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Abstract

Objective:

Peer support providers are part of the behavioral health workforce. Research indicates that peer support helps care recipients achieve recovery and engage with behavioral health services. This article investigated how many U.S. behavioral health facilities offer peer support services and compared the frequencies of peer support services in facilities providing mental health and substance use services.

Methods:

The authors conducted a secondary analysis of facilities in the Substance Abuse and Mental Health Services Administration’s National Mental Health Services Survey (N=11,582) and the National Survey of Substance Abuse Treatment Services (N=13,585), including descriptive and comparative analyses on reported mental health and substance use treatment services in the 50 U.S. states in 2017.

Results:

The findings revealed state-to-state variation in the number and availability of mental health and substance use service facilities and in facilities that reported providing peer support services. Facilities providing substance use treatment services offered peer support services at more than twice the rate (56.6%) found in mental health facilities (24.7%). The authors also identified program characteristics associated with the inclusion of peer support services in behavioral health. Provision of peer support services was more frequently reported by public facilities than by for-profit and nonprofit facilities.

Conclusions:

Behavioral health facilities that serve individuals with serious mental illness and co-occurring substance use and mental health conditions reported offering peer support at a higher rate than did other facilities. Inconsistent definitions of peer support in the two surveys limited the comparability of the findings between the two reports.

HIGHLIGHTS

This study focused on the peer support workforce in mental health and substance use treatment facilities across the United States.
An analysis of the licensed facilities surveys by the U.S. Substance Abuse and Mental Health Services Administration revealed substantial state-to-state variation in the percentage of facilities offering peer support services.
Facilities providing substance use treatment offered peer support services at more than twice the rate of mental health facilities, and a higher percentage of public facilities reported providing such services than for-profit or nonprofit facilities.
Facilities with programs for people with serious mental disorders and co-occurring behavioral health disorders offered peer support services at a higher rate than all other facilities without these programs.
Only 44% of the 50 million American adults with a mental disorder and 10% of the 19 million adults with a substance use disorder receive any care for their condition (1, 2). Peer support providers are members of the behavioral health workforce who help promote service engagement, recovery, and reduction in health care disparities (35). Peer support in behavioral health is one type of help under the broader cluster comprising self-help, mutual aid, and peer support (58). The peer support workforce shares their lived experience with clients, supports clients’ recovery, and promotes client engagement in behavioral health care.
Although mental health and substance use treatment facilities both provide peer support, these systems have distinct histories related to treatment philosophies and approaches (511). Responses to the misuse of alcohol and drugs, historically viewed as caused by personal moral failure, have included moral education, supportive treatment, and criminalization (9). Mutual aid has been a part of care for substance use since the earliest temperance-driven efforts to manage alcoholism, such as the Washington total abstinence movement and “recovery circles” (10). Modern treatment for alcohol misuse was transformed in 1935 with the founding of Alcoholics Anonymous (AA), which has been widely adopted (9, 11). Peer recovery coaches and mentors, who have lived experiences of recovery, have been employed in substance use treatment facilities since the 1990s and are an optional service reimbursable by Medicaid in 38 states (12, 13).
Before the late 20th century, peer support was largely unrecognized within formal mental health care, despite early activists’ ideas about the social and environmental aspects of treatment (5, 14). Mental health consumers, also identifying as survivors or former patients, advocated for the inclusion of peer support in mental health care for many years. The 1979 publication of the book On Our Own, by Judi Chamberlin, articulated the goals and growth of this movement, and the 2003 President’s New Freedom Commission report put forth the goal of recovery for all people with mental health conditions (6, 15). “Recovery” is defined as a strategy for achieving a productive life, free from discrimination and social exclusion (6, 15). With strong support from the Substance Abuse and Mental Health Services Administration (SAMHSA), and building on the psychiatric rehabilitation approach, states created paid roles for peer support specialists (4, 8, 1618). Today, peer support in mental health facilities is a standard service reimbursable by Medicaid in 48 states (19).

