On the Job

Peer specialists support their peers, other individuals who identify as having personal experience living with a mental health or substance use condition, both individually and in small groups. Just as there are many different skills, tools, and resources that peer specialists share with the individuals they support, there are countless roles, activities, and responsibilities that a peer specialist may be assigned.

Peer specialists:

  • Help peers create individual service plans based on recovery goals and steps to achieve those goals
  • Use recovery-oriented tools to help their peers address challenges
  • Assist others to build their own self-directed wellness plans
  • Support peers in their decision making
  • Set up and sustain peer self-help and educational groups
  • Offer a sounding board and a shoulder to lean on…and more!

Peer specialists are found in many different settings throughout the country. These settings can include providing outreach to many unique individual experiences, including among people who are homeless, within transitional or long-term housing programs, acute and longer-term hospital settings, employment programs, Clubhouses, jails and prisons, diversion programs, outpatient treatment programs, recreation programs, Assertive Community Treatment teams, warm lines and hotlines, and even in Primary Care settings. These are just some of the many different settings in which a peer specialist can be found, and this list is expanding steadily as the workforce grows. Most frequently, peer specialists work as paid employees, although some choose to offer their services as volunteers.

Income

Wages can vary greatly, beginning with a local minimum hourly rate, to a salary with benefits, depending on where a person is employed and the experience they bring to the position. Recently, a national study was conducted of over 1,600 peer specialists about earnings.

Employment Opportunities

Many states, counties, agencies, and health centers post employment opportunities in newsletters and on websites. Searching online with the name of your city and state, along with specific titles such as “peer support” and “peer specialist,” can also provide listings of positions. Networking with other peer specialists, mental health professionals, and the program contacts where you participated in training can provide connections and open the lines of communication about job opportunities. The DBSA Peer Leadership Center also has a job board where organizations interested in hiring peer specialists post opportunities.

Supporting the Supporters

Self-care and prioritizing one’s own wellness and recovery plan cannot be stressed enough to peer specialists. Living in recovery is a requirement of this role, so actively choosing wellness is one of the most important parts of being a peer specialist. Peer specialists might find supports beyond their local community or agency by staying connected with individuals who attended peer specialist training with them, connecting with other peer specialists who are co-workers, attending continuing education classes, and/or participating in mental health and peer support conferences. Peer specialists are also encouraged to connect with other peer specialists through the DBSA Peer Leadership Center, where peer specialists can participate in discussion boards and send messages to one another.

Relapse

As peers know, relapse can be a part of recovery. It’s important that peer specialists have a wellness and recovery plan, and to stay in tune with personal changes and warning signs. Having a plan in place, whether a Wellness Recovery Action Plan (WRAP), DBSA’s Wellness Tracker, or another type of wellness tool or strategy, can provide guidance on positive steps to take if symptoms or signs occur. Wellness plans and supports may also assist in preventing a debilitating relapse and/or reducing the severity and length of a relapse. Peer specialists’ wellness plans can be tailored to include the possibility of relapse, as well as how to work with an employer if it occurs, including how to communicate the situation, adjust time schedules, and determine and use additional supports. And seeing a peer specialists experience a relapse and successfully manage it can provide consumers they work with the opportunity to see an example of how a wellness plan works.

Clinical Peers

The question of if an individual is trained as both a clinician and a peer specialist, and how might these roles integrate, is both wonderful and challenging! An individual with personal lived experiences can be an especially empathetic clinician with strong rapport and credibility with those that they work. “Professional boundary” issues for clinicians might limit the extent to which those with personal lived experience can relate their own recovery stories, or perhaps not be allowed to mention them at all. Some clinicians who identify as peers might reference their experience briefly, using phrases such as “I, too, am in recovery from….” or “There was a time in my life when….” Even without sharing details of one’s own recovery, a clinician who is also a peer will know from their own personal experience that recovery is possible and that therapeutic efforts should focus on ways to overcome any barriers to a person achieving self-selected goals.

When working as a peer specialist, an individual with clinical training can further understand some of the diagnosis and treatment issues and will help work in a partnership with clinicians while still supporting peers in achieving their goals. For individuals who have been trained as both a peer specialist and a clinician, it can be difficult to avoid slipping into a clinical role while in the peer specialist role. Separating the peer specialist and clinical roles can require extensive self-awareness, especially for someone who works or has worked in both roles at different times.

Triggers

No matter what type of wellness plan a peer specialist chooses, self-care is vital. Peer specialist wellness plans should include as many known triggers as possible, with additions if more become apparent. With each of those triggers, peer specialists can include how to respond and cope. Peer specialists may find it helpful to reconsider any known triggers and coping strategies specifically with their positions in mind. When triggered, some peer specialists find that calmly saying something such as, “That’s difficult for me. Can we take a break from that right now and I will give it further thought, and then we can come up with a plan about how to talk about it?” Another possibility might be, “This is a tough topic for me. I’d like to consult with my supervisor about how I can talk with you about this.”

Peer specialists actively focus on their own recovery and health, so communicating with one’s supervisor about triggers is very important. Supervisors and the peer specialist’s supporters can be very helpful in dealing with triggering situations. If a peer specialist finds that working with a specific peer is consistently triggering, it is best to consult their supervisor about making a change. Sometimes, a peer specialist might not be able to work with an individual who triggers them.

