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Service Delivery Innovation Profile

Peer-Based, Interactive Sessions Empower Individuals to Live Successfully With Serious Mental Illness


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Snapshot

Summary

In partnership with community-based organizations such as hospitals, mental health centers, and jails, the National Alliance on Mental Illness Peer-to-Peer Recovery Education Program is a structured, interactive program designed to help individuals live successfully with mental illness. Trained peer mentors guide participants through a 10-week course that includes lectures and exercises designed to increase their ability to live successfully with a mental illness, with a focus on preventing relapse. The program increased participants' knowledge and ability to manage their illness, giving them more confidence in themselves and a greater connection with others.

Evidence Rating (What is this?)

Moderate: The evidence consists of pre- and post-implementation data from participant surveys of 138 individuals across 13 states. The survey measured the impact of the program on knowledge, ability to manage their illness, level of self-confidence, and degree of connectedness to others.

Use By Other Organizations

As of 2010, 29 local and state NAMI affiliates run the program in partnership with community-based organizations; examples of local partners are listed below:
  • Muscogee County Mental Health Course Program at Muscogee County Jail, Columbus, GA
  • Yolo Community Care Continuum Farmhouse Program in Davis, CA
  • Mid-Coast Mental Health in Rockland, ME
  • Winnebago Mental Health Institute in Oshkosh, WI
  • Jame's A. Haley Veteran's Hospital in Tampa, FL

Date First Implemented

2000
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Patient Population

Vulnerable Populations > Mentally illend pp

Problem Addressed

Mental illnesses remain common and frequently lead to disability and lost productivity for individuals in the prime of life. Isolation, stigma, and a lack of knowledge and support often lead to relapse and/or prevent mental health consumers from living full lives.
  • A common problem: Approximately one in four adults (55.7 million) live with a diagnosable mental disorder in any given year.1 Examples include mood disorders, major depressive disorder, bipolar disorder, schizophrenia, anxiety disorders, and obsessive-compulsive disorder.
  • Leading to disability and lost productivity: Mental disorders are the leading cause of disability for people ages 15 to 44 in the United States and Canada.2 In the United States, mental illnesses cause an estimated $63 billion in lost productivity each year.1
  • Driven by isolation, stigma, lack of support and information: The failure of those with mental illness to live full, productive lives often stems from a sense of isolation and stigma and a lack of information and support, which frequently leads to relapse.

What They Did

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Description of the Innovative Activity

In partnership with community-based organizations, the National Alliance on Mental Illness (NAMI) Peer-to-Peer Recovery Education Program offers a free, structured, interactive 10-week course for adults interested in living successfully with their mental illness. Trained peer mentors guide participants through lectures, educational materials, and interactive exercises designed to increase their knowledge and ability to live successfully with a mental illness, with a focus on preventing relapse. Key elements of the program include the following:
  • Community partnerships: Local and State NAMI offices work in partnership with community organizations serving diverse populations prone to mental illness, including hospitals, mental health centers, homeless shelters, and jails, to offer the program on a local basis to those living with mental illness.
  • Peer-led sessions: Trained peer mentors act as role models for participants by showing them how one can live well with a mental illness. These interactions help to decrease stigma by normalizing the experience of living with a mental illness. The program consists of 10 weekly 2-hour classes (including the orientation class) led by two peer mentors, with classes ranging in size from 8 to 20 participants.
  • Interactive curriculum, focused on relapse prevention: All classes combine lecture and interactive exercises, ending with a short mindfulness exercise. Peer mentors lead group discussions and brainstorm about real-world coping strategies for managing symptoms, making better life decisions, increasing wellness, and accepting mental illness. Each class includes a discussion of a specific topic selected to increase the participants' understanding of mental illness and common issues faced by those living with them (e.g., stigma, discrimination, addictions, medications, and spirituality). One session includes a family guest who speaks about his/her personal experience coping with a mentally ill family member. The course also includes small-group activities, such as storytelling, where participants share personal stories to help normalize living with mental illness. Participants leave the program with a relapse prevention plan and an understanding of how to complete an advance directive, as described below:
    • Relapse prevention plan: Each class includes completion and discussion of a relapse prevention grid that helps participants identify major areas of their life affected by mental illness (e.g., employment, relationship with one's self, living situation, education/employment, health, etc.), and learn how to recognize and manage relapse triggers within each area. Information gleaned from this activity is then distilled into a reusable decisionmaking tool that outlines healthy responses for coping with real life struggles pertaining to symptoms of mental illness. Participants use this information to create a relapse prevention plan focused on three areas of their life.
    • Advance directive: Participants leave the program with an understanding of how to fill out an advance directive for mental health care. This helps the individual to outline in advance their wishes, such as desired/undesired treatments, in the event that the individual becomes so incapacitated by mental illness they are unable to communicate effectively or their judgment is impaired.