Peer Support

Peer support is an exchange between two or more people who share a similar lived experience. It is distinct from clinical services and focuses on recovery and self-management of behavioral health disorders. Values of peer helping include antistigma efforts and nonhierarchical approaches (46, 20). SAMHSA defines peer providers as “people who have been successful in the recovery process who help others experiencing similar situations” (4, 21). Key actions of peer support include reducing isolation, focusing on strengths, increasing access to services, mentoring, serving as recovery role models, coaching, providing empathy and hope, encouraging services engagement, building community on the basis of identity and mutual respect, and developing skills for coping, problem solving, and recovery (2225).

Effects of Peer Support Services

A body of research including randomized trials, quasi-experimental designs, and systematic reviews of the impact of peer support specialists and recovery coaches on client outcomes has provided promising findings but has also revealed methodological limitations across studies. Studies have been conducted with diverse samples of recipients of mental health and substance use treatments who have received peer support services in treatment settings such as public and private behavioral health care, child welfare, homelessness services, prisons, and general medical care, although these have typically been convenience samples. Peer interventions have been shown to achieve diverse study outcomes, such as enhancing recovery behaviors and life skills, reducing depression and demoralization, meeting clients’ perceived needs, lowering substance use, increasing family reunification, enhancing emotional well-being, increasing engagement with general medical and behavioral health services, providing residential stability, raising hope, improving service engagement, and obtaining supports and tangible resources (2636). Only one systematic review, which did not examine treatment engagement or other recovery-related variables, found no effects of peer support on hospitalization and mortality rates for persons with serious mental disorders (37). No studies have found peer support services to be harmful.
This article presents a secondary analysis of national data on peer support services in behavioral health facilities. We posed three questions: How many licensed mental health and substance use treatment facilities are in the United States and in each state, and how many provide peer support services? Is the availability of peer support services proportional to the population of each state? Do facilities offering specialized programs for co-occurring disorders or serious mental illness provide peer support services at a rate higher than that of all mental health or substance use treatment facilities?

Methods

This study used data from the 2017 National Mental Health Services Survey (N-MHSS) and the 2017 National Survey of Substance Abuse Treatment Services (N-SSATS) (3841), two annual SAMHSA-sponsored, census-based surveys of licensed mental health facilities in the United States. The study was approved by the University of Michigan Human Research Protection Program.

Sampling

The N-MHSS and N-SSATS mailed computer-based questionnaires to all licensed public and private U.S. facilities that provide treatment services for mental or substance use disorders. The data, as well as sampling and data collection reports, are publicly available (4245). N-MHSS surveyed 13,618 eligible facilities, with a final sample of 11,582, an 85.0% response rate (38). N-SSATS surveyed 15,528 eligible facilities and obtained a sample of 13,585, a response rate of 87.5% (39).

Variables

The N-MHSS and N-SSATS are not identical, although some variables are operationalized similarly in both surveys. The key variable for this study was whether the facility provided peer support services. In both surveys, the question is worded, “Which of these services and practices are offered at this facility, at this location?” Respondents are directed to “mark all that apply.” The surveys differed in the wording describing the peer support services. The N-SSATS includes an additional item about peer support services that does not appear in the N-MHSS: “self-help groups (for example, AA, NA [Narcotics Anonymous], SMART [self-management and recovery training] Recovery).” SAMHSA does not provide definitions for peer support services, except for parenthetical examples, as given above. It is possible that the surveyed facilities interpreted these questions differently.
We analyzed the SAMHSA Public Use Files (40, 41). We combined the classifications of ownership type into three categories: private for-profit, private nonprofit, and public. As an indicator of the availability of facility-based peer support services in each state, we created availability ratios of the number of facilities offering peer support services per 100,000 population. Findings from the N-SSATS and N-MHSS are reported separately.

Data Analysis

The study team conducted parallel descriptive analyses of the N-MHSS and N-SSATS data by using IBM SPSS, version 28.0.1.1, with facility as the unit of analysis. Because the wording related to peer support services differed in the N-MHSS and N-SSATS, we did not assume that “consumer-run (peer support) services,” and “mentoring/peer support” were equivalent variables. Therefore, no hypotheses were tested, and the data were used descriptively. Frequency distributions were used to examine state-to-state variations in the presence and availability of peer support services in each facility. We compared characteristics of facilities with and facilities without peer support services, including those that offered specialized programs for co-occurring disorders or serious mental illness. Maps showing the states with the highest and lowest frequency and availability of peer support services were created by using Tableau Public, version 2022.1.

