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Exploring New Frontiers: Recovery-Oriented Peer Support Programming in a Psychiatric ED
Abstract
Enhancing the diversity of roles for paid peer-support specialists is a topic of increasing interest throughout the country. Peer specialist positions promote a renewed sense of hope for the possibility of recovery, while also offering unique and valuable competitive employment options for mental health consumers. As we strive toward local and national recovery-oriented systems of care, we must continue to explore practical program applications and their associated benefits and challenges. The authors describe the development and implementation of a recovery-oriented peer support team within the psychiatric service of an emergency department (psychiatric ED) located at an academic medical center in a northeastern state.
... We also found how some PSWs, in the beginning when they talked about their role, identified stigma (Asad, 2015;Asad & Chreim, 2016;Burr et al., 2020;Collins et al., 2016;Elias & Upton-Davis, 2015;Gillard, Edwards et al., 2014;Hensley & Dawson, 2017;Migdole et al., 2011;White et al., 2017). A PSW said: "There's definitely a stigma there that was experienced . . . ...
... Supervision (Debyser et al., 2018;Elias & Upton-Davis, 2015; S. G. Gillard et al., 2013;Gillard, Edwards et al., 2014;Hensley & Dawson, 2017;Lloyd et al., 2017;Migdole et al., 2011) and support (Asad, 2015;Debyser et al., 2018;Lloyd et al., 2017;Nossek et al., 2021), which were also considered important for the PSWs, were not always offered (S. G. Gillard et al., 2013). S. G. Gillard et al. (2013) concluded that in mental health services there is often lack of support that is important to bring the PSWs' "distinctiveness to the team" (p. ...
... The review also demonstrated the significance of remuneration (Burr et al., 2020;Collins et al., 2016;Gillard, Edwards et al., 2014;Migdole et al., 2011;Mulvale et al., 2019;Nossek et al., 2021;Otte et al., 2020a) that also seemed to be important when recognizing a PSW's contribution (Asad, 2015;Asad & Chreim, 2016;Storm et al., 2020). Some PSWs thought that remuneration correlates with legitimacy but also tokenism on the team: If you're paid less than the other professionals, you don't have legitimacy. ...
Interprofessional learning (IPL), which is learning arising from the interaction between representatives of two or more professions, has not been studied extensively in relation to peer support workers (PSWs) in mental health care teams. PSWs support others who face challenges with their own experience of similar challenges of mental health problems. The role of PSWs has been studied in mental health care interprofessional teams. However, researchers have not paid attention to IPL where the PSWs contribute their knowledge. This paper is a scoping review that aims to highlight existing knowledge of the PSW role and expertise in IPL in the context of mental health care. The findings show knowledge of (a) the key factors and challenges when interprofessional teams include the PSW role, (b) the legitimacy of the PSWs' role and expertise, and (c) the benefits of the PSW role. A knowledge gap was identified of teams' use of PSWs' expertise and its implications for IPL.
... Hospitals must introduce programs designed to enhance the psychological well-being of healthcare workers during this critical time. For instance, Resilient in Stressful Events (RISE) and Second Victim Experience Support Tool (SVEST) help reduce stress caused due to work and non-work related issues (Scott, 2009;Migdole et al., 2011;Burlison et al., 2017;Connors and Wu, 2020). On a more general level, it is crucial to develop a supportive organizational culture FIGURE 2 | Moderating role of safety consciousness. ...
... Shows bootstrapping results for direct and indirect effects where safety specific transformational leadership enhances psychological well-being of employees by reducing COVID-19 perceived risk. (Higgins, 2015) by adopting a peer support program, as suggested by De Clercq et al. (2020), in which senior healthcare workers are asked to encourage fellow employees with selfcare tips and psychological first-aid (Migdole et al., 2011). These programs have the purpose of providing peer support to employees who are facing any mental health issues. ...
... These programs have the purpose of providing peer support to employees who are facing any mental health issues. They comprise different activities such as giving emotional support, discussing workplace practices, listening to employees' issues, and creating a supportive environment (Scott, 2009;Migdole et al., 2011). ...
Occupational health researchers have begun to realize that the psychological well-being of healthcare workers who are providing treatment against COVID-19 is deteriorating. However, there is minimal research conducted on it, particularly in the context of leadership. The current study aims to fill this important gap by identifying critical factors that can enhance the psychological well-being of healthcare workers. We proposed that safety specific transformational leadership enhances psychological well-being among healthcare workers, and COVID-19 perceived risk mediates this relationship. Furthermore, the safety conscientiousness of healthcare workers was proposed to be a boundary condition that enhances the negative relationship between safety-specific transformational leadership and COVID-19 perceived risk. Data were collected from healthcare workers (N = 232) treating COVID-19 patients in the hospitals of Pakistan through well-established adopted questionnaires. The discriminant and convergent validity of the data was tested through confirmatory factor analysis by using AMOS statistical package. The mediation and moderation hypotheses were tested by using PROCESS Macro by Hayes. The results showed that safety specific transformational leadership enhances psychological well-being among healthcare workers, and COVID-19 perceived risk mediates this relationship. Moderation results also confirmed that safety conscientiousness moderates the relationship between safety specific transformational leadership and COVID-19 perceived risk. This study offers implications for both researchers and practitioners.
