Beyond the Medical Model with Neesa

Beyond the Medical Model with Neesa
A Column by Neesa Sunar, Peer Specialist, Transitional Services for New York, Inc.
Changing the Language That is Used to Describe Us

Many of us who find ourselves in the mental health system have shared experiences as to how we got there. To speak on my own experiences, I first displayed “maladaptive,” saddening symptoms as a teen, which then led to my first hospitalization at around my fourteenth birthday. I was diagnosed with clinical depression and medicated with Zoloft. Upon returning to school, I labeled myself as “depressed,” which elicited within me a negative worldview amongst my classmates. My experiences with mental illness seemed alien to them, so my label further served to summarize my failures in forging meaningful friendships.

My condition turned for the worse when I developed schizoaffective disorder in my early twenties. Again, this diagnosis became a box I fell into, deeming me a “schizophrenic.” Adopting this label as a self-descriptor caused me to feel broken in mind and character. And even as I remained compliant with medications and psychiatric appointments, I continued relapsing, causing me to believe that my schizophrenia would haunt me for the rest of my life. Thus, the label seemed inescapable, thus sadly accurate.

My inability to work caused me to file for disability, which was an incredibly freeing experience. I began openly disclosing my illness to anyone who would serve as an audience, and even felt proud that my struggles had a name, instead of being some amorphous spiritual curse. At the same time, the label of “schizophrenic” still caused people to distance themselves from me. Perhaps my label served as a threat, indicating that I had lying dormant within me a sense of criminality.

When discovering the peer movement in 2014, beginning as a student at Howie the Harp Advocacy Center, I learned that I had been entrenched in the Medical Model for my entire mental illness “career.” I realized that I had completely internalized and unconditionally accepted the top-down dynamics of the therapeutic relationship between practitioner and consumer. I absorbed that my mental illness diagnosis served as a label that indicated who I was and the future trajectory for the remainder of my life. And that all this was an injustice.

I became appalled that I had never even heard of the Recovery Model as a counter to the Medical Model. Even in this massive city of New York, brimming with resources, I had never encountered peer specialists or Recovery Model enthusiasts. How could this be? Many of the peers I have since met proudly disown their diagnoses as descriptors, instead using more affirming language such as, “I am a person with schizophrenia,” or “I have past lived experience.” The peer community is a group of vibrant people with dynamic personalities, free from such labels. Bearing this perspective, we flourish and grow in our own recovery journeys as we influence and support one another.

Many of us peers are compelled to take action as mental health advocates in our communities. When we fight for widespread awareness of peers and the Recovery Model, we hope to challenge people in reevaluating their perspectives of those with mental illness. Part of our advocacy efforts should also include the request for creating alternative language that is person-centered, trauma-informed and affirming. A person “suffers from” or “experiences” mental illness and is not the illness itself. And what defines mental illness anyway? Descriptive words such as “crazy,” “insane” or “dysfunctional” also serve to obscure the personhood of one suffering. When insensitive language is used, a person can internalize this and develop a sense of shame and fear. This can prevent a person from reaching out to friends, family, and/or professionals. In the worst of situations, such silence can end in immense and irreversible tragedy.

As we advocate for change in language, we must also recognize that each individual has their preference for how they should be regarded. Some people prefer to be called “disabled,” while others eschew the term. Other terms can be preferred as well, such as “mentally ill,” “other-abled,” “neurodiverse,” “chronically ill,” “in remission,” or simply “a human being.” In the same way that the transgender community has fought for preferred pronouns, so too should we demand that mainstream society develops interest in engaging the mental health community with respectful language.

We each have our individual journeys towards recovery, as we leave behind our pasts to walk towards a bright future. The hope and vision that guides us in this process can be the foundation on which we stand, as we fearlessly share our stories of recovery. Part of our stories can include how we have reclaimed our lives by adopting affirming language. If we are able to incite curiosity in our audiences, we may enjoy immense success in this endeavor.

Beyond the Medical Model with Neesa

A Column by Neesa Sunar, Peer Specialist, Transitional Services for New York, Inc.

Advocating for Clients Can Require a Team Effort by Peer Workers
Many of us peers in New York City are incredibly passionate about what we do. We work at agencies where our consumers desperately need our services, giving voice to their concerns in the face of other less- or non-sympathetic psychiatric professionals. We act as a go-between, giving credibility and weight to our consumers’ needs and requests. We give their voices legitimacy, and we stand strong in the face of dissent.

Our sentiment for individual advocacy can take a natural turn towards systems advocacy as well. We as peers desire change in mainstream society regarding its awareness of mental illness. Understandably, opinions on how to achieve this differ from person to person. Some of us are of an anti-psychiatry and/or anti-medication sentiment, advocating for steps towards disavowing the traditional Medical Model altogether. Others among us take a pro-choice stance, where we figure that each person can self-determine their treatment plan and goals for wellness. Still others strive to strike a balance between the Medical Model and the Recovery Model, valuing the opinions of non-peer psychiatric professionals. There is of course overlap, and many of us embrace more than one perspective to varying degrees.

As advocates, we peers can come up against people who do not understand the scope of professional services that we provide. As we work with clients, remaining true to peer principles, our supervisors and coworkers may judge our techniques as something unprofessional. Even though principles such as mutuality and person-centered treatment are evidence-based practices, professionally corroborated by modalities such as Intentional Peer Support, we are still questioned. This resistance we run into only fuels our fire, compelling us to courageously continue staying true to our cause.

It still stands that many employers do not fully understand the roles of peers. Given that peer services are only now being integrated into service delivery programs in New York City, agencies are finding themselves hiring peers for the first time. Since peers are new, job descriptions and responsibilities are uncertain, and employers do not have the expertise or resources to provide sufficient supervision for peer staff development. It may not occur to supervisors that peers serve as agents of change, who purposely go against the grain of office culture to support consumers. On the contrary, supervisors may require peers to conform to the existing culture of the office.