Results

N-MHSS Sample

Table 1 provides the characteristics of the facilities in the N-MHSS and N-SSATS samples. Because the surveys differed in the wording describing peer support services, the table shows the specific wording used for each study variable. The N-MHSS sample included residential and hospital (N=3,649, 31.5%) and outpatient settings (39.8%), community mental health centers (21.9%), day treatment (3.4%), multiservice facilities (i.e., inpatient plus outpatient services; 3.4%), and other (often administrative) settings (<0.1%). Most were private nonprofit facilities (63.8%). Overall, 42.8% offered special programs for populations with co-occurring disorders (i.e., psychiatric and substance use disorder diagnoses), and 44.2% reported that they hosted special programs for people with serious mental disorders.
TABLE 1. Characteristics of behavioral health facilities in the 2017 N-MHSS and N-SSATS samplesa
CharacteristicN%
N-MHSS (N=11,582)
Facility type  
 Psychiatric hospital6685.8
 General hospital, inpatient1,0769.3
 Residential, children6015.2
 Residential, adult8717.5
 Residential, other76.7
 Veterans Health Administration3573.1
 Community mental health center2,53821.9
 Multisetting (outpatient and inpatient) mental health3883.4
 Day treatment3913.4
 Outpatient mental health4,61239.8
 Other4<.1
Ownership type  
 Private for-profit2,05417.7
 Private nonprofit7,39063.8
 Public2,13818.5
Programs for special populationsb  
 Co-occurring disorders4,95942.8
 Serious mental illness5,11844.2
Peer support services  
 Consumer-run (peer support) services2,84924.6
 No peer support8,73075.4
N-SSATS (N=13,585)
Facility typeb  
 Hospital, general9256.8
 Hospital, psychiatric2932.2
 Hospital, other specialty57.4
 Nonhospital, residential3,12523.0
 Outpatient11,18482.3
Ownership type  
 Private for-profit4,93136.3
 Private nonprofit7,16352.7
 Public1,49111.0
Programs for special populations  
 Co-occurring disorders6,71949.5
Peer support services  
 Mentoring or peer support only3,07722.6
 Self-help group only1,67712.3
 Both mentoring/peer support and self-help group4,60033.9
 No mentoring/peer support or self-help4,23131.1
a
Total N includes agencies reporting from Puerto Rico and other U.S. territories. N-MHSS, National Mental Health Services Survey; N-SSATS, National Survey of Substance Abuse Treatment Services.
b
Percentages do not sum to 100% because instructions were to “check as many as apply.”
Consumer-run (peer support) services were provided by 24.6% of all mental health facilities, with the highest rates reported by community mental health clinics (N=912, 35.9% of community mental health centers) and multiservice facilities that offer residential and outpatient services (N=122 of 388, 31.4%). Residential and hospital (N=817 of 3,649, 22.4%), day-treatment-only (N=60 of 331, 18.1%), and outpatient-treatment-only (N=936 of 3,674, 25.5%) facilities offered consumer-run (peer support) services at lower rates. Publicly sponsored facilities offered peer support services at a higher rate (N=887 of 2,138, 41.5%) than nonprofit (N=1,666 of 7,390, 22.5%) or for-profit (N=296 of 2,054, 14.4%) facilities.

