Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .
Employers often place peer support specialists in administrative staff roles, like driving people to and from appointments, said Jessi Davis, former president of the National Association of Peer Supporters and current Senior Program Coordinator of South Southwest Mental Health Technology Transfer Center (MHTTC) at the University of Texas at Austin.
Davis notes that, in mental health services, peer specialists have long been referred to as paraprofessionals. “The definition of a paraprofessional is someone who assists a professional in their job,” she said. “That’s not what we do.”
The lack of understanding of the peer role hinders the implementation of peer support services in organizations that have taken steps to hire peers.
In a prior job, Davis had to explain her role to colleagues. Her first day was bumpy. The employer didn’t let staff know she was starting, nor did they provide an orientation.
“My colleagues had me watch front desk staff check people in because that was closest to what they thought I’d been hired to do,” she said. Davis spent much of her time with the organization teaching colleagues about peer support as opposed to providing peer support. “That’s not uncommon when you’re the first peer at a workplace.”
Before hiring peers, Davis recommends employers do training to understand the peer support specialist role. She referenced a training by the nonprofit Mental Health Resource of Texas (known publicly as Via Hope) called “Demystifying the Peer Workforce: Ethical Considerations for Non-Peer Professionals.”
“Organizations that want a regional or local training can reach out to their Mental Health Technology Transfer Center, MHTTC,” she said.
A frequent mistake organizations make is hiring just one peer. “Employers often want to start with one and see how it goes,” said Davis, adding that doing so places tremendous stress on the peer to be the only person providing peer support services. “It also means the service isn’t available if the peer is out sick or on leave.”
Where there’s only one peer support specialist, that person is at a higher risk of “role drift,” making it more likely that they’re tasked with administrative jobs or asked to step into a therapist’s role, like running group therapy. It’s important to note that peer support specialists aren’t trained to provide therapy and can’t step into the therapist’s role even if asked.
Miscategorizing the peer support specialist role as paraprofessional also means peers are often underpaid. In 2016, a national survey on peer support specialist compensation revealed peers earned an average hourly wage of $15.42. A peer workforce survey conducted by Davis’s employer, the Texas Institute for Excellence in Mental Health at the University of Texas at Austin, indicated that much has stayed the same, at least in Texas. The average hourly wage for peers in 2021 was $16.30. The median, at $15.81, was lower. Davis shares that post-Covid, she believes pay is improving.
“Pre-Covid, I’d see positions consistently posted for $12, $13, $14 an hour,” she said. “Recently, I’m seeing growth, with wages around $20 per hour, but that’s still not the norm.”
A challenge to tracking peer pay is that the U.S. Department of Labor combines data on peers with that of community health workers. Clumping the data, notes Davis, gives the false impression of a different national pay average of around $49,900, with a mean hourly wage of $23.99.
“We are advocating to get our own standard occupational code within the Department of Labor,” she said. “Community health workers seem to support this [separation] because rolling us together also messes up their data.”
When employers don’t pay peer specialists a living wage, it is detrimental to the people receiving services and the organization’s ability to provide them. “You’re going to lose your peer supporters if they can’t afford an apartment in the city where they work,” said Davis.
Without sustainable and adequate funding, access to peer support services is limited. While most states reimburse for peer services, which ones they reimburse varies; many state mental health agencies report that Medicaid reimbursement rates are too low.
Employment barriers also hinder the development and implementation of peer support programs, including policy relics that contradict a state or community’s intent to support and build out its peer workforce. Davis shares that many states are trying to address the misalignment.
“In Texas, we’ve worked really hard to make sure that mental health peer support specialists didn’t have more restrictive requirements or background checks than our licensed chemical dependency counselors,” she said.
Unlike the corporate workforce, which suggests that a person’s professional growth and pay may benefit from changing jobs every 2-4 years, Davis points out that the peer support role is far more focused on building relationships with the people they’re helping. In Texas, the average employment tenure for peers in 2021 was 5.3 years. The median was 4.3 years.
“What we do is so deeply tied into the relationships we build with the people we work with,” she said, adding that high turnover degrades the efficacy of peer support programs.
The emphasis on relationships and the collaborative process of peer supporters make peer respites — home-like, short-term residential centers staffed with peers that divert people from the emergency room and inpatient hospitalization — an integral part of the crisis continuum.
“People can voluntarily go and take a break from whatever is creating the crisis and have the space and support to get out of the crisis,” said Davis.
She’s witnessed the benefits of peer respite. A close friend lost their housing because of rising living costs. They were at risk of living in their car. “That can be a crisis for anyone,” said Davis, “and it worsened their mental health.” The friend went to a peer respite for a week, receiving peer support from peers and connecting to community resources.
“It was a mental health informed space and my friend was cared for,” she said.” “That helped them get through a hard time. That kept them out of the emergency room and from living out of their car.”