This expectation can prove incredibly detrimental to peers, forcing them to compromise the integrity of their work in order to keep their jobs. Peers may be forced to use their mutuality to forge a trusting relationship with a consumer, and then use that trust to make the person comply with a top-down, Medical Model treatment plan. Or, if a peer communicates a consumer’s message to staff, that peer can be shut down and told that the person is not lucid, and therefore cannot determine goals for themself. At the very worst, a peer may find that the rest of the office does not have faith in a consumer’s capacity for recovery.

It is beneficial when a peer works with an employer that has hired multiple peer staff. Peers can support one another, and can band together to impart suggestions to employers on how their agencies can adopt a more recovery-oriented perspective. When peers work together, they can also assist one another in making sure that everyone remains true to the values and mission of the peer cause. Compare this to the peer who finds themself as the only peer at their office. It can be difficult for an isolated peer to remain motivated, especially in situations where a peer’s legitimate comment is the only voice against the unanimous voices of the rest of the office.        

Peers can find camaraderie by venturing outside of the workplace and into the community, and New York City has current initiatives that can aid in this process. There are committees with the New York City Department of Health and Mental Hygiene, including the Office of Consumer Affair’s Consumer Advisory Board (CAB), a committee comprised of peers that reviews and offers feedback on upcoming city mental health initiatives. The DOHMH also has the Regional Planning Consortium (RPC)’s peer steering group, which also allows for peers to join and offer critique on upcoming initiatives. The CAB accepts board members by application, while the RPC has an open invitation for those interested to join at any time, provided that they are a Medicaid recipient of mental health and/or substance use services.

There is also the Peer Workforce Consortium, a committee of peers who are currently making strides towards creating a professional organization that represents the priorities and welfare of peer specialists, both working and aspiring. The Leadership Committee of this group meets monthly, and large “summits” commence quarterly. Topics covered in summits will include educational seminars, presentations and opportunities for networking.
There are also annual conferences that peers regularly attend. Within New York State, there is the NYC Peer Specialist Conference typically held in mid-July at the Kimmel Center in Manhattan, and also the NYAPRS state-wide conference, typically held in mid-September in Kerhonkson, NY. The former is free to attend, while the latter requires a registration fee in conjunction with hotel and travel, depending on where one lives. 

We must recognize that the values of peers are worth fighting for. One way for us to express the effectiveness of the Recovery Model is to live it ourselves. By reaching and striving towards recovery in our own lives, we can peacefully inspire the people around us, creating within them a sense of curiosity that compels them to wonder…how did they do it? How did they achieve the impossible?

But more importantly, living a life of recovery aids in inspiring the people we work with. We create a spark within people who have been beaten down and discarded, giving them a chance to ignite it. With such chance comes the opportunity for blossom and growth, enabling a person to move not only forward but upward.

The NYC Peer and Community Health Workforce Consortium

By Lori Tannenbaum, PhD, Director, Peer Workforce Consortium
Seeking to Support the Expansion of Peers in Programs Across NYC

The idea for the Peer and Community Health Workforce Consortium began May 2016 at the Mental Health Workforce Summit in New York City. A group of community health and peer workers, researchers, trainers, and representatives from managed care and the Department of Health and Mental Hygiene met for the day and came up with a new initiative to improve mental health services in New York City by expanding the use of peers and community health workers to connect New Yorkers to services and promote recovery.

The Peer and Community Health Workforce Consortium is part of Thrive NYC, the $850 million plan to make sure New Yorkers get the mental health assistance they need. The Consortium will develop pipelines and career ladders for peer support and community health workers, including peer specialists, family- youth- and recovery-peer advocates. These workers provide support outside of a typical service hierarchy. We believe the Peer Workforce Consortium will impact service users and providers, as well as peers and community health workers because: 

The model works
Studies show that individuals with mental health problems benefit from having a team including peer support workers. People who use peer support better manage treatment, substance use and family problems in the community, and have fewer hospitalizations. Peers and community health workers can also help navigate health care systems, develop natural supports and lead a healthier lifestyle. 

The time is right
Changes to health care provision have come to New York City. People need more information and assistance to take advantage of the opportunities for individualized care that are now available. The Health and Recovery Plan (HARP) is a new type of insurance plan for some individuals with Medicaid who have a serious mental illness. If a person is in a HARP insurance plan, they may be able to receive Home and Community Based Services (HCBS) such as individualized vocational, educational or rehabilitation services. Medicaid redesign also aims to improve outcomes at reduced costs and with improved satisfaction with care. Through these initiatives, certified peers in mental health and substance abuse services can now provide Medicaid-funded services.

The field of peer services is growing in New York City. Many organizations are hiring peers to work in programs such as Assertive Community Treatment (ACT Teams) and Crisis Respite Centers which aim to reduce the need for inpatient hospital stays. There are more than 600 certified mental health peer specialists in New York City, and that number is growing. The On-Track programs use peers to help people with a new mental health diagnosis to get back “on-track” with tasks like work and education. Peers also staff warm-lines and crisis hotlines for people to get the support and referrals they need. 

It is sustainable
Peers and community health workers can be found in almost any kind of inpatient or outpatient program, whether it’s for family and youth, substance abuse or mental health. As someone from a service user’s neighborhood, community health workers are uniquely positioned to understand a person’s needs and concerns, while having knowledge to navigate a variety of services. 
The Consortium will share resources to enhance peer services for all New York City residents. They will meet with groups throughout the city to learn about the role of peers and community health workers, certification, workforce development issues and the integration of health, mental health, and substance abuse services. 

How you can get involved?
1) Use peer services.
If you use mental health, substance use, youth or family services and don’t yet work with a peer, please consider talking with a peer or other staff member to explore how working with a peer may benefit you. If there are no peer staff where you receive services, consider suggesting that program leadership add peer services to help create a stronger recovery focus and better health outcomes.
2) Train to become a peer
There is currently free training available through Thrive NYC for mental health peer specialists, recovery peer advocates and family peer advocates. 
More information about training to prepare to become a Certified Mental Health Peer Specialist can be accessed through Thrive at Work at: 
http://www.communityaccess.org/our-work/educationajobreadiness/thriveatwork

Learn about upcoming training dates for Certified Recovery Peer Advocacy training by emailing Lila Boyer at lboyer@health.nyc.gov or calling her at 347-396-4992.

