Recovery coaches and peer mentors 鈥� known in Alcoholics Anonymous as 鈥渟ponsors鈥� 鈥� have for decades helped those addicted to alcohol or drugs. Now, peer support for people with serious mental illness is becoming more common. Particularly in places like Texas, where mental health professionals are in short supply, paid peer counselors are filling a gap.
David Woodside, who has lived with bipolar and schizoaffective disorder his whole life, is getting help this way. Not long ago, he wound up in a Dallas County jail for the first time, at age 57. Woodside had gotten upset and kicked his brother.
鈥淣othing good happens in jail,鈥� he said. 鈥淭hey don鈥檛 give you your medication.鈥�
After his brothers, including the one he kicked, bailed him out, Woodside enrolled in an anger management class听in Dallas听at听, a nonprofit serving people with mental illness in North Texas.
At Metrocare, Woodside started visiting David Yarborough鈥檚 office several times a week. Inside, there鈥檚 an American flag on the wall, a popcorn machine in the corner and tissues on the wooden desk.
The two Davids have much in common.
Both are fathers and have worked as electricians, and both are taking the same antipsychotic medicine. That鈥檚 because Yarborough also copes with mental illness. He鈥檚 not a volunteer 鈥� he鈥檚 a full-time, paid, peer specialist. Woodside said, for him, seeing Yarborough has been better than seeing a psychiatrist.
David Woodside visits David Yarborough鈥檚 office several times a week to get helpful coaching on how to manage the symptoms of his bipolar and schizoaffective disorder. 鈥淒ave鈥檚 been through a lot of the things I鈥檝e been through 鈥� and vice versa,鈥� Woodside says. (Lauren Silverman/KERA)
鈥淸Psychiatrists] see you for about six or seven minutes,鈥� Yarborough said. 鈥淭hey don鈥檛 know what鈥檚 going on with you. And Dave鈥檚 been through a lot of the things I鈥檝e been through 鈥� and vice versa.鈥�
Metrocare employs five trained peer specialists, including two who are part of the statewide Military Veteran Peer Network. In Texas, more than 900 people have gone through the statewide certification process provided by the nonprofit organization听. The training requires 43 hours over five days and covers topics such as ethics, effective listening, the role of peer support in recovery and using your personal story as a recovery tool. The certification is valid for two years, and a person needs to earn continuing education credits to renew their certification.
Dennis Bach, executive director of Via Hope, said most of the certified peer specialists are employed by community mental health clinics and state hospitals.
, with, said the idea of peer services has been around for decades but only recently have research studies shown how powerfully effective the approach can be.
鈥淥ne of the problems with mental health is we鈥檝e learned how to keep people 鈥榮table鈥� on their medications and get them out of the hospital. But recovery is about having a life in the community,鈥� Zahniser said. 鈥淎nd peer services are often focused on those things: How do you get your life back?鈥�
听show peer support specialists can do as well as traditional case managers 鈥� if not better 鈥� in keeping patients with severe mental illnesses out of psychiatric hospitals.
And, Zahniser said, when it comes to persuading people who are suspicious of doctors to seek help, peers are often the ones who can connect fastest, and get them to accept treatment.
Peer counselors historically were volunteers. But as the Centers for Medicare & Medicaid Services recognized their value, and more training programs were established and standardized, it became easier for hospitals and clinics to employ these specialists full time.
Texas is one of more than 35 states that finance peer services through Medicaid. There鈥檚 a severe听in the state, so certified peer specialists bridge the treatment gap.
, a researcher of workforce issues with the Institute for Health Policy Studies at the University of California-San Francisco, says听听鈥� alongside doctors and social workers.
鈥淲hen [programs] first brought in peers,鈥� Spetz said, 鈥淸they] had to spend a lot of time with the social workers, explaining to them that we were not going to take their work and hand it off to a cheaper person 鈥� that what the peer did was complimentary, but it was different.鈥�
(Martin Barraud/Getty Images)((Martin Barraud/Getty Images))
Peer specialist Yarborough was offered a job precisely because of his success in coping with his own mental illness and overcoming his past use of methamphetamines. When he works with clients, he can talk openly about how, decades ago, he fell into a very dark place.
鈥淚 went from the outdoorsman 鈥� fishing, yardwork, just really enjoying all that stuff 鈥� to 鈥� the guy who wants to lie in bed all day and stare out the window,鈥� Yarborough remembers.
He started having suicidal thoughts.
鈥淚 gave my wife the key to my gun safe,鈥� Yarborough said, 鈥渂ecause I did not feel comfortable having access to my pistols.鈥�
Eventually, Yarborough was diagnosed with bipolar II disorder. His condition has been stable for seven years and he has been drug- and alcohol-free for 10.
When he trained to become a peer specialist, Yarborough said, he learned to work with others while keeping a close watch on his own mental health. Every week, he helps dozens of people manage their symptoms.
His mantra? 鈥淚t鈥檚 not how you fall, it鈥檚 how you get back up,鈥� he said. 鈥淎nd I鈥檝e really stuck to that concept.鈥�
There can be a lot of stumbling with a mental illness, Yarborough noted, and having a shoulder to lean on makes the journey much smoother.
The idea of relying on peer providers in this way isn鈥檛 unique to the U.S.
鈥淭here are many parts of the world where peer specialists are being deployed in the health care system to provide mental health care interventions,鈥� says, a psychiatrist and professor of global health and social medicine at Harvard Medical School.
Patel says nearly 450 million people are affected by mental illness worldwide. In developing countries, the听, he says, because psychiatrists are in such short supply. Patel has looked at the potential of peer support to help meet mental health needs听听and Pakistan.
鈥淲e鈥檝e completed听showing people affected by schizophrenia can be very effective in supporting other people in their own community by befriending them and giving them social support,鈥� he said.
Patel is completing a trial that trains women in a community to help their neighbors recover 鈥� mothers suffering from depression.
He hopes Texas and other states in the U.S. continue to experiment with using peer providers, especially to serve people who are finding it difficult to get access to mental health professionals.
鈥淢any groups experience such difficulties 鈥� for example, minorities and those who are homeless,鈥� Patel said. 鈥淭his model is one that should be adopted and integrated into the mental health care system.鈥�
This story is part of a reporting partnership with , and听Kaiser Health News.