From Crisis to Recovery: On Becoming a Peer Specialist and Collaborating with Other Behavioral Health Professionals

Origins of my career

How does one become a peer specialist? Diagnosed after my first suicide attempt in 1973 with “manic-depression”—that’s what bipolar disorder was called then—I managed to pass for what peers jokingly call “chronically normal” as an urban planner for 25 years. Because my younger brother and I experienced mental health challenges since
childhood, our mother, a social worker, became president of our community mental health center.

For years, she mailed me the newsletters of the National Alliance on Mental Illness (NAMI). Finally, in 1998, I became a volunteer for the NYC Metro chapter, speaking at their community meetings, where I was the only peer with bipolar disorder among parents whose loved ones struggled with schizophrenia.

NAMI was founded in 1972 by the mothers of children with schizophrenia in a rebellion against the psychiatric establishment who branded them “schizophregenic” or the cause of their sons and daughters illnesses. Ironically, NAMI would later embrace psychiatry and the pharmaceutical industry, in part, because a biological explanation of mental illness absolved them of blame. More recently, NAMI has recognized the psychological and social risk factors for mental illness, in addition to the genetic ones. But that’s another story.

In 2000, as director of the merchants’ association on Brooklyn’s Atlantic Avenue, I visited the Baltic Street Mental Health Board’s Baltic Bazaar, a fabric store that employed mental health “consumers,” the politically correct term then. I was so impressed by how this “affirmative business” trained my peers for jobs that I became a volunteer there and then joined the agency’s board as the first peer member.

One of my tasks for the merchants’ group was running the Atlantic Antic, the largest street fair in Brooklyn, that required months of 60-hour work weeks in preparation. The high this induced in me led to a crash after the 2002 event; I decided it was time to switch gears professionally.

The Baltic Street Mental Health Board, now the peer-run Baltic Street Advocacy, Employment, and Housing (AEH), had an opening for a job counselor in their assisted competitive employment program. I flunked the first interview out of nervousness, but, thanks to my relationship with the executive director, I obtained the job on the second
try, proving the first rule of job counseling: Who you know is just as important as what you know.

The rest is history but a convoluted one because after three years at Baltic Street and another year at the psycho-social clubhouse, Venture House in Queens, this workaholic experienced a depression lasting five years, including suicide attempts and hospitalizations. I chronicled my eventual recovery in “Saved by Imagination: How Reading and Writing Restored My Mental Health” that was published by psychologist Patrick Corrigan in Coming Out Proud Against the Stigma of Mental Illness (available from Amazon).

Since then I have worked as a peer specialist for a mobile crisis team, hotline, ER, inpatient units, a clinic, day treatment program, a self-help group, another clubhouse, and Baltic Street AEH.

My current peer specialist gigs

Now I’m a peer navigator, working with peers who have experienced psychosis, and have been diagnosed with schizophrenia, bipolar disorder, or major depression, for the Sunset Terrace Family Health Center’s Enhanced Treatment and Recovery (EnTRy) program, funded by the U.S. Substance Abuse and Mental Health Services
Administration (SAMHSA). In addition to clinical treatment and care management, including help with housing, employment, education, and financial benefits, EnTRy provides peer support.

I benefitted from the support of peer specialists during my recoveries. Not only do we peer navigators meet individually with clients in their homes, online, and at the clinic, we facilitate such support groups as Wellness Recovery Action Planning, Wellness in Eight Dimensions, Art, and Recovery at the Movies.

We are planning others, such as Humor and the Healing Arts and Family Education, the latter to be co-led by a social worker. A peer and a social worker also run Staying Healthy out of the Hospital and Hearing Voices groups. A social worker alone runs an adolescent self-esteem group. (I learned my skills as a facilitator with the Mood Disorders Support Group between 2003 and 2006.)

Working for the behavioral health clinic, that offers services for mental illness and substance abuse, does not induce the same kind of adrenalin rush as responding to the suicidal behavior of peers, especially teenagers, during the Covid pandemic, when NYC Well and VNS Health’s Brooklyn Mobile Crisis Team employed me.

Although I no longer help arrange for the transport of people in crisis to hospitals, I do visit inpatients to enroll them in EnTRy at such Brooklyn medical centers as Maimonides, NY Presbyterian-Methodist, and NYU Langone in Sunset Park, the parent organization of the Sunset Terrace Family Health Center. But, working there is more rewarding because I get to witness the progress my peers make over time. Plus, our program requires even more teamwork between peer specialists and social workers than at NYC Well and Brooklyn Mobile Crisis.

Also, as a consultant to Rutgers University’s Psychiatric Rehabilitation Department, I am designing courses for the New York State Academy of Peer Services about older adult behavioral health. With the help of the Geriatric Mental Health Alliance, I convinced New York’s Office of Mental Health that a supplemental peer certification for this purpose was needed. (Advocacy is an important part of being a peer specialist, especially as a volunteer for the New York Association of Psychiatric Rehabilitation Services (NYAPRS). That, too, is another story.)

On not becoming a social worker

I’m proud to have been one of NYC’s first peers to become a certified psychiatric rehabilitation practitioner (CPRP in 2004) and one of the first New York State certified peer specialists (CPS in 2015).