Context of the Innovation

Since 1979, NAMI has offered support, education, and advocacy to people living with mental illness and their families. This grassroots organization reaches 15 million Americans through its state and local affiliates in 1,200 communities across the United States. In the early 1990s, the organization developed the Family-to-Family Education Program to address a major service gap in the mental health system—that is, addressing the needs of family members of mentally ill persons. This program's overwhelming success helped to spur the development of the Peer-to-Peer Recovery Education Program, first piloted in 2000.

Did It Work?

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Results

The program increased participants' knowledge and ability to manage their illness, giving them more confidence in themselves and a greater connection with others; the program also led the vast majority of participants to complete an advanced directive.
  • Enhanced knowledge and ability to manage illness: A pilot study of 138 participants from 13 states found that all participants reported a better understanding of mental illness after completing the program, including more knowledge about triggers, signs of relapse, medications, and the biological basis of mental illness. All participants also reported feeling satisfied with their ability to manage their illness, due primarily to the use of new coping skills and stress management techniques learned from the course.
  • Greater self-confidence: The vast majority of participants (136 of 138) reported being more confident in their ability to make decisions. A majority also reported having increased motivation to take responsibility for making decisions around finances, personal life, and legal issues.
  • More connected to others: Many participants reported feeling less alone as a result of having participated in the program, particularly due to the opportunities it provided to hear other people's stories, share similar experiences, make new friends, and have a safe place to discuss problems. Some participants even expressed an interest in getting involved in mental health advocacy efforts as a result of taking the course.
  • Vast majority completing advance directive: Almost all participants (129 of 138) reported completing relevant sections of the advanced directive.

Evidence Rating (What is this?)

Moderate: The evidence consists of pre- and post-implementation data from participant surveys of 138 individuals across 13 states. The survey measured the impact of the program on knowledge, ability to manage their illness, level of self-confidence, and degree of connectedness to others.

How They Did It

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Planning and Development Process

Key steps in the planning and development process included the following:
  • Developing curriculum: Kathryn Cohan McNulty, the Director of Recovery Education and Support at NAMI in the early 2000s, created and revised the original course curriculum materials in consultation with Joyce Burland, PhD, author of the Family-to-Family Education Program.
  • Conducting pilot test, revising curriculum: Several state NAMI offices pilot tested the program in 2000, after which program developers revised the curriculum based on lessons learned from this test. The National NAMI periodically updates the program curriculum by consulting experts on the latest research in mental health.
  • Securing funding for program expansion: The program expanded beginning in 2005 after NAMI secured program sponsorship from the Justine Firestone Memorial Scholarship Fund and AstraZeneca.
  • Creating marketing materials: NAMI's national office began advertising the program on its Web site and created and distributed a video with participant testimonials to showcase the program.
  • Training program mentors: To allow for broad implementation, NAMI's national office offers a training of state trainers each year. This 2.5-day training course provides current Peer-to-Peer mentors with the skills needed to train new groups of mentors in their home states. Peers wishing to become mentors in their own states attend a 3-day training session provided by their local or state NAMI office and led by the trained Peer-to-Peer state trainers. Peers learn an array of important skills including lecture skills training, facilitation skills, and an orientation to the teaching materials.

Resources Used and Skills Needed

  • Staffing: Two trained mentors and a third volunteer run each 10-week course. In addition, a full- or part-time coordinator (potentially a volunteer) sets up the classes and training, handles finances, conducts interviews with potential mentors and participants, and reports data from the courses back to the NAMI national office.
  • Costs: Program expenses include class and training materials, facility space (which may be provided free of charge by partner organizations), food, stipends for class instructors (up to $500 per instructor per 10-week course, plus reimbursement for travel expenses) and those leading training sessions (up to $500 each for two trainers, plus travel expenses), and compensation of the program coordinator (if a paid position).
begin fsxml

Funding Sources

AstraZeneca; National Alliance on Mental Illness; Justin Firestone Memorial Scholarship Fund
The national NAMI office sometimes covers part of the program's costs, but typically a state or local NAMI chapter raises funds to cover the costs.end fs