The Parent Empowerment Program (PEP) helps to prepare for Family Peer Advocate work and can be accessed for free in October through www.ftnys.org or by calling Nancy Craig at Families Together NYS at 716-432-6238. The next PEP will be held 10/30/17-11/3/17 at the FRC Eastern Queens at St John’s Hospital, 148-45 Hillside Ave, Jamaica NY. Updated information and Registration can be obtained at http://www.ftnys.org/upcoming-pep-trainings/.

3) Peers and Community Health Workers--Please take our survey!
If you are currently working as a peer in health, mental health, substance use, youth or family services please take our survey by copying and pasting the following address into your Internet browser: https://www.surveymonkey.com/r/PCHWSurvey17
This survey will help identify where peer and community health resources can be found, and will help determine current wages, working conditions and satisfaction in these areas. Results are confidential and there is a small incentive to participate. 
4) Contact us
If you have anything you would like to add to the conversation around developing the peer workforce, please contact Consortium Director Lori Tannenbaum at ltannenbaum@health.nyc.gov or by calling 347-396-4995.

Beyond the Medical Model with Neesa

Beyond the Medical Model with Neesa

A Column by Neesa Sunar, Peer Specialist, Transitional Services for New York, Inc.

The Vital Profession of the Peer Specialist

For the past couple of years, I have been employed as a “peer specialist.” A peer specialist is a mental health professional who has personal lived experience with mental illness. Because peers have suffered themselves, they are able to understand and empathize with the people they work with. This type of experience cannot be learned in university. Thus, peers have expertise that doctors and social workers do not.

I learned about the peer profession when I was in a psychiatric day program in 2012. Once I heard about it, I wanted to work as a peer myself. I applied to the peer specialist training program at Howie the Harp Advocacy Center (HTH) and was accepted. I attended classes at HTH five days a week for twenty weeks, totaling to 500 classroom hours. A 12-week internship followed.

Howie the Harp Advocacy Center is named after one of the first pioneers of the peer movement. Howard Geld was psychiatrically hospitalized as a teenager in the late 60s. At seventeen, he left New York and relocated to the west coast, where he became involved in the Insane Liberation Front. During his life, he was involved in mental health advocacy efforts on the east and west coasts. He earned his moniker of “Howie the Harp” because he was a street performer on the harmonica. In 1993, he became the Director of Advocacy for Community Access. He garnered funds to start a peer specialist training center, slated to open in 1995. Unfortunately, he passed away two weeks before the school opened. The school was named after him in his honor.

While at Howie, I learned about the Recovery Model, which is in stark contrast to the Medical Model. Typically, when one is physically ill, s/he will go to the doctor. The doctor prescribes a medication, and treatment is determined successful when the person’s symptoms are eradicated. Yet with mental health, absence of symptoms is not enough. Side effects can make the “cure” as bad as the mental illness.

The Recovery Model goes beyond this. Everyone is entitled to living a fulfilling life. People should be encouraged and supported to reach for complete wellness, no matter how “severe” their condition may seem. They do not have to submit to the limited expectations that standard providers have. In the past, I held jobs where I hid my diagnosis, only causing additional stress. Now as a peer, I can use my experiences as a strength which can help others. No longer do I feel “broken” and a “danger to society.” Instead, I have developed a sense of empowered pride. I have risen from the ashes of profound disability.

About two years ago, I began working full-time at Transitional Services for New York, Inc. We offer apartments in the community, as well as active case management services. Whenever I meet a new client, I immediately disclose myself.

“Hi, I’m Neesa! I am a peer specialist. Do you know what a peer is?”

Oftentimes, the client does not know. Thus I explain:

“A peer is a person who has mental illness themselves. I myself am diagnosed with schizoaffective disorder. I’ve been hospitalized seven times. I have been on disability since 2011. I know how this system can wear you down, trying to juggle public assistance and Medicaid and psychiatrists…I’ve lived it. I’m here so that I can relate to you. I know where you’re coming from.”

At this point, I always feel like this invisible wall melts between me and the client. My hope is always to strike a chord within the person, wherein s/he can feel safe and open. The greatest fulfillment I experience as a peer is developing that one-on-one relationship with the client. In this therapeutic partnership, I encourage them to determine their own path towards wellness instead of dictating to them how “I think how it should go.”

The peer movement specifically strives to create awareness about mental illness akin to a civil rights movement. So often, psychiatric clients are stripped of their rights, whether it be in institutions or with an outpatient psychiatrist. People are forced into treatments they don’t want for themselves, intimidated by doctors. And then there is also stigma, that pervasive societal attitude that discriminates against those who have a diagnosis.

My hope is that there soon will be widespread awareness about peer specialists. We are able to reach clients in ways that doctors and therapists cannot. We are able to stand as examples of recovery, and we inspire one another to reach higher and further than the negative prognoses from our providers. The work of peers is the future, and we must create awareness to make this happen.

Forward to Peer Specialist Section by Director of Consumer Affairs

Forward to Peer Specialist Section
By Carlton Whitmore, Director, Office of Consumer Affairs, NYC Dept. Health & Mental Hygiene

Never before in the history of the peer movement has there been a time when Peer Specialists were valued as much as they are today. Peer Specialists are now recognized as an integral piece of systemic transformation and considered a “best practice” for the communities we serve. Peer support services have proven effectiveness in many different research studies. Reduction in hospitalization and increased recovery for individuals working with peer support specialists has been documented.

The Affordable Care Act will help to create many new opportunities for the peer workforce to help individuals receive the services and supports they need to achieve and sustain long-term recovery.

Some of the most important steps in supporting the peer workforce are credentialing for peers and training for supervisors. Training for supervisors and others is needed to increase the understanding of the unique role of peers. In addition, peer credentialing is probably the single most important step in growing and supporting a qualified peer workforce. Without credentialing it will be difficult for the peer workforce to expand in reach and scope.