N-SSATS Sample

Facilities responding to the N-SSATS included inpatient services at hospitals and residential facilities (N=4,400, 32.4%) (Table 1). Most facilities offered outpatient treatment (82.3%). N-SSATS ownership differed from N-MHSS, with double the proportion of for-profit (36.3%) and lower proportions of private nonprofit (52.7%) and publicly sponsored (11.0%) facilities. Nearly half of N-SSATS facilities (49.5%) offered programs for co-occurring disorders.
In total, 56.5% (N=7,677) of facilities in the N-SSATS sample reported providing mentoring or peer support (combining facilities that offer peer mentoring or support with facilities that provide both services), and 46.2% (N=6,277) reported providing self-help groups (combining self-help groups only with both services). Overall, 68.9% (N=9,354) of the facilities offered either mentoring and peer support or self-help groups. Only 31.1% offered no peer support services at all. Mentoring and peer support services were offered in 48.0% (N=2,366 of 4,931) of for-profit facilities in the N-SSATS sample, compared with 61.0% (N=5,279 of 8,654) of both nonprofit and publicly sponsored facilities. Because the N-MHSS did not ask about self-help groups, the N-SSATS mentoring and peer support variable was used in the remaining analyses.

U.S. Facilities Offering Mental Health and Substance Use Treatment Services

Table 2 and Table 3 present state-by-state comparisons (excluding U.S. territories) of facilities in the N-MHSS and N-SSATS samples, respectively. These tables include the number of responding facilities for each state and the availability of facilities per 100,000 population. They also present the number of treatment facilities that provide peer services and the availability of N-MHSS and N-SSATS facilities with peer support services per 100,000 population.
TABLE 2. Number of all N-MHSS facilities and of those offering peer support services, by U.S. statea
State2017 state populationbN of mental health facilitiesFacilities per 100,000 populationN of facilities offering peer support servicesPeer support services per 100,000 population
Alabama4,887,8711753.625.5
Alaska737,4388611.7101.4
Arizona7,171,6463725.21221.7
Arkansas3,013,8252187.221.7
California39,557,0458662.2277.7
Colorado5,695,5641853.2791.4
Connecticut3,572,6652166.0381.1
Delaware967,171333.49.9
District of Columbia702,455375.3101.4
Florida21,299,3254692.2103.5
Georgia10,519,4752001.967.6
Hawaii1,420,491352.512.8
Idaho1,754,2081468.3563.2
Illinois12,741,0803893.187.7
Indiana6,691,8782754.145.7
Iowa3,156,1451504.8391.2
Kansas2,911,5051234.227.9
Kentucky4,468,4022084.7681.5
Louisiana4,659,9781763.837.8
Maine1,338,40418613.9302.2
Maryland6,042,7182644.449.8
Massachusetts6,902,1493154.649.7
Michigan9,995,9153373.41121.1
Minnesota5,611,1792244.050.9
Mississippi2,986,5301735.8612.0
Missouri6,126,4522123.5641.0
Montana1,062,305878.2151.4
Nebraska1,929,2681336.9281.5
Nevada3,034,392461.58.3
New Hampshire1,356,458634.6171.3
New Jersey8,908,5203063.451.6
New Mexico2,095,428582.812.6
New York19,542,2098434.32391.2
North Carolina10,383,6202572.539.4
North Dakota760,077324.27.9
Ohio11,689,4425514.772.6
Oklahoma3,943,0791433.633.8
Oregon4,190,7131563.7611.5
Pennsylvania12,807,0605714.51341.0
Rhode Island1,057,315565.3181.7
South Carolina5,084,1271092.148.9
South Dakota882,235515.8121.4
Tennessee6,770,0102744.048.7
Texas28,701,8453411.2122.4
Utah3,161,1051384.4401.3
Vermont626,2997411.8264.2
Virginia8,517,6852653.177.9
Washington7,535,5913174.21161.5
West Virginia1,805,8321146.312.7
