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January 01, 2006

The fastest way we know to transform a mental health agency into a recovery- oriented operation is to involve the people being served in all levels of the program. Perhaps the most talked about consumer role these days is that of “peer support.” Just about any conference you attend has several workshops on this subject. Peer support is a lot more than just the latest buzzword in behavioral health; it is in fact one of the most powerful tools for transformation.

The best way to gain an understanding of what peer support is and how it works is to go to the source and talk to people who are actually doing peer-support work. This quote from a peer graduating from the META Services Peer Employment Training program at META Services in Phoenix illustrates the powerful impact that even a brief peer encounter can have:

Consensus has not yet emerged among various peer-support experts on the finer points of this new discipline, but strong agreement exists on the major defining factor: Peer support is based on mutuality, which means partnering with people as colearners to assist them in discovering the expertise they already have within themselves.

This is the key to inspiring people to become active participants in their own lives. The person receiving peer services guides the process and has the freedom and responsibility to communicate what works best for him/her. Here's how another peer describes this process:

Peer support has been propelled forward in mental healthcare because it works. It works on several levels simultaneously. The accounts above illustrate the benefits both to the person receiving the peer service and to the peer employee. The third beneficiary, the program or system, derives several advantages from the inclusion of well-trained peers in its workforce.

Organizations in the midst of transforming programs into recovery-based services will find that integrating peer employees into the programs will expedite the movement toward recovery. Having peers present in the service system adds a constant source of accountability to the culture, which helps sustain the steps taken toward transformation. Well-trained peers are an excellent addition to existing services, particularly during the engagement phase. They constitute a committed and enthusiastic workforce who brings a level of authenticity and empathy to those trying to recover.

A side benefit of peers having an opportunity to contribute to the recovery of others is that their own recovery is strengthened. Programs that elicit input from peer employees are able to make relevant changes in services that can lead to better treatment outcomes.

Two of the largest peer-training programs are located in Georgia and at META Services in Arizona. Larry Fricks, director of consumer relations and recovery at the Georgia Division of Mental Health, has been a key player in pioneering Georgia's program evolution from a strong grassroots consumer movement to a partnership between his office and the Georgia Mental Health Consumer Network, Inc. Consumer leaders were at the table six years ago when the state redesigned its services and included a new Medicaid-billable service for peer support under the rehabilitation option.

“I'm convinced that the greatest potential for actualizing the vision of recovery lies within each individual, not in the system,” Fricks says. “Peers can tap into this potential and nurture the hope that fosters recovery not only through role modeling, but also by being trained in skills that call forth the strengths of the individuals they serve.”

The META Services program in Arizona, developed under a Medicaid waiver that reimburses peer services, has been training and employing peers for the past five years. The META experience is best summarized by this comment from CEO Gene Johnson: “We have graduated over 800 peers from our classes in the United States and other countries and we have learned more about recovery from each and every student. Applying what we've learned has allowed us to transform services that more effectively promote and sustain recovery in all of our programs.”

One of the best-known pioneers in the area of peer support is consultant Shery Mead. It seems appropriate to close this column with a quote from her: “When people find others who have had similar challenging experiences, there is almost instant connection (finally someone who really gets it). But the real gift in peer support goes beyond initial affiliation. The real gift lies at the intersection of true reciprocity and the exploration of new meaning and possibility.”

William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University. Lori Ashcraft, PhD, directs the Recovery Education Center at META Services, Inc., in Phoenix.


  1. Ashcraft L, Johnson E, Zeeb M. Peer Employment Training Workbook. Phoenix: META Services, Inc., 2004.
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