This year marked the milestone celebration of peer support being a Medicaid-billable service for 25 years, with the first state doing so in 1999. While this is monumental, there’s still much room for growth across the country in truly integrating peers into the mental health and crisis services landscapes. With the help of the Centers for Disease Control and Prevention’s Overdose Data to Action Grant, Arkansas has been a pioneer in demonstrating the value of lived experience by embedding peer support workers into their 988 Suicide and Crisis Lifeline work since 2020. [In July 2022, SAMHSA’s National Suicide Prevention Lifeline was renamed the 988 Suicide & Crisis Lifeline (988 Lifeline). SAMHSA funds the 988 Lifeline. Vibrant Emotional Health (Vibrant) is the 988 Lifeline national administrator.]
The Arkansas Department of Health also understood the importance of the connection between mental health and substance use services for the community. It was the Department’s leadership and the CDC’s grant that together provided the opportunity to integrate substance use support and suicide prevention efforts by incorporating peer support specialists into their Arkansas Lifeline Call Center. The center is one of over 200 local crisis centers across the U.S. and territories that are a part of the 988 Lifeline national network.
We recently sat down with the Arkansas Department of Health’s Aaron Milligan, injury prevention section chief, and Ashley Costa, suicide prevention program manager, to talk about their experience and how lived experience has benefited community members contacting them. Milligan started her career as the state’s first certified peer recovery specialist at the Arkansas Lifeline Call Center and is credited for implementing the department’s first Peer Service Program. Costa was initially hired to continue the growth of the peer service program.
To answer 988 calls as a peer support suicide prevention call center specialist at the Arkansas Lifeline Call Center, peers must apply and complete the peer recovery specialist certification through the Arkansas Department of Human Services. This certification requires that peers have two years in recovery, over 30 hours of training and an additional 500 work or volunteer hours as a peer. They must also complete Vibrant’s foundational 988 trainings (not peer-specific) that are required for all crisis counselors answering the 988 Lifeline.
When asked what a typical peer support suicide prevention call center specialist shift looks like, Milligan and Costa say it mirrors that of a suicide prevention call center specialist with the additional role of conducting scheduled follow-up calls for those who would like to connect with a peer for additional support. To help other staff who aren’t peers better understand the role of peers, they developed a training illustrating what peers do and how that relates to and benefits crisis services, especially the center’s 988 services. Costa shares that her lived experience fosters common ground. “Whenever I could talk about my personal experience and find a commonality between what I had gone through and what they were currently going through, I could talk to them about the things that worked for me — and the things that didn’t work for me — and help them create their own [safety] plan.”
One of the biggest advantages of uniting peer support with the Arkansas Lifeline Call Center, emphasized by Milligan and Costa, was the ability to connect almost instantly with the person reaching out to the center via 988. Building rapport and trust during a 988 Lifeline interaction is crucial in providing effective and person-centered support. However, building rapport and trust often takes crisis counselors time, and that time can feel very limited in a crisis. One of Arkansas’ peer support suicide prevention call center specialists shared, “As soon as a caller hears that I am in recovery, the door opens, and I have their trust. They know that I am there to support them and not judge them.” Additionally, they have found that from the help-seekers’ perspective, peer support has provided another layer of legitimacy and authenticity to the Arkansas Lifeline Call Center. That is, the center doesn’t just use training and textbook data as tools when answering 988 calls; they can also provide support with real-life experience from those who have been there themselves and recovered. “It saved my life being able to talk to someone who’s been in my situation instead of being listed things from a textbook,” said Milligan. It opened my eyes to see that recovery is possible.” Costa added, “The whole goal is to save lives and doing whatever it takes to make that happen, then that’s what needs to happen. We [peers] can still cover all of the bases [while utilizing our lived experience].”
There’s a persistent myth that incorporating peers into the 988 Lifeline could adversely affect the peer support specialist’s recovery. Milligan responds to this by emphasizing that her lived experience is a strength, not a trigger. “I lost my brother to suicide, and I had already lost my father to suicide in 2007,” she said. “Instead of that being a trigger, I thought to myself, ‘Well, I had all the tools necessary to be able to try to fix or manage or control the situation.’ When, in reality, I did everything I could on my part, and that wasn’t for me to carry… I didn’t keep that as a heavy blanket like I used to when I first lost my father to suicide.”
Additionally, the Arkansas Lifeline Call Center has cultivated a work culture that focuses on their staff’s mental well-being, healthy boundary setting and self-care to support them with handling the stress that can accompany their lifesaving work. Being a program of the Arkansas Department of Health, the center has a robust Employee Assistance Program offering multiple counseling sessions that employees can access numerous times and allowing them to seek professional help anonymously. They also provide internal support to one another, such as promoting self-care, debriefing sessions after heavy calls and encouraging the team to use their management’s open-door policy of always being available to talk.
When asked about the future of peer support and the Arkansas Lifeline Call Center, Milligan and Costa say the goal is to continue increasing the number of peer support suicide prevention call center specialists. They’ve also offered support to other states and 988 Lifeline centers interested in incorporating peers into their 988 Lifeline work to reach out. Costa elaborates, “We’ll talk about the process and support every step of the way. We feel that it’s important that we promote the program.”
Speaking as peers, Milligan and Costa also wanted to convey that peers help people every day, emphasizing that being part of the 988 Lifeline is just another way of supporting people at their most vulnerable time.
This article is reported and written in collaboration with the National Association of State Mental Health Program Directors (NASMHPD) and Vibrant Emotional Health — the nonprofit that operates the SAMHSA-funded 988 Suicide & Crisis Lifeline.
