Anton Sluder never thought he’d be excited about his future. “Who was going to help someone like me?” he says. With a felony record and a history of substance use, he had little hope. But when Sluder left prison in September 2021, he was assigned a peer support specialist through Investments Supporting Partnerships in Recovery Ecosystems, INspire, a program that assists people facing certain barriers to employment. “And look at me now,” he says.
Sluder is employed with a temp agency, acquired a driver’s license for the first time in years, has stable housing and continues in his recovery. He’s also a recent graduate of a peer support specialist training class; he can apply for a job in the field earning up to $20 an hour in Asheville and share the tools he’s learned.
According to the Depression and Bipolar Support Alliance, a nonprofit that has trained peer supports since 2004, “a peer support specialist is a professional with lived mental health experience who is trained and certified to provide help and encouragement for others working their way toward wellness.” Personal experience might cover depression, addiction, post-traumatic stress disorder, domestic violence or other issues.
Peer support specialists serve as frontline mental health workers for those dealing with substance abuse and homelessness; they work in hospitals, treatment centers, social service agencies and veterans’ organizations. Municipalities, first responder agencies and schools contract with PSS services.
The relationship between a PSS and his or her peers is one of support and gentle guidance; peer supports serve as coaches, mentors, advocates and role models. The relationship typically lasts about six-12 months, says INspire coordinator Philip Cooper.
Finding common ground
Lauren Garvie is a former IV drug user who has experienced incarceration and being unhoused. Peer support “is a career path that gives a lot of us a chance when we don’t have many options,” says Garvie. After two years in a long-term recovery house, Garvie earned peer support certification in 2018 and works full time for Sunrise Community for Recovery and Wellness, a nonprofit run by PSS.
To be eligible for peer support certification, an individual must have a high school diploma or GED diploma and have lived through and currently manage their own challenges. During training, candidates learn how to find local resources, build community relationships and help peers with things such as obtaining a driver’s license, applying for assistance like food stamps, enrolling in training programs, finding housing and joining support groups.
Peer support grew as a field during the mid-2000s. DeDe Severino, section chief for addictions and operations team for N.C. Department of Health and Human Services, says the department began certifications here in 2007. All PSS trainers in North Carolina must hold the PSS certification themselves, she adds, because the theory that it takes one to know one is true for teaching PSS skills, too. According to N.C. Certified Peer Support Specialist Program data, Buncombe County has 242 certified PSS as of September.
Peer support distinguishes itself from other mental health services in that it can only be performed by someone who has lived through a mental health crisis. “The greatest gift we have is lived experience and the ability to listen,” says Michael Hayes, a PSS and founder and executive director of the Umoja Health, Wellness, and Justice Collective, which supports a range of mental health services in the Black and Latinx communities. His programs are “culturally specific, trauma-informed and resiliency-focused,” which are also important for PSS relatability, he says.
Bryan Creech is one of four PSS trainers for Vaya Health, a managed care organization that oversees Medicaid for mental health claims in North Carolina. “My life was touched by mental illness and took me out of the workforce for about five years,” Creech says. He was assigned a PSS and then became one himself in 2012. He adds that Vaya’s 40-hour, one-week peer support training is one of the most affordable at $30. It covers the cost of the training book and also explains the class’s long waiting list.
Other peer support training courses, which must include 40 hours of instructions to be state-approved, can cost up to $375. The list of upcoming courses, many of which are held on weekends, is available here.
Peer support services are funded by Medicaid, insurance for eligible low-income populations. Peer support may be provided as a one-on-one service or in a group setting. It’s a covered benefit when deemed medically necessary for Medicaid recipients with a mental health or substance abuse diagnosis.
Joe Yurchak is program director of certified community behavioral health clinics at Mountain Area Health Education Center, a WNC health care provider, which received a $4 million grant in 2020 from the Substance Abuse Mental Health Services Administration. Some of the funding will be used to pay MAHEC’s seven full-time peer supports. (He says individuals who are not covered by Medicaid are also eligible for PSS services through the grant.)
INspire, the program Sluder attended, began in 2021 through NCWorks, the state’s workforce development system and the Mountain Area Workforce Development Board. Its WNC Recovery to Career program is funded through a $1 million grant paid for by Appalachian Regional Commission, an economic development agency, Vaya Health and Dogwood Health Trust.
“With the grant, we pay our staff PSS and also pay peers we work with to go through the 40-hour PSS training,” says Cooper. “Then we have contracts to place them in good-paying jobs, such as MAHEC, RHA [Health Services, a mental health clinic], Buncombe County and Sunrise.” Sunrise and Umoja also rely on grants and donations to pay salaries, travel expenses and support services.
A future goal, says Severino, is to have peer support provided as a benefit in all mental health coverage: “I would love to see private insurance cover it.”
Supporting the peer supports
While PSS must renew their certification every two years after participating in 20 continuing education hours, Severino says accountability is one of the areas that the growing PSS field needs to work on, in addition to funding and ongoing educational opportunities. “There really is no oversight at this time,” says Severino, referring to the continued successful recovery of each PSS and the effectiveness of their work.
But Kevin Mahoney, a PSS who supervises the peer support program at MAHEC, disputes there is oversight of the peers. PSS are asked to self-report slip-ups with drug or alcohol use, or a mental health issue, and colleagues regularly check in with each other. Mahoney adds that if individual struggle with maintaining recovery, their employers may allow a leave of absence to get back on track.
Cooper stresses that accountability is a priority for his PSS. “It’s mandatory they practice a strong recovery program to be able to help others and deal with the stress,” he says. “We’re not a regular workforce. We can’t model ourselves after other kinds of jobs, so we need to be able to hold each other accountable. What qualifies us as PSS professionals is our lived experience, which means we’re also vulnerable to using again if we don’t practice a program of recovery.”
In addition to regular 12-step meeting attendance, Jenna Woodman, an INspire PSS, says she hikes and attends regular church services. “Self-care is vital in this job,” she says.
Mahoney says he’s partnered with Sunrise to offer a PSS support group every two weeks. Garvie, one of 37 full-time PSS at Sunrise, says the support from her colleagues, volunteering at a women’s correctional facility and regular meeting attendance keep her grateful and balanced in her recovery.