Stacy Paul remembers her breakdown vividly. She was riding the bus home after her night shift at St. Mary's Hospital when it happened.
"For whatever reason, I couldn't remember where I lived or my name," says Paul, who was 23 and working as a nursing assistant at the time. "I didn't remember my address."
The bus driver helped her figure out where she lived by getting her to remember landmarks -- in this case, a park. Doctors later diagnosed her with post-traumatic stress disorder (for things that happened during a troubled childhood), but in fact, she was bipolar, a diagnosis that would take years to make.
She moved back to where family lived in La Crosse and remembers years of hard times. "I'd sit and stare into the mirror and talk to myself for hours," Paul says. "I couldn't deal with people. I was very, very suicidal. For a while, I went mute.
"I thought my life was over when I was diagnosed, and I guess for a while it was."
But once she got back on her feet, Paul, now 41, found purpose in helping others get through similar trauma.
She worked until recently as a peer recovery support specialist, a relatively new profession that helps others struggling with mental illness get their bearings. She loved the work, especially helping her clients.
But she and others in the field find that many other mental health professionals don't understand the role of a peer recovery support specialist. They talk of being assigned tasks they're not qualified for, including dispensing medication.
Says Paul: "We're really at risk out there because people don't even know what we're supposed to be doing."
Sharing stories
Peer specialists require training and certification, but they aren't doctors or counselors. They offer something different for those recovering from mental illness or addiction.
"We share our story," says Paul. "That's one thing unique about peer specialists."
Evonne Kundert, vice president of the Wisconsin Association of Peer Specialists, says sharing experiences can help specialists gain clients' trust.
"A peer specialist is a person who has lived experiences," says Kundert. "By being able to disclose some of those experiences, they can build a much stronger trust level to people who have mental health or addiction issues."
Using peer specialists in recovery has come into vogue in recent years. Faith Boersma, who works for the Division of Mental Health and Substance Abuse Services in the state's Department of Health Services, says they've been used more often since 2007, when Medicaid began reimbursing for their services.
In Wisconsin, peer specialists mainly assist those suffering from mental illness and drug addictions, but in other states they also help prisoners, at-risk youth and others.
The state began certifying peer specialists in January 2010, says the DHS's Kenya Bright, and there are currently 289 certified in Wisconsin. They're generally hired by health agencies doing contract work for county governments.
Paul says that peer specialists meet with clients weekly for three months to help them work on their treatment plans and help them find housing or jobs. They help develop questions for their clients' doctors and identify situations that could lead to a crisis. The specialists also help figure out how to cope with crises.
Paul recalls helping one woman, who hadn't left her house in five days, go across the street to a restaurant, where they sat and had coffee.
"There've been a few [clients] who were rocky, but clients love having peer specialists," she says. "We're a bridge between them and the doctors and clinicians. They'll tell us stuff they won't tell other people."
Kundert, herself a peer specialist, sees the job as offering a real-world example for how people can recover. "I still have difficulty, but I'm living a happy and fulfilling life and I'm holding a job -- things we've been told we would never do. Hope is really there," Kundert says. "I consider myself a recovery trainer in a lot of ways. Because I want people to understand recovery is possible."
Misunderstood roles
Some peer specialists say mental health professionals often misunderstand the role they play -- and have them doing inappropriate work.
Paul says she's been asked to give meds to clients, and also to help them clean their homes or move to a new one. "There are services to do that, but it costs money," she notes.
Donna Dalrymple describes the work environment at a local mental health agency as being hostile toward peer specialists. "In staff meetings, we weren't included," says Dalrymple, who no longer works at the organization. "We didn't get to talk about our clients. I don't think they understood what a peer specialist is supposed to do."
Workloads are sometimes heavy. Paul was assigned to work with 23 clients but was scheduled for only 12 hours a week. Ideally, a specialist would spend an hour with each of them every week, and that doesn't include travel time (Paul's clients were scattered around the county). Complicating matters is that many specialists receive disability, meaning they're limited in the number of hours they can work each week.
Kundert says the experiences of peer specialists vary wildly around the state, with some doing meaningful work and others used as taxi drivers or to run errands.
Growing pains
Officials with the state's Department of Health Services admit there have been issues with the use of peer specialists at some agencies. The department recently produced handbook (PDF) for employers on how to best utilize them.
"As with any new profession, there's going to be growing pains around that role," Boersma says, noting that roles and responsibilities need to be more clearly defined.
Boersma and Bright both expect the use of peer specialists to increase, both because there's evidence it helps and because there's more money available to hire them.
Gov. Scott Walker, in his biennial budget, provided $10.2 million to "expand comprehensive community support programs," which includes the use of peer specialists. But, Bright says, "Providers have to be introduced to it."
"I'm pretty confident that some of the work we're doing is going to help," Boersma says. "And the benefits of the program are well worth it."
Paul has, temporarily at least, given up her peer specialist job to work on a degree in social work. But she remains a believer in the power of peer work. And self-evaluation.
"If we are to move forward, we need to know what is working and what is not. That way we, as peers, have opportunities to actively participate as agents of change, to improve services and to enhance our skills."
