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Challenges Experienced by Paid Peer Providers in Mental Health Recovery: A Qualitative Study

Abstract

Peer providers are increasingly employed in mental health services. We explored challenges experienced by 31 peer providers in diverse settings and roles using in-depth interviews, as part of a larger study focusing on their recovery (Moran et al. in Qual Health Res, 2012). A grounded theory approach revealed three challenge domains: work environment, occupational path, and personal mental health. Challenges in the work environment differed between conventional mental health settings and consumer-run agencies. Occupational domain challenges included lack of clear job descriptions, lack of skills for using one’s life story and lived experience, lack of helping skills, and negative aspects of carrying a peer provider label. Personal mental health challenges included overwork and symptom recurrence. Implications for all domains are discussed, with focus on training and skill development.

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References

  • Anthony, W. A., Cohen, M. R., Farkas, M., & Gagne, C. (2002). Psychiatric rehabilitation. Boston, MA: Center for Psychiatric Rehabilitation.

    Google Scholar 

  • Boston University Center for Psychiatric Rehabilitation. Retrieved from http://www.bu.edu/drrk/research-syntheses/psychiatric-disabilities/job-accommodations/.

  • Campbell, J. (2004). Consumer-operated services program (COSP) multisite research initiative overview and preliminary findings. Retrieved from http://www.power2u.org/downloads/COSPVAREPORT.pdf.

  • Campbell, J., & Leaver, J. (2003). Emerging new practices in organized peer support: Report from NTAC’s national experts meeting, March 17–18, 2003. Retrieved from http://www.consumerstar.org/pubs/Emerging%20New%20Practices%20in%20Oraganized%20Peer%20Support.pdf.

  • Carlson, L. S., Rapp, C. A., & McDiarmid, D. (2001). Hiring consumer-providers: Barriers and alternative solutions. Community Mental Health Journal, 37(3), 199–213.

    Article  PubMed  CAS  Google Scholar 

  • Chinman, M., Shoai, R., & Cohen, A. (2010). Using organizational change strategies to guide peer support technician implementation in the veterans administration. Psychiatric Rehabilitation Journal, 33(4), 269–277.

    Article  PubMed  Google Scholar 

  • Chinman, M., Young, A. S., Hassell, J., & Davidson, L. (2006). Toward the implementation of mental health consumer provider services. Journal of Behavioral Health Services & Research, 33(2), 176–195.

    Article  Google Scholar 

  • Clay, S. (2005). On our own together: Peer programs for people with mental illness. Nashville, TN: Vanderbilt University Press.

    Google Scholar 

  • Cleary, M., Freeman, A., & Walter, G. (2006). Carer participation in mental health service delivery. International Journal of Mental Health Nursing, 15(3), 189–194.

    Article  PubMed  Google Scholar 

  • Cook, J. A., Copeland, M. E., Floyd, C. B., Jonikas, J. A., Hamilton, M. M., Razzano, L., et al. (2012). A randomized controlled trial of effects of wellness recovery action planning on depression, anxiety, and recovery. Psychiatric Services, 63(6), 541–547.

    Article  PubMed  Google Scholar 

  • Copeland, M. E. (2002). Wellness recovery action plan. West Dummerston, VT: Peach Press.

    Google Scholar 

  • Craig, T., Doehrty, I., Jamieson-Craig, R., Boocock, A., & Attafua, G. (2004). The consumer-employee as a member of a Mental Health Assertive Outreach Team. I. Clinical and social outcomes. Journal of Mental Health, 13(1), 59–69.

    Article  Google Scholar 

  • Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D., & Tebes, J. (1999). Peer support among individuals with severe mental illness: A review of the evidence. Clinical Psychology: Science and Practice, 6(2), 165–187.

    Article  Google Scholar 

  • Davidson, L., Chinman, M., Sells, D., & Rowe, M. (2006). Peer support among adults with serious mental illness: A report from the field. Schizophrenia Bulletin, 32(3), 443–450.

    Article  PubMed  Google Scholar 

  • Dixon, L., Hackman, A., & Lehman, A. (1997). Consumers as staff in assertive community treatment programs. Administration and Policy in Mental Health, 25(2), 199–208.