Wisconsin5,813,5684207.251.9
Wyoming577,737427.3132.3
Total or mean327,167,43411,5173.52,8460.9
a
Includes the District of Columbia but does not include facilities that responded from Puerto Rico or other U.S. territories. N-MHSS, National Mental Health Services Survey.
b
Population estimates obtained from the U.S. Census Bureau Report, updated March 2022.
TABLE 3. Number of all N-SSATS facilities and of those offering peer support services, by U.S. statea
State2017 state populationbN of substance use treatment facilitiesFacilities per 100,000 populationN of facilities offering peer support servicesPeer support services per 100,000 population
Alabama4,887,8711292.6891.8
Alaska737,4388912.1466.2
Arizona7,171,6463414.82373.3
Arkansas3,013,8251183.9491.6
California39,557,0451,3113.39192.3
Colorado5,695,5643816.72173.8
Connecticut3,572,6652105.91163.2
Delaware967,171343.5161.7
District of Columbia702,455273.8202.8
Florida21,299,3256683.13711.7
Georgia10,519,4752922.81741.7
Hawaii1,420,49116811.81319.2
Idaho1,754,2081247.1885.0
Illinois12,741,0806335.03032.4
Indiana6,691,8783054.61502.2
Iowa3,156,1451635.2862.7
Kansas2,911,5051826.3933.2
Kentucky4,468,4023598.02164.8
Louisiana4,659,9781362.9901.9
Maine1,338,40419914.9795.9
Maryland6,042,7183876.42103.5
Massachusetts6,902,1493515.11952.8
Michigan9,995,9154564.62582.6
Minnesota5,611,1793566.32304.1
Mississippi2,986,530893.0592.0
Missouri6,126,4522574.21532.5
Montana1,062,305706.6312.9
Nebraska1,929,2681256.5623.2
Nevada3,034,392772.5561.8
New Hampshire1,356,458674.9423.1
New Jersey8,908,5203443.91641.8
New Mexico2,095,4281366.5693.3
New York19,542,2098424.34132.1
North Carolina10,383,6204724.52021.9
North Dakota760,077719.3243.2
Ohio11,689,4424093.52312.0
Oklahoma3,943,0791914.81162.9
Oregon4,190,7132265.41573.7
Pennsylvania12,807,0605023.92812.2
Rhode Island1,057,315484.5323.0
South Carolina5,084,1271082.1501.0
South Dakota882,235586.6262.9
Tennessee6,770,0102173.21231.8
Texas28,701,8454311.5264.9
Utah3,161,1052397.61404.4
Vermont626,299426.7314.9
Virginia8,517,6852232.61291.5
Washington7,535,5913965.31932.6
West Virginia1,805,8321025.6532.9
Wisconsin5,813,5682734.71111.9
Wyoming577,737478.1295.0
Total or mean327,167,43413,4814.17,6242.3
a
Includes the District of Columbia but does not include facilities that responded from Puerto Rico or other U.S. territories. N-SSATS, National Survey of Substance Abuse Treatment Services.
b
Population estimates obtained from the U.S. Census Bureau Report, updated March 2022.
As shown in Table 2, considerable variation in the presence and availability of mental health facilities existed across states in the N-MHSS sample. Overall, states had a mean of 3.5 and a median of 4.2 mental health facilities per 100,000 population. Facility availability across states ranged from a high of 13.9 mental health facilities per 100,000 population in Maine to a low of 1.2 facilities in Texas. All other states had at least 1.5 mental health facilities per 100,000 population. These results did not address access at specific locations, such as urban or rural areas, or facility size.
Table 3 shows state-specific frequencies of facilities in the N-SSATS sample. Nationally, states had a mean of 4.1 and a median of 4.8 substance use treatment facilities per 100,000 population, a 17% higher mean than for mental health facilities. The availability of facilities in the N-SSATS sample across states also varied considerably. Substance use treatment facilities per 100,000 population ranged from a low of 1.5 facilities in Texas to a high of 14.9 in Maine.

