Increasing Peer Support: A Radical Proposal for a Governor

New Hampshire Governor John Lynch could save a ton of money by increasing peer support.

New Hampshire Governor John Lynch could save a ton of money by increasing peer support.

Damien Licata, chair of the NH Mental Health Consumer Advocacy Council (my old job) asked me for some thoughts prior to his meeting with NH Gov. John Lynch, whose “broken” mental health system is being sued for civil rights violations by the U.S. Justice Department and others.

Here is what I told a friend to tell the governor about increasing peer support:

Public mental health systems all over the country are becoming economically unsustainable.  State governments can’t afford to give everyone with a problem a psychiatrist, case manager, disability and poverty benefits, and expensive medication for the rest of their lives.

That is a new, permanent reality, that started long before the current fiscal crisis all state governments face, and is now an emergency, in many states, including New Hampshire.  Basic change can no longer be avoided or delayed.

It is possible to address this problem without limiting the number of people eligible for state-funded services, or the amount of Medicaid service people can get in a year.  But only if a governor, someone with more political power and will than the state Bureau of Behavioral Health (BBH) or Department of Health and Human Services (DHHS), gets behind a fundamental change in the way the system has always done things and starts working on increasing peer support.

Meds First For Everyone For Life Hasn’t Worked

No reasonable person denies that medication helps many people in the short term, but many studies question the long-term outcomes of meds in people who have been taking them for 10 to 30 years. These studies have recently gotten more publicity and indicate long-term medication keeps some people sick, prolongs disability, or makes them worse (Robert Whitaker, Anatomy of an Epidemic).

The public mental health system should triage people to see if they need medication right away, or if alternatives can avoid it, or limit the amount needed.  The system should also help people safely reduce or withdraw from medication, gradually, safely, under doctor’s supervision, after they’ve been on it several years. The current system almost always discourages anyone anyone wanting to come off medications even if there’s a chance it might improve their condition.

Increasing peer support is the best alternative, completely evidence-based, and a fraction of the cost of  using mental health centers only. New Hampshire was the fist state to fund a network of peer support centers.  But we don’t use what we have enough, or to best advantage.

Increasing Peer Support works because of the Disease vs. Distress model

Medication first for everyone for life has not worked.  Not enough people get well, or become low utilizers.  Assuming a chemically- based brain disease, giving people a diagnostic label right away,  and telling them they’ll be sick and need medication for life is often self-fulfilling.  We call that a permanent “disease model” compared to a temporary view of “emotional distress.

Often, what we diagnose as mental illness is caused by previous traumas, social and economic situations, loss, isolation, loneliness, and hopelessness.  It is possible to get through this kind of distress, and come out whole or stronger on the other side.  The best way to move through overwhelming emotions is by increasing peer support and building connections to the community.

This  “distress model” shows solutions much more clearly.

Peer Support: States Should Take This Option More Seriously

Peer Support: States Should Take This Option More Seriously

The 2002 report from the National Association of State Mental Health Program Directors said  “increasing peer support from trained people, who have overcome post-traumatic feelings and distress, is the most effective intervention.”

We’ve already documented that our peer support centers make members less dependent on the most expensive Medicaid services: psychiatrists, hospital beds, emergency rooms, one-on-one visits in the community with case managers, and expensive medication.  Members learn skills and get jobs, become empowered and more independent.

Peer support centers can divert many people from professional treatment before they decide they are “mentally ill.”  The state has never given that serious thought.  Medication should be presented to people as one of many options, not the only option.

Wellness Wordworks, the Kansas City-based think tank I joined in 2009, has proposed eight non-medical alternatives in Kansas and Missouri, that help people overcome emotional distress and adversity through exercise, the arts, peer support, and community building.  Increasing peer support is a key approach to these programs.

Peers could share the idea they can come out on the other side, and only refer them to mental health centers for medication if necessary. Mental Health centers would still be needed to prescribe medicine and other medical services, and bill insurance, Medicare, and Medicaid.  Peer support is not a medical or Medicaid service.

It would save the state a fortune and create better outcomes for many people.  But a governor, not the permanent bureaucracy, must drive that change. How can your state become more serious about peer support and the distress model? Who has the power to create real change?

How can you make allies for increasing peer support?


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