Been There, Done That: The Mental Health Peer Support Project
June 2001
by Judith Holtz, Mary Ann Jones and Keith Miller.
Introduction and Background
While it is understood that centers for independent living work with
and on behalf of people with all types of disabilities, it must be acknowledged
that many centers, especially in the early days of center development,
dealt primarily with persons who had physical and sensory disabilities.
Indeed, some refer to mental disability as the "stepchild" of
the IL Movement. In the mid-90s, the Westside Center for Independent Living
(WCIL) made a conscious decision to reach out to consumers with mental
health issues. Staff developed a pilot Peer Support Staff project for
persons with mental health/psychiatric disabilities. The project was aimed
at empowering these individuals to take charge of their own support group
and to increase their employability by having them work with other staff
at the agency. The project was a struggle to keep going primarily because
there was no dedicated funding for staff or participants and it lacked
timely placement in real jobs. The project fizzled, but the basic premise
hovered about WCIL.
In April of 1999, WCIL had an opportunity to take what it had learned
and create a new project in response to a request for proposals (RFP)
for consumer run services from the Los Angeles County Department of Mental
Health (DMH). This RFP was part of DMH's initiative to increase the role
of consumers throughout the LA County mental health system. Many people
in the mental health community believed this to be the most critical element
in ensuring an effective and responsive mental health delivery system.
A major part of WCIL's mission is to advocate for the inclusion of people
with disabilities in the planning and delivery of programs and services
designed for them. WCIL viewed this RFP as a unique opportunity to increase
service delivery to consumers with mental disabilities, meet community
needs and contribute some much needed systems change.
The Peer Support Project (PSP) takes people with mental disabilities
and eases them back into the workforce to assist others with mental disabilities
to lead independent and productive lives.
Steps Taken
WCIL regularly attended several different mental health network meetings
where participating agencies used ideas from consumers and their families
when discussing service issues. Many meetings centered on the idea that
service provision which included more direct involvement by consumers
would be a significant asset to the mental health community. Consumers,
it was noted, find it easier to communicate with people who have "been
there, done that." The long-standing consensus was that a program
to train mental health consumers to be paraprofessionals would be an important
step toward their independence. From these meetings, WCIL's Peer Support
Project (PSP) was born.
WCIL submitted a concept paper that included paid participant training
and internship as well as a paid consumer project coordinator. The training
would assist consumers in the mental health system to provide direct services
to others needing those services. A panel of agency directors, consumers,
and mental health personnel reviewed the submitted papers, discussed the
viability of the papers and voted on which one could best serve the community.
Subsequently, they chose WCIL's proposal. Since the funding provided by
the Department of Mental Health could only be used for consumer stipends
and salaries, WCIL immediately went to work identifying additional funding
to help defray project expenses. With an additional grant from a community
church, WCIL was able to increase the project facilitator's hours from
10 to 16 and have a tiny bit left for supplies.
The Plan
Unwittingly, staff incorporated the four elements of the vocational
rehabilitation process that have been identified as important in effectively
helping people with mental illness to obtain employment: the practitioner
(mental health professionals), the process (flexibility), the program
(consumer-run programs, real work for real pay in community settings,
transitional employment) and the principles (empowerment, integrated settings,
rapid placement, supportive services). ("Strategies to Secure and
Maintain Employment for People with Long-Term Mental Illness," National
Institute on Disability and Rehabilitation Research, Vol. XV, No 10, 1993.
ISSN: 0732-2623.)
To accomplish this goal, the Peer Support Project (PSP) offered the following
supports.
- An eight-week training period involved topics such as crisis intervention,
boundaries between counselor and consumer, stigma of mental disabilities,
Social Security benefits, case management, community resources, advocacy,
housing issues, incident/abuse reporting, goal setting and prioritizing,
information recording, forms and statistical reporting. An important
part of the training dealt with the empowerment of the participant/consumer.
Many participants utilized empowerment in their daily lives. The PSP
coordinator and WCIL supervisors critiqued role-playing scenarios used
for training purposes.
- A ten-week internship after training placed the participants in various
mental health agencies throughout WCIL's service area. During this period,
they worked under the guidance of professional who assisted them in
a variety of peer counseling techniques learned during training.
- An $8.00 per hour stipend was paid to the PSP participants for both
the training and internship.
The Project
Prospective participants applied to the PSP by submitting their resume
and a cover letter explaining why they wanted to enroll in the program
and what they wanted to achieve as a result of it. The criteria for selection
required the participants to be LA County Department of Mental Health
consumers and be stable in regard to their disability. To date, the project
range of disabilities has included depression, bipolar disorders, anxiety
and panic disorders, schizophrenia and obsessive-compulsive disorders.
Each of the prospective participants completed an employment application
and went through a formal job interview. The application included a set
of field related questions. Some of the questions included scenarios related
to things that could happen in an agency and tested their knowledge of
community resources.
Important to their selection as a participant in the project was the
way they handled the job interview. The questions asked gave an idea of
the applicants' knowledge of the field. WCIL also tried to achieve a diverse
representation of disabilities among the participants.
Training
WCIL staff who developed the training curriculum included the director
of services, a licensed clinical social worker, the program manager, the
advocacy supervisor, and the peer support project coordinator, a consumer
in the mental health system. The needs of the community and the information
needed to be an asset to the community formed the basis of the PSP curriculum.
The PSP training module consisted of an eight-week course. WCIL established
a ten-hour, three-day week. WCIL found that people receiving certain medication
therapies had difficulty concentrating for more than 3-4 hours at a time.
Rest breaks helped to alleviate stress and enhance retention of the curriculum.
