The Peer Mental Health Advocate Model

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The Peer Mental Health Advocate (PMHA) Model

How the first non-university sanctioned peer counseling program was built and led by students with mental illness

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The Conversation "I was helping to connect a struggling student to university resources; and the next week, she asked if I could possibly connect her to someone who was in recovery from an eating disorder. Though she saw a therapist and nutritionist, she said, There are so many other hours in the week. And I'd really like to see how someone else is surviving. After that day, I connected her to another student I knew in recovery, and their relationship was an important model for us. After that, I started building our curricular model so we could make these connections on a much larger scale at Brown."

- Stefanie Kaufman, Founder

How It All Started In 2013, after launching the Project LETS international Crisis Line, our team realized immediate crisis intervention was only one small piece of the puzzle. We began researching programs and interventions that sought to connect those in crisis to longer-term, follow-up care.

In early 2014, Project LETS began offering one-on-one peer counseling services to individuals from all over the world. Following the success of this model, and a conversation held with a student at Brown University, the PMHA program was born.

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How It Was Built

Brown university students who do not like the idea of seeking institutional support

In 2013, before Project LETS became a student group on campus, a team of dedicated students (including Stefanie Kaufman - founder & Executive Director of Project LETS, and Molly Hawes - Director of Expansion) interviewed students on campus who felt they had experienced discrimination, ableist policies, and mistreatment at the hands of Brown University (due to their identities as mentally ill students).

This team of students began meeting with a group of administrators, including: the former Director of Psychological Services, the former Vice President of Student Life, and the Senior Associate Dean of the College for Class Advising / Health and Personal Issues.

After presenting grievances, identifying ableist and discriminatory practices, and proposing student-led and institutional solutions, the intention of the student team was to build a university sanctioned (university supervised/controlled) program to achieve sustainability.

"I realized a tendency I have to fault myself when a system failed to meet my needs. For example, blaming myself for bad experiences with therapists or little responsiveness in terms of accommodations from the university. Learning about the progress to be made in systems of mental health care has been a relief, and definitely re-framed my perception about my ability to be helped and supported through different services I've used in the past." - Brown University PMHA

www.LetsEraseTheStigma.com

After lengthy bureaucratic processes and hesitation on behalf of the administration, Project LETS made the decision to move forward as a non-university sanctioned peer counseling program. It was our opinion that the university was also concerned with potential liability issues, and was unwilling to build the program internally.

Additionally, Project LETS saw an invaluable strength in existing and operating outside of university supervision, surveillance, and risk management. For those reasons, many students with mental illness fear using on-campus resources; and LETS worried that another university sanctioned resource would prove inaccessible by similar means.

Project LETS: Brown University Impact Report

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How We Built Our Training

SAMHSA Guide In 2015, SAMHSA led an effort to identify the critical knowledge, skills, and abilities (leading to Core Competencies) needed by anyone who provides peer support services to people with or in recovery from a mental health or substance use condition.

Nationally Certified Addiction Recovery Support Specialist (NCPRSS) The purpose of the National Addiction Recovery Support Specialist Credential is to standardize the knowledge and competency of recovery support to individuals with substance use and co-occurring disorders.

The core of our training curriculum comes from state-level Certified Peer Recovery Specialist (CPRS) training. From here, we derive the job responsibilities, ethics, and main roles of a peer supporter. Additional training components were developed by the Project LETS Team, and work to prioritize a social justice lens and intersectional feminist framework; as well as social models of disability, and history of psychiatry.

Our Relationship to the University Our PMHA program, though on a university campus, is not affiliated directly with the university, or the school’s Counseling and Psychological Services (CAPS). Our program operates under the Project LETS chapter model; developed and supervised by Project LETS. Our program is the first non-university sanctioned peer counseling model. In order for our program to work effectively, it is essential that we do not work under the supervision or purview of the university or university administration.

Who supervises PMHA Coordinators?

Mental Health America’s National Certified Peer Specialist (NCPS) The first national advanced peer support specialist credential. Developed with the input of thousands of peers and leaders from both public and private services, MHA’s NCPS credential is true to the core values of peer support and creates the high, uniform standards needed for expansion into the private sector.

State-Level CPRS Guides Peer Recovery Specialists (or Recovery Coaches) are current or former consumers of mental health services who are trained and certified to offer support and assistance to those in the recovery and communityintegration process. Peer Support Services (PSS) are specialized, therapeutic interactions between peers and individuals in the process of recovery. The service is designed to promote empowerment, selfdetermination, understanding, coping skills, and resiliency through mentoring and service coordination supports. These Specialists work in a wide range of settings including community mental health centers, behavioral health programs, peer-run organizations, community based organizations, emergency rooms, courts, homeless shelters and outreach programs.

The PMHA Coordinator will be connected to and supervised by a Project LETS National Coordinator-- who will establish a routine scheduled check-in process. The National Coordinator will also act as a resource for the PMHA Coordinator and program, and coordinate trainings at the university. Additionally, the National Coordinator is always available to answer questions - whether they are minor, or crisis related. It is important that chapters establish a strong relationship with their National Coordinator.

Why do PMHAs remain confidential regarding self-harm and suicidal thoughts?