... Nurses who are emotionally and psychologically traumatized as a victim of work-related stressor and social undermining in families often engage in deviant behaviour, which is risky for patient health and hospital operations. A pressing concern exists for health care organisations to implement different types of programmes aimed at averting the adverse consequences of work and non-work-related events (Scott, 2009(Scott, , 2010 (Burlison, Scott, Browne, Thompson, & Hoffman, 2017;Connors & Wu, 2020;Migdole et al., 2011;Scott et al., 2009). These programmes were originally designed to tackle work-related stressful events, but they can also be modified for the purpose of reducing non-work-related stressors such as family social undermining. ...
... Moreover, a supportive organisational culture is also pertinent to the reduction of stress among health care workers (Quillivan, Burlison, Browne, Scott, & Hoffman, 2016). As such, peer support programmes were introduced in 2001 with the aims of providing peer support to reduce the intensity of a work-related stress (Migdole et al., 2011). A typical peer support programme involves different activities such as discussing hospital procedures, providing emotional and physical support, listening to the problems of fellow colleagues and promoting a support-oriented culture (Migdole et al., 2011;Scott et al., 2009). ...
... As such, peer support programmes were introduced in 2001 with the aims of providing peer support to reduce the intensity of a work-related stress (Migdole et al., 2011). A typical peer support programme involves different activities such as discussing hospital procedures, providing emotional and physical support, listening to the problems of fellow colleagues and promoting a support-oriented culture (Migdole et al., 2011;Scott et al., 2009). More specifically, a peer support programme like SVEST aims at encouraging employees to share details of their negative work experiences with their peers and managers. ...
Aim(s):
This study tested a moderated mediation model based on the hospital industry in Pakistan. Adopting the spillover theory, we examined whether negative emotions could mediate the association linking social undermining in families (i.e., negative judgments that prevent the maintenance of positive familial ties) to nurses’ deviant workplace behaviors (i.e., behaviors that disrupt the normal functioning of organizations), and whether neuroticism could moderate the association linking social undermining in families to negative emotions.
Background:
Negative familial stressors can disrupt work‐related behaviors, but it remains unknown as to how negative emotions and personality traits can affect this family‐to‐work relationship.
Method:
Temporally segregated survey data was collected from nurses (n = 325 dyads) working in the hospitals of Pakistan.
Results:
Findings showed that social undermining in families triggered deviant workplace behaviors in Pakistani nurses through the mediating effect of negative emotions. High levels of neuroticism strengthened the association linking social undermining in families to negative emotions.
Conclusion:
Our moderated mediated model showed that family‐related stressors can “spill over” to the workplace and disrupt employee behaviors under the mediating effect of negative emotions. The perception of family‐related negative emotions can also be increased among individuals with high levels of neuroticism.
Implications for Nursing Management:
We recommend the establishment of social support networks and workshops for nurses to cope with the negative emotions they experienced from family and non‐work domains.
... Peer-based support services in the context of substance use exist across a continuum. This includes peer-based prevention [15], harm reduction [12,16,17], and recovery support [11,14,18,19] services. Peers, or individuals with lived experience using substances or engaging in the recovery process, are often categorized as paraprofessionals when utilized in formal systems infrastructure [18], but within harm reduction and recovery support services, can often be the leaders, administrators, and primary service delivery staff of an organization [11,12,16]. ...
... This includes peer-based prevention [15], harm reduction [12,16,17], and recovery support [11,14,18,19] services. Peers, or individuals with lived experience using substances or engaging in the recovery process, are often categorized as paraprofessionals when utilized in formal systems infrastructure [18], but within harm reduction and recovery support services, can often be the leaders, administrators, and primary service delivery staff of an organization [11,12,16]. ...
... Preliminary evidence suggests that the use of peers in the recovery process can lead to reductions in hospital readmissions, extend the length of sobriety, encourage post-discharge treatment plan adherence, increase housing stability, and improve mental health functioning [11]. Peer recovery services are delivered in a variety of settings, including emergency departments [18], collegiate recovery programs [24], and recovery community organizations (RCO) [19]. As the only setting among these that is entirely peer-lead, RCOs are uniquely positioned apart from emergency departments, which are situated in hospital systems, and collegiate recovery programs, which are situated in institutions of higher education. ...
Background: Peer-based support services are often used within harm reduction organizations, and more recently within recovery community organizations (RCO). Identifying the characteristics of individuals who engage with these novel RCOs is needed. Additionally, conducting collaborative research with communities of people who use drugs (PWUD) or are in recovery is an effective and rewarding approach that allows individuals to take ownership and play a critical role in the study.
Methods: This exploratory study employs a community-based participatory research (CBPR) framework in partnership with a peer-led hybrid recovery community organization, Rebel Recovery, in Florida. Peer staff participated in all phases of the study, helping to inform the study protocol, data collection, analysis, interpretation, and results write-up. A cross-sectional survey instrument was used to collect consumer intake data. Pearson Chi-square tests and multivariate binomial logistic regressions were used to examine relationships between consumer characteristics and service utilization.
