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I am a certified peer specialist: but I didn't sign on just to be the van driver

May 25, 2014
by Steve Bell
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As the demand for quality behavioral health care services grows, so does the need for a larger, better trained workforce.   The employment of persons with lived experience (peers) to work with clients and perform other assigned duties offers: (a) increased value for clients seeking recovery-based services; and (b) greater opportunity for meaningful paid employment for persons in recovey.

How does an employer determine what job duties peer workers should perform?  Are certified peer specialsts and recovery coaches professionals, para-professionals or support staff?  Is it a good use of a peer workers' time, talent,experience and education to assign someone, who has months or even years of volunteer work experience at a community mental healthcare program site and 40 to 80 hours of specialized training to help clients, to spend 50 percent of their part-time work hours doing paperwork for a case manager or driving a van? 

Since there is currently no national, standardized peer specialist curriculum, each state chooses how people are certified or licensed  and what that means in terms of Medicaid reimbursement.  Which raises other questions.  Who is qualifed or required to do the pre-licensing training?  The state?  Managed care orgaizations?  Statewide peer-run organizations affiliated with, for example, the International Association of Peer Specialists? 

One major concern in the peer provider community is how does the actual work being done at program sites by peer staff line up with the pre-employment training subject matter and who decides the content of job descriptions, reporting relationships, and the process for performance evaluation?  Another concern is the perception that unless a peer specialist has an academic degree, does an extended internship (often with no compensation) at a community mental health center in addition to completing a certificaton course, the non-peer staff do not respect these new hires or appreciate the value they bring to the healing and recovery process.

These workforce issues are complex and will take time for all the players to successfully work through them.  Based on my own experience as a peer provider, a small businessman, an employee of large corporations and an advocate in what many of us still call the consumer-survivor community, I want to share two observations; one for peer staff and one for employers.

If you are an employee with lived experience and are in recovery working inside or outside the behavioral health system, the people that sign your paycheck have the ultimate say in what the nature and scope of your work is.  And for employers, it is imperative that peer staff are treated in the same manner as other people in your workforce, but with two caveats: people in recovery unless they self-identify otherwise qualify for reasonable accomodations under the Americans with Disabilities Act; and their jobs should be structured to fit not only the many tasks that need to be performed, but fully utilize the unique benefits clients will receive from those who have walked many miles in the same shoes.



"If you are an employee with lived experience and are in recovery working inside or outside the behavioral health system, the people that sign your paycheck have the ultimate say in what the nature and scope of your work is." This is one reason independent volunteers are needed as some organizations are only interested in enriching the organization no matter how much harm they inflict. "Many mental health programs are not staffed with physicians practiced in medical diagnosis and thus are unprepared to detect a large proportion of physical diseases in their patients. As described elsewhere, California’s state mental health programs fail to detect many diseases that could be causing or exacerbating psychiatric disorders” (A Medical Algorithm for Detecting Physical Disease in Psychiatric Patients, Hospital and Community Psychiatry Vol. 40 No. 12 Dec 1989, Pg. 1270)In 1995 a study found that from 5–40% of psychiatric patients have medical ailments that would adequately explain their symptoms.(Allen MH, Fauman MA, Morin SF. Emergency psychiatric evaluation of “organic” mental disorders. New Dir Mental Health Serv 1995;67:45-55. ) The next year, in 1996, Sydney Walker III, M.D., a psychiatrist, in his book, A Dose of Sanity, claimed studies have shown that from 41% to 75% of individuals are initially misdiagnosed, often due to overlooked treatable conditions. In 2009, it was found that up to 25% of mental health patients have medical conditions that exacerbate psychiatric symptoms.(Christensen RC, Grace GD, Byrd JC. Refer more patients for medical evaluation. Curr Psychiatr 2009;8:73-74.) Yet, most of the debate today centers on forcing drugs on individuals, not providing effective, adequate diagnosis and treatment.

Steve Bell

Peer-Provider and Advocate

Steve Bell

Steve Bell is the co-founder and executive director of  BrainStorm Career Services, a consumer-...