Due to standard university confidentiality policies regarding self-harm and suicidal thoughts, many students are too afraid to utilize these services when and if they need to. Additionally, even if students are working with a therapist, for example, students are often too afraid to be honest about self-harm and suicidal thoughts for fear of hospitalizations, or forced medical leave. Though most universities report that forced medical leaves are either: a) against the ADA and not instituted (source: Brown University); or b) used in only extremely necessary situations, when a student is an imminent risk to themselves or others, in our extensive experience, these situations are not often the case-- and forced hospitalizations and medical leaves occur to students who do not feel they are a threat to themselves or others; and would prefer to stay on campus.

Furthermore, universities are often not transparent about what constitutes an imminent threat to oneself or another student. www.LetsEraseTheStigma.com

Project LETS: Brown University Impact Report

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A large majority of students we work with also cite confidentiality breaches, in which third parties have access to private information (sometimes medical) they did not provide. Universities engage in various public health threat assessment strategies to monitor ‘at-risk’ students, and from our research, these systems can include regular administrative meetings where ‘at-risk’ students are discussed. Many universities are not transparent about the existence or operation protocol of their threat assessment teams.

"These policies institute fear and take power and autonomy away from students. Our model is built on trust, partnership, mutual decision making, and transparency. We actively work to give power back to the students we work with, and therefore make it a top priority to create a safe place for students to talk about heavily feared and stigmatized topics."

Additionally, self-harm on university campuses has often been handled as: a) a disciplinary action; or b) a sign of suicidal intent. Robust evidence shows, however, that most individuals who self-harm are not suicidal; and are engaging in non-suicidal self-injury, or utilizing selfharm as a coping mechanism. Furthermore, our go-to response for individuals who are suicidal is to ‘call 911’ which may be an option in emergency situations, but fails to recognize individuals who live with constant and/or chronic suicidal ideation; and/or marginalized communities who may be at further risk when engaging police.

The PMHA Training spends an extensive period of time covering crisis situations; and we are able to work within these confidential frameworks by developing robust crisis plans, and preemptively discussing situations with our peers (see: Non-Negotiables Document). Our goal is not to isolate students from services on campus, rather, to build a relationship with individuals (who may otherwise be too afraid), and work with them to become more comfortable engaging with professional services (if that is what they choose to do). We also tend to work with ‘hard to reach’ students; and students who cannot or are not accessing services on campus.

What safeguards and protections exist for Project LETS?

What is QPR Training?

QPR (Question, Persuade, and Refer) Gatekeeper Training for Suicide Prevention is a 1-2 hour educational program designed to teach lay and professional "gatekeepers" the warning signs of a suicide crisis and how to respond.

www.LetsEraseTheStigma.com

As stated above, the Project LETS PMHA program is not directly affiliated with universities, and therefore, PMHAs are considered volunteers of the national organization. All volunteers are protected by the Federal Volunteer Protection Act; and we are furthermore protected under the Good Samaritan Law. Project LETS uses evidence-based training curricula developed by state-led Peer Recovery Specialist programs and certified curricula, such as QPR Suicide Prevention Training. All PMHA Training Facilitators have participated the training themselves, are QPR certified, and have undergone further more specific instruction regarding facilitation. Project LETS is also recognized as a global partner of Peers for Progress, and abides by strict ethical standards and guidelines for operation. PMHAs have a very specific role, and do not operate outside of this role, or their expertise. Additionally, we have strict reporting and note-taking requirements; as well as a built-in support network for all PMHAs.

Project LETS: Brown University Impact Report

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Are PMHAs therapists?

PMHAs are not, and do not claim to be therapists. PMHAs participate in a rigorous and comprehensive seven-week training, and only work within the realms of their training and lived experience.

Can programs work with a university liaison?

Yes, in fact, we highly recommend it! It is great to have individuals within the administration that you trust and support, and can reach out to for advice or resources. Project LETS is willing to have a program advisor from the university, but this individual will not see any records.

They will strictly act as a resource and link between the PMHA program and the university.

Who manages the PMHA program on campus?

PMHA Coordinators are responsible for overseeing their school’s peer counseling program, remaining up-to-date on new administrative policies, organizing the training of new peer counselors, and remaining in frequent communication with their Project LETS supervisor.

Are there any requirements to be a PMHA Coordinator?

Lived experience with mental illness (“official” diagnosis not required) Personal experience with mental health services at your university A solid understanding of the university’s mental health policies (or lack thereof) An investment in mental health care reform and social justice An enthusiasm for learning more about inclusive peer support A willingness to dedicate time and energy to the role and its necessary trainings

What are the main responsibilities of PMHAs? Creating personalized safety/relapse prevention plans Sending reminders about medication and appointments Cultivating your peers’ ability to make informed, independent choices Helping your peers identify and build on their strengths Supporting your peer in accessing help/resources, and learning how to interact with the healthcare system Answering questions about mental illness to develop confidence and reduce stress Providing support in times of struggle and crisis Providing information relating to coping mechanisms and how to maintain healing Assisting your peers in gaining information and support from the community to make their goals a reality www.LetsEraseTheStigma.com

Project LETS: Brown University Impact Report