Results: Consumers (n = 396) of Rebel Recovery peer support services had a mean age of 35.60 years (SD = 9.74). Many were experiencing homelessness (35.4%), unemployed (69.7%), high school graduates or GED holders (68.2%) and had a last year income of less than $10,000 (58.3%). The majority were users of heroin primarily (70.7%), with intravenous use being the preferred route of administration (63.9%). Exploratory analysis found that gender, marital status, and involvement in the child welfare system were significantly related to primary substance of use. Past 30-day engagement in recovery meetings had several statistically significant predictors including primary substance of use, age, housing status, annual income level, past-30-day arrests, tobacco use, and alcohol harm perception. Process findings from the CBPR methods used reconfirm the value of including peers in research involving PWUD and individuals in recovery.
Conclusions: Results suggest that peer-based support services at a hybrid recovery community organization can successfully engage populations that are often underserved (i.e., experiencing homelessness, involved in drug court, intravenous users, etc.). Significant relationships identified in the exploratory analysis suggest that additional education concerning overdose and the potential benefits of recovery meetings may be useful for specific consumers. Additionally, several recommendations and benefits of engaging in community-based participatory research with peer-led organizations are made for future research.
... Recovery models of care recognize that pathways to recovery are highly individualized and that better outcomes may be realized when people are active participants in their own healing process (Caldwell, Sclafani, Swarbrick, & Piren, 2010). The traditional medical model employed in most EDs involves educated authorities and passive consumers and an emphasis on persons' dysfunctions, while the recovery model emphasizes persons with mental illness having a significant and active voice in choosing their treatment options (Migdole et al., 2011). ...
... A recent study shows that compared to inpatient hospitalization, significantly greater improvement in psychopathology was noted in a consumer-managed residential crisis program (Greenfield, Stoneking, Humphreys, Sundby, & Bond, 2008). A variety of alternative approaches are being developed and studied, including community-based crisis resolution teams (Cotton et al., 2007), provision of peer-support in EDs (Migdole et al., 2011), and interventions for frequent users of the ED for psychiatric crisis (Adams & Nielson, 2012). Other studies show that service-users are less likely to be admitted to an inpatient setting if they go to an peer-managed crisis setting when in severe emotional distress, than if they go to an ED (Howard, Rigon, Cole, Lawlor, & Johnson, 2008 ) and suggest that service users prefer alternatives to EDs for addressing emotional distress (Mead & Hilton, 2003). ...
... This new direction is promising but as research continues to accrue, there is a need to provide detailed illustrations to guide providers to effectively use a recovery-oriented model for persons with mental illness who are on the verge of being hospitalized or who are in psychiatric crisis (Felton, Barr, Clark, & Tsemberis, 2006). It also is critical that researchers seek out and include the voices and perspectives of those who use psychiatric services; recovery needs vary in relation to the severity of crisis as well as the context of the crisis (Migdole et al., 2011 ). In addition, because recovery is a " full human experience , " characterized by change, complexity, and varying levels of wellness and distress, the voices of those with experience are essential to the development of a fully informed, effective model of recovery-oriented care (Gwinner, Knox & Brough, 2013, p. 99). ...
Persons with severe mental illness experience episodic crises, resulting in frequent visits to hospital emergency departments (EDs). EDs, however, are not the most effective treatment environments for these individuals who might better be served elsewhere in an environment based on recovery-oriented framework. The purpose of this study is to describe the lived experience of guests (persons in emotional distress) and staff (counselors, psychiatric nurses, and peer counselors) of a community, recovery-oriented, alternative crisis intervention environment-The Living Room (TLR). The total sample is comprised of 18 participants. An existential phenomenological approach was used for this qualitative, descriptive, study. Through non-directive in-depth interviews, participants were asked to describe what stands out to them about The Living Room. Interviews were audio-recorded, transcribed verbatim, and systematically analyzed using descriptive phenomenological methods of analysis by an interdisciplinary and community-based participatory research team. Participants' experiences in hospital EDs and inpatient psychiatric units contextualized the phenomenological experience of TLR environment. The final thematic structure of the experience of TLR included the following predominant themes: A Safe Harbor, At Home with Uncomfortable Feelings, and It's a Helping, No Judging Zone. Findings from this qualitative study of a recovery-based alternative to hospital EDs for persons in emotional distress are supported by anecdotal and empirical evidence that suggests that non-clinical care settings are perceived as helpful and positive.
... In mental health care, IPL has directly or indirectly been related to peer programs/ education. One example is Migdole et al. (2011), who described a peer-based patient support program in the context of a psychiatric emergency department (ED). In the program, former consumers of mental health system were recruited and trained to function as PSWs helping other consumers in the care. ...
... In the program, former consumers of mental health system were recruited and trained to function as PSWs helping other consumers in the care. Migdole et al. (2011) also indirectly exemplified a potential IPL when PSWs were described sharing their experiences when educating medical students during their emergency room rotation. Weller et al. (2021) introduced a workforce development program called Interprofessional Peer Education and Evidence for Recovery program (I-PEER), where master's students in social work and occupational therapy participated with PSWs. ...
Purpose
The purpose of this paper is to contribute theoretical ideas of how peer support workers (PSWs) bring added value to interprofessional learning (IPL) in mental health care teamwork. The question is: How can we theoretically understand the value of PSWs’ expertise for IPL in mental health care teamwork?
Design/methodology/approach
Initially, the authors formulate a hypothesis. Then, the authors describe the focus and context in IPL and PSWs, respectively, and the PSWs’ and mental health professions’ different roles, expertise and perspectives. The authors also refer to some peer provided programs related to IPL. Finally, the authors construct an outline and apply ideas from Wenger’s Communities of Practice (CoP).