Adoption Considerations

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Getting Started with This Innovation

  • Contact state or local NAMI office: Tap into the program coordinator at a local or state NAMI office as a resource to start the program. The NAMI office may be able to provide financial support, train peer mentors, provide curriculum materials, and offer technical assistance.
  • Develop budget and strategic plan: Prepare a program budget that includes the costs of holding annual training. Decide how many courses to hold yearly (preferably two or more), and create an outreach plan to find participants and mentors.
  • Create and leverage community partnerships: Partnerships are essential for starting and maintaining the program, because partners often provide free space to run the program and help to facilitate access to a group of potential participants. To create such partnerships, contact local mental health organizations, state government agencies, local nonprofits, and local hospitals to gauge their interest. To "sell" them on the program, have an "elevator speech" ready that highlights the program's potential benefits and personalize the program by sharing success stories, including the aforementioned video developed by the NAMI national office.

Sustaining This Innovation

  • Keep networking: Continually network with potential partner organizations, including providing a brief, to-the-point presentation highlighting the program's value.
  • Seek sustainable funding: Work with a local or state NAMI office to find diverse sources of state and local funding.
  • Continue training volunteers: To ensure program sustainability, have at least six trained mentors available to teach the class.
  • Make ongoing efforts to retain peer mentors: Find ways to recognize and appreciate the hard work of the peer mentors. This may include distributing a certificate of appreciation to mentors for teaching a specified number of classes, providing a mentor appreciation luncheon, potluck, or ice cream social, or public recognition of mentors in local or state NAMI newsletters.
  • Identify and address barriers to participation: The NAMI national office has learned several lessons related to how to keep participants interested in the program, particularly in rural areas, where participants may have difficulty getting transportation to the weekly sessions. To get around this problem, local program leaders have leveraged the strengths of rural communities, including effective communication via word-of-mouth and a genuine neighborly attitude. For example, mentors in rural communities often call participants between classes to encourage them to attend the next class, frequently suggesting that multiple participants travel together as a way to ensure that everyone has a way to get to and from the sessions.

Use By Other Organizations

As of 2010, 29 local and state NAMI affiliates run the program in partnership with community-based organizations; examples of local partners are listed below:
  • Muscogee County Mental Health Course Program at Muscogee County Jail, Columbus, GA
  • Yolo Community Care Continuum Farmhouse Program in Davis, CA
  • Mid-Coast Mental Health in Rockland, ME
  • Winnebago Mental Health Institute in Oshkosh, WI
  • Jame's A. Haley Veteran's Hospital in Tampa, FL

More Information

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Contact the Innovator

Sarah O'Brien
Director of Training
NAMI Education, Training and Peer Support Center
3803 N. Fairfax Dr.
Suite 100
Arlington, VA 22203-1701
Phone: (703) 516-7226
E-mail: saraho@nami.org

Innovator Disclosures

Ms. O'Brien has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

References/Related Articles

The National Alliance on Mental Illness Peer-to-Peer Program Web site is available at: http://www.nami.org/template.cfm?section=peer-to-peer. The Web site provides an outreach video, participant testimonials, course outlines, and information on how to start a program in your area.

The NAMI Helpline is (800) 950-NAMI (6264).

Lucksted A, McNulty K, Brayboy L, et al. Initial evaluation of the Peer-to-Peer program. Psychiatr Serv. 2009;60(2):250-3. [PubMed]

Lucksted A, Hawes R, Dixon L. Investigating the Evidence-Base for NAMI's Family-to-Family and Peer-to-Peer Programs. NAMI Advocate. 2007:1-4.

Mental Illness: Facts and Numbers. National Alliance on Mental Illness. Available on NAMI Web site at: http://www.nami.org/factsheets/mentalillness_factsheet.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).

Footnotes

1 Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62(6):617-27. [PubMed]
2 The Global Burden of Disease: 2004 Update. Table A2: Burden of disease in DALYS by cause, sex and income group in WHO regions, estimates for 2004. Geneva, Switzerland: WHO, 2008. Available at: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html.
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Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: November 10, 2010.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: November 20, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: October 27, 2011.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

Back Story
Peer-to-Peer emphasizes recovery from mental illness as a feasible, supportable goal, and challenges the stigma often wrongly associated with mental illness; let's look at how this life-changing course can affect the people who participate.

It is a rainy evening in Montgomery County, MD, and a new Peer-to-Peer class will soon be...

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