The NYC Peer Workforce will continue to grow and create more opportunities for all communities to have access to and benefit from peer support services.

Everything You Need to Know About the 10th Annual NYC Conference for Working Peer Specialists

Everything You Need to Know About the 10th Annual NYC Conference for Working Peer Specialists
By Gita Enders, MA, CPRP, NYC Health + Hospitals and Jonathan P. Edwards, LMSW, ACSW, M.Phil., NYC Dept. of Health & Mental Hygiene

Hearts and Minds Fulfilled Like Never Before

The 10th Annual NYC Conference for Working Peer Specialists, aptly branded “Then, Now, WOW!” was held on July 14, 2016, at New York University’s Kimmel Center. Nearly 300 individuals who identify themselves by a host of titles that contain the word peer attended this event, bringing greater visibility to NYC’s peer specialist workforce. 

Every successful event begins at the door! We would like to acknowledge Deborah Short, Pat Feinberg, Rachel Salomon, and Margie Staker for their graciousness and efficiency in greeting and registering participants, presenters, invited guests, and exhibitors.

An enthusiastic group of Howie-the-Harp trainee volunteers under the direction of Lynnae Brown provided a solid foundation for the conference, assisting with everything from early registration to prepping the resource room and providing invaluable assistance throughout the day’s program. As people gathered near the breakfast tables they were provided with conference programs, lunch and raffle tickets, as well as a commemorative “Conference Players” keepsake booklet, created by Jonathan Edwards, containing photographs and biographies celebrating ten years of speakers and attendees. The booklet also acknowledged the efforts of the conference planning committee: Teena Brooks, Celia Brown, Lynnae Brown, Jonathan Edwards, Gita Enders, Sara Goodman, Larry Hochwald, Yumiko Ikuta, Desiree Moore, Digna Quinones, Deborah Short, Ellen Stoller, Carlton Whitmore, and Moneer Zarou. Moneer, who supplied a video performance for the opening program, also received an award in recognition of his tremendous support and creative contributions to the committee and to the conference.

The conference opened with the Lavender Light Choir singing “Seasons of Love,” from the musical “Rent,” which asks what is the proper way to measure the value of “a year in a life.” We chose it to open our 10th anniversary conference as a way to honor the passage of time, what we have achieved as a group, and what all peers have achieved in their lives. The chorus says that the most effective way is to measure in love. When Lavender Light was formed in 1985, it was the only lesbian and gay gospel choir in the world; they strive to offer strength, peace, and hope to their members and to their audiences, similar to messages of hope shared by peer specialists.

Following welcoming remarks by Celia Brown, Regional Advocacy Specialist, New York City Field Office of the NYS Office of Mental Health (OMH), Carlton Whitmore, Director, Office of Consumer Affairs, New York City Department of Health and Mental Hygiene (DOHMH), OMH Commissioner Ann Marie T. Sullivan, M.D., Myla Harrison, ?Assistant Commissioner, Bureau of Mental Health, DOHMH and Lynn Videka, Ph.D., Dean of the NYU Silver School of Social Work, a lively panel discussion, moderated by Peter Ashenden, Director of Consumer and Family Affairs for Optum Behavioral Solutions, set the tone for a hugely successful event. Panelists Celia Brown, Laverne Miller, Leslie Nelson, and Dr. Peter Stastny shared their histories as agents of change and talked about their visions for the future of peer specialists and peer services.

Each year the resource room, overseen by Yumiko Ikuta, attracts more and more attendees as our dedicated exhibitors provide useful information on job opportunities, educational, vocational, advocacy and health care options. In addition, wellness activities such as chair massage and Reiki were provided throughout the entire day. The resource room has grown in popularity from a “clearinghouse” for information to a lively meeting place where people reunite, network, and gather resources. This year was particularly exciting with the new addition of several managed care and behavioral health organizations including Beacon Health Options, Optum and Empire Blue Cross Blue Shield.

We acknowledge and extend our gratitude to our community partners and stakeholders: Academy of Peer Services; Alcoholism and Substance Abuse Providers of New York State (ASAP); Baltic Street AEH, Inc.; Beacon Health Options; City Voices; Coalition of Behavioral Health Agencies Center for Rehabilitation and Recovery; Community Access, Inc.; Howie the Harp Advocacy Center; Empire Blue Cross Blue Shield; Health Plus; Hearing Voices NYC; Jewish Board of Family and Children’s Services; Mental Health Empowerment Project; Mental Health Association of Westchester; NYC Department of Health and Mental Hygiene, Office of Consumer Affairs; NYS Peer Specialist Certification Board; NYS Office of Mental Health, NYC Field Office Office of Consumer Affairs; and UnitedHealthcare Community Plan. 

Workshops and Activities
Our morning lineup addressed such topics as Medicaid Managed Care, Health Homes, supervision, and career development, while also exploring current issues involving suicide, trauma-informed care and advocacy, as well as the role of peers. The morning saw participants hard at work as they experienced interactive breakout sessions and activities. As a testament to the conference as a whole, the afternoon workshops did not wane in comparison to earlier workshops and activities that set the stage for the day. Knowledge, inspiration, tools, skills, and creative expressions were as abundant as they had been in the morning workshops.

A selection of hearty box lunches was followed by a comedy program directed by David Granirer of “Stand Up For Mental Health,” which teaches stand-up comedy to people with mental illness as a way of building self-esteem and fighting public stigma. More about David and his exciting programs can be found at http://standupformentalhealth.com. Comedians included Angela Cerio, Jonathan Edwards, Gita Enders, Sara Goodman, Jeff McQueen, Digna Quinones, Laurie Vite, and Dennis Whetsel.

Raffles were held throughout the day, offering terrific prizes such as books donated by Darby Penney and Mary Ellen Copeland, and other products and tools, including candles and incense, promoting wellness and job readiness, and a lucky few were the winners of Galaxy tablets and a fitbit device designed to keep track of fitness goals such as walking and heart-rate.