Findings
Using CoP, the PSWs as newcomers can by their perspectives change mental health professions’ perspectives and stimulate IPL in teamwork.
Originality/value
The paper gives theoretical insights of how PSWs can facilitate IPL in mental health care teamwork.
... Search terms for "suicide" were based on those included in a recent systematic review of suicide prevention (Zalsman et al., 2016) which included "suicide," as well as the subheadings "suicide, attempted," and "prevention and control." Terms representing "crisis" were also included because this term has been used in the literature to encompass suicidal periods of intense distress (Dalgin et al., 2011;Gilat et al., 2011;Greenfield et al., 2008;Migdole et al., 2011), the specific terms used were "crisis," "crisis intervention," crisis services," "emergency services, psychiatric," "crisis intervention services," "crisis intervention/methods," "crisis intervention/organization and administration," and "hospitals, psychiatric." ...
... In the course of conducting this review, we identified additional articles in which peers played important roles in crisis support but not in the specific context of suicide prevention. Many of these interventions had the goal of providing a peer-based alternative to inpatient psychiatric care (e.g., peer respites; Bouchery et al., 2018;Doughty & Tse, 2011;Dumont & Jones, 2002;Greenfield et al., 2008;Lyons et al., 1996;Ostrow & Croft, 2015; consumer-run mental health organizations (Nelson et al., 2006;Nelson et al., 2007;Rosen & O'Connell, 2013), providing community-based crisis support delivered by peer providers (Emotions Anonymous, 2003), creating a forum in which peers could provide emotional support to one another during times of crisis (Scanlan et al., 2017), facilitating a smoother transition into inpatient care (e.g., embedding a peer representative as a patient advocate within the emergency room; Migdole et al., 2011), or providing support in the period following discharge from inpatient psychiatric care (Chinman et al., 2001;Johnson et al., 2018;Johnson et al., 2017;Johnson et al., 2005;Milton et al., 2017;O'Connell et al., 2018;Pfeiffer et al., 2017;Scanlan et al., 2017;Simpson et al., 2014;Sledge et al., 2011). Although suicide prevention was not their stated goal, we mention them briefly because they may represent useful models for addressing suicide risk in addition to other acute stressors and psychiatric conditions. ...
Peers of individuals at risk for suicide may be able to play important roles in suicide prevention. The aim of the current study is to conduct a scoping review to characterize the breadth of peer‐delivered suicide prevention services and their outcomes to inform future service delivery and research. Articles were selected based on search terms related to peers, suicide, or crisis. After reviews of identified abstracts (N = 2681), selected full‐text articles (N = 286), and additional references (N = 62), a total of 84 articles were retained for the final review sample.
Types of suicide prevention services delivered by peers included being a gatekeeper, on‐demand crisis support, crisis support in acute care settings, and crisis or relapse prevention. Peer relationships employed in suicide prevention services included fellow laypersons; members of the same sociodemographic subgroup (e.g., racial minority), workplace, or institution (e.g., university, correctional facility); and the shared experience of having a mental condition. The majority of published studies were program descriptions or uncontrolled trials, with only three of 84 articles qualifying as randomized controlled trials. Despite a lack of methodological rigor in identified studies, peer support interventions for suicide prevention have been implemented utilizing a diverse range of peer provider types and functions. New and existing peer‐delivered suicide prevention services should incorporate more rigorous evaluation methods regarding acceptability and effectiveness.
... Peer-led, peer-driven services have been proposed as both an adjunct to existing services and an alternative altogether. An early US-based study of peer support programme set up in the psychiatric service of an ED reported that a sustained, wellsupported programme led to consumers feeling supported, respected and understood (Migdole et al., 2011). The viability and practicalities of providing a peer support service in the ED setting have more recently been explored by Minshall et al. (2020) who reported strong support for the peer support workers from consumers, support persons and also from ED staff; of note, the peer workers provided what was considered to be much needed support for the support persons as well as the person presenting in distress. ...
The international need for innovation and reform in policing remains acute, but lacks a conceptual framework that could help guide it towards the goal of achieving public safety effectively, equitably, and with minimal collateral consequences. This article argues that policing and public health are natural conceptual partners in that both seek to reduce morbidity and mortality with broad interventions at the community level. That said, to overcome the problems that lead to recurring crises in policing—things which the medical profession would refer to as the iatrogenic harms of policing’s interventions—policing would be well-served to adopt many of the concepts and metrics of public health. One way to start this process would be to create an international center for policing and public health, which would combine research and practice in an iterative way that brings the two sectors into closer collaboration. The process could start with a series of executive sessions. Such an evolution would allow the civic leaders responsible for a community’s policing and public safety to demonstrate increased accountability by aligning measures of their success with evidence-informed endpoints that show how policing has decreased a community’s morbidity and mortality in meaningful ways, with minimized iatrogenic effects.KeywordsEvidence-based practiceAccountabilityMetricsPublic safetyInnovationPolice reform
... Peer-led, peer-driven services have been proposed as both an adjunct to existing services and an alternative altogether. An early US-based study of peer support programme set up in the psychiatric service of an ED reported that a sustained, wellsupported programme led to consumers feeling supported, respected and understood (Migdole et al., 2011). The viability and practicalities of providing a peer support service in the ED setting have more recently been explored by Minshall et al. (2020) who reported strong support for the peer support workers from consumers, support persons and also from ED staff; of note, the peer workers provided what was considered to be much needed support for the support persons as well as the person presenting in distress. ...
