Review recommendations for integrating peer support services into healthcare systems as promoted by the Affordable Care Act.
Change is on the horizon for healthcare systems in the United States. The 2010 Affordable Care Act was designed to improve the way Americans receive health care and access health insurance. As the health financing law is implemented in communities around the country, there are additional opportunities for peers to be integrated in the design, delivery, and evaluation of mental health services. There are many different terms used as identifiers for people with lived experiences such as consumer, patient, ex-patient, and survivor. It is with the utmost respect that the term “peer” is used in this writing.
There is increasing respect for the unique and valuable skills of peer providers. Peers fill diverse roles and duties that require varying levels of skills. According to Pillars of Peer Support reports, although formal training is not always required, peer specialists can be trained, certified, and supported in their work in state mental health systems of care. Establishing Medicaid-billable peer support further emphasizes the professional role of peer specialists, the reports state.
With the introduction of the Affordable Care Act, peer providers will continue to expand their role in the delivery of mental health services. Peers for Progress information on the law and peer support – 2012 highlights the role of community health workers (CHWs). The Affordable Care Act defines CHWs as people who promote health or nutrition within their community by:
- Serving as liaisons between communities and healthcare agencies
- Providing guidance and social assistance to community residents
- Enhancing community residents’ ability to effectively communicate with healthcare providers
- Providing culturally and linguistically appropriate health and nutrition education
- Advocating for individual and community health
- Providing referral and follow-up services or otherwise coordinating care
Additionally, CHWs are in a good position to proactively identify and enroll eligible individuals in federal, state, and local private or nonprofit health and human services programs.
A 2010 study on peer knowledge and roles in treatment support found that organizations can leverage the financial mechanisms available for CHWs by incorporating peers. These peers have received specialized training and who use their recovery journey to support other consumers. Peers can improve the delivery of mental health care services in multiple ways.
Promoting Social Inclusion
Social exclusion relates to the act or the fear of being discredited or devalued because of a personal attribute. This can keep people from accessing treatment and it may stall the recovery process. Social exclusion remains a persistent problem in mental health services and has its roots in the provider-patient relationship. Professionals and peers can be skeptical of each other’s motives, but they also remain deeply intertwined and share the burden of missed opportunities to develop services that inspire hope, impart skills, and lead to a bright future for people served in behavioral health settings.
One role of the CHWs is to serve as liaisons between communities and healthcare agencies. Peers can help eliminate the social exclusion that surrounds mental health services by serving as a bridge between professionals and consumers. At a local level, peers can help other consumers navigate the healthcare system, accompany consumers to appointments, and help them develop positive relationships with their care providers.
Joining the Dialogue
Another role of the CHWs is to advocate for individual and community health. This provides an opportunity for people who are served to continue to have a seat at the table in the design, delivery, and evaluation of services. The national advocacy group Faces & Voices of Recovery suggests, “To ensure that these decisions are fully peer-informed and recovery-oriented, it is essential that advocates and recovery community organizations are informed and vocal participants in the decision-making process.”
One example of this national advocacy work was seen at the Pillars of Peer Support Services summits. These summits brought together nationally recognized experts and stakeholders from across the country to identify and create consensus around factors that support the use of peer support services. Such services support recovery from mental illness among people served in state systems. These national dialogues are valuable tools for improving the delivery of mental health services.
The integration of peer support workers into behavioral and primary health care is rapidly expanding as a quality and cost-effective service. It is up to providers, peers, and policy-makers to ensure that the movement to integrate peer support is not derailed or delayed. As stated in the Peers for Progress report, Accelerating the Availability of Best Practices in Peer Support Around the World – 2012 (PDF | 1.73 MB), the work of peer providers is essential because “peer support services have the potential to improve the quality of healthcare delivery, lower healthcare expenditures, and reduce health disparities."
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