The frontier of peer support moves to our jails and courts

Over the past decade, peer support has become essential for mental health and substance use care throughout the United States. Research shows that its key features—support, mutuality, and knowledge—are as effective as professional interventions. Today, about three quarters of the states recognize peer support formally in their Medicaid Programs.

As peer support has evolved, exciting new horizons have come into view. Peer support now plays a major role in improving personal health literacy and in promoting personal health activation. Helping others understand their own triggers for illness and wellness empowers them and powerfully promotes their recovery.

The Affordable Care Act (ACA) has extended peer support to even more distant horizons. With its focus on whole health care and person centered care, the ACA rapidly is fostering a new generation of integrated care programs—health homes and medical homes. These integrated delivery settings call for integrated peer support for clients who do not have any behavioral health conditions, but who suffer from long-term physical illnesses, such as heart disease, diabetes, etc.

These wonderful developments in peer support--its content, setting, and clients--now make possible the extension of peer support into our criminal justice system.

Jails, prisons, and other correctional arrangements now house very large numbers of persons with mental health and substance use conditions. As a primary example, tonight our county jails will serve about 735 thousand persons. Of this number, about one-quarter will have a mental illness, and about one half will have a substance use condition, with considerable co-morbidity between these two groups.

Peer support can be undertaken in our county and city jails for persons with mental health and substance use conditions at several key points in the incarceration process. The first point of intervention would be to work with local police to divert a person from the jail to a behavioral health program; the second point would be to provide needed support once a person arrives at the jail; the third point would be as a person encounters the court system; the fourth point would be post sentencing; and the fifth point would be to provide needed support as a person re-enters the community.  

Peer support with jail detainees also will foster an exceptional opportunity to work directly with judges and with the courts. Here, work can be undertaken to educate judges, other court officers, and police personnel about the potency of peer support, as well as to do direct peer advocacy on behalf of people with behavioral health conditions who become incarcerated. We could even envision a “friend of the court” role for a peer.

The entire topic of peer support and advocacy in the criminal justice system is so large and complex that a national workgroup will be needed to consider how to parse the problem, identify early priorities, discuss potential problems, and set initial directions. Work should be undertaken as soon as feasible to examine certification and licensure requirements; variations in local regulations regarding contact with police and detainees; and current systems where this type of work already is underway.

Peer support in our jails and courts represents a vast new frontier for the peer community.  Because the involvement of persons with behavioral health conditions in our county and city jails is now at the forefront of our national dialogue (i.e., the National Association of Counties and the Council of State Governments have begun a national initiative to reduce the prevalence of mental illness and co-morbidity in county jails), the time is very appropriate to begin this much-needed work.