People with lived experience should be seen as an effective, accessible and realistic solution to nonprofit staffing woes
Nonprofits providing services to our most vulnerable people are struggling with understaffing. Finding those with master’s degrees willing to do challenging work for what is too often low pay and under-resourced services has been a problem since long before I worked for Cascadia Behavioral Healthcare more than 15 years ago.
We were able to provide staffing for housing and addiction services utilizing people with lived experience but not necessarily academic credentials.
With the scarcity of well-schooled individuals only increasing, this is an opportunity to hire more people with lived experience and fewer degrees. And the dirty little secret is that they may be better suited to help those who are houseless, addicted and/or struggling with mental illness.
Respected psychologist Joseph Durlak published a study in 1979 combining research comparing the outcomes of psychologists, psychiatrists and social workers with those of paraprofessionals (i.e., nonexpert, minimally trained community volunteers and helpers). His analysis of 42 studies led to the conclusion that paraprofessionals were more effective than trained professionals.
“Professionals do not possess demonstrably superior therapeutic skills compared with paraprofessionals,” Durlak concluded. “Moreover, professional mental health education training and experience are not necessary prerequisites for an effective helping person.”
Other researchers using meta-analyses replicated his results, even controlling for the difficulty of the patients with whom professionals were working. This has long been recognized in addiction treatment, where years of sobriety were treated as more of a credential than an academic degree. And peer-led Alcoholics Anonymous groups have helped millions with their issues.
House Bill 2445, which allows independent behavioral health certification for addiction peer support specialists without forcing all approvals to go through the Oregon Health Authority, is a positive step. This should be broadened to include those with mental health lived experience.
Defining what constitutes lived experience will be an important early step. Should diagnoses like ADHD and dysthymia, relatively widespread, make someone eligible? Or should lived experience be based on diagnoses like schizophrenia, PTSD or bipolar disorder?
It is important to acknowledge the role of trained mental health professionals. Psychiatrists and psychiatric nurse practitioners are irreplaceable in their role of determining who should get what medications. Psychologists’ expertise includes doing complex testing as well as providing counseling. Counselors and social workers have the education to diagnose and handle the delicate work that goes into providing effective therapy.
But this is not really necessary when doing crisis work. It’s more about building a human connection. A famous meta-analysis of what worked in counseling found the relationship had twice the importance of the therapeutic techniques.
Not that people with lived experience will be doing therapy. It wouldn’t be appropriate for them to discuss family-of-origin issues with someone who is standing on a bridge or doing deep trauma work with a fragile individual. It’s more about validation and emotional connection — understanding what it is like to live a life in crisis — and helping engage them enough to get more services. And some of those services can be performed by peers.
Jane Remfert, who leads a Portland-based peer support group for people with obsessive-compulsive disorder, noted peers can be vital at “inspiring hope that things can and will get better, encouraging people to seek professional therapy, and simply being a set of ears that does not judge and understands in a way that other people simply can't.”
A July 2019 article in Psychiatry Advisor by Dr. Nicola Davies further backs up Remfert’s observations.
“Systematic reviews have confirmed that, while peer support and clinical practice typically perform fairly equally on traditional outcome measures like rehospitalization and relapse, peer support scores better in areas related to the recovery process,” Davies wrote. “In particular, peer support tends to offer greater levels of efficacy, empowerment and engagement.”
Another benefit is that peer support may provide a more diverse workforce. Helping professionals drawn from graduate schools are largely a different population than those with lived experience.
While people with lived experience will clearly need education in essential skills to be able to provide effective peer support, many companies offer several-day trainings on crisis de-escalation. People with lived experience will need education in ethics, understanding boundaries and practicing self-care, so they themselves do not succumb to crisis. The federal government, through the Substance Abuse and Mental Health Services Administration, also offers guidelines like “Core Competencies for Peer Workers.” Clearly, very careful screening, good supervision and ongoing support will be necessary to ensure that those providing help don’t wind up needing more help themselves.
But as Gov. Tina Kotek looks for ways to address the challenge of staffing behavioral health care providers, there is a vast pool of untapped talent that can be drawn from.
Mark Schorr is a licensed professional counselor and certified addictions counselor with 30 years of experience. The former director of staff development for Cascadia, he is a member of the Mental Health Alliance Work Group.
Street Roots is an award-winning weekly investigative publication covering economic, environmental and social inequity. The newspaper is sold in Portland, Oregon, by people experiencing homelessness and/or extreme poverty as means of earning an income with dignity. Street Roots newspaper operates independently of Street Roots advocacy and is a part of the Street Roots organization. Learn more about Street Roots. Support your community newspaper by making a one-time or recurring gift today.
© 2023 Street Roots. All rights reserved. | To request permission to reuse content, email editor@streetroots.org or call 503-228-5657, ext. 404