Peer Services

Table 2 and Table 3 show facility Ns including the District of Columbia but excluding Puerto Rico or other U.S. territories. Table 2 shows that 24.7% (N=2,846 of 11,517) of facilities in the N-MHSS sample offered consumer-run (peer support) services. States with the highest percentages of facilities offering peer support services included South Carolina (44.0%), Colorado (42.7%), Oregon (39.1%), Idaho (38.4%), and Washington (36.6%). States with the lowest percentages of peer services in mental health facilities included Arkansas (9.6%), West Virginia (10.5%), Alaska (11.6%), Wisconsin (12.1%), and Ohio (13.1%). The mean of mental health facilities offering peer support services was 0.9 per 100,000 population (Table 2), and the median was 0.9. (Figure S1 in the online supplement to this article shows a map of the states in the lowest and highest deciles of availability ratios representing facilities with mental health peer support per 100,000 population.) Nevada, North Carolina, Alabama, Florida, and Texas reported the lowest availability of peer support services. Vermont, Idaho, Wyoming, Maine, and Mississippi reported the highest availability.
Table 3 shows that 56.6% (N=7,624 of 13,481) of facilities in the N-SSATS sample offered mentoring or peer support services, more than double the aforementioned rate of N-MHSS facilities offering consumer-run (peer support) services (24.7%). The mean availability of peer support services in all facilities in the N-SSATS sample was 2.3 facilities per 100,000 population, more than 2.5 times the availability in facilities in the N-MHSS sample (mean=0.9). The availability of peer support services at N-SSATS facilities varied across states, from 0.9 per 100,000 population in Texas to 9.2 in Hawaii. (Figure S2 in the online supplement shows a map of the states reporting the highest and lowest deciles in availability of peer support services in substance use treatment facilities per 100,000 population.) Hawaii, Alaska, Maine, Wyoming, and Idaho reported the highest availability of peer services. Delaware, Florida, Georgia, Virginia, South Carolina, and Texas reported the lowest availability.

Special Populations

We also examined whether facilities providing mental health and substance use treatments that host special programs for populations with co-occurring disorders or serious mental illness provide peer support services at a higher rate than the national average. These populations were selected because they have heightened need, and peer interventions have been demonstrated to be effective for them. Findings of this analysis are presented in Table 4.
TABLE 4. Peer support services in facilities in the N-MHSS and N-SSATS samples with special programs for populations with serious mental illness and co-occurring disordersa
 N-MHSS facilities (N=11,582)N-SSATS facilities (N=13,585)
CharacteristicN%N%
Programs for co-occurring disorders4,95942.86,71949.5
 Peer support1,79836.34,34464.7
 No peer support3,16163.72,37535.3
Programs for serious mental illnessb5,11844.2NA
 Peer support3,22162.9NA
 No peer support1,89637.0NA
a
Ns include agencies reporting from Puerto Rico and other U.S. territories; the denominators for percentages of subcategories are the Ns of the main categories. N-MHSS, National Mental Health Services Survey; N-SSATS, National Survey of Substance Abuse Treatment Services.
b
The N-SSATS did not include a question about programs for serious mental illness; therefore, no data were available for this category.
In both the N-MHSS and N-SSATS samples, facilities with special programs for people with co-occurring disorders were more likely than facilities without such programs to offer peer support services, with facilities in the N-SSATS sample offering mentoring or peer support more frequently than facilities in the N-MHSS sample. Of note, self-help groups were not considered in this analysis. The difference in offering peer support services between facilities that did and facilities that did not offer special programs for individuals with co-occurring disorders was greater among N-MHSS facilities (an 11 percentage point difference between facilities that offered a special program for co-occurring disorders and the rate for all facilities) than for N-SSATS facilities (a 7 percentage point difference).
Special services for people with severe mental illness were identified only in the N-MHSS. Facilities in the N-MHSS sample with a special program for serious mental illness reported offering peer services at more than double the rate (62.9%) than was reported by all facilities (24.6%) (Table 1). We also examined facilities in the N-MHSS sample that offered clinical interventions typically used to treat populations with serious mental disorders and found that rates of offering peer support services at those facilities were higher than the average across all facilities. Peer support services were offered in 29.9% (N=473 of 1,583) of facilities providing assertive community treatment, 61.0% (N=1,071 of 1,756) of those providing supported housing, 70.0% (N=3,329 of 4,755) of those providing psychosocial rehabilitation, 47.0% (N=1,295 of 2,755) of those providing intensive case management, 69.9% (N=5,118 of 7,322) of those offering family psychoeducation, and 66.0% (N=3,420 of 5,183) of those providing court-ordered outpatient treatment. Further details are available in the final study report (46).