The day, much too soon, culminated in a reception that boasted colorful vegetable platters, bowls of creamy hummus, sinfully delicious chocolate brownie squares, and an assortment of chilled beverages. In these final moments, participants, still energized by who they saw, what they contributed, and what they learned, moved swiftly through the narrow reception space, completing evaluations, exchanging contact information, snapping final pictures, and languishing in the feeling of accomplishment. Yes, this was our 10th year of working and growing together, building the peer specialist profession, and creating many ways to share a message of hope. Above the Washington Square arch the sun faded from bright yellow to amber. We were transformed. Hearts and minds fulfilled like never before, yet already looking forward to our next conference on July 13th, 2017. So please save the date!

Grateful thanks and acknowledgments are made to sponsoring agencies: New York State Office of Mental Health; New York City Department of Health and Mental Hygiene; NYC Health + Hospitals, Office of Behavioral Health; Community Access, Howie the Harp Advocacy Center; Baltic Street AEH, Inc.; The Coalition of Behavioral Health Agencies; YOUTH POWER!; NYAPRS; and Advocacy Consultation Services.

The NYC Peer Workforce Development Committee is Striving to Overcome All Obstacles

The NYC Peer Workforce Development Committee is Striving to Overcome All Obstacles
By Helen “Skip” Skipper, NYS Certified Peer Specialist

Now is the Time to Get Involved as the Peer Workforce Grows
The Peer Workforce Development effort was born out of a need to support our newly expanding peer workforce. In 2015, when New York State Medicaid reimbursable behavioral health services for adults moved from a fee-for-service system to a value-based-payments managed care system, federal rules permitted reimbursement for rehabilitative services, including peer and family support, when provided by Certified Peer Specialists and Certified Peer Recovery Advocates. New York City and New York State have begun to implement these Home and Community Based Services in a wide array of behavioral health treatment programs. While this has created many new opportunities for New York peers it has also opened our eyes to a range of disparities. The Peer Workforce Development Committee, which includes our Leadership and Steering members, is striving to overcome ALL obstacles.

We are comprised of peers in all titles, including but not limited to: peer specialists, peer counselors, peer wellness coaches, and peer recovery coaches. We are trained professionals who work in every aspect of behavioral health, and who are mentored by established New York State and City peer leaders. Our message is simple. In the words of the great tradition of basketball, “We Got Next!”
We got next: In involving all behavioral health services in New York City in an open dialogue concerning the implementation of peer support.

We got next: In discussing pay parity, supportive services and ongoing/next-level trainings.

We got next: In formulating our own “Peer Workforce Culture.”
We got next: In advocating for more/better jobs, full-time hours, more responsibilities, and supervisory positions.

We got next: In ensuring that ALL behavioral health agencies in New York City incorporate some form of peer support.

We got next: In organizing our workforce; preparing for the possibility of eventual unionization, offering us even more protections and security.

We got next: In building a bridge between providers and peers…breaking down all barriers!

We got next: In developing funding streams with fiscal partners to help us achieve our goals. 

We got next: In developing partnerships with other organizations geared towards peer development, both national and international.

We encourage all New York City peers to join our Workforce Development effort by attending one of our meetings or signing up for our mailing list. We can be reached at: oca@health.nyc.gov.

My First Job as a Peer Specialist

My First Job as a Peer Specialist
By Boyd Perez, NYS Certified Peer Specialist
Peers Can De-escalate a Situation

My life changed the moment I began training to become a certified peer specialist at Howie-the-Harp Advocacy Center. The two things that impressed me, out of the many things taught at Howie the Harp, were the importance of treating everyone with unconditional high regard, and the need to meet people where they are at. The thought of dealing with people in this fashion rang my bell. If everyone did this the world would be a paradise. 

After five months of intensive classroom training, I began my internship at Education Assistance Corporation (EAC) in Brooklyn. This agency helps those with forensic backgrounds and a diagnosis to reintegrate into the community. My supervisor allowed me to complete the Academy of Peer Services online exams at work, for which I was grateful. When I passed the courses I began doing a lot of outreach (calling hospitals to help locate peers with whom the agency had lost contact) and escorts (taking peers to the Human Resources Administration, Social Security or housing appointments). 

On my first escort, I shadowed an intensive case manager. We picked up a peer who had been released from an upstate prison, at a parole office in midtown Manhattan, and took him to Bellevue to be processed into the shelter system. Because no beds were available at Bellevue, the peer was referred to Wards Island. The peer became extremely agitated, and vehemently told the case manager that he didn’t want to go to Wards Island, but instead wanted to stay at his mother’s apartment in Coney Island. After much cajoling, the case manager convinced the peer it would be in his best interest not to violate his parole, and to stay at Wards Island until he received permission from his parole officer to stay at his mother’s place. The subway ride up to 125th Street to catch the bus to Wards Island was tense. The anger never left the peer as he started ignoring the case manager. 

When we arrived at 125th Street, the three of us stood silently together on Lexington Avenue. The case manager pulled me to the corner and said, “This guy is angry. See if you can calm him down.”

So I approached the peer and asked, “How are you doing?”
“I don’t want to stay at Wards Island. I just got out of jail, man, I don’t want to deal with no one’s bull anymore,” he said.
“I know you’re being done dirty, bro,” I replied.
The peer’s body softened and his eyes became wide with relief. We connected.

I continued, “No one who wants to do right should be put in this shelter system. I spent ninety-nine days at the Men’s Atlantic Shelter and five months at Samaritan Village. So I know what you’re concerned about. But understand that the people at EAC are doing what they can to get you your own place. You’re not alone. You’re being looked out for. The process of getting your own place will be long, but I went through it and now I have an apartment of my own. I think you can stand the wait to get your own place too.” 

The peer smiled, asked me for a cigarette, and the M35 bus arrived. 

