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Is recovery realistic: the future of peer support in Tennessee

Posted Apr 09 2010 7:40pm
The Future of Peer Services in Tennessee

The concept of peer support services is at a crossroads in Tennessee.  It looks likely that state funding will be cut at least 50%.  Efforts are underway to find a way to diversify the funding for peer support by trying to establish it as a Tenncare eligible service throughout the mental health system.  Those efforts though face real problems.  There are many real issues that need to be solved in a comparatively brief period of time in order for this to be operational at the beginning of the next fiscal year.  Even if it is established at current reimbursement rates it will still not make up for the loss in funding.  It is a very worthwhile effort, but far from a guarantee.  I would propose the following:

  1. Redouble advocacy efforts.  If funding can be established at something above a 50% cut it makes it more likely that other funding streams if they can be established make it more likely the decrease in funding can be accounted for.  One thing to tell legislators would be that if peer support services could be given some time, efforts are under way which make it more likely that options to state funding can be found.  If peer support services were funded at 100% then efforts are underway through TAMHO that might with time to develop both save this valuable service, as well as save the state money in the long run.
  2. Do all that is possible to support the development of alternate funding.  One thing to do would be to increase the awareness of legislators of these efforts and ask for them to support the efforts of these mental health programs.  It should be made very clear that providers are trying to be part of the solution and save a valuable service, but do it in a way that lightens the burden on everyone.  This might give some legislators the justification to vote for a more complete budget that they might need.
  3. The long term solution is to change the way peer support is seen by providers, by legislators, by mco’s, and by the public at large.  That issue is discussed below.

The role of peer support services

Peer support services are not meant to be second rate counseling, bargain basement case management or anything like that.  Peer support can and should be seen as an integral part of the service delivery system.  It is not simply a diluted version of more professional services or something that would be nice if only we had enough money to do something extra.  It addresses core issues not addressed by other methods:

  1. For many people with severe and persistent mental illness the issue is not just to manage their illness.  It is equally and for many people a question of how to cope with the mental health system.   Studies have shown that not enough people who need services enter the system and not enough people who enter the system stay to receive the services they need.  Many consumers experience the system as being confusing, large and overwhelming, not always friendly or supportive and not always relevant to what they see as the needs of their daily life.  Some people simply refuse to accept the stigma attendant with receiving mental health services.  Peer support services can fulfill a unique role here.  The peer support specialist can act as coach, cheerleader, confidant, and whatever else is needed to help people to understand and be successful in the system they depend on.  Research is clear.  People who are involved with peer support services tend to be more involved and more compliant with treatment.  They tend to have less bad consequences like hospitalization.  By using peer support services in this manner providers would increase the amount of people they serve and the success with which they serve.
  2. It helps to deal with someone who understands the pain.  Someone who has been there and survived and been successful is so important to someone who has no concrete vision of what it looks like to make it.  Stories matter and finding someone with a story like yours who has made it can give you hope where you saw none.
  3. Peer support services give a model.  They make treatment more than recommendations or suggestions, but something worth caring about, worth wanting and worth pursuing.  Peer support specialists motivate consumers just merely by being there.
  4. Peer support specialists give the message to consumers that they can do far more than they thought.  One of the messages that too many get in treatment is to “be realistic” and to give up hopes of being significant.  They give them a goal.

These are only some things that come immediately to mind.  I am sure there are many other core ways that peer specialists can and do play integral roles in the mental health system.

If you have any reactions to some of these ideas I would be delighted to hear from you and talk further.

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