Self-Help Interest Group

The principles and practices of member-run mutual-help groups or self-help support groups have been increasingly adapted into new forms of mental health peer provider roles.  An increasing number of US states sponsor peer provider credentialing programs that are reimbursable by Medicaid, and mental health consumers are frequently being employed as peer providers in consumer-run services and in professional, clinical, and rehabilitative services (Myrick & del Vecchio, 201; Salzer 2010).

This article describes the Peer Bridger, a distinctive (or unique) peer support staff role. We describe examples of how Peer Bridgers are used in several sites and emphasize how Peer Bridgers are being distinctively used at SHARE! the Self-Help And Recovery Exchange in Los Angeles, California. Peer Bridgers at SHARE! have been evolving since 2005 and represent a promising practice that, based upon preliminary information, offers the potential for becoming an important evidence-based practice.

A Peer Bridger is someone with lived experience who provides a 'bridge' for a person transitioning between life situations, places, and/or identities. Examples of critical transitions are from homelessness to housing, incarceration to the community, locked mental health facility to the community, and/or unemployment to employment. For the SHARE! Collaborative Housing project, bridging is distinctive in that it also includes offering support in the form of: a) self-help support groups; b) opportunities to learn to live collaboratively with others; and c) participation in the democratic management of the shared housing.

Ideally, Peer Bridgers get to know the person they are bridging before the person transitions to the new setting or situation. By disclosing their similar lived experiences, Peer Bridgers normalize the fears, concerns and feelings that people in the new situation have. Peer Bridgers connect people to self-help support groups, and may themselves attend self-help support groups alongside newcomers, to model effective interactions within groups. While only 70% of SHARE! Collaborative Housing residents actually attend self-help support groups, the impact of those who do is to make the houses more functional, as people bring benefits from the groups to the house, such as learning to listen and problem solve effectively. The Peer Bridger uses recovery planning to empower the person to move forward and function as a supporter and a role model, sharing their experience, tools and skills to make the transition successful.

Peer Bridgers first appeared in the Peer Bridger Project, developed by the New York Association of Psychiatric Rehabilitation Services in 1994 as part of their mission to help people transition out of psychiatric hospitals into the community in a manner that circumvented the revolving door phenomenon.  Until then, 50 percent of people would get readmitted to the hospital within a year. By 2008, the Peer Bridger Project had reduced this to 29 percent (NY Peer Bridger Project, 2012).

Peer Bridgers have been utilized in several mental health programs. The Housing First model, launched at Pathways to Housing New York, found that with the use of Peer Bridgers, 80% of people maintained housing over two-years, compared to 30% for people who received traditional housing services (typically shelters and transitional housing, with access to permanent housing if they complied with program requirements) (Tsemberis et al, 2004). As a progressive program model, the philosophic premises, service structure, and empirical support of Pathways to Housing New York's Housing First model have led to its increasingly widespread dissemination (Stanhope & Dunn, 2011).

Peer Bridgers are also using Critical Time Intervention (see https://www.criticaltime.org/cti-model/), which helps vulnerable people during times of transition in their lives by strengthening their network of support in the community. In a study of Peer Bridgers supporting people exiting New York psychiatric hospitals with time-limited care coordination, participants increased their use of outpatient services over 12 months and decreased hospital use compared to a control group (Nossell, 2016).  Peer Bridgers supported veterans in the MISSION-VET treatment program, serving as role models and a source of encouragement and support (Rodrigues, 2011). Peer Bridgers implementing Critical Time Intervention in Brazil and Chile are currently under study (Stastny, 2012; Baumgartner, 2012). Peer bridging those leaving psychiatric hospitals has been shown to improve symptom severity, functioning and employment (Franx, 2008). A two-year study at nine Canadian hospitals found that the length of hospital stays was reduced due to peer bridging (Forchuk, 2015).

SHARE!’s Model of Peer Bridging

Established in 2005, SHARE! Collaborative Housing uses Peer Bridgers to support more than 600 people a year in its housing program. The purpose of the approach is to maintain a high degree of recovery orientation, where recovery is defined as “a process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential” (SAMHSA, 2012). Participants maintain housing and are supported in pursuing personal growth and change through self-help support groups, and pursuing their personal idea of success, which often includes education and/or employment.

Peer Bridgers at SHARE! are employees who have met the standard requirements for employed peer staff; this consists of being in successful recovery from their relevant issues, and presently attending self-help support group meetings. They receive ongoing training in SHARE!’s approach to Peer Bridging and in the SHARE! Peer Toolkit— the relational dynamics, developed by Executive Director Ruth Hollman - the 2016 recipient of SCRA’s Distinguished Contribution to Community Psychology Practice Award. SHARE!’s Advanced Peer Specialist training, which includes three courses, is funded by the State of California.

SHARE! tracked participants in SHARE! Collaborative Housing with serious mental illness and found that 26% found employment within a year. Participants also showed high rates of pursuing higher education, family reunification and volunteering. 98% maintained their housed status even after they moved out.

One of the difficulties in implementing Peer Bridging is the lack of suitable training. There is a lack of studies comparing peer training of any sort with outcomes in the people served.  Many peer certification programs do not teach best practices in peer services, relying on what should work rather than what actually has been shown to work.  SHARE! has had difficulties with Peer Bridgers who want to pass into the Case Manager role, as it more familiar and also wields more power. Acknowledging the widespread confusion about best practices in Peer Bridging (Henwood, 2011), SHARE! trains staff and aspiring Peer Bridgers in the most effective traits of Peer Bridgers using the following matrix.