Peer Support within Criminal Justice Settings: The Role of Forensic Peer Specialists

The CMHS National GAINS Center
Larry Davidson, Ph.D., and Michael Rowe, Ph.D.

May, 2008

The past decade has witnessed a virtual explosion in the provision of peer support to people with serious mental illness, including those with criminal justice system involvement. Acting on one of the key recommendations of the President’s New Freedom
Commission on Mental Health, 30 states have developed criteria for the training and deployment of “peer specialists,” while at least 13 states have initiated a Medicaid waiver option that provides reimbursement for peer-delivered mental health services.

What Is Peer Support?

While people in recovery can provide conventional services, peer support per se is made possible by the provider’s history of disability and recovery and his or her willingness to share this history with people in earlier stages of recovery. As shown in Figure 1, peer support differs from other types of support in that the experience of having “been there” and having made progress in one’s own personal recovery comprises a major part of the support provided.

Forensic peer support involves trained peer specialists with histories of mental illness and criminal justice involvement helping those with similar histories. This type of support requires special attention to the needs of justice-involved people with mental illness,
including an understanding of the impact of the culture of incarceration on behavior. Recognition of trauma and posttraumatic stress disorder, prevalent among this population, is critical.

What Do Forensic Peer Specialists Do?

Forensic Peer Specialists assist people through a variety of services and roles. Given the history of stigma and discrimination accruing to both mental illness and incarceration, perhaps the most important function of Forensic Peer Specialists is to instill hope and serve as valuable and credible models of the possibility of recovery. Other roles include
helping individuals to engage in treatment and support services and to anticipate and address the psychological, social, and financial challenges of reentry. They also assist with maintaining adherence to conditions of supervision.

Forensic Peer Specialists can serve as community guides, coaches, and/or advocates, working to link newly discharged people with housing, vocational and educational opportunities, and community services. Within this context, they can model useful skills and effective problem-solving strategies, and respond in a timely fashion to prevent or curtail relapses and other crises. Finally, Forensic Peer Specialists provide additional
supports and services, including:

• Sharing their experiences as returning offenders and modeling the ways they advanced in recovery
• Helping people to relinquish attitudes, beliefs, and behaviors learned as survival mechanisms in criminal justice settings (such as those addressed by SPECTRM [Sensitizing Providers to the Effects of Incarceration on Treatment and Risk Management] and the Howie T. Harp Peer Advocacy Center)
• Sharing their experiences and providing advice and coaching in relation to job and apartment hunting
• Supporting engagement in mental health and substance abuse treatment services in the community, including the use of psychiatric medications and attending 12-step and other abstinence-based mutual support groups
• Providing information on the rights and responsibilities of discharged offenders and on satisfying criminal justice system requirements and conditions (probation, parole, etc.)
• Providing practical support by accompanying the person to initial probation meetings or treatment appointments and referring him or her to potential employers and landlords
• Helping people to negotiate and minimize continuing criminal sanctions as they make progress in recovery and meet criminal justice obligations.
• Working alongside professional staff
• Training professional staff on engaging consumers with criminal justice history

How Forensic Peer Specialists Can Help Transform Mental Health Services and Linkages Between Systems

Forensic Peer Specialists embody the potential for recovery for people who confront the dual stigmas associated with serious mental illnesses and criminal justice system involvement. Forensic peer specialists are able to provide critical aid to persons in the early stages of re-entry, in much the same way that peer specialists who support
peers with mental illness alone (i.e., without criminal justice system involvement), have been able to engage into treatment persons with serious mental illnesses (Sells et al., 2006; Solomon, 2004). Beyond the initial engagement phase, however, little is known empirically about the value Forensic Peer Specialists add to existing services. Nonetheless, in the limited number of settings in which they have been supported, case studies clearly suggest using Forensic Peer Specialists is a promising, cost effective practice.

