Patients With Serious Mental Illness Helped By Peers on Recovery Path

The use of peer support to assist patients with serious mental illness (SMI) at mental health centers has increased over the past 15 years—spurred in part by recommendations of President George W. Bush’s New Freedom Commission on Mental Health to place greater emphasis on patient resiliency and recovery in mental health care.

Even before this commission was formed, faculty at Yale University had shown that people recovering from SMI can be valuable at helping others recover as well. One of their signature programs is peer mentoring. Yale’s peer mentoring program—in place since 1992—connects individuals in recovery from an SMI such as schizophrenia or severe depression with people recently hospitalized with similar disorders. The peers act as coaches, motivators, and advocates, using their journey to recovery as a bridge to help mentees realize their own goals for wellness, whether it be a stable job, a place to live, or reconnecting with family and friends.

“The role of psychiatrists and other health professionals should not be understated in patient recovery, but when it comes to understanding a patient’s life experience, we are in another world,” said William Sledge, M.D., the George D. and Esther S. Gross Professor of Psychiatry Emeritus at Yale and former medical director of Yale-New Haven Psychiatric Hospital. “The mentors are able to connect and build relationships in a way we cannot. And that relationship is a primary vehicle for change.”

To qualify for a peer mentor position, individuals are expected to be in recovery from an SMI themselves, have strong interpersonal skills, and a desire to help others in the community. The mentors receive training in principles of recovery by Chyrell Bellamy, Ph.D., M.S.W., director of peer services and research at the Program for Recovery and Community Health, and they participate in weekly team meetings with supervisors. Following training, peer mentors are given independence in how and how often they provide support.

“We know that mentors, through their shared experiences, will come up with things we could never think of,” said Martha Staeheli, Ph.D., an associate research scientist who leads the weekly team meetings. “We let them tell their own stories and let magic and alchemy take its course.”

The freedom given to the mentors appears to work, as multiple studies conducted by the Yale team demonstrate that the peer mentoring program can help people with frequent, recurrent inpatient admissions due to SMI feel better and become more engaged in their communities.

The most recent study, published in the July issue of Psychiatric Services, compared outcomes of patients with SMI who had been admitted to Yale-New Haven Psychiatric Hospital and were assigned a peer mentor with the outcomes of those who received standard postdischarge recovery services care. All 76 participants enrolled had a severe mood or psychotic disorder and had at least two psychiatric hospitalizations within the past 18 months.

Nine months after the participants were discharged, those assigned to the peer mentor program had on average improved physical health, better hygiene/self-care, fewer unusual thoughts or behaviors, and less substance use than those receiving standard care. Additionally, the individuals in the mentor group had double the average time to psychiatric rehospitalization than those receiving standard care—270 days compared with 135 days.

“Peer support programs remain a contentious issue,” said Larry Davidson, Ph.D., who has directed the Program for Recovery and Community Health since 2000. Some physicians still have concerns that working in a mental health setting may be too stressful or burdensome for people recovering from SMI or that they need extra supervision, which bogs down the rest of the staff, he said. “Getting good data to the contrary, particularly our rehospitalization data, is important.”

One intriguing tidbit among that data, noted Maria O’Connell, Ph.D., an associate professor of psychiatry at Yale, is that many patients assigned to the mentorship program showed improvements even if they never met their assigned mentor. “It hints that for some people, just knowing that there is someone available to reach out to might help spur recovery,” she said, though she acknowledged that this is only a speculation.

“What is wonderful is that everyone is benefiting from this program,” said Kim Young, one of the program’s pioneers who has been a peer mentor since 2004. “It has been rewarding to see all these people who don’t think they can live normally get better, and then they call you and invite you to their graduation.”

“But coming from three generations of people hospitalized for mental illness, doing this program has made me stronger, too,” she continued.

“From the perspective of someone who grew up in Brazil, studies like this are very welcome in lower- and middle-income countries, because they have a great need for mental health care but lack professional resources,” said Mark Costa, M.D., M.P.H., also an associate research scientist at the Program for Recovery and Community Health. “The idea of using people in recovery is an innovative way to get around this problem.”

The Psychiatric Services study was supported by grants from the E. K. Dollard Foundation and Eli Lilly and Co. ■

“Outcomes of a Peer Mentor Intervention for Persons With Recurrent Psychiatric Hospitalization” can be accessed here. “Transforming Mental Health Care in America,” the report by the New Freedom Commission on Mental Health, is available here.