Over the past four decades, there has been rapidly growing interest in revising and expanding training and education opportunities throughout the world for law enforcement officers. Research has demonstrated that stronger links between police departments and higher education institutions result in increased professionalism in policing. Throughout this period, societal expectations of law enforcement personnel have changed and expanded. This has been accompanied, regrettably, by too many examples of police brutality in the United States. Police officers are being called upon as the “first contact” for an increasing number of societal problems, and especially for citizens experiencing mental health issues. Another factor that has harmed police–community relationships is the trend towards the “militarization” of law enforcement in many nations. Strengthening the relationships between law enforcement and tertiary education faces many challenges, including mutual distrust and high costs. Two illustrations of innovative educational programs are provided and additional opportunities for collaboration and partnerships identified as pathways towards the goal of better education for police, expanded applied research and evidence-based policing.KeywordsLaw enforcementEducationTrainingTrustCollaborative opportunitiesMilitarization
... 16 There is minimal literature addressing the implementation of PSWs in the ED. 17,18 A US study by Migdole et al. described a recoveryoriented ED programme which identified the importance of allies and support strategies. Chavulak et al. explored the impact of an Australian Pre-Admission Liaison (PAL) programme to support individuals in the ED who were waiting for an inpatient admission. ...
Objective
This study explored the benefits and limitations of employing peer support workers, who utilise their own lived experience of mental distress and recovery, to support people experiencing mental distress who are attending the ED.
Methods
This co-produced qualitative study utilised four phases: (i) assemble a collaborative multi-disciplinary research team and Expert Panel, of which at least half identified as having lived experience; (ii) a site visit to an ED; (iii) focus groups with consumers, support persons and ED staff; and (iv) a learning workshop for peer workers.
Results
Focus groups were run for consumers (n = 7), support persons (n = 5) and ED staff (n = 7). Eleven consumer peer workers participated in the learning workshop. Four themes were identified and triangulated: the individual in distress, peer support work, a ‘Peers in EDs’ service and the ED context. Overall, findings suggest that peer support workers contribute important skills including listening, de-escalation, relationship-building and empathy.
Conclusions
This study identified that peer support workers would bring important skills to an ED (e.g. empathetic support, de-escalation). However, significant workforce and organisational support would be required.
... PSS can serve in a variety of roles, such as advocacy, navigation, outreach, case management, developing and facilitating treatment services/activities, mentoring, supervision, training, administration, and education (Salzer et al. 2010). PSS can also serve in a variety of settings including emergency rooms, hospitals, jails, prisons, state psychiatric hospitals (Cronise et al. 2016;Salzer et al. 2010, Migdole et al. 2011. A peer-run is a program that unlike traditional treatment models, is more focused on socialization, self-directed support, empowerment and hope (Swarbrick et al. 2009). ...
This paper is a qualitative analysis of perspectives on leadership development among working peer support specialists and highlights the challenges, needs and efficacy these individuals experience in their work settings. Six participants engaged in a 2 h semi-structured focus group. Participants were guided through a series of nine questions regarding their transition to leadership, professional communication and relationships. Seven themes emerged: managing dual relationships; having difficult conversations; push and pull of leadership; taking responsibility for others; taking responsibility for self-care; addressing stigma in the workplace, and, spirituality/a calling to help. These professionals integrate their personal experiences of recovery into their direct care and leadership approaches in the workplace. This blending of recovery concepts and supervision approaches reflect some of the powerful elements that peer recovery specialists are uniquely qualified to lead in the healthcare workforce. These findings provide important implications for leadership development among this growing segment of the healthcare workforce.
... Despite the lack of suicide-focused research, peer specialists work in a variety of clinical and community settings to provide services to individuals with mental illness, a population that is at increased risk for suicide (Ilgen et al., 2010;Salzer, Schwenk, & Brusilovskiy, 2010). Many peer specialists also work with individuals at specifically high risk who have been discharged from a psychiatric hospital, who utilize peer-run residential alternatives to hospitalization, who access emergency rooms-crisis centers, or who are callers to peer-run warm lines (less acute alternatives to crisis hotlines; Dalgin, Maline, & Driscoll, 2011;Greenfield, Stoneking, Humphreys, Sundby, & Bond, 2008;Migdole et al., 2011;Shattell et al., 2014;Sledge et al., 2011). Although reports on these programs often demonstrate favorable outcomes in terms of acceptability, potential cost savings, or reductions in inpatient care, their effects on suicide-related outcomes have not been described. ...