    Article  PubMed  CAS  Google Scholar 

  • Enosh, The Israeli Association for Mental Health. Du-Siach. Retrieved from http://www.enosh.org.il/Index.asp?ArticleID=7034&CategoryID=654&Page=1.

  • Farkas, M., Gagne, C., Anthony, W., & Chamberlin, J. (2005). Implementing recovery oriented evidence based programs: Identifying the critical dimensions. Community Mental Health Journal, 41(2), 141–158.

    Article  PubMed  Google Scholar 

  • Felton, C. J., Stastny, P., Shern, D. L., Blanch, A., Donahue, S., Knight, E., et al. (1995). Consumers as peer specialists on intensive case management teams: Impact on client outcomes. Psychiatric Services, 46(10), 1037–1044.

    PubMed  CAS  Google Scholar 

  • Gagne, C. A., White, W., & Anthony, W. A. (2007). Recovery: a common vision for the fields of mental health and addictions. Psychiatric Rehabilitation Journal, 31(1), 32–37.

    Article  PubMed  Google Scholar 

  • Gates, L., & Akabas, S. (2007). Developing strategies to integrate peer-providers into the staff of mental health agencies. Administration and Policy in Mental Health and Mental Health Services Research, 34(3), 293–306.

    Article  PubMed  Google Scholar 

  • Hebert, M., Rosenheck, R., Drebing, C., Young, A. S., & Armstrong, M. (2008). Integrating peer support initiatives in a large healthcare organization. Psychological Services, 5(3), 216–227.

    Article  Google Scholar 

  • Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38(2), 139–149.

    Article  Google Scholar 

  • Hutchinson, D. S., Anthony, W. A., Ashcraft, L., Johnson, E., Dunn, E., Lyass, A., et al. (2006). The personal and vocational impact of training and employing people with psychiatric disabilities as providers. Psychiatric Rehabilitation Journal, 29(3), 205–214.

    Article  PubMed  Google Scholar 

  • Katz, J., & Salzer, M. S. (2006). Certified peer specialist training program descriptions. Retrieved from www.upennrrtc.org/var/tool/file/33-Certified%20Peer%20Specialist%20Training%20-%20PDF.pdf.

  • Legere, L. (2010), June 28, Personal communication.

  • Mancini, M. A., & Lawson, H. A. (2009). Facilitating positive emotional labor in peer-providers of mental health services. Administration in Social Work, 33(1), 3–22.

    Article  Google Scholar 

  • McCorkle, B. H., Dunn, E. C., Wan, Y. M., & Gagne, C. (2009). Compeer friends: a qualitative study of a volunteer friendship program for people with serious mental illness. International Journal of Social Psychiatry, 55(4), 291–305.

    Article  PubMed  Google Scholar 

  • Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical perspective. Psychiatric Rehabilitation Journal, 25(2), 134–141.

    Article  PubMed  CAS  Google Scholar 

  • Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to change (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Min, S.-Y., Whitecraft, J., Rothbard, A. B., & Salzer, M. S. (2007). Peer support for persons with co-occurring disorders and community tenure: A survival analysis. Psychiatric Rehabilitation Journal, 30(3), 207–213.

    Article  PubMed  Google Scholar 

  • Moran, G., Russinova, Z., Gidugu, V., Yim, J. Y., & Sprague, C. (2012). Benefits and mechanisms of recovery among peer providers with psychiatric illnesses. Qualitative Health Research, 22(3), 304–319.

    Article  PubMed  Google Scholar 

  • Moran, G., Russinova, Z., & Stepas., K. (in press). Toward understanding the impact of occupational characteristics on the recovery and growth processes of peer-providers. Psychiatric Rehabilitation Journal.

  • Mowbray, C., Moxley, D., & Collins, M. (1998). Consumers as mental health providers: First-person accounts of benefits and limitations. The Journal of Behavioral Health Services and Research, 25(4), 397–411.

    Article  PubMed  CAS  Google Scholar 

  • NAMI. In our own voice. Retrieved from http://www.nami.org/template.cfm?section=In_Our_Own_Voice.

