1. Supports: An Abridged History and Research of
Peer1, CPS2, CSX3 Programs Supporting
Outcomes
Who then can so softly bind up the wound of another as he who has felt
the same wound himself?
--Thomas Jefferson
Brief History of Peer Support
It can be reasonably argued that peer support—the act of a person with the same or similar experience
helping another—is as old as humanity itself. Indeed, early man learned to work co-operatively for
food gathering and shelter purposes. These early people had shared experiences and it was through that
co-operation they survived. Later, the early Greeks and Romans learned that peer support had a
valuable role on the battlefield and soldiers were encouraged to form trusting, supportive bonds to
enhance their fighting abilities and care for each other in battle.4
In more contemporary times, peer support was recognized for mental health and substance use
disorders as early as 1838. At least three of the 13 original founders of the American Psychiatry
Association expressed the need for asylum patients to socialize so as to discuss illnesses.5 “Patients are
often much interested in the delusions of their neighbors, and by their effort to relieve the affliction of
others, frequently do much toward getting rid of their own.6
Peer support and other social and environmental concerns languished after the moral treatment period
ended around the turn of the 20th Century, although vestiges existed until the 1920s.7 In the 1960s, the
Civil Rights Movement fostered basic human rights principles such as self-determination, dignity and
1
“Peer” refers to a person with a psychiatric condition or a history of such a condition.
2
“CPS” means “Certified Peer Specialist” and refers to a person who is trained and employed to use his/her recovery
experience to help others similarly situation.
3
“CSX” means a person or persons who are “consumers,” “survivors” and/or “ex-patients.”
4
Peer support prevails in contemporary military organizations, especially in special forces units.
5
Caplan, R.B. (1969). Psychiatry and the Community in Nineteenth-Century America: The Recurring Concern with
Environment in the Prevention and Treatment of Mental Disorder. Basic Books, New York: NY.
6
Kirkbride, T.S. (1854-55). In The American Journal of Insanity, XI, p. 143.
7
Johnson, H. (2001). Angels in the Architecture: A Photographic Elegy to an American Asylum. Wayne State University
Press, Detroit, Mich. See also: Tomes, N. (1984). A Generous Confidence: Thomas Story Kirkbridge and the Art of Asylum-
Keeping, 1840-1883. Cambridge University Press, Cambridge: Mass.
Supports: An Abridged History and Research of Peer, CPS, CSX Programs Supporting Outcomes Page 1

2. choice. But, generally, that movement did not encompass the rights of those with psychiatric
conditions and/or substance use disorders.8
During the 1970s and 80s, as mental health treatment shifted from long-term institutional care to
community-based care, the peer voice emerged loud and clear. That voice advocated changes in the
way in which mental health (and to some extent substance use disorder) services were delivered and by
whom.9 Disparities between physical and mental health care in the 1990s to the present became more
evident to more people as advocates from diverse backgrounds exposed inadequate care if not outright
abuse.10
As the voice of peers grew louder and was persistently heard, peer support services
emerged and became formalized with training requirements and government-
sponsored certification. Self-help groups and a variety of peer-run mental health and
substance use disorder services emerged by the end of the 1990s.11 At the same time,
peers became recognized as change agents helping to transform “legacy” services to
more progressive, recovery-oriented services.12
Peer support is vital toLate in 2004, the National Association of Peer Specialists (NAPS) was formed in
my recovery journey. Michigan and quickly became a recognized membership-based organization for
peer supporters across the U.S. Three years later, the first national peer specialist
--Susan Meekhof
conference was held in Denver, CO and brought together more than 225 peer
supporters. The organization has sponsored annual conferences since their
inception. The association has also published a quarterly newsletter, performed job
satisfaction/compensation research and maintained a website. NAPS has also provided technical
assistance to state officials establishing peer support programs and has promoted peer support
throughout the U.S. and internationally.13,14
Outcomes
Beginning in the later 1990s, a relative “handful” of social researchers performed diverse studies
focusing on peer support. These initiative efforts focused primarily on implementation issues, such as
the “why,” “where,” “when,” and “how” of peer support. In the last decade, other studies have
8
MaAdame, A.L. & Leitner, L.M. (2008). Breaking out of the mainstream: The evolution of peer support alternatives to the
mental health system. Ethical Human Psychology and Psychiatry, Vol. 10, 3.
9
Ibid.
10
Boyle, P.J. & Callahan, D. (1993). Minds and hearts: Priorities in mental health services. The Hastings Center Report, Vol.
23, 5. See also: Davidson, L., Harding, C. & Spaniol, L. (2005). Recovery from Severe Mental Illnesses: Research Evidence
and Implications for Practice. Center for Psychiatric Rehabilitation, Boston University, Boston, Mass.
11
Swarbrick, M., Schmidt, L.T. & Gill, K.J. [Eds.] People in Recovery as Providers of Psychiatric Rehabilitation: Building on
the Wisdom of Experience. U.S. Psychiatric Rehabilitation Association, Linthicum, MD.
12
MaAdame & Leitner, (2008) and Boyle & Callahan, (1993).
13
National Association of Peer Specialists. (2010). Recovery to Practice: Situational Analysis for the National Association of
Peer Specialists. (Author). Grand Rapids, Mich.
14
In 2012, the organization will officially change its name to “InterNational Association of Peer Specialists” to recognize
members and conference attendees from the United Kingdom, Japan, Australia, Puerto Rico, Canada and other countries.
Supports: An Abridged History and Research of Peer, CPS, CSX Programs Supporting Outcomes Page 2

