In border towns, the border is the business. Imports, exports, smuggling. There are things that are legal on one side of the border but illegal on the other; every detail of life is an arbitrage opportunity created by the border itself. El Paso, Texas is the northern half of a single divided city, closely coupled with Juarez, Mexico. For the Recovery Alliance (RA) of El Paso to develop a peer-to-peer services recovery model is a recognition that they live along la frontera (“the frontier”). They must do it the way it works on the frontier, which in El Paso/Juarez is peer-to-peer recovery. “Peer developed, peer driven, and peer run,” explained Ben Bass, RA Executive Director.
Connecting Peer Support Specialists with Veterans
RA’s residential facility, Casa Vida, currently has 23 veterans experiencing homelessness receiving services for co-occurring substance and mental use disorders, including post-traumatic Stress Disorder (PTSD). They also have 25 self-paid clients. The Casa Vida program goes for at least 90 days, or as long as the client feels it is needed. They also offer a Level 3 recovery house at the most structured level.
And Casa Vida gets results. They received a SAMHSA grant between 2008 and 2011 to serve 387 people experiencing homelessness with co-occurring substance use and mental health disorders. The clients received clinical outpatient substance use treatment, mental health treatment, and long-term engagement with peer support specialists. Participants were surveyed after completing the program; over 70% were still abstinent after six months, and were also 12 times less likely to seek mental health services than before they showed up for the program.
“It was a huge money saver,” said Mr. Bass. “But it is hard to sell to funders because peer specialists aren’t credentialed. But we are putting it together anyway, without Texas or federal government support. We are getting private funding from those in the recovery community. And we are gaining support for other issues, like a medical care facility that provides primary care. We also have a strong connection to mental health providers.”
RA was the recipient of Recovery Community Services Program (RCSP) grants from SAMHSA to help build their efforts into a large recovery community organization. “Our program is a local, recovery-oriented system of care program. We provide a menu of recovery resources across the community. It works best if the clients stay in El Paso because we work them into the recovery community. And over half of Casa Vida workers and volunteers have completed our program. The rest are from the local recovery community,” said Mr. Bass.
Mr. Bass understands that there are principles to be practiced, but there are local practicalities to be respected in order for RA to be successful. “People see what we do and they want what we have. There have been hundreds of people in these rooms, at least 2000 people since 2005. We work with AA, NA, churches, and secular organizations throughout El Paso. Eighty-five percent of the people we work with are Hispanic. We are family oriented and we speak Spanish in all we do. The culture of la frontera is built right into it.”
Elevating the Role of Specialists in the Field
Jack Cameron, of Ohio Empowerment Coalition, emphasizes the importance of having peer specialists and supporters at the table. “We are a consumer organization—we define a consumer as someone who is self-declared as having a mental illness or other related issue, like substance use. In Ohio, a consumer-operated service must have at least 51% of these consumers on the Board of Directors, and our organization has 100% consumers. We do advocacy work—that’s system advocacy and personal advocacy. We faced a lot of cuts from 2008 to 2010, and we want to make our work sustainable. As part of that, we are working with the Ohio Department of Mental Health, training certified peer specialists and peer supporters—they are ‘specialists’ in the mental health world and ‘supporters’ in the substance use world—in part to ensure that the money is spent efficiently.”
Mr. Cameron thinks that peer specialists are an important part of the future of mental health care in the Buckeye State. It was important to learn more about how the consumer voice and work impacts mental health and systemic advocacy from another geographical perspective.
“We are promoting peer supporters. We want to elevate the role of peer supporters in health care in general. The home health care provider is really a model for mental health care and the role peer supporters can play. We are looking at schizophrenia, bipolar disorder, diabetes care, medical care.”
Peer support specialists are becoming more vital to the field. Mr. Cameron believes peer supporters fill an important role in the behavioral health workforce. “The real value a peer supporter has is that they are uniquely qualified to engage people with mental health issues. When we look at what we call ‘hotspots’—people who use a lot of health care services—early evidence indicates that peer supporters can reach people who are hard to reach. Sometimes, someone who has a similar history but who has developed the ability to stay out of the hospital has credibility, can get people to try things they might be reluctant to try. They engage the consumer, make a connection, do the little things. It is really an art form. Like health coaches, they get the consumer to do things that are fun, like take part in a walking group or a dance class. They have fun, but it is exercise. And then they are interacting socially, no longer totally sedentary, and they lose weight. The peer supporter can focus on little things, like helping the consumer eat less salt today. It is a holistic model that helps focus the consumer on strengths, and the result is that the consumer’s blood pressure is not so high.”
Ohio Empowerment has helped trained 200 peer specialists. The Ohio Department of Veterans Affairs is the largest employer of peer specialists, but about 70% have part-time status due to a disincentive to go full time, which might lead to a loss of benefits. But expanded Medicare may remove that disincentive. Mr. Cameron has a modest wish list. “I would like to some real, hard evidence that peer supporters save lives and improve outcomes—we see it but we haven’t tested it.”
This article was originally published in September 2014 to highlight the theme of Recovery. September is National Recovery Month. Learn more about being a peer support worker and core competencies for peer workers.
Access more behavioral health and homelessness resource.