Suicide rates in the United States have been increasing in recent years, and the period after an inpatient psychiatric hospitalization is one of especially high risk for death by suicide. Peer support specialists may play an important role in addressing recommendations that suicide prevention activities focus on protective factors by improving hope and connectedness. The present study developed a peer specialist intervention titled Peers for Valued Living (PREVAIL) to reduce suicide risk, incorporating components of motivational interviewing and psychotherapies targeting suicide risk into recovery-based peer support. A randomized controlled pilot study was conducted to assess the acceptability, feasibility, and fidelity of the intervention. A total of 70 adult psychiatric inpatients at high risk for suicide were enrolled into the study. Participants were randomized to usual care (n = 36) or to the 12-week PREVAIL peer support intervention (n = 34). Those in the PREVAIL arm completed an average of 6.1 (SD = 5.0) peer sessions over the course of 12 weeks. Fidelity was rated for 20 peer support sessions, and 85% of the peer specialist sessions demonstrated adequate fidelity to administering a conversation tool regarding hope, belongingness, or safety, and 72.5% of general support skills (e.g., validation) were performed with adequate fidelity. Participants’ qualitative responses (n = 23) were highly positive regarding peer specialists’ ability to relate, listen, and advise and to provide support specifically during discussions about suicide. Findings demonstrate that a peer support specialist suicide prevention intervention is feasible and acceptable for patients at high risk for suicide.
... PRSS are delivered in a variety of settings, including RCOs [9], emergency departments [10], collegiate recovery programs [11], and in general community locations [12]. In a recent systematic review, Bassuk and colleagues report that PRSS have a positive impact on participants and substance use disorder (SUD) outcomes [13]. ...
Background
Recovery from substance use disorder (SUD) is often considered at odds with harm reduction strategies. More recently, harm reduction has been categorized as both a pathway to recovery and a series of services to reduce the harmful consequences of substance use. Peer recovery support services (PRSS) are effective in improving SUD outcomes, as well as improving the engagement and effectiveness of harm reduction programs.
Methods
This study provides an initial evaluation of a hybrid recovery community organization providing PRSS as well as peer-based harm reduction services via a syringe exchange program. Administrative data collected during normal operations of the Missouri Network for Opiate Reform and Recovery were analyzed using Pearson chi-square tests and Monte Carlo chi-square tests.
Results
Intravenous substance-using participants (N = 417) had an average of 2.14 engagements (SD = 2.59) with the program. Over the evaluation period, a range of 5345–8995 sterile syringes were provided, with a range of 600–1530 used syringes collected. Participant housing status, criminal justice status, and previous health diagnosis were all significantly related to whether they had multiple engagements.
Conclusions
Results suggest that recovery community organizations are well situated and staffed to also provide harm reduction services, such as syringe exchange programs. Given the relationship between engagement and participant housing, criminal justice status, and previous health diagnosis, recommendations for service delivery include additional education and outreach for homeless, justice-involved, LatinX, and LGBTQ+ identifying individuals.
... The continuing growth and expansion of peerprovided support has created a gap in our understanding of these evolving roles and service delivery settings. For example, peers are integrated into care teams in new settings, such as emergency departments (Migdole et al., 2011) and state psychiatric hospitals (Unger, Pfaltzgraf, & Nikkel, 2010). Furthermore, peers are delivering wellness coaching services to help individuals in their pursuit of individually chosen health and wellness goals (Swarbrick, Murphy, Zechner, Spagnolo, & Gill, 2011). ...
Objective:
This article examines how the history and philosophy of peer support services has shaped current mental health and substance use service delivery systems. The growth of peer-run and recovery community organizations in the changing health care environment are discussed, including issues related to workforce development, funding, relevant policies, and opportunities for expansion. These initiatives are designed to increase access to recovery-promoting services.
Methods:
We conducted an environmental scan and analysis of peer support services within the behavioral health care field in the United States, with particular attention to initiatives of the Substance Abuse and Mental Health Services Administration. Published manuscripts, policy statements, and reports were reviewed.
Findings:
There is abundant and growing literature illustrating how peer support services have become an integral component of behavioral health care systems in many states. Peer support services have the potential to increase access to recovery-oriented services for people with mental and substance use disorders served by the public behavioral health care system. Numerous initiatives in various states are being undertaken to build this workforce.
Conclusions and implications for practice:
Workforce and financing challenges exist, yet opportunities, including among others those made possible by the Affordable Care Act, will continue to strengthen the peer support workforce within behavioral health service delivery systems. (PsycINFO Database Record
... Models of care have been developed and implemented in EDs over the past decade to better serve persons with mental illness, including a psychiatric ED within the general ED (McKenna, 2011), peer support programs in EDs and situating advanced practice RNs who specialize in mental health in the ED (Migdole et al., 2011). These models are far from universal and are usually only found in large, urban areas in the US, as are the following crisis-oriented services identified by the Substance Abuse and Mental Health Services Administration (SAMHSA). ...
... Psychiatrists may also benefit from working in partnership with peer programs, which utilize people with mental illnesses to provide social support and care (Davidson et al., 1999;Solomon, 2004). Studies have described the many benefits of peer programs (Woodhouse and Vincent, 2006;Repper and Carter, 2011;Faulkner and Kalathil, 2012;McLean et al., 2009), which has led to the expansion of peer services into emergency departments and inpatients units to engage people in recovery (Migdole et al., 2011). The Implementing Recovery through Organizational Change project in the UK found that a major step toward providing recoveryoriented care is to enlist the involvement of people with lived experiences recovering from mental illnesses to serve as trainers, coaches, and consultants in mental health systems. ...
Purpose
– To galvanize practical discussion about how to modify psychiatry residency programs to instill the recovery paradigm into students who will become psychiatrists.
Design/methodology/approach
– A review of relevant literature is undertaken.
Findings
– Eight suggestions are offered to help residency programs initiate conversations about recovery.
