People recovering from mental illnesses have been helping heal each other for a long time—at least since the Alleged Lunatics’ Friend Society formed in London in 1845—but not until recently have psychiatrists emphasized peer counseling in their treatment plans, recognizing the benefits of using survivors as coaches. Consider the first large randomized trial study of a peer-led intervention program—the Health and Recovery Peer (HARP) program in Atlanta, where participants and their peers talk about the best ways to manage chronic illness. The study included 400 participants, mostly female, African American, and poor. All had a psychiatric diagnosis, such as major depression, bipolar disorder, or schizophrenia, and also at least one chronic medical condition, such as hypertension, asthma, or diabetes.
“People with mental illness have high rates of adverse behavior—particularly smoking, but also poor diet, limited exercise, and obesity,” says Benjamin Druss, a professor of public health at Emory University who helped organize the HARP program in 2006 and ran the trial study from 2011 to 2016. The findings, released in February, showed that after peer intervention, roughly half the participants reported a “modest but significant” boost in their health, along with a more significant improvement in “recovery,” or their self-assessment of confidence and hope, willingness to ask for help, personal goals, reliance on others, and easing of symptoms. “Recovery is a long process,” says Chacku Mathei, the CEO of the Mental Health Association in Rochester, New York, and a beneficiary of peer counseling when he was addicted to drugs at the age of 15 and attempting suicide. “It isn’t enough to get us out of the hospital. We also have to get the hospital out of us.”
Until the 1960s, American doctors usually treated mentally ill people by institutionalizing them. Early psychiatric drugs and treatments were somewhat effective but had brutal side effects, and ex-patients organized self-help groups to offer a more humane alternative. Judi Chamberlin’s 1978 book, On Our Own, became the manual for a movement that was as much about civil rights as recovery. Today’s peer support groups often trace their roots to that movement. The barriers really started to fall when health administrators redefined peer support as preventive care, thus making their Medicaid payments go further. (Georgia was the first state to allow Medicaid to reimburse peer counselors. Now many states do.)
Druss says that several other large, randomized trial studies of peer programs are in the works. This ongoing work is even more urgent, given the current health crisis and the enduring stigma of mental illness. A 2006 survey of eight states showed that the life expectancy of Americans with a major mental illness ranges from 49 to 60 years. The national average is 78.