The Strategy Workshop for Peer Career Development

The Strategy Workshop for Peer Career Development
By Elizabeth Breier, M.A., Director of Wellness Centers Administration, Collaborative Support Programs of New Jersey and Jessica Wolf, Ph.D, Principal, Decision Solutions and Assistant Clinical Professor in the Yale Department of Psychiatry

From the 10th Annual NYC Conference for Working Peer Specialists 

The workshop goal was to increase working peer specialists’ knowledge about how to progress in their careers. Half of the 20 participants were certified peer specialists; others were working peers not yet certified as well as supervisors and non-peer staff. The co-presenters described the current status of peer training and certification in New York City, State and nationally as well as the variety of roles and settings in which peers can work. 

Specific individual and organizational actions needed to support and promote peer career development were described.

These include: proactive human resources strategies; the Certified Psychiatric Rehabilitation Practitioner (CPRP) credential; academic credit for life experience; academic credit for peer training; community college degree options; non-credit continuing education options; in-service training; and training programs such as eCPR, WHAM (Whole Health Activation Management), WRAP (Wellness Recovery Action Plan), IPS (Intentional Peer Support), Veterans’ peer roles, etc. 

Also considered were challenges and rewards of moving into non-peer positions, impact of organizational culture on peer career mobility, higher education and career path options, and ongoing networking.

One example of success: A person with lived experience who had a bachelor's degree in an unrelated field (sports management), obtained a 27-credit mental health certificate from a community college, went to work in a psychosocial clubhouse and also a mental health center as a peer worker. Then this individual studied for an MSW degree and graduated with honors. After that, the new MSW undertook the number of hours to become licensed as an LCSW (Licensed Clinical Social Worker). This finally led to an increase in compensation into the social worker job series.

Another example of success: A student with lived experience had taken some community college courses and never finished until obtaining the 27-credit mental health certificate. She went on to obtain a bachelor's degree in social work and has been working for a mental health agency ever since.

Lively interchange followed on private and public career paths; reasons why peers work in the field; challenges in retaining “peer-ness” while acquiring additional educational credentials and moving ahead in a peer career; moving into non-peer positions; wage equity issues; avoiding “coercion, co-optation, compliance” and tokenism; attaining an agency critical mass of peer workers; and disclosure issues in peer and non-peer roles. 

A handout provided information on specific options peers can undertake as well as possible new credentials and modified academic curricula that may become available in the future. 

New York State Peer Specialist Certification

New York State Peer Specialist Certification
By Tara Davis, Certification Coordinator, The New York Certification Board

Some History and Information on the Process

As many of you know, increasingly the dream of hope offered by the delivery of peer recovery services is no longer considered “alternative,” but is something that is more accepted; that more agencies are incorporating into their menu of services; and is even Medicaid billable! Exciting times indeed as we witness massive (and long overdue) changes to our healthcare system.

History of the NYCPS Certification
In 2014, the New York State Office of Mental Heath officially launched the Academy of Peer Services, the training platform that would become the basis for the certification. Peer leaders from across NYS were instrumental in developing this course work.
In 2015 the NYPSCB (New York Peer Specialist Certification Board) was formed. The NYPSCB is also formed of peer leaders in the state, and included some of the same people who developed the course work.

The NYBSCB began to issue certifications as of August 2015, and, as of September 2016, over 750 professionals have been certified as New York Certified Peer Specialists. 

The NYCPS Certification Process
For those of you new to the process, general information about certification as a New York Certified Peer Specialist, including the application, can be found on our website here: http://nypeerspecialist.org/

Tip: Visit our website for the most up-to-date information regarding certification. Announcements and updates will be posted there!
The first step is to complete the core courses offered by the Academy of Peer Services.

The Academy offers free, online training funded through the NYS Office of Mental Health and can be accessed online here: http://www.academyofpeerservices.org/

Once coursework has been completed, candidates wishing to apply for certification should submit an application and all required documentation to our offices according to the instructions found in the application. Processing time for a complete application is typically 4-8 weeks (it can take longer if any of the required documentation is missing.)

Tip: The key to being approved is that all requirements for certification must be met and all required documentation submitted. Use the checklist in the application to make sure you are submitting everything that’s required!

Standard Launch
In February 2016, the “full” or “standard” level of certification (NYCPS) was launched. NYCPS was first offered to candidates already certified as New York Certified Peer Specialist Provisional (NYCPS-P) and anyone with an application in process who meets the requirements. This level of certification is intended for candidates that have been providing peer services in a work or volunteer setting for one year or more. To date (September 1, 2016) we have issued NYCPS certification to 97 professionals.
For more information and to view the requirements please visit our website at: http://nypeerspecialist.org/resources-publications

The Standard application will be available soon and posted on the website at that time.

Annual Renewal Standards
The Annual Renewal Standards are 10 hours of peer specialist specific training, but the board has not yet made a final determination on what training will be approved for CEUs (Continuing Education Units). It is very likely to include coursework from the Academy of Peer Services. Once a determination is made, we will send out an announcement and post details on the website.

Please contact us with any questions at: info@nypeerspecialist.org

Peer Advocacy: It Takes One to Know One

Peer Advocacy: It Takes One to Know One
By Carl Blumenthal, Peer Advocate

Hello, our names are Albert, Chrispin, Tamara, Stephanie, and Clyde, and we have mental illness!

If you’re familiar with how Alcoholics Anonymous begins its meetings, our chorus of voices may sound like the same melody in a different key. Every AA meeting is led by someone who has “been there and overcome that” so that person can encourage group members in their recoveries.  

For people living with mental illness, Catholic Charities offers a peer advocacy program. We have become peer advocates here by coping with psychiatric difficulties and training to meet the needs of folks like us. That’s paying our dues twice. We do not replace mental health professionals. Rather, we complement them by using our recoveries as a road map for peers’ journeys toward wellness. We’re like driving instructors who double up on the gas and brake-pedals.  

Albert Sypher: “I’ve learned how to navigate New York City’s mental health and substance abuse systems for myself and other peers. I see myself through them. I’m grateful for my family’s support and encourage peers to get backing from their families and friends. I try to engage peers with the confidence of someone who’s turned his disability into a strength. I love my job. It sustains me in my recovery.