Originality/value
– There has been little, if any, discussion about how psychiatry residency programs must change in terms of curriculum and pedagogy.
... This statement illustrates the frustration involved in meeting the needs of people experiencing acute psychiatric distress. While much has been written about the need to minimise the impact of mental illness through a comprehensive approach to health services based on consumer driven recovery principles (Geraghty et al., 2011;Migdole et al., 2011;Ramon et al., 2007;Bertolote and McGorry, 2005;Olmos-Gallo et al., 2012), limited inquiry has focused on how acute intensive care units deliver a recovery-oriented approach as part of a comprehensive mental health service. ...
Purpose – This paper adds to growing research of psychiatric intensive care units (PICU) by recounting descriptions of psychiatric intensive care settings and discusses the perceptions held by nurses of the organisational interfaces, arrangements and provisions of care in these settings.
Design/methodology/approach – Data gathered from focus groups held with nurses from two PICUs was used to establish terminology, defining attributes, related concepts, antecedents, values, processes and concepts related to current practices. A literature search was conducted to permit a review of the conceptual arrangements and contemporary understanding of intensive care for people experiencing acute psychiatric illness based on the perspectives held by the nurses from the focus groups.
Findings – Dissonance between service needs and the needs and management of individual patients overshadow strategies to implement comprehensive recovery-oriented approaches. Three factors are reported in this paper that influence standards and procedural practice in PICU; organisational structures; physical structures; and subtype nomenclature.
Practical implications – Acute inpatient care is an important part of a comprehensive approach to mental health services. Commonly intensive acute care is delivered in specialised wards or units co-located with acute mental health inpatient units mostly known as PICU. Evidence of the most effective treatment and approaches in intensive care settings that support comprehensive recovery for improved outcomes is nascent.
Originality/value – Current descriptions from nurses substantiate wide variations in the provisions, design and classifications of psychiatric intensive care. Idiosyncratic and localised conceptions of psychiatric intensive care are not adequately entailing effective treatment and methods in support of recovery principles for improved and comprehensive outcomes. The authors suggest that more concrete descriptions, guidelines, training and policies for provision of intensive psychiatric health care encompassing the perspective of nursing professionals, would reinforce conceptual construction and thus optimum treatments within a comprehensive, recovery-oriented approach to mental health services.
... Keywords Peer provider Á Stereotype threats Á Stigma As part of an effort to advance recovery-oriented service provision, peers have increasingly been employed in various mental health settings as wellness coaches (Swarbrick et al. 2011), case managers (Chinman et al. 2000, and emergency support staff (Migdole et al. 2011) among other emerging roles. But some administrators and practitioners doubt the peer role, questioning whether or not people with mental illnesses are really capable of functioning as legitimate service providers (Besio and Mahler 1993; Davidson et al. 1999;Fisk et al. 2000;Manning and Suire 1996). ...
Mental health organizations are increasingly employing peers, but not without set-backs. This brief commentary explores the possible adverse impact of stereotype threats on the performance of peer providers. A review of social psychology literature would suggest that at least some of these set-backs emerge from the peer's apprehension about fulfilling some of the negative stereotypes that exist about people with mental illnesses. Additional training and supervision are indicated for both peer and non-peer staff members in order to reduce the salience of negative stereotypes in the workplace.
Purpose
In mental health care the peer support workers (PSWs) are, by their experience based expertise, supporting the recovery of people using services and have also been shown to stimulate interprofessional learning (IPL) but which, due to hierarchical teams, is challenged. Therefore, to prepare the teams for IPL that includes PSWs, this study aims to suggest an interprofessional education (IPE) for mental health professions and PSWs. What would such an education look like?
Design/methodology/approach
The base, in the development of the IPE, is two earlier studies of teams’ inclusion of PSWs and the IPL.
Findings
The present study suggests Knowledge base 1 with three categories: different roles, expertise and perspectives, and Knowledge base 2 with two categories: teamwork and IPL. The conclusion is that such online IPE offers a readiness for mental health professions and PSWs, in teamwork, to exchange their different expertise to facilitate IPL. This is important to improve the quality of mental health services.
Research limitations/implications
One limitation is that the empirical study, this paper is based on, is a small-scaled study. Nevertheless, the main results from this study and the other were considered useful as a ground for the development of the IPE.
Originality/value
By suggesting an IPE for mental health professions and PSWs, this paper adds to the literature on peer support as well as IPL.
Abstract: Commonly, in the course of their duties, the police will come into contact with people who
have a lived experience of mental illness. It is acknowledged that these contacts can and do happen
for a wide variety of reasons and in a broad range of circumstances. Increasingly, police have found
that they are responding to call outs and situations involving people experiencing distress or mental
health symptoms. While there are ongoing tensions among the police, and community members,
about whether this should even considered ‘police work’ or not, the reality of this situation has
required police, health and social welfare services to develop both local and organisation-level
partnerships to help articulate and delineate roles, functions and professional boundaries. This chapter
will consider the development and function of these partnerships as they relate to responding to
mental health-related situations. We will argue that current partnerships are failing to meet the needs
of the ‘missing middle’; this group represent a significant proportion of the population who have
mental health-related needs but do not meet the threshold for admission to public mental health
services, and for whom other community-based care and support are insufficient. We will exemplify
these limitations by focussing on mental health presentations to Emergency Departments and look to
pockets of innovation internationally that have sought to address what represents a significant unmet
need.