3. examined outcomes, i.e. “Is peer support effective and, if so, why?” This second generation of research
has been performed by dozens of highly respected social scientists.15
What has been found? Evidence shows peer support:
 Is often as effective as services provided by “traditional” mental health professionals16
 Can significantly reduce rehospitalizations and associated costs17
 Helps peers establish supports and relationships in their communities18
 Increases personal empowerment19,20
 Introduced beneficial treatment alternatives to traditional services21
 Has become Medicaid reimbursable in a growing number of states22
 Has resulted in peer-run service organizations in areas where legacy programs have been slow
to change to a recovery orientation23
 Has expanded to include diverse workforce niches.24
In addition to serving mental health users, peer supporters Peer support is finding
serve those with substance use disorders, the elderly, youth, places in mental health,
substance abuse, prisons
and peers in forensic settings (courts, jails, prisons). Peer and jails and among
supporters also act as educators in their communities and youth and the elderly.
.
--Antonio Lambert
15
MaAdame, A.L. & Leitner, L.M. (2008).
16
Bologna, M.J. & Pulice, R.T. (2011). Evaluation of a peer-run hospital diversion program: A descriptive study. American
Journal of Psychiatric Rehabilitation. 14: 272-286.
17
Bergeson, S. (2011). New Report Reveals Mental Health Cost Savings Through Peer Support, NAPS Newsletter, Spring,
2011, Vol. 7; 2.
16
Ashenden, P. (2012). Personal communication, March 14, 2012.
17
Chinman, M., Hamilton, A., Butler, B., Knight, E., Murray, S. & Young, A. (2008). Mental Health Consumer Providers: A
Guide for Clinical Staff. Rand Health, Pittsburgh, PA. Downloadable from www.rand.org, search for publication: tr584.
18
Townsend, W. & Griffin, G. (2006). Consumers in the Mental Health Workforce: A Handbook for Providers. National
Council for Community Behavioral Healthcare, Rockville: MD.
19
MaAdame & Leitner, (2008).
20
Eiken, S. & Campbell, J. (2008). Medicaid Coverage of Peer Support for People with Mental Illness: Available Research
and State Examples. Healthcare, Thomson Reuter, Baltimore: MD.
21
Ibid.
22
Gill, K.J., Murphy, A.A., Burns-Lynch, W. & Swarbrick, M. (2009). Delineation of the job role.
23
National Association of Peer Specialists, (2010).
24
MaDame & Leitner, (2008).
Supports: An Abridged History and Research of Peer, CPS, CSX Programs Supporting Outcomes Page 3

4. within service agencies and provide vocational and academic peer support. Peer support tasks are also
becoming increasingly diverse as peers explore ways to exploit their strengths, talents and gifts for the
benefit of others. Those tasks include, but are not limited to: facilitating support groups, connecting
others with community resources, life enrichment, community and social inclusion activities, research
and administration.25
More than two decades of contemporary use of peer support in mental health and substance use
disorder treatment services has proven the value of peer support in both settings. Despite an impressive
body of credible evidence and support by federal government agencies, issues remain regarding the
recruitment, hiring, training and task assignment.
Needs
As peer support establishes itself as a profession, important needs have emerged. These needs are
viewed as part of a natural process of the discipline’s development and include:
 Greater use of peers as service providers in meaningful ways
 Establishment of a national certification program instead of state-by-state control
 Creation of a national database of peer supporters throughout the U.S.
 Establishment of a “career ladder” through recognition and respect of one’s “lived experience”
as opposed to heavy or sole reliance on academic credentials
 Systematic continuing education process and system
 Increased support of agency co-workers, administrators and government officials
 Greater access to Medicaid reimbursement for peer support services
 Funding stability for peer support services
 Greater number of peers in leadership roles including policy making and organizational
leadership
Serious questions remain as to who will lead the peer support movement and how. Incumbent peer
leaders are already hard-pressed as they have taken on leadership duties for a variety of mental health
and substance use disorder organizations. In addition, these leaders are working diligently in local and
state venues to introduce or expand peer support in a variety of contexts. Without
focused attention—and quickly—on the peer leadership
Lived experience is not
“pipeline,” the movement risks the loss of incumbent enough. We must be
leaders leaving lessons to be relearned. Feeding the peer recognized as the
leadership pipeline falls heavily on peers but assistance professionals we are.
from other disciplines and financial support for training
are of increasing importance. --Lyn Legere
This document was drafted by Steve Harrington, Executive Director of the National Association of Peer Specialists and does
not necessarily reflect the views of other persons or organizations.
25
National Association of Peer Specialists. (2008). Compensation and Satisfaction Survey Report. NAPS Newsletter,
Winter, 2008. Vol. 8, No. 1.
Supports: An Abridged History and Research of Peer, CPS, CSX Programs Supporting Outcomes Page 4

5. To comment on this presentation or for more information, contact:
Lead Presenter: Jen Padron,
Office (817) 263-HOPE (4673);
Mobile (512) 966-6830;
jenpadron@me.com
Supports: An Abridged History and Research of Peer, CPS, CSX Programs Supporting Outcomes Page 5