When young people step into a community mental health agency in Massachusetts, they may soon find a new kind of service. In addition to licensed adult therapists, they may find another young adult who has struggled with mental health issues — and is willing and available to talk about it.
Through this peer support program — known as STAY, Success for Transition Age Youth and Young Adults — two peer mentors now work in each of eight community mental health agencies and will eventually be located in all 32 in the state.
“They’re authentic. They can speak from real experience,” said Ann Capoccia, the Department of Mental Health coordinator for interagency activities and leader of the STAY grant program.
“They have tremendous ability to connect. And they use social media in a way that’s really important.”
For the public health department, it’s a way to get more young adults ages 16 to 21 into treatment before their condition reaches a crisis. For the advocacy organization Youth M.O.V.E. National, it’s an approach that empowers young people to shape the mental health services they receive.
And it provides a route to employment for peer mentors — young people whose own mental health struggle has made it harder for them to get a job.
Reluctance to get help
STAY is a project of the Massachusetts Department of Mental Health and the Children’s Behavioral Health Initiative, a state effort to strengthen services for children and youth. The two partners received a $4 million 4 ½-year grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) to put together the program. Their goal is to increase participation in community treatment among young adults who are Medicaid-eligible.
Young people — particularly ages 16 and 17 — make less use of mental health services than younger children and youth, according to the Children’s Behavioral Health Initiative.
“They want to go live their own lives,” Capoccia said. But those who are dealing with depression, substance abuse, bipolar disorder or other conditions really struggle to cope and to engage with other people, she said. They have a hard time attending to their mental health needs, such as seeing a therapist, taking medications, staying in touch with a psychiatrist.
They need to stay involved and connect with services, she said.
But they often wait until a crisis to seek treatment, according to the Children’s Behavioral Health Initiative.
Peer mentors can connect with teens and young adults, Capoccia said, and the mentors bring a different perspective about mental health: The mentors’ approach is that mental health problems do not define them as people.
“They are not the mental health issue,” Capoccia said. “They are people with lots of strengths, attributes and gifts. Mental health is something they struggle with.”
Mentors and mentees “can feel comfortable telling each other when they need support,” she said. And mentors “feel they can really help someone like they have been helped.”
“It’s important for those who have really lived the experience to be able to support other young adults,” she said.
The STAY program, now in its third year, is training as many as 40 peer mentors each year — young people who may have struggled with depression or bipolar disorder or have been hospitalized after suicide attempts. Many have post-traumatic stress syndrome, caused by traumas such as sexual abuse, violence at home, bullying or abandonment, Capoccia said. Many have struggled with substance abuse.
Some have been in the child welfare system or the juvenile justice system. The program is beginning to train mentors who are on the autism spectrum.
Peer mentors have actively worked toward their own recovery.
They receive training sponsored by the Massachusetts Department of Health one day per week for 12 weeks, in classes of 10 to 12 participants.
“It’s a pretty rigorous program that helps young adults develop a vision for themselves and look at their strengths and values and what they would like to do,” Capoccia said.
Each public health agency will hire two peer mentors, who will each work part-time and provide support for each other, as well as for the youth they mentor.
They will work alongside the professionals and get additional training from them.
Capoccia pointed out that the department has made a point of hiring diverse young adults to serve as mentors, including African-Americans, Latinos, Asian and LGBTQ young people, giving them the ability to work across cultures.
The mentoring work is a step forward for the mentors as much as it is for the mentees.
“A lot of our young people have a very hard time getting into the employment world,” she said. “They worry what might happen to them at work if they miss a day, if they’re late, if they have to take medication at certain times of the day or go to a therapist appointment.”
“This is a job they can do without being judged,” Capoccia said.
Mentors bring a different voice
It’s an approach that has been strongly advocated by the group Youth M.O.V.E. National, which has worked with the Massachusetts Department of Mental Health and agencies in other states. Youth M.O.V.E. (which stands for Motivating Others through Voices of Experience) is an advocate for the voices and rights of young people in the mental health system, as well as in the child welfare and the juvenile justice systems.
“We promote youth-guided and young-adult-driven care,” said Brie Masselli, director of technical assistance and evaluation for Youth M.O.V.E. National.
“Young people should have an active role in [determining] what the care looks like,” she said. “... They should have the opportunity to make decisions around the mental health care they receive.”
In Youth M.O.V.E's chapters in 39 states around the country, young people speak up about what works for them and what doesn’t in the mental health, child welfare and juvenile justice systems.
Peer mentoring has been used in helping adults with mental health and substance abuse issue, and “is urgently needed among youth in transition,” according to Youth M.O.V.E. National in its 2013 report “Youth Peer to Peer Support: A Review of the Literature.”
With the backing of SAMHSA, Youth M.O.V.E. National created the Commission on Youth Peer Support in 2013 to develop best practices for youth peer support.
Rooted in a movement
Peer mentoring comes out of the recovery movement, which had its roots in Alcoholics Anonymous, according to the report.
Other self-help programs grew on the AA model, including Schizophrenics Anonymous. Then, in the 1960s, amid burgeoning civil rights movements, protests took place against conditions in mental hospitals. Mental health advocacy groups developed to press for a new approach to people with mental illness, the report said. The movement viewed mental health services as having a rigid medical model that treats clients like they are the disease; whereas the recovery movement treats clients like they are people first, asserts M.O.V.E.’s lit review.
Massachusetts is not the only place peer mentoring is being used.
Youth M.O.V.E.’s Masselli has provided information and assistance to other state mental health departments.
“We’re forging a new approach that young adults need,” she said.
For more information — peer support in mental health
- International Association of Peer Supporters is a nonprofit that focuses on providing peer support worldwide. Mostly geared to adult peer support, but informative.
- Youth M.O.V.E. provides information and webinars about peer-to-peer support.
- National Alliance on Mental Illness offers NAMI Peer-to-Peer, a free 10-session educational course that is sometimes offered specifically to young adults. It is mostly designed to promote support within a group.
- “What are Peer Recovery Support Services?” This 2009 publication by the Substance Abuse and Mental Health Services Administration describes peer mentoring as well as other support services.
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