Peer support within mental health services has a growing evidence base and aligns with current policies of recovery-oriented care. Despite these advantages, widespread implementation of peer support remains limited, likely due to various methodological and implementation issues. Researchers have noted the importance of utilizing an implementation framework to understand best practices for implementation. Therefore, the purpose of the current study was to synthesize the existing literature on the implementation of peer support interventions and identify barriers and facilitators using an implementation framework. The Consolidated Framework for Implementation Research (CFIR) was used to organize the literature obtained in the systematic search and synthesize best practices for implementation. The systematic search identified 19 published articles that were coded for relevant information including implementation barriers and facilitators. The review highlighted a number of important elements for implementation within the CFIR domains, including clear role definition, a flexible organizational culture, and education for peer and nonpeer staff. Implementation barriers included an organizational culture without a recovery focus, allied practitioners’ beliefs about peer support, and an unclear peer role. The results of this review provide a summary of best practices for the implementation of peer support in mental health services that can be used by researchers and service providers in future implementation. These practices should continue to be tested and reworked as the climate of recovery-oriented services within mental health organizations evolves.
Rationale:
Novel approaches to suicide prevention are needed to address increasing rates of suicide deaths. Research suggests that interventions led by certified Peer Specialists may improve suicide protective factors such as hope and connectedness; however, the effectiveness of a Peer Specialist intervention for reducing suicidal thoughts or behaviors has not previously been tested empirically.
Design:
We describe the methodology of a randomized controlled hybrid effectiveness-implementation trial of a peer specialist intervention known as PREVAIL (Peers for Valued Living). The primary effectiveness aim is to determine whether the 3-month peer mentorship intervention compared to a minimally enhanced usual care condition reduces suicide attempts and suicidal ideation among adults at high risk for suicide who have been psychiatrically hospitalized. Secondary effectiveness outcomes include medically serious suicide attempts according to chart review and self-reported self-efficacy to avoid suicide. We also describe suicide risk management, supervision, and fidelity monitoring in the context of Peer Specialist providers and our methods for assessing implementation barriers and facilitators.
Conclusion:
The PREVAIL trial will demonstrate novel methods for incorporating peer providers into a suicide prevention effectiveness trial with high-risk study participants. PREVAIL's hybrid effectiveness-implementation design aims to maximize the likelihood of rapid implementation in the community if shown to be effective.
This study aimed to explore, articulate and expand on existing concepts of recovery and paid peer support within consumer-operated mental health organizations. Focus groups and interviews were conducted with 32 participants to identify elements of paid peer support work in two organizations in Queensland, Australia. Participants included peer-supported consumers, paid peer support workers, managers and other key stakeholders. Through a grounded theory analysis, eight categories of paid peer support were identified. For the most part, the categories aligned well with evidence in the literature. However, two of these categories, issues of power and the ‘dark side’ of peer support, have been relatively unexplored and understated in previous studies. These findings provide an expanded understanding of the role of paid peer support as part of the recovery process in mental health service delivery. The effective use of paid peer support workers can be enhanced through attention to the issues identified.
This chapter focuses on the research literature, as well as experiential knowledge as a scholar in suicide prevention and being a suicide attempt survivor. When suicidal experiences lead to changes in behavior, or cause intense distress for an extended period, it is called a suicidal crisis. National Suicide Prevention Lifeline indicate increases in crisis call volume at the time of prominent news releases describing personal experiences, with some growth sustained after the initial spike. The Action Alliance is a national-level group comprising government and private sector organizations established to prioritize and coordinate suicide prevention efforts. Most immediately, a person who is subjected to negative stereotypes from others or has adopted them about himself or she acquires a negative self-image. Discrimination can stop a person from fulfilling physical and psychological needs while also contributing pain and burden, which fuel the urge to perform suicidal acts.
Understanding ambulance utilization patterns is essential to assessing prehospital system capacity and preparedness at the national level.
To describe the characteristics of patients transported to U.S. emergency departments (EDs) by ambulance and to determine predictors of ambulance utilization.
Data were obtained from the National Hospital Ambulatory Medical Care Survey using mode of arrival, demographic and visit information, ICD-9-CM E and V-codes, and classified reasons for the visit.
The rates for ED visits of persons conveyed by ambulence were stable between 1997 and 2003, consisting of approximately one in every seven ED visits (14%). In 2003, there were 16.2 million ED visits for which an ambulance was used in the U.S. However, for patients with mental health visits, nearly one in three ED presentations (31%) arrived by ambulance. Significantly higher rates of ambulance use were associated with: (1) mental health visits; (2) older age; (3) African-Americans; (4) Medicare or self-pay insurance status; (5) urban ED location; (6) U.S. regions outside of the South; (7) presentation between 12 midnight to 0800 hours; (8) injury-related visits; (9) urgent visit status; and/or (10) those resulting in hospital admission. Among mental health patients, older age, self-pay insurance status, urban ED location, regions outside the southern US, and urgent visit classification predicted ambulance use. Ambulance usage within the mental health group was highest for suicide and lowest for mood and anxiety disorder-related visits.
Reliance on ambulance services varies by age, insurance status, geographic factors, time of day, urgency of visit, subsequent admission status, and type of mental health disorder. Even after controlling for many confounding factors, mental health problems remain an important predictor of ambulance use.