“Users of our program report such challenges as homelessness, unemployment, limited education, poor insurance, inadequate food, and unpaid rent and utility bills. To reduce these barriers, we’re certified by the State’s Office of Mental Health to work with peers on their life-goals, health education, financial benefits, social services, and access to healthcare. One-stop shopping for assistance is a necessity not a fashion.”

Chrispin Charles: “In smoking cessation group we encourage members of our program to make positive choices about their health. Many have quit and/or reduced their tobacco use. Understanding the effects of second-hand smoke has also motivated people to change because they don’t want to hurt their family and friends.

“We collaborate with Catholic Charities’ clinical and rehabilitation counselors to assure clients obtain holistic, self-directed care. We relate to peers as equals with shared experiences rather than different illnesses. Feeling safe, they tell us and each other what might be too personal for their therapists to know. It’s like having a buddy or a 'sponsor' (AA talk) to confide in when the going gets rough.”

Tamara St. Fleur: “In co-occurring disorders group (mental illness and substance misuse), we keep an open mind. There’s no judgment, only understanding how to get over our fears. From the experiences of others, I’ve learned a lot about myself. The group is a place where people can be heard and know it’s safe to express themselves. We give them hope, purpose, and self-confidence.”

In a recent group on self-help and peer support, here’s what participants said about the peer advocacy program: 
Gary: “It helps with my well-being.”
Machelle: “Allows me to set step-by-step goals.”
Dennis: “Learn how to use a computer.”
Howie: “I express concerns about my housing.”
Terrica: “Because the groups teach self-love, I get therapy and meds.”
Barbara: “An advocate goes with me to my medical doctor.”      
James: “Good to have others to talk to.”
Eric: “I’ve stayed out of the hospital for five years.”

These are not just soundbites. Between August 2015 and February 2016, consumer satisfaction rose 18% on nine measures of quality. If the program has improved, members’ expectations have risen. Their desire to meet one-on-one grew by 32%. They deserve the attention and the City's Department of Health and Mental Hygiene (DOHMH) emphasizes this approach, like tutoring, is the best way to learn.  

Samuel James, director of rehabilitation, elaborated: “Peer advocacy began here in 2011 with two advocates. Now we have six. DOHMH and Catholic Charities’ management guide us. Peer advocates have walked in the shoes of the members. They work together here and in the community to instill the message ‘we can recover.’

“Advocates are much better trained now in motivational interviewing, the basis for working individually with peers. Getting certified and practicing more, they’ve also improved as facilitators of groups: smoking cessation, co-occurring disorders, food education, wellness self-management, wellness recovery action planning (WRAP), and SAMHSA’s (Substance Abuse and Mental Health Services Administration) eight dimensions of wellness.” 
Stephanie Thompson: “I was first trained as a spiritual life coach at the Inner Visions Institute. Then in addiction recovery. With harm reduction and trauma-informed care, there’s more than one pathway to recovery. You’ve got to have a holistic approach. I’m inspired when peers go through the many stages of change I have. In food education we see mind, body, and spirit as one. I’ve been diagnosed with diabetes—“diagnosed” because language is important. Plus I know nutrition is connected to mental health. It affects your mood. Some psychiatric medications cause weight gain.”   

Clyde Walcott: “I want to serve, reach out, motivate, and inspire. I’m trained in theater arts and worked in radio and TV. Being productive and creative is important for recovery.” 
Mr. James added, “Peer advocates are an integral part of the recovery system and will play a more prominent role, especially as insurance companies look for proof of quality outcomes. Reimbursement is possible for person-centered care, WRAP, advanced directives, coping skills, recovery concepts, self-sufficiency and self-care. The new Medicaid Home-Based Community Services will also pay for peer support.”
Bottom line: Peers are hospitalized less, work more, are better educated about their health, and have greater social support. Equally important: With behavioral health workers striving to improve care while saving taxpayers’ money, peer advocates have a role to play in making this “brave new world” freer and more humane.  

Bipolar, With a Side Order of Psychosis

Bipolar, With a Side Order of Psychosis

By Jason Matlack, CPS

How My Illness Was a Blessing In Disguise

It's amazing how sometimes the worst things in our lives can become our greatest assets. It isn't the cards we're dealt but the way we play our hand. Who would have thought having mental illness would become the exact thing that has made my life worthwhile.

I never did well in school. When I was young they didn't have all of these diagnoses and tests to discover what was what. Maybe that was a good thing. Even though I always felt like I was failing at a lot of things in my life I never seemed to give up. Without a diagnosis I did not have an excuse to give up.

Growing up I experienced sexual abuse at an early age. I don't know how much of that played a part in my mental illness. That experience and my inability to keep up with my peers in school always made me feel inadequate. Sometimes I would fail tests that I would have passed because I didn't meet the time frame.

I discovered alcohol and marijuana at an early age. When I drank and got high all those feelings of inadequacy went away. In fact, with a little alcohol I became self-confident, or so I thought. I never drank like regular folks from the start. I drank too much and too often.

When not drinking, my self-hatred surfaced and I would say horrible things to myself in the mirror. Sometimes I would do things to hurt myself. I thought about suicide often. Drinking to oblivion was my only release.

I began to drink to the point of blacking out and became violent when drinking. At 19-years-old my verbal abuse turned into an attempt to beat up my girlfriend. I finally sought help in a 12-step program. I was raised in a loving family and thought female abusers were the bottom of the barrel. I moved out on my own, partially blaming my unhappiness.

I couldn't remain sober because of the secrets of the abuse and dysfunction in my childhood. I ended up in rehab and stayed sober for eight years with the help my involvement in a 12-step program. Even then I still didn't fit in. I was able to curb the anger and dealt with my childhood by finding peace and self-forgiveness. But the bipolar mood swings were a constant battle. While in my mid to late twenties I began to experience psychotic episodes. After indulging in the instant gratification of mania, I would then experience great guilt.

