Linking Discharged Patients With Peers in the Community

Few would disagree that peer support for people with severe and persistent mental illness strengthens the likelihood of their successful reintegration into the community, but little has been done to formally develop a consumer-centered approach within the discharge planning process at state hospitals. Eastern State Hospital in Medical Lake, Washington, has set up an innovative social network intervention that links patients who are being discharged from the hospital with peers in the community. Besides providing social support and friendship, a key role of peers is to help discharged patients consistently attend their weekly case management appointments at the local community mental health center.

The hospital's social work department began the intervention by selecting inpatients with an axis I diagnosis who met discharge criteria and expressed willingness to be matched with a peer. These patients were then referred by their social worker to a discharge readiness group to prepare them for reentry into the community. Participation in the group and in the peer support intervention, which was part of the group's focus, was voluntary.

A pool of potential peers was selected from three local resources: a psychosocial rehabilitation clubhouse, an Alliance for the Mentally Ill chapter, and a Depressive and Manic-Depressive Association chapter. During patients' participation in the discharge readiness group, a profile of each patient's preferences about a peer's age, interests, and similar factors was compiled. This information was provided to the patient's case manager at the community mental health center, who then selected the peer who best matched the patient's interests and commonalities. At the patient's discharge, case managers met with the patient and facilitated the initial meeting with the peer.

Thirty-five patients who were linked with peers in the community were followed up for one month after hospital discharge. Twenty-three of these patients consistently attended their weekly case management appointments, a 66 percent compliance rate. Aftercare service records indicated that discharged patients who did not participate in the peer support intervention attended only one-third of their postdischarge appointments. A 66 percent attendance rate for discharged patients is encouraging when compared with national study reports that only 30 percent of patients keep their first postdischarge appointment.

The majority of patients who received this intervention were enrolled in clubhouse services, which made outreach by peers easier, and most peer relationships were ultimately strengthened. The peer-linkage approach proved cost-effective and easy to implement. Initial observations were that it works best as a component of the discharge planning process and that its success depends on the level of case manager involvement, the rapport established between the patient and the peer, and the quality of their developing relationship. It was also found that for the peer linkage to be successful, it must be arranged within two days of the patient's discharge.

The linkage of patients with their peers in the community is a normalizing intervention that helps ease patients' transition from a highly structured ward milieu, which is often their only social support system. Replacing such supports by facilitating an active relationship with a peer is an opportunity to model "wellness" that cannot be duplicated by mental health professionals or therapeutic groups. Such an intervention also provides a social structure that is accepting and empowering. A more formal and comprehensive peer support program is currently being developed within the hospital.