Each class session began with the PSP coordinator checking in with each
participant to see how he or she felt that day. This allowed the participants
to vent their fears and receive needed support. The topic order remained
flexible to accommodate fluctuations related to participants' disabilities.
WCIL noticed the class ran best when the PSP coordinator focused on one
topic per class. WCIL's specialist staff conducted the majority of the
lectures. Additional guest speakers came from different service area providers.
WCIL found that the agencies in its service area supported the project
and very willingly participated in the training process. Questions and
answers followed each lecture. Whenever possible, WCIL created scenarios
and vignettes to assist participants to obtain hands-on experience. Inclusion
of a recap of the previous day ensured maximum retention. The final class
focused on a comprehensive review of the entire course. At the end of
the training module, the PSP participants took part in a graduation ceremony
that included their families and other guests. This enhanced their sense
of accomplishment by allowing them to share their success.
Internships
Internships began the week immediately following the conclusion of the
training module. Internships were served at local mental health service
agencies. These agencies included a residential treatment center for adults
with severe and persistent mental illness, an agency that provides social
and educational advocacy as well as housing assistance to adults diagnosed
with serious mental illness, and a drop-in center for homeless mentally
ill women. When determining internship assignments, the PSP coordinator
took into consideration both the participant's disability and the agency's
needs. The PSP coordinator followed each participant's progress by visiting
the host agency several times during the internship period. The PSP coordinator
also made regular phone calls to each host agency to ensure the participants
continued to honor their work commitment and to troubleshoot any problems
as needed. The participants met at WCIL once a month for a support meeting.
This gave the participants an opportunity to verbalize any fears and/or
problems as well as share accomplishments.
Each agency that hosted interns from the WCIL Peer Support Project requested
to be included in future trainings and internships. The response was so
great that WCIL created a waiting list of area providers wanting to be
included in the PSP program. WCIL found as each module was completed that
changes were necessary to provide an even more comprehensive program.
The participants and agencies gave feedback to the PSP coordinator who
incorporated that information in subsequent modules.
Outcomes of the Project
The primary focus of the WCIL Peer Support Project included the experience,
understanding, and resources, as well as the knowledge, of people with
mental disabilities as part of service delivery to their peers. This approach
allowed for sharing of experience beyond what is available in traditional
models. It also included a key component of the Independent Living philosophy
at the heart of the project - peer support and role modeling. The PSP
consumers discussed how they managed their disability, how they successfully
accessed services, their firsthand knowledge of obstacles to meeting their
needs, and how to effectively deal with those obstacles. Further, the
project illustrated to those requesting assistance that they could be
independent and utilize their skills to enhance their functioning in their
communities.
The experience of the Peer Support Project empowered consumers as they
developed successful work habits, learned to manage their disability in
the work environment, and learned to recognize their specific needs for
reasonable accommodations--all factors that could ensure the success of
future employment.
The best feature of this project is its ability to further expand the
service delivery system to reach more consumers and to provide the more
intensive one-on-one assistance that many agencies cannot provide. As
a bonus, agencies and staff had the opportunity to hear the consumer's
perspective regarding agency procedures and ultimately provide another
avenue for consumer input into all parts of the organization.
Success
How does one measure success? WCIL noticed that success came in many
forms. One could look at the actual completion of the program as a success.
Since many of the participants either never worked or did not work for
many years due to their disability, WCIL found that the completion of
the PSP was a success in itself. Opening up, communicating with others
and higher self-esteem also signified success in this program. Feedback
from the participants ran the gamut from feeling better about themselves
to a better quality of life through employment.
Out of the three completed modules, twenty participants graduated. Among
those participants, ten received gainful employment, one decided to return
to school, and two have jobs pending. Also, two who were in shelters and
transitional housing have now found permanent housing.
As employment was not the only measure of success, the other unemployed
participants who used the skills they learned to communicate better with
family, the system, and obtain a better quality of life than before are
considered successful as well.
Another indication of the PSP's success came in December 2000 when representatives
of WCIL's Peer Support Project gave the keynote address at a luncheon
for the Westside Mental Health Network. This network included approximately
twenty-five mental health agencies and numerous consumers of the Department
of Mental Health. The speakers included WCIL's program manager, the PSP
coordinator, and several participants from the first two modules. Several
agencies spoke of the program's merits as they pertained to receiving
the newly trained participants. The program was well received and several
new agencies signed on to participate in future sessions. The director
of the LA County Department of Mental Health commended the program's merit
in the community. The success and overall opinion of WCIL's Peer Support
Project has been such that the LA County Department of Mental Health is
considering increasing its funding of the program.
With proper training and support we can continue to better the lives
of those who in the past were overlooked. The goal of the Peer Support
Project is to give people with mental disabilities an opportunity to change
their lives for the better by assisting those they serve to do the same.
Contact Information
Judith Holtz
Westside CIL
12901 Venice Boulevard
Los Angeles, CA 90066
Phone: (310) 390-3611, ext. 214
TTY: (310) 398-9204
E-Mail: Judith@wcil.org
Visit WCIL on the web at http://www.wcil.org
About the Authors
Judith Holtz is WCIL's Peer Support Project
coordinator and has been employed there for two years. She has extensive
experience with the mental health system, both as a service provider and
as a consumer.
Mary Ann Jones is the executive director of
WCIL, where she has been employed for the last 10 years. She has a bachelor's
degree in psychology and mass communications with an emphasis in public
relations. For more than 30 years she has worked and volunteered for several
non-profit organizations, most of which have been directly linked to disability-related
issues and the independent living movement.
Keith Miller is the program manager of WCIL,
where he has been employed for three years. He has been involved in the
mental health community as a service provider for the past 14 years.
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