We Shouldn’t Fund Peer Support-Based Initiatives for Mental Illness
There is this growing movement of people who think that peer support is critical in the treatment of people with mental illness – but I would contend that, in spite of this movement, peer support does not treat mental illness. And, in fact, by funding these peer support-based initiatives and peer-delivered services we take away dollars that should actually be spent on the evidence-based treatment of serious mental illness.
Peer Support Initiatives / Peer Support Groups
Some peer supporters and peer support groups are run out of the goodness of people’s hearts, and that’s nice. There’s no doubt that talking to someone empathetic and, likely with a similar illness, gives people warm feelings and possibly enhances both parties’ social lives. But when people start believing that peer support can actually treat a mental illness that’s when I start to pull on the reins. When people start insisting that peer supporters should be licensed so that Medicaid will pay the organization money, that’s where I draw the line. Why are government dollars – your dollars – going to facilitate empathy and a pleasant conversation?
Limited Funds Shouldn’t Go to Peer Support or Peer-Delivered Services
In the mental health care system, funds are extremely limited and all too many of them go to what many of us call the “worried well.” In other words, all too many funds go to people with minor mental disorders and not to people with serious mental illnesses. Getting quality treatment for a homeless person with schizophrenia or bipolar disorder is nearly impossible in our society because of this lack of funds. When you go to an Emergency Room because you’ve just attempted suicide it is equally likely as not that you will get almost immediately released from the hospital because of this lack of funds. When you don’t have good health insurance, you’ll only have access to the older, more side effect-laden drugs because of this lack of funds.
So when I have a choice between a floridly psychotic person talking to a “peer” or actually getting treatment, I’m going to pick treatment 10 times out of 10, and when I think about where our limited dollars should be going, I’m going to pick actual treatment 10 times out of 10, too.
Does Peer Support Have Benefits?
Don’t get me wrong, I’m not saying that peer support doesn’t have benefits, likely for both parties in terms of temporary, warm fuzzies, but there is no high-quality research saying that this will actually improve a severe mental illness.
According to a meta-analysis done in 2014 by Lloyd-Evans et al on peer support for people with severe mental illnesses:
. . . there was little or no evidence that peer support was associated with positive effects on hospitalisation, overall symptoms or satisfaction with services. There was some evidence that peer support was associated with positive effects on measures of hope, recovery and empowerment at and beyond the end of the intervention, although this was not consistent within or across different types of peer support.
Moreover, the analysis notes a “high risk of bias” in studies, perhaps overestimating even this limited finding of benefits.
The limited evidence base suggests that peers may have a small additional impact on patient’s outcomes, in comparison to standard psychiatric care in high-income settings . . . No effect of peer-delivered interventions for depression was observed on any outcome.
In other words, there is essentially no high-quality evidence that says that peer support or peer-delivered services make people with severe mental illnesses better. The only benefit these services seem to have is that they are cheaper and make people feel like something is being done.
Are There Dangers to Peer-Delivered Services?
And to top that all off, there are dangers to peer-delivered services, too. Because peers are not professionals and do not have professional guidance, oversight or ethics, they often take liberties that are far outside of what is reasonable.
For example, a peer might be talking to someone who is having depressive symptoms and say, “I went on X drug and it changed my life.” This is completely inappropriate. That drug may actually be dangerous for the person in question. The only person who should be making drug recommendations should be a doctor.
Another example might be a person that is dealing with psychosis and a peer that says, “Don’t you know that voices are just part of your subconscious and should be dealt with in therapy and not through medication?”
Again, this is a terrible thing for a peer to say. The peer has absolutely no right to make such biased, ill-advised and unscientific comments.
You say this doesn’t happen? It has happened during my own experiences with peer support and during the delivery of peer-driven services to others I know. This is really what happens. It really invalidates a person’s experience with mental illness. It can really steer a person away from real, evidence-based treatment. It can really make a person run to his or her doctor and demand a medication change that isn’t right for him or her.
Money for Evidence-Based Approaches, Not Dangerous, Peer-Delivered Services
I’m not saying there isn’t a place for peer-delivered services in some way. For example, if a peer wants to facilitate the life of another who may not be functioning at a high enough level to take care of him or herself. This makes sense. But only if the task is simple, non-psychiatric and the peer knows not to try to influence the other with personal opinions.
So if you want to be a peer support person or if you want to partake of peer support, feel free, just don’t use the taxpayer’s funds to do it.
PS: Considering all the comments, I wrote a response to some of them at In Response to the Peer Supporters Who Want Government Funding.
Update: See this great article from an ex-SAMHSA employee that talks about this very issue: The Federal Government Ignores the Treatment Needs of Americans With Serious Mental Illness.
Image by Flickr user Garry Knight.