Discussion

These findings show that peer support services in behavioral health, as defined in the two different surveys, are established in every U.S. state. However, the availability of these services varied considerably both across and within states, with facilities in several southern states reporting the lowest rates. Publicly funded facilities reported providing peer support services more often than did nonprofit and for-profit facilities. Community mental health centers and facilities that offered both inpatient and outpatient care reported offering peer support services at higher rates than did other mental health facilities. Peer support services were offered more frequently in facilities that had programs for populations with serious mental disorders or co-occurring disorders. Services designated as “mentoring and peer services” were provided in a higher proportion of facilities in the N-SSATS sample than were services designated “consumer-run (peer support) services” in facilities in the N-MHSS sample.

Future Research Needs

It is important to have accurate and comparable peer support workforce data for health services in the United States. After passage of the Affordable Care Act, roles for peers have increased, including as peer support specialists, peer navigators, and community health workers (42, 4751). Furthermore, people with lived behavioral health experiences are deeply committed to shaping responsive service systems driven by options that service recipients find useful and respectful and to achieving this ideal by assuming a role in creating services that are relevant to the needs of behavioral health recipients, in the truest sense of person-centered care (6, 8, 11, 20, 47, 48).
Population-based studies of the peer support workforce are needed. Because of studies’ reliance on convenience samples, little is known about this workforce, including its demographic characteristics such as race, ethnicity, age, and education. One study reported that its sample of peer support providers comprised predominantly women and individuals who were White and had at least some college education (25). Better information is needed about the extent to which peers reflect the identities of service recipients, the optimal peer support workforce size, peers’ workload, and the cost efficiency of peer support services. Studies have described the range of peers’ helping roles (68, 18, 23, 24). This work should be further developed to determine who participates in peer support services, the impact of such services on the designated helper and the designated help recipient, and how various peer support roles benefit services and service recipients.
A common core of comparable data included in the N-MHSS and N-SSATS would be useful. As currently designed, the surveys vary in the language used in their questions, making comparisons difficult. With 7.7 million Americans reporting co-occurring substance use and mental disorders, developing a shared set of information about facilities that serve this population would be beneficial (43). Suggestions for future data collection on peer support services include providing clear definitions of the categories “consumer-run peer support services” and “mentoring or peer support” as well as investigating several questions: Are peers paid or voluntary? How many peer support providers are employed in state behavioral health workforces? What are the training and credentials of those offering peer support services? Are the peer support services run by peers or by other staff? and To what extent are nonlicensed facilities offering these services?

Limitations

This study did not address peer support outside of licensed behavioral health facilities. Cronise et al. (7) reported that a broad array of formal and informal peer support services were available in both unlicensed and licensed behavioral health facilities.
Because the N-MHSS and N-SSATS are separate surveys that use differently phrased questions, it is possible that differences in wording of the questions influenced our findings. The data did not include facility size, the numbers of peer support providers in each facility, or peer roles. For example, although there were fewer facilities in the N-MHSS sample than in the N-SSATS sample, the N-MHSS facilities may have been larger than the N-SSATS facilities, may have employed larger peer support workforces, or may have been structured differently.
The study was conducted before the COVID-19 pandemic and did not address the impact of the pandemic or the $8.56 billion allocated for additional pandemic-related mental health funding for fiscal years 2020 and 2021 (44, 45). Policy changes resulting from the pandemic and its impact on peer support are important areas for future investigation.

Conclusions

Peer support services are provided in facilities providing substance use and mental health treatments in every U.S. state. Substance use treatment facilities reported offering peer support services more frequently than did mental health facilities, with proportions varying within and across states as well as by the types of programs facilities offered. Although the research base for the peer support workforce has grown, more clarity is needed about workforce training, credentialing, and deployment, both in mental health and in substance use treatment services.

