Crisis Response: the Question of the Peer role in Emergency Community Mental Health

Crisis Response: the Question of the Peer role in Emergency Community Mental Health

I hear it all the time: ‘Why are arent peers going out on calls? The police are hurting people who are emotionally disturbed! When is this going to change?’

The ongoing spirited conversation about the peer role in emergency mental health and community response protocol is getting tired. When I say exhausted, I mean it is about time we reach a consensus that if we are to keep pace with our claims’ intensity and rigor, reform is urgently needed. In this advocate’s opinion, this highly contested subject seems to be the most significant issue in advocacy circles over the last few years. Wait, what? Do advocates argue? You mean we all don’t get along because we are feeling people? The answer is NO. We all don’t get along.

With the reinvigoration of the social justice issues plaguing our country, this issue will only get more attention. As our society reevaluates the intersections of disability, mental health, and social inequity, we can be sure the ‘spirited’ nature of this debate persists. I only hope all the enthusiasm is put to fair use. Let’s apply all this energy and taking a real pragmatic approach to reform. 

For the same reason we are advocates, we argue with each other. We are passionate people from all walks of life. We don’t always agree with the way things are in society and will question the status quo. 

For this conversation, I want to circle my puzzlement. I seem to be either getting confused or feel something is a bit skewed about how we advocates are approaching this subject. Specifically, why are we still at odds? Why haven’t we reached a consensus and passed the debate phase of how this talk will translate into the new policy. When are we going to reform the way crisis intervention in the community operates finally?

At its root, the peer workforce is not ready or competent to be emergency mental health responders in the community. 

I can hear it now from other advocates and peers supposedly ready to take on roles in crisis response teams: ‘Not ready?! What exactly do you mean?’ I mean in terms of preparedness—training, education, practice, and skill set.

I am making these claims because we measure these areas of readiness through competencies and a system for evaluating them. Like the Social Work Accreditation Boards, the ASWB: Association of Social Work Boards and other regulatory bodies credential and assess content areas’ rigor in disciplines of education and curriculum. A lot more is lacking, but let us start there for this conversation.

The Academy of Peer Services (APS) in New York State overseeing the peer curriculum and certifies Peer Specialists does not target educating peers on how to be crisis responders in the community. The curriculum does not focus on it. Generally, in this program, learning about a crisis is a theoretical and abstract, superficial, and academic understanding of what it means for someone to be in distress. Extremely problematic, right?

In terms of theory and practice, or praxis, the curriculum needs to bridge an academic understanding of what it means to be in crisis. Indeed, we can start with arming peers with real skills and interventions beyond Social Work 101. I am afraid learning Motivational interviewing, and basic de-escalation strategies is not a sufficient skillset to take on emergency response calls. We need to think about what practice means, given the current regulatory instruments already established for determining if these disciplines are ready and competent to perform the work. In my opinion, my recommendations would at least be a start, and a big one, towards advancing the curriculum towards peer workforce readiness in crisis intervention.

What would this look like, and how would we roll it out? The next steps would be requiring peer internships to have some crisis intervention component. We need to (as much as possible) prepare peers to go on crisis calls. Adapting the practice component to peer education through a revision in the internship would provide the peer workforce with credence. It would also extend the Peer Certification merits and make our trade more marketable to people and the community. All of this revision, and credence, takes time. I would hazard to say, and it takes years.

Before we make a big mistake and prematurely throw peers in precarious situations where there can be the potential loss of life, why not pause and reevaluate these aspects of the peer education and certification process? I see no reason to be hasty and potentially make a made a name for our emerging discipline.

I am not suggesting or hinting ‘peers’ or someone with lived experience is not suited to take on an emergency worker’s role. However, peer training, education, and how the community understands the discipline needs to shift and be better understood. Peers do not go on calls in many American cities. I believe, the absence of peers in crisis models is less about stigma and more about the misunderstanding of our role and what our lived experience might mean in relating and helping someone in crisis.

Optimally, being proficient enough to get in and get out of a situation safely without causing unnecessary harm is very different.  People are hiring for jobs in crisis response measure competence this way. Peer training and curriculum need to center around these areas, so the peer workforce is ready for crisis response.

J. Peters

J. Peters

Max Guttman '08, MSW '12, is the owner of Recovery Now, a private mental health practice. Through his work as a Licensed Clinical Social Worker, therapist and disability rights advocate, Max fights for those without a voice in various New York City care systems. He received a 2020 Bearcats of the Last Decade 10 Under 10 award from the Binghamton University Alumni Association. Guttman treats clients with anxiety and depression, but specializes in issues related to psychosis or schizoaffective spectrum disorders. He frequently writes on his lived experiences with schizophrenia. "I knew my illness was so complex that I’d need a professional understanding of its treatment to gain any real momentum in recovery," Guttman says. "After undergraduate school and the onset of my illness, I evaluated different graduate programs that could serve as a career and mechanism to guide and direct my self-care. After experiencing the helping hand of my social worker and therapist right after my 'break,' I chose social work education because of its robust skill set and foundation of knowledge I needed to heal and help others." "In a world of increasing tragedy, we should help people learn from our lived experiences. My experience brings humility, authenticity and candidness to my practice. People genuinely appreciate candidness when it comes to their health and recovery. Humility provides space for mistakes and appraisal of progress. I thank my lived experience for contributing to a more egalitarian therapeutic experience for my clients."
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