Thoughts on the future of peer-run services: Part 1

I loved Ron Manderscheid's recent article (Nov/Dec 2013 issue) describing the roles peers could play in integrated care as a result of the Affordable Care Act (ACA). The vision Ron offers gives the rest of us a glimpse of how things could be if we take courage and behave ourselves.

When I read and reread this piece, I get happy, but then realized all the things that could get in the way of that future. As I begin to move forward, stepping on the invisible stepping stones that mark the way, I find myself sinking into muddy water, a swamp of doubt and despair as I realize  how broad the gap is between where we are today and where Ron envisions us in the future.

When I start sinking, I know that it's time to ask for help. What follows here is the help I received from friends and other peers, many of whom have "lived experience" and are in in recovery from a mental illness or addiction.  They're people who've struggled with the same vision and slipped on the same stepping stones that I have.

You will see a tapestry woven with cords of hope, fear, and rage, with occasional threads of glittering optimism. Fear and rage are the residue of past, hard-won battles needed just to sustain core beliefs and programs. Hope and optimism are the things that keep us going - believing that we can someday achieve what people like Ron have envisioned.

Steve Miccio

Let’s open this discussion with some thoughts from Steve Miccio. Steve is Chief Executive Office at PEOPLe, Inc., located in the Mid-Hudson region of New York State. PEOPLe has developed an array of peer-run diversion services and crisis-respite houses in New York. It also consults nationally and internationally, helping to develop additional peer diversion services.

Steve agrees that this is a timely discussion. To him, the ACA is offers both opportunity and danger to peer-run services. He sees the value of spreading what we’ve learned about recovery to all others struggling with chronic illnesses. His conclusion is that this opportunity is a slippery slope, but one where the seeds of evolution could be planted. “Like other civil-rights or grassroots movements, evolution is inevitable if the movement is successful. Many of us have gotten better at providing advocacy and mutually supportive services. As we have improved, our outcomes have improved. We’ve moved into a respectable position, but if we are to hold our ground, we need to continually improve infrastructures and policies to support value-based service delivery that embraces the mutuality we have had from the beginning.”

Steve is less reluctant than others to consider integrating peer services with traditional community providers, but only under certain conditions. He doesn’t want peer-run services to be absorbed by traditional services. He believes they should be separate and complementary: “While it is a good practice for traditional services to hire peers, there is much more that an independent peer service can do to improve outcomes. The independent peer service shares a very personal and special mutuality that a clinic, a hospital or a larger traditional provider may not be able to practice.”

Steve gives considerable thought to what just what peer-run services can deliver that traditional services often cannot: "Our focus and practice comes from a special place called shared mutual experiences that contribute to a more trusting and honest exchange of wellness strategies.”

In the next piece, we'll hear from Rob Walker, who works with government agencies and peer-run programs on the East Coast, and Deborah Delman, the Executive Director of The Transformation Center.