Supplementary Material

File (appi.ps.20220366.ds001.pdf)

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 1247 - 1255
PubMed: 37254506

History

Received: 16 July 2022
Revision received: 29 March 2023
Accepted: 5 April 2023
Published online: 31 May 2023
Published in print: December 01, 2023

Keywords

  1. Mental health systems
  2. Recovery
  3. Psychosocial rehabilitation
  4. Self-help
  5. Alcohol and drug abuse
  6. Peer support

Authors

Details

Lynn Videka, A.M., Ph.D. [email protected]
School of Social Work (Videka, Evans) and Michigan Medicine (Neale), University of Michigan, Ann Arbor; Behavioral Workforce Research Center, School of Public Health, University of Michigan, Ann Arbor (Page, Buche, Beck, Grazier); New York Harbor Healthcare System, U.S. Department of Veterans Affairs, New York City (Railey); Behavioral Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Gaiser).
Cory Page, M.P.H., M.P.P.
School of Social Work (Videka, Evans) and Michigan Medicine (Neale), University of Michigan, Ann Arbor; Behavioral Workforce Research Center, School of Public Health, University of Michigan, Ann Arbor (Page, Buche, Beck, Grazier); New York Harbor Healthcare System, U.S. Department of Veterans Affairs, New York City (Railey); Behavioral Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Gaiser).
Jessica Buche, M.P.H., M.A.
School of Social Work (Videka, Evans) and Michigan Medicine (Neale), University of Michigan, Ann Arbor; Behavioral Workforce Research Center, School of Public Health, University of Michigan, Ann Arbor (Page, Buche, Beck, Grazier); New York Harbor Healthcare System, U.S. Department of Veterans Affairs, New York City (Railey); Behavioral Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Gaiser).
Jodi Neale, M.S.W.
School of Social Work (Videka, Evans) and Michigan Medicine (Neale), University of Michigan, Ann Arbor; Behavioral Workforce Research Center, School of Public Health, University of Michigan, Ann Arbor (Page, Buche, Beck, Grazier); New York Harbor Healthcare System, U.S. Department of Veterans Affairs, New York City (Railey); Behavioral Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Gaiser).
Elizabeth Evans, M.S.W.
School of Social Work (Videka, Evans) and Michigan Medicine (Neale), University of Michigan, Ann Arbor; Behavioral Workforce Research Center, School of Public Health, University of Michigan, Ann Arbor (Page, Buche, Beck, Grazier); New York Harbor Healthcare System, U.S. Department of Veterans Affairs, New York City (Railey); Behavioral Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Gaiser).
Angela J. Beck, Ph.D., M.P.H.
School of Social Work (Videka, Evans) and Michigan Medicine (Neale), University of Michigan, Ann Arbor; Behavioral Workforce Research Center, School of Public Health, University of Michigan, Ann Arbor (Page, Buche, Beck, Grazier); New York Harbor Healthcare System, U.S. Department of Veterans Affairs, New York City (Railey); Behavioral Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Gaiser).
Kyle L. Grazier, M.S., Dr.Ph.
School of Social Work (Videka, Evans) and Michigan Medicine (Neale), University of Michigan, Ann Arbor; Behavioral Workforce Research Center, School of Public Health, University of Michigan, Ann Arbor (Page, Buche, Beck, Grazier); New York Harbor Healthcare System, U.S. Department of Veterans Affairs, New York City (Railey); Behavioral Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Gaiser).
James A. Railey, M.S.W., Ph.D.
School of Social Work (Videka, Evans) and Michigan Medicine (Neale), University of Michigan, Ann Arbor; Behavioral Workforce Research Center, School of Public Health, University of Michigan, Ann Arbor (Page, Buche, Beck, Grazier); New York Harbor Healthcare System, U.S. Department of Veterans Affairs, New York City (Railey); Behavioral Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Gaiser).
Maria Gaiser, M.P.H.
School of Social Work (Videka, Evans) and Michigan Medicine (Neale), University of Michigan, Ann Arbor; Behavioral Workforce Research Center, School of Public Health, University of Michigan, Ann Arbor (Page, Buche, Beck, Grazier); New York Harbor Healthcare System, U.S. Department of Veterans Affairs, New York City (Railey); Behavioral Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (Gaiser).

Notes

Send correspondence to Dr. Videka ([email protected]).

Competing Interests

The contents in this article are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. government.
The authors report no financial relationships with commercial interests.

Funding Information

This study was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS).

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