Once the psychotic episodes began, I would go super spiritual and hear a voice I thought was God. The business that I had started and ran for fourteen years began to fall apart due to my inability to cope. My wife couldn't take it and we ended up divorcing.

I started drinking again every now and then since my episodes isolated me. But I did not drink much. Instead, I would smoke marijuana. I didn't realize it, but the smoking prevented my psychotic episodes from occurring. Unlike alcohol, marijuana did not cause me to black out or become violent.

By my mid-thirties I lost my business. I went through some sales and management jobs, but manic episodes only caused more compulsive decisions.

When the economy crashed, the time share company I worked for as a marketing manager laid off 50% of the work force. I went into a psychosis that lasted about a year, thinking I was the second coming of Jesus Christ.

When the psychosis broke, I admitted myself to a psychiatric hospital. That was where I was diagnosed and started to receive proper medical care. It is also where I had my “Patch Adams” moment. I knew I wanted to get into the mental health field and help others like myself.

I had a difficult time coming to terms with the guilt from the damage I had caused others with my manic episodes and psychosis. I experienced a lot of anger about being born with this condition and became angry with God. Thoughts of suicide continued to plague me regularly.

I continued in sales, which I hated, but it was the only skill I knew would earn me enough money to survive. After getting laid off from a job selling cars, my therapist told me about a Certified Peer Specialist job, which is someone with a mental health diagnosis who helps others recover from their mental illness and create a better life for themselves.

I have been a Certified Peer Specialist for almost a year now. It is the best thing that has ever happened to me. I thrive on the personal satisfaction of helping others and witnessing their progress. This job is what I was looking for my entire life but was unaware of it. Every day I go to my job with great enthusiasm. If I wouldn't have gone through hell, I would have not found heaven.

All I can say is that to those of you who think you can't, you have to know that you can. To those who are our supporters, do not sell us short. It is through your support and encouragement that we will soar to new heights.

The common threads to those that find a quality life are those that have support, whether it is family, friends or professionals. No one can do this alone. If you do not belong to a support group please find one. There are some that meet in person. If that isn't possible, there are tons of them on the internet. I belong to a few myself. There are also support groups for our supporters. I love you all and good luck on your journey!

Meet the New Deputy Executive Commissioner

Meet the New Deputy Executive Commissioner

By Dan Frey, Editor in Chief

Crucial Issues to the Mental Health Community Discussed

On January 20^th at Fountain House clubhouse in Hell's Kitchen, members of New York City's mental health community met the new Executive Deputy Commissioner for the New York City Department of Health and Mental Hygiene (DOHMH), Division of Mental Hygiene: Gary Belkin, MD, PhD, MPH. The event was organized by the DOHMH Office of Consumer Affairs whose mission is to ensure that the consumer perspective is heard and integrated at all levels of government. Carlton Whitmore is the director of this office and Teena Brooks, LMSW, assistant director.

Dr. Belkin responded to questions from a planning committee whose members were: Wendy Brennan, Lynnae Brown, Angela Hebner, Carla Rabinowitz, Samene Reid, Rachel Saloman and Moneer Zarou. Topics ranged from housing and criminal justice to employment and managed care. Some topics listed in the evening's program such as cultural competence and the assisted outpatient treatment program were barely touched upon.

Housing

On housing, Dr. Belkin said that governor Cuomo might approve funding for around 5,000 units of housing for New York State's homeless, mental health, HIV/AIDS, substance abuse, and domestic violence populations, including families and youth. The campaign for supportive housing, known as NY/NY 4, requested 30,000 units for these disadvantaged groups in New York City over ten years.

Criminal Justice

On criminal justice, Dr. Belkin said that, in response to the unnecessary death of a mentally ill Rikers' inmate, mayor de Blasio's criminal justice taskforce will address issues of mental illness and substance abuse at every stage of the criminal justice system, including proper discharge planning from jail to the community. He said “drop-off centers” will be created as alternatives to incarceration for people with mental illness, with the first one to roll out in the fall of 2015 in upper Manhattan. These drop-off centers should offer an array of services to help keep our peers out of the justice system. As part of a comprehensive plan, corrections officers and police officers will receive training on “deescalation” and understanding behavioral health issues similar to what other states have been doing with good results.

Employment

The unemployment rate among people with serious mental illness is a staggering 90%. Dr. Belkin said his department funds 15 different employment programs and continues to advocate for more peer hiring. He said that in the future managed care environment, providers will be held accountable for improved employment outcomes and that peer services will be Medicaid reimbursable. He said an “RPC” or regional planning consortium will be created that brings advocates and stakeholder groups together to discuss issues of standardization, performance, service planning, and resource allocation.

Medicaid Managed Care

On the future of service delivery in a Medicaid, managed care environment (see “Medicaid Managed Care: Rising to the Challenge” by Briana Gilmore, Winter 2015 edition), Dr. Belkin said “HCBS” (home and community-based services) will be offered through the “HARP” (health and recovery plans) for individuals with significant health and behavioral health needs. Fully integrated dual advantage plans (FIDA)will be available for people with both Medicaid and Medicare who use community-based long-term care services.

Peer Jobs

There was a concern among those in attendance that peer workers who lacked a GED or high school diploma, which is currently required to become a certified peer specialist, would lose their jobs in this new billing environment, but Dr. Belkin assured us that not all services will be billable to Medicaid and some will continue to receive funding from the city. The smaller provider organizations will receive technical support to help them make the transition to Medicaid billing. He said he was unsure how many city contracts, if any, will be displaced by the shift to Medicaid billing.

Conclusion

Although Dr. Belkin and his senior staff were weary from a long day at the office, we were glad that they made it to the forum that evening. His liberal use of acronyms was a bit off-putting, but he did his best to explain some difficult concepts. The crowd seemed pleased with the event, but I was left wondering how much influence we would have on future policies that will affect our lives. Most of us don't even know how to speak the language that large bureaucracies use, let alone how to affect change within them. For those of us who do, I hope you step up to the plate and get involved. We desperately need representation with sensitivity, intelligence and strength.