In addition to earning a master’s in environmental health from Hunter College (1988), I was twice admitted to Hunter’s social work school (2006 and 2021) but didn’t attend, first due to a “nervous breakdown” and second because, at age 70, I decided there were better and cheaper ways of spending my time.

Thus, the line of social workers in my family ended with my mother and one of my sisters. (I and my wife, Susan Palm, an artist and a horticultural therapist, don’t have children but we have raised ten unlicensed therapy cats!)
Of course, my best therapists have been social workers, with a shoutout here to Yelena Repka of Maimonides Medical Center, who saved my life on more than one occasion.

She considered me a natural supporter of my peers, especially during group therapy. However, not every social worker has worked with peer specialists who have the gift of engaging and building trust with other patients on the basis of shared experience.

But just as social workers once fought for legitimacy against the psychiatric establishment, and only won their licenses by becoming clinicians themselves, diminishing the community model pioneered by Jane Addams in the 1890s at Chicago’s Hull House, so, we peer specialists have to justify ourselves not just to psychiatrists but also the social workers who currently dominate the ranks of therapists. (Pity the poor psychiatrists who get blamed for everything. Actually, I have worked with many psychiatrists, as well as psychologists, who appreciate what peer specialists do.)

Sure, a few peer specialists become social workers, mental health counselors, or psychiatric rehabilitation specialists (based on a psycho-social rather than a medical model of recovery), just as I once aspired to do. But, I like to say, “scratch a social worker (or any mental health worker for that matter) and you’ll find a peer” because not only did I major in psychology to figure out my own mishigas (Yiddish for “craziness”) but many mental health workers have dealt with psycho-social challenges personally or in their families and friends.

Secondary trauma is not the only reason that clinicians have high suicide rates. The not so dirty secret is that deep down they too are sometimes behavioral health peers.

How peer specialists and social workers can collaborate

Much as I have benefitted from the transference and counter-transference of therapy (working out the unresolved love and hate I have for my mom and dad), it was my social workers’ empathy that grounded our relationship as much as their therapeutic techniques. For empathy based on our lived experience is the stock and trade of peer
specialists.

And, after more than 50 years in therapy, I have learned by osmosis some of the tricks of the trade. That is partly why, after 20 years as a peer specialist, who has passed 57 courses at the Academy of Peer Services, and published more than 100 articles about behavioral health, I prefer to call myself a “peer counselor.” (Anyway, what does “peer
specialist” really mean? Joke: Is “living with” a mental illness like living with a bad roommate or with unpacked baggage?)

But don’t worry! We’re not competing with social workers because, just as they are considered cut-rate clinicians by insurance companies, peer specialists, at best, earn half of what social workers do. Yet, according to SAMHSA, peer specialists and social workers both provide an evidence-based practice that is effective at relieving mental health conditions.

So, how can we work together? For better and worse, the medical model still predominates, which is why there are more than 500 diagnoses in the Diagnostic and Statistical Manual or DSM5, many overlapping if not contradictory. As Dr. Thomas Insel, head of the National Institute of Mental Health, famously said, psychiatry is more an art
than a science.

We can begin by agreeing that not only is mental illness a mystery—and who knows how long researchers will be scrounging around for the genes and neural pathways at its base—but recovery from it and substance abuse is a crapshoot, even with the support of the best practitioners of the art.

Here is where humility and faith enter. As a Jew turned member of the Religious Society of Friends (Quakers), I have Sigmund Freud and all his Abrahamic inheritors on one side of my cultural tree. On the other, Quakers have practiced “moral treatment” of mentally ill folks since the 1790s, including founding the first private psychiatric hospital in the U.S. (Friends Hospital still operates in Philadelphia and the Thomas Scattergood Foundation, named for the founder, is a major supporter of behavioral health care innovations.)

Dare I say, my recoveries have been the kinds of rebirths that qualify as minor miracles, even if their divine origins are open to speculation. Essential to those rebirths has been my ability to pass on the gift of new life to my peers using empathy and the catechism of motivational interviewing or OARS (Open-ended questions, Affirmations, Reflective listening, and Summarizing collaborative problem-solving) Once again, if I scratched any social workers worth their salt, I would find that the momentum of OARS plus faith rather than the almighty dollar is what keeps them going.

Ultimately, we can learn from each other. Social workers can build on their empathy by sharing a little of their own struggles (without the fear of being unprofessional) and peer specialists can model recovery by being more goal-oriented (without the fear of being “co-opted,” an infamous accusation by the peer movement’s trend-setters.)

This collaboration is the third story of this essay requiring elaboration, for, as David Granirer, founder of the comedy program, Stand Up for Mental Health, taught me, punch lines work best when they come in threes. (Forgive me if I say this is the comic’s holy trinity.)

In other words, social workers and peer specialists are in this recovery boat together, for which we have to improvise OARS. But, that boat is often more like a life raft, the metaphor Doris Lessing employed in her novel, Briefing for a Descent into Hell, the most imaginative description of psychosis I have read.

And, with a master’s in comparative literature and 50 years as an arts reporter, I can vouch for the cathartic nature of literature, art, theater, dance, etc. for not just those of us who live with behavioral health challenges but anyone who has suffered life’s slings and arrows.

Carl Blumenthal lives in West Flatbush, Brooklyn, with his wife, Susan, and their feline femme fatales, Tuxedo Heidi and Calico Dream.