  • New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final report (DHHS Pub. No. SMA-03-3831). Rockville, MD. Retrieved from http://www.mentalhealthcommission.gov/reports/FinalReport/toc.html.

  • Onken, S. J., Craig, C. M., Ridgway, P., Ralph, R. O., & Cook, J. A. (2007). An analysis of the definitions and elements of recovery: A review of the literature. Psychiatric Rehabilitation Journal, 31(1), 9–22. doi:10.2975/31.1.2007.9.22.

    Article  PubMed  Google Scholar 

  • Patton, M. Q. (1990). Qualitative evaluation and research methods. Newbury Park: Sage Publications.

    Google Scholar 

  • Ratzlaff, S., McDiarmid, D., Marty, D., & Rapp, C. (2006). The Kansas consumer as provider program: Measuring the effects of a supported education initiative. Psychiatric Rehabilitation Journal, 29(3), 174–182.

    Article  PubMed  Google Scholar 

  • Ridgway, P. (2001). Restorying psychiatric disability: Learning from first person recovery narratives. Psychiatric Rehabilitation Journal, 24(4), 335–343.

    Article  PubMed  CAS  Google Scholar 

  • Rivera, J. J., Sullivan, A. M., & Valenti, S. S. (2007). Adding consumer-providers to intensive case management: Does it improve outcome? Psychiatric Services, 58(6), 802–809.

    Article  PubMed  Google Scholar 

  • Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55, 68–78.

    Article  PubMed  CAS  Google Scholar 

  • Sabin, J. E., & Daniels, N. (2003). Managed care: Strengthening the consumer voice in managed care: VII. The Georgia peer specialist program. Psychiatric Services, 54(4), 497–498. doi:10.1176/appi.ps.54.4.497.

    Article  PubMed  Google Scholar 

  • Salzer, M. S. (1997). Consumer empowerment in mental health organizations: Concepts, benefits, and impediments. Administration and Policy in Mental Health, 24(5), 425–434.

    Article  PubMed  CAS  Google Scholar 

  • Salzer, M. S., Katz, J., Kidwell, B., Federici, M., & Ward-Colasante, C. (2009). Pennsylvania certified peer specialist initiative: Training, employment and work satisfaction outcomes. Psychiatric Rehabilitation Journal, 32(4), 301–305.

    Article  PubMed  Google Scholar 

  • Salzer, M., & Shear, S. L. (2002). Identifying consumer-provider benefits in evaluations of consumer-delivered services. Psychiatric Rehabilitation Journal, 25(3), 281–288.

    Article  PubMed  Google Scholar 

  • Sherman, P., & Porter, R. (1991). Mental health consumers as case management aides. Hospital and Community Psychiatry, 42(5), 494–498.

    PubMed  CAS  Google Scholar 

  • Social Firms Australia (2010). Roles, rights and responsibilities disclosure of a mental illness in the workplace: A guide for employment consultants. Social Firms in Australia LTD; Legal Service Board. Retrieved from: http://www.socialfirms.org.au/files/downloads/SoFA_DES_handbook_disclosure.pdf.

  • Solomon, P. (2004). Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal, 27(4), 392–401.

    Article  PubMed  Google Scholar 

  • Walker, D., & Myrick, F. (2006). Grounded theory: An exploration of process and procedure. Qualitative Health Research, 16(4), 547–559.

    Article  PubMed  Google Scholar 

  • Williams, C. C., & Collins, A. A. (1999). Defining new frameworks for psychosocial interventions. Psychiatry, 62(1), 61–78.

    PubMed  CAS  Google Scholar 

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Correspondence to Galia S. Moran.

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Moran, G.S., Russinova, Z., Gidugu, V. et al. Challenges Experienced by Paid Peer Providers in Mental Health Recovery: A Qualitative Study. Community Ment Health J 49, 281–291 (2013). https://doi.org/10.1007/s10597-012-9541-y

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  • DOI: https://doi.org/10.1007/s10597-012-9541-y

Keywords

  • Consumer providers
  • Mental illnesses
  • Job development
  • Workforce integration