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Peers Give Hope to Mental Health Patients

Pilot Project Offers Support With Mental Crises in Bid to Prevent Needless Hospital Admissions

By Tony Leys Indianapolis Star ��February 26, 2012

Decorah, IA.��–�� Phyllis Taylor resisted her son’s demand that she go to the emergency room for psychiatric help after she threatened to kill herself last August.

Taylor, 83, was despondent over her husband’s entry into a nursing home’s dementia unit and her own move to a small apartment in a town where she knew hardly anyone.

“I said, ‘I wish I was dead. Everybody would be better off,’ ” she recalled. “My son heard that and said, ‘We’re going to the hospital.’ ”

She feared that if she went to the local emergency room, she would be carted off to another city and locked up in an unfamiliar place. That happens often in Iowa, where few small-town hospitals have inpatient psychiatric units – or even psychiatrists.

Her son took her to Winneshiek Medical Center anyway, and Taylor found unusual support there from a woman who’d walked in her shoes. “Now I know that it was probably the best thing that could have happened,” Taylor said of her trip to the hospital.

Taylor was one of the first clients of a pilot project that pairs psychiatric patients in emergency rooms with specially trained “peer support specialists,” who have learned to cope with their own mental illnesses.

State leaders hope to expand the idea across Iowa to help prevent people with mental health crises from being locked needlessly in psychiatric wards. The peer supporters work alongside physicians and professional counselors to help calm patients and see whether they could cope outside the hospital if they had extra support.

“We’re here to say, ‘There is help out there – you’re not stuck,’ ” said Connie Bourassa, the peer supporter who was matched with Taylor. Bourassa, 58, of Cresco, attempted suicide seven years ago after losing her marriage, her home and her job. She remembers how lonely she felt in the overburdened mental health system.

After three days of inpatient treatment, hospital officials said they were sending her back home. “I was like, ‘Back home to what?’ ” she recalled.

Bourassa eventually found a good therapist, who helped her see a path to recovery and recommended that she apply to become a peer supporter. She now performs the service and trains others to do so.

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Offering someone who can understand

Bourassa remembers the day last August when she was called to the Decorah hospital to meet with Taylor. The older woman already had seen a doctor, but she mainly needed to talk to someone who understood her. Taylor said Bourassa mentioned her own experience with depression, but didn’t dwell on it.

“I probably didn’t give her a chance to get a word in,” Taylor recalled with a smile. “I think I kept her up until 4 a.m., just listening to my blabbing.”

Taylor talked about the pain of seeing her husband of 63 years, Wallace, move into a dementia care unit in Ossian. She talked about selling their big home in Storm Lake and moving to a little apartment 225 miles away in Decorah, so she could be near her son. She talked about having to give up her beloved cat and most of her belongings. “It was just too much,” she said, tearing up.

Taylor continues to have regular appointments with a psychiatrist and a licensed therapist. But she said she’s closest to Bourassa. “I don’t know where I’d be without Connie,” she said. “She’s my crutch.”

Too often, the public hears only about people who fail to recover from mental illness. They don’t see the thousands of Iowans who quietly learn to cope with it and lead rewarding lives.

Victoria Oestmann, who also works as a peer supporter, sees her role as helping patients understand that their crises should pass.

“Sometimes it’s not about people getting totally better. Sometimes it’s about people having a better quality of life,” said Oestmann, 60, of Fort Atkinson. “They might still have that diagnosis of schizophrenia or depression or whatever, but that doesn’t have to define who they are.

“The first thing they think about themselves doesn’t have to be that they’re bipolar or something. We need to help people realize that the first thing when you introduce yourself is not your diagnosis. The first thing could be, ‘I like dogs,’ or ‘I’m a grandma.’ ”

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Not a replacement for professionals

Oestmann, who has been treated for depression and anxiety, stressed that the peer supporters are not meant to replace psychiatrists or professional counselors.

“We’re not coming in here and waving some kind of magic wand to make everything better,” she said. “We’re kind of a first-line response. It’s a first-aid kind of thing.”

Also, they’re called in only for fairly low-key cases. Patients who are completely out of control are likely to be sent directly to a psychiatric hospital.

State officials hope to add similar services elsewhere as part of an overhaul of Iowa’s mental health system. “There’s the potential for the general concept to spread to many places in Iowa and to provide tremendous support,” said Rick Shults, a Department of Human Services administrator overseeing the system.

Shults predicted that peer support programs would be included in core services that new regional mental health agencies would have to offer under the reform plan being considered by the Legislature. He said the state would give the regions latitude in deciding how to set up such programs, but it would not allow them to replace professional counseling or treatment.

“The key is to make sure we’re not trying to apply this service to someone who needs something more intense,” he said.

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Study: With support, fewer readmitted

The idea is fairly new here, but it has been used elsewhere for years.

Yale University psychiatry professor William Sledge, who has studied such programs, said they have grown in popularity recently. Sledge published a study last year that found psychiatric patients who received peer support were less likely to be readmitted to Yale-New Haven Psychiatric Hospital, where he is medical director. However, he said it will be a while before large, definitive studies can determine exactly how well the programs work and whether they save money.

Sledge said it’s important that the peer supporters see themselves as providing comfort and emotional support instead of therapy.

“They don’t substitute for professional care, they enhance it,” he said. “You have to be careful that you don’t consider it a replacement.”

He also said peer supporters should have continuous training and should check in often with trainers to make sure they’re giving the right advice.

“It’s actually very hard work for the people providing the service,” he said. “They see people making the same mistakes they made, and they want to argue with them – and arguing doesn’t help.”

Professional counselors generally are discouraged from sharing too much about their personal histories. But Sledge said the peer supporters’ role is different. They gain credibility by sharing their experiences, the same way Alcoholics Anonymous sponsors gain trust by divulging their pasts.

Sledge noted that other medical areas have used similar ideas. For example, he said, cancer survivors often volunteer to help support current patients.

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How the Project Works

The peer-support pilot project is run by Northeast Iowa Behavioral Health, which is headquartered in Decorah. It also serves hospitals in Guttenberg, Elkader and Waukon.��
Marcia Oltrogge, who runs the agency, said the project is running on a two-year, $236,000 state grant. The five peer supporters make up to $29,000 each per year. To qualify, they must show that they’re stable and that they have a good handle on their mental health problems. They undergo a weeklong training program, which includes ethics lessons, plus follow-up training. Among other things, they learn how to mention their own experiences without losing focus on clients’ problems.��

Victoria Oestmann, who works as a peer supporter, said that unlike busy medical staff members, she has lots of time to spend with patients, to soothe them and hear them out. She also can help them with important non-medical tasks, such as finding a place to stay if they need it.��

She can help buy time while emergency-room doctors, who usually are general practitioners, determine whether it would be safe to send patients home instead of having them committed to an inpatient psychiatric unit. Under the rules of the program, staff members have 23 hours to determine if hospitalization is needed. The answer usually is no, but sometimes commitments are ordered.

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