no psych survivors.
        Taking the increased death rate from psych drugs psychiatry kills in America alone half a million people a year.
        I’m not sure why the term “psych survivor” is a counter productive and negative term. I don’t know if I would be able to connect and agree that the term shouldn’t be used. But Given when it comes to many opinions I reside in the minority your best argument against using the term “psych survivor” might be very convincing.

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        • You’re extrapolating a little too much from what I said. It’s really not a big deal, I was just exploring the implications of the term, and of using it as an “identity.” By no means do I consider “survivor” to be “negative and counterproductive”; if I did I wouldn’t use it.

          When I left the movement, or more accurately when the “movement” left us in the early 80’s, the going terms were inmate and ex-inmate (to which I have suggested adding “outmate,” to describe those in “treatment” outside institutional walls). By the time I reconnected with the movement’s remnants in 2014 “survivor” had become the term of record, and I have accommodated myself to it.

          The reservation I was expressing has to do with basing one’s “identity” on their worst experiences. But if the identification as “survivor” is inspirational and empowering for some, by all means go for it! 🙂

          There is another distinction to be made here too — when speaking in a political context “survivor” describes a political class, just as “woman” describes a political (as well as biological) class. So, just as someone who in a political context identifies as a “worker” might not see that as his/her identity as a whole, one can identify as a “survivor” when working on AP stuff, while considering their “greater identity” as encompassing more than that one aspect.

          However — I was approaching this primarily in a “chat” mode. I think if AP survivors are ready to tackle a discussion of issues which are integral to the definition and progress of the AP movement, those issues would the “peer” industry and the concept of “madness” as an “identity.” Neither of these discussions should take place primarily on MIA however — if you’d like to move this to a survivor forum give me the word!

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      • I believe the “survivor” concept came from the world of domestic abuse/sexual assault intervention. Could be wrong there, but that is my impression. The intent as I understand it is to define someone by their strengths and accomplishments rather than by their victimization. But that’s my limited understanding.

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  1. I’d probably enjoy being a specialist, but I’d never get by, because of a drawback the author didn’t mention- that of the specialist being more knowledgeable than his/her professional, something similar to owning a dog who was smarter than you were.
    I’d already had such an experience at my last MH related job at a residential treatment center for substance abusers, where a new hire had run a gent who’d deliberately cut himself to the hospital, leaving the other residents behind, and one of them called me.
    The next afternoon I was sitting in the flunkies’ office wondering if B3 would help this guy, when another resident came to the door and asked me it I thought he was schizophrenic, so I gave him a session with my HOD test, which I kept on the property at the time, and he scored in the “schizophrenic” range, so I suggested he see about B3 (amide, because it doesn’t induce flushing) and educate himself with How to Live with Schizophrenia.
    He began to take the B3, whereupon the cutting guy became fascinated and started the B3 himself, both getting 3g/afternoon (only on my shift) unbeknownst to the clinical staff. Both graduated from the program, despite an assessment from the clinical staff on their admissions that neither would.
    Naturally, the clinicians called me on the carpet, upset that their residents both graduated despite their awful prognoses (they must have talked to their new graduates, baffled that they were graduating), making awful faces and noises. I refused to tell them, as I suspected they’d accuse me of medicating their patients and I wanted my unemployment free of having to dispute them, as B3 isn’t a drug, plus, I didn’t want to keep my job in order to watch patients fail their treatments out of staff ignorance.

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  2. Though it would never see the light of day today, John Lennon’s most lasting and dramatic anti-misogynist lyrics can be found in his classic “Woman is the Nigger of the World,” which he recorded with Yoko Ono. It came to mind while pondering the role of “peers” in the “mental health” gulag.

    If you see the psychiatric system as a caste system, “peers” are next to the bottom, which of course is occupied by those “served” by these alleged “peers.” It’s infinitely disturbing how “highly functioning mental patients” are groomed to oversee those who haven’t yet mastered the subtleties of the “mental health” hierarchy, and even more disturbing that survivors are conditioned to look up to those who have become “successful” mh professionals as role models, rather than as examples of compliance (again we’re talking systemic so any individuals who feel offended must be feeling guilty).

    If the definition of a “peer” is someone who is essentially just like you, why is someone being materially compensated for being “just like you” when you’re not?

    Here’s the dividing line: “Peerdom” is a creation of psychiatry, and there is almost always a psychiatrist at the top of the ladder capable of rescinding a “peer’s” accreditation. Even if there may be variations now & then. The question is not even whether it’s “consensual” (though that’s always in the background), but whether adopting the psychiatric mentality, which targets individuals (the branches) rather than the criminal system (the root) is backwards and perpetuates that system. If people took the latter attitude there might be a consensual revolution in short order. Or close.

    My main point is that aspiring to be a “good peer” is not logical or consistent if someone identifies as “anti-psychiatry” or “abolitionist.” They are opposite directions.

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  3. LOL, funny article. Scariest of all is to meet a peer that thinks you are suffering from an illness. LOL, the peer talking to a shrink about you, just to save his own ass. You are never saved nor free as long as you are in the system. Neither is the shrink, he is in the biggest prison of all. Lock up is nothing compared to being in a false belief system that people are too stupid to realize. Does a shrink ever get to go home and relax? No. He is frozen in time. There is no hope of him changing his mind. It is made up. Forever.
    No doubt, no thought. Just adherence to a concept.

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  4. I find this article troubling, and this line gets at why:

    “Peer specialists are defined as those who self-identify as having a mental illness or receiving mental health services and combine their personal experience with training to support others.”

    Defined by *who*? That’s just wildly inaccurate, and yet seems to be getting offered here not by the research, but by you, Gavin, as a factual definition.

    People in peer roles neither need self-identify as having a ‘mental illness,’ nor be receiving mental health services. To suggest otherwise is to contribute to the worst, most oppressive aspects of this work… those that involve buying into a one-size-fits-all medicalized perspective, and the idea that we all need to be put in these awful little boxes.

    There are certain elements of ‘peer support’ that are really problematic as currently (and likely ever to be) employed by the ‘system.’ But there are certain aspects of it that are also quite powerful, particularly when offered outside of a conventional clinical environment. In those spaces where there is power, people get to come with whatever experiences have interrupted their lives or led society to ‘other’ and ostracize them… They often do come with experiences with system responses (many of them – though not all – harmful), and some identify as ‘survivors’ of that system… But there is neither a requirement to be *in* services, nor to regard any current or past history with those services as a necessary thing.

    Please don’t contribute to boxing us in. Some of us are doing our very best to come at all this from an anti-oppression, rooted-in-community sort of way and this frame doesn’t help.


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    • Sara,
      For me to get a job as a “Peer Specialist ” for Massachusetts I had to be willing to identify myself as a person who experienced recovery from both mental health and substance abuse.
      I was let go from a job at MRC due to having dyslexia. Because of this employers wouldn’t offer me a job so getting work as a Peer was the better than living on SSDI.

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