Recovery Disclosure

A peer specialist’s recovery story is their “street cred” and resume. It is important for peer specialists to remember that this work is not all about their specific stories and experiences, but rather the story must be used in relevant bits and pieces. Committing to working as a peer specialist means committing to a willingness to share one’s recovery story with colleagues and consumers, but only in relevant and succinct ways, and only with details with which the peer specialist is comfortable.

One thing for peer specialists to consider is whether they’re really telling their “recovery story,” or maybe are they actually telling their “illness story”?  An illness story describes the issues and difficulties an individual faces, and focuses mostly (or entirely) on problems. A recovery story briefly mentions such issues, but then most of the focus is instead on how the individual overcame barriers and challenges, and what skills and strengths were discovered that are now aiding the individual in achieving goals.

As a peer specialist, if your employer states that story sharing is not allowed, try acknowledging their reasons for feeling that way while also explaining the difference between the boundaries about self-disclosure for clinicians, compared with the essential role of recovery stories in providing hope, role modeling, and mentoring. This is a foundational piece of the work that peer specialists can do, so sharing examples of situations in which a recovery story might aid in supporting an individual can be helpful. Sharing when a recovery story might make an impact, and how a story might be shared, can help a peer specialist relate the importance of the story to their supervisor, while also reassuring them that the focus is on recovery, not the peer specialist as an individual.

Changes in Peer Relationships

If a peer specialist received treatment at the place where they are employed, there is the possibility that they may be assigned to work with peers who they received services with. This can be awkward, especially in the beginning, as it can be something of a loss for both the peer specialist and the peer, since the relationship has changed. It can be helpful for the peer specialist to explain what the role entails and share details of the training and certification process. It is important for the peer specialist to reassure the peer that this does not make anyone “better than” another, and that the lessons learned together as peers are part of what prepares peer specialists for this role.

As a peer specialist, it is very important to reflect on personal comfort and boundaries when it comes to receiving services and socializing. If the agency where you are employed is where you receive services, talk with your teams to establish boundaries, or to discuss the process of transitioning to new service providers. If you are friends with individuals who receive services at the place where you are a peer specialist, have conversations with your supervisor, team, and friend about the best practices both for ensuring everyone’s comfort and maintaining appropriate boundaries. Finding a balance between roles as peer and peer specialist can be a delicate process; communicating with all individuals involved is the best place to start.

Obstacles

A tough reality is that sometimes a peer specialist connects with a person who seems as if they are not at a place in their life where they are open to help. Sometimes people just want to be heard but don’t want to take any actions yet. It is important for peer specialists to try to maintain a positive, open relationship, because these individuals may well be ready for change in the future.

The peer specialist can re-examine what tools they are using in their work with the peer, consult with their own peer specialist network, and strategize with their supervisor.

For some peer specialists, reflecting on the relationship, and what tools and actions have been or not been helpful, may allow them to see that they are trying to set goals for the person rather than supporting them in setting their own goals. When other people set goals for a person, they may reject those goals, and it may end up looking as if the person does not want help.

Another possibility for a peer specialist to consider is that the individual might be able to connect with a different peer specialist in more productive ways. Building an open, trust-based relationship with a peer is the foundation for peer support, so it is crucial to make that connection first.

Rights Violations

Some states view peer specialists as mandatory reporters, meaning that peer specialists are obliged to report certain issues to the appropriate agencies and/or people in that state. Most agencies and mental health centers have reporting policies, so it is important for peer specialists to learn and understand those policies. Some states and systems have an ombudsperson or consumer rights office, and every state has a federally mandated Protection and Advocacy System and Client Assistance Program all of which are resources that a peer specialist might find helpful in relationship to consumers’ rights.

Boundaries

Self-care is vital to maintaining wellness and recovery, which will help ensure that a peer specialist is best able to perform at work.  Because of peer specialists’ natural empathy and personal lived experiences, there can be a high risk of burnout, which can then impact recovery. Accordingly, although it can be challenging, most agencies ask that employees limit their contact with consumers to work hours. The reasons for that vary but include liability issues, the potential for consumers to misinterpret the nature of their relationship with the peer specialists, and work-life balance.  It can be very difficult to put aside one’s thoughts, feelings, and concerns at the end of the day and may require the mutual support of other peer specialists.  It can be very helpful for peer specialists, and fair for both parties, to be very clear with consumers about when the peer specialist is going to be available to them as a support.  Making sure the peers that a peer specialist is working with have a list of emergency resources to contact outside of working hours can be helpful for everyone, and it can help begin this conversation.  Should a peer specialist be contacted outside of work, it is important for them to explain why they cannot talk with the peer at that time, to ensure the peer has emergency resource contact information if necessary, and to let the peer know when they will next be able to talk with them. If it is an emergency, a peer specialist might also contact emergency responders to report it.

Transitioning to the Team

Change can be challenging! Remember that peer specialists are relatively new additions to the network of supports in a time of transformation to mental health care. Supervisors and clinicians share peer specialists’ vision of supporting people to live rich, joyous, fulfilling lives, but they might not have had much exposure to the field of peer specialists, or know how best to support their new team members.

Sometimes it can be helpful for a peer specialist to review the materials from their peer specialist training with their supervisor. Peer specialists can also share specific examples of skills learned that will add to the productivity of the team, and even provide information about peer support as an evidence-based practice. The DBSA Peer Leadership Center has a number of resources for supervisors of peer specialists, and many organizations have educational resources for supervisors. Working together to identify situations in which a peer specialist could make a positive impact is a great opportunity for peers to demonstrate the effectiveness of this role.