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Celebrating our unsung labor for Labor Day: Peer specialists and secretaries

August 30, 2011
by H. Steven Moffic, MD
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I usually don’t easily admit I was wrong. But I was wrong about peer specialists.

Years back, I thought it would be inappropriate for patients to become staff in mental healthcare. Even if they were mentally stable, I thought maybe the stress would cause them to decompensate. Or, would they be likely to inappropriately self-disclose? Or, sabotage what we professionals were trying to do?

I even felt this way somewhat about AODA treatment services, where counselors who have also had AODA problems were more commonplace than with non-AODA services. Certainly, the success of Alcoholic Anonymous is based on peer support.

However, as the peer specialist profession started to emerge out of the larger consumer and recovery movement, I reluctantly went along. Prove it, I somewhat smugly said to myself. And they did!

What I saw in some of my own work settings is peer specialists who filled important services that had fallen through the cracks. Some of these were conducting patient satisfaction surveys, providing practical information about available services, and being informally available for support.

Nationally, in 2001, Georgia became the first state to obtain Medicaid reimbursement for such services. Since then, at least 13 other states have done so. National guidelines and certification are beginning to emerge. Outcomes tend to be positive overall, including a significant reduction in rehospitalization of those they serve. Of course, the mental health of the peer specialists themselves may improve, given the benefits and self-esteem from helping others. Moreover, given that finding work is so difficult for the more seriously mentally ill in the first place, getting a job as a peer specialist fills that need.

Sure, there are problems. More education on cultural competency, trauma, and ethics is needed. Adequate on-site supervision is a challenge. Such supervision can help to avoid patient interactions that may be triggers to trauma in the lives of the peer specialists. What not to do, such as parking lot security, or medication monitoring, needs to be emphasized and operationalized. Appropriate salary is unclear. Career ladders are missing for the most part. More acceptance by traditional professions like mine is important.

On the other had, I’ve always been a big fan of the important roles that secretaries, aka administrative assistants, play in our community mental health settings. At their best, they can do much more than the routine secretarial work that secretaries in any work setting do.

Was a life ever saved in your setting because the front desk administrative assistant heard a patient mentioning suicide on a (cell) phone call? Were there ever times you didn’t realize that a patient left in anger, only to have the administrative assistant gently tell you that? Or, that the patient wanted more time? Did they ever have to be the first responder for a patient agitated or medically ill? Or, other important things that you did not know, including good things a patient might have said about you that you didn’t realize? At the very least, they can provide a “welcome center” for people who are stigmatized for their illness.

Or, if you are an administrator rather than a clinician, and I’ve been both, how often has your administrative assistant caught a mistake? Or absorbed your anger? Or, told you when other staff might be slacking off? Shared institutional gossip?

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Great insights, Steven.

To hear one more psychiatrist acknowledge the value and impact of peer specialists is wonderfulsomething that will be music to the ears of their advocates. I'm going to pass your blog along to a few other folkssome of whom are doing research on the topic.

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H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...