Five Things Your Community Can Do to Integrate Forensic Peer Specialists in Services and Supports

1. Identify and educate key stakeholders, including consumers, families, victims’ rights organizations, mental health care providers, criminal justice agencies, and peer-run programs regarding the value of Forensic Peer Specialists.
2. Convene focus groups with these constituencies to assess the demand for trained Forensic Peer Specialists and to identify barriers to their employment.
3. Identify and contact potential funding sources such as state vocational rehabilitation agencies, local and state departments of health, and the judiciary.
4. Work with human resources departments of behavioral health agencies to identify and
   overcome bureaucratic obstacles to hiring Forensic Peer Specialists, such as prohibitions to hiring people with felony histories.
5. Address stigma within both the local community and the larger mental health and criminal justice systems so that people with histories of mental illness and criminal justice involvement will be more readily offered opportunities to contribute to their communities.

Future Directions

Little attention has been paid to the nature of training and supervision required by  Forensic Peer Specialists, Study in this area would ensure that systems of care are able to reap the maximum benefit from the contributions of Forensic Peer Specialists. Future directions should involve systematic efforts to design and evaluate training curricula, and to build on and expand current knowledge about the effectiveness of forensic peer services through research and information sharing. Future work should also involve creating clear roles, job descriptions, and opportunities for advancement in this line of work. In addition, for this alternative and promising form of service delivery to mature, barriers to the implementation and success of Forensic Peer Specialist work, including non-peer staff resistance, the reluctance of behavioral health agencies to hire people with criminal justice histories, and state criminal justice system rules forbidding exoffenders from entering prisons to counsel returning offenders, will need to be addressed.

Resources

Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D. & Tebes, J.K. (1999). Peer support among individuals with severe mental illness: A review of the evidence. Clinical Psychology: Science and Practice, 6:165-187.

Davidson, L., Chinman, M., Sells, D. & Rowe, M. (2006). Peer support among adults with serious mental illness: A report from the field. Schizophrenia Bulletin, 32:
443-450.

Felton, C.J., Stastny, P., Shern, D., Blanch, A., Donahue, S.A., Knight, E., & Brown, C. (1995). Consumers as peer specialists on intensive case management teams: Impact on client outcomes. Psychiatric Services, 46: 1037-1044.

Lyons, J.S., Cook, J.A., Ruth, A.R., Karver, M., & Slagg, N.B. (1996). Service delivery using consumer staff in a mobile crisis assessment program. Community Mental
Health Journal, 32: 33-40.

Mowbray, C.T., Moxley, D.P., Thrasher, S., Bybee, D., McCrohan, N., Harris, S., & Glover, G. (1996). Consumers as community support providers: Issues created by role innovation. Community Mental Health Journal, 32: 47-67.

Rowe, M., Bellamy, C., Baranoski, M., Wieland, W., O’Connell, M., Benedict, P., Davidson, L., Buchanan, J. & Sells, D. (2007). Reducing alcohol use, drug use, and
criminality among persons with severe mental illness: Outcomes of a Group- and Peer-Based Intervention. Psychiatric Services, 58(7): 955-961.

Sells, D., Davidson, L., Jewell, C., Falzer, P., & Rowe, M. (2006). The treatment relationship in peer-based and regular case management services for clients
with severe mental illness. Psychiatric Services, 57(8): 1179-1184.

Sherman, P.S., & Porter, R. (1991). Mental health consumers as case management aides. Hospital and Community Psychiatry, 42:494-498.

Solomon, P.S. (2004). Peer support/peer provided services: Underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal, 27(4): 392-401.

Solomon, P.S., & Draine, J. (1995). The efficacy of a consumer case management team: Two year outcomes of a randomized trial. Journal of Mental Health Administration, 22:135-146.

Solomon, P.S., Draine, J., & Delaney, M.A. (1995). The working alliance and consumer case management. Journal of Mental Health Administration, 22:126-134.

Stoneking, B.C., & Greenfield, T. (1991). Adding trained consumers to case management teams as service coordinators.Paper presented at the Annual Meeting of the American Public Health Association, Atlanta, Georgia.

Recommended citation: Davidson, L., & Rowe, M. (2008). Peer support within criminal justice settings: The role of forensic peer specialists. Delmar, NY: CMHS National GAINS Center.

 

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