Peer support is transforming mental health care for some in Massachusetts

There’s a quiet sea change going on in some mental health settings in Massachusetts and beyond, and it often looks very different from therapy.

People who have struggled with bipolar disorder, depression, anxiety and other conditions are joining the mental health workforce to support patients who are experiencing some of the same difficulties they have worked to cope with or overcome .

Their titles vary, but include Certified Specialist and Young Adult Mentor. They work alongside therapists and others, sometimes in offices with comfortable chairs and white noise machines. But their goals often emphasize building connections over clinical work.

Support through fun

Im poppin bro, Im poppin, shouted Nathaniel, a 16-year-old frantically flipping cards in a game called Trash. Her opponent is Jake Look, a certified mentor for young adults at Riverside Community Care Center in Milford.

It’s not over yet, Mira answered. This turned out to be an illusion. Nathaniel scored another victory.

“I’ll always beat you bro,” he said with a sly laugh. WBUR agreed not to use Nathaniel’s full name, because his family is concerned that discrimination may follow mental health patients.

In his 45-minute session with Look, there was no mention of medication or behavioral therapy. Look asked a few questions about Nathaniel’s home and school life, as well as the issues he was working with a more traditional therapist. But Nathaniel just wanted to play.

When I started this role, if we didn’t get into intimate feelings, I felt the session was almost a failure, Mira said. But, 45 minutes of play could be the best part of his week. It’s about giving Nathaniel ownership of those 45 minutes.

Nathaniel has left therapy in the past. But she says she never hesitates to come see Look and her social worker in Riverside, Sean Smith.

I could say anything to both of them and since they are like my team, they can talk to each other, Nathaniel said. So they can always make sure I’m okay.

But there are some topics he finds easier to talk about. Drugs and alcohol, for example.

Sean could just say, that’s bad, don’t do it, Nathaniel said. Jakes had more flexibility to be real.

Look is part of a Riverside youth treatment team that includes clinical social workers and psychiatrists. Riverside is one of about 30 community behavioral health centers in Massachusetts that offer a variety of mental and behavioral health care services. Many of the centers have employed peer specialists for a decade or more, and are now adding more as part of a mental health road map that Massachusetts launched in 2023. The initiative aims to improve access to mental health care, recruiting more professionals from the industry and encouraging wider use of non-conventional staff as peer specialists.

These roles are a complete game changer, said Brooke Doyle, commissioner of the states’ Department of Mental Health.

“When I started this role, if we don’t get into intimate feelings, I felt that the session was almost a failure. But, 45 minutes of play could be the best part of your week.”

Jake Look

Doyle said young adult mentors like Look could play a critical role as more teens and young adults grapple with mental health challenges. Doyle said she is impressed by how co-workers initiate therapy through fun activities like sidewalk chalk drawing or video games and eventually connect clients with other supportive teammates.

Using non-traditional ways, Doyle said, is really the bridge to these other services.

But bringing peer specialists into the clinical team doesn’t work if they’re isolated or if their input into clinical decisions isn’t respected, Doyle said. Vic DiGravio, the president of Riverside where Look works, said he sees some of those tensions playing out as Riverside integrates more specialists into care teams.

It’s still a work in progress, because it’s a cultural change, DiGravio said. But even with that, it’s impossible to understate how innovative and transformative this has been in 14 months and the potential to transform the system moving forward.

Stepping into this role has also been transformative for Look. In his late teens and early 20s, Look said he used drugs and alcohol to cope with anxiety and depression, experiences he’s willing to share.

There was a time in my life when I felt so ashamed, Look said. But now it has really become a powerful tool for me. And it’s something I can use as a representation of hope for others.

Nathaniel said he still gets angry, anxious and depressed at times. But her grandmother and guardian, Mirabel, said she is doing much better.

In school, her grades are incredible, she said. His behavior has changed. And finally he is proud of himself.

I could tell them anything and since they are like my team, they can talk to each other. So they can always make sure I’m okay.

Nathaniel

According to the Kiva Centers, a training program for certified peer mentors, there are currently more than 600 young adult mentors in Massachusetts. Workers take training courses that last about two weeks depending on their specialty and must pass a test to obtain certification.

In the field of mental health, there are unique roles for family partners and older adult peer specialists, in addition to young adult peer mentors. Co-workers known as recovery coaches work in many areas of addiction treatment.

While the specialists won’t solve the broader shortage of mental health workers, they expand options for patients and providers, said Amie Sica, director of recovery and peer services at Riversides. Some Riverside youth may spend much of their time with a young adult mentor. Other treatment plans will be more focused on psychiatry or sessions with a social worker.

That works, Sica said, because the state Medicaid program gives community behavioral health centers a blanket payment for mental health care and lets the centers decide how to spend it.

The bundled rate gives us much more flexibility to meet the individualized needs of each person who works at our doors, Sica said.

The states’ largest private insurers have not established a similar arrangement with community behavioral health centers, so patients with private insurance typically don’t have access to all the options, including the young adult mentors that Nathaniel receives.

That’s one way Massachusetts lags behind other states, said Dr. Ken Duckworth, medical director of the National Alliance on Mental Illness. He would like to see support for peer specialists grow rapidly.

There isn’t a big push to create more psychiatrists, psychologists and social workers, Duckworth said. So the opportunity is for peer support to become a material part of the equation of what helps people get better.