YAKIMA, Wash. — David Scofield has been on the receiving end of services at Comprehensive Mental Health since 1999, when he was diagnosed with bipolar disorder.
But a year and a half ago, at his therapist's recommendation, he began providing services as well.
In almost every department, Comprehensive employs peer support counselors, people who have worked through significant mental health challenges themselves and can now offer empathetic help to those struggling with day-to-day life.
"Right now, I'm working with a number of people who have issues with isolating, and so I reflect back on the period of time when I didn't want to leave the house," Scofield, 52, said last week. "And I help them understand that recovery is possible, if you work at it."
Peer support counselors must complete 40 hours of state-run training to be certified. The job can involve a wide range of activities, from helping clients learn to use public transportation, to taking them grocery shopping, to just talking with them and encouraging them to spend time out in the community.
Counselors also serve as advocates, making sure clients connect with other necessary support services, such as disability insurance.
"I think that there has been a general feeling of wellness and of being heard and understood," said licensed social worker Nikki Roger, Scofield's team leader on Comprehensive's rehab team. "It's broken down barriers, basically."
The Division of Behavioral Health and Recovery, under the state Department of Social and Health Services, conducts six standard peer training sessions each year and six specifically for youth and family peers. Additional training sponsored by regional entities around the state brings the total number of people trained annually to 550, says Jennifer Bliss, peer counselor program administrator in Behavioral Health and Recovery.
The state has held training sessions in Yakima since 2012, said Bliss, who's also senior manager in DSHS's Office of Consumer Partnerships.
Staff is excited to see organizations like Comprehensive embracing peer counselors as part of the care team.
"At the state level, we see it as adding just high value to the mental health system," she said. "When you meet someone ... who's in recovery, who's living a good life, even though they have mental health challenges, it's really inspiring."
Bliss herself has gone through mental health challenges, and called her experience with peer support "life-changing."
"I've been in a place where it just seemed like the whole world was made up of hospitals and doctors and clinics and medications, and then seeing peers and seeing people work and have families ... Their lives were not consumed by mental health challenges," she said. "That you can go out and have a full, happy life — that was just really important to me."
Counselors meet with clients on an as-needed basis. For some people, that means twice a week; others might only ever need two or three appointments to get pointed in the right direction.
And they work closely with other members of the care team — social workers, therapists, case managers — to ensure every need is addressed.
"The peers aren't replacements for professional staff who do the social work and therapy sorts of things, but they're support," and help communicate between the client and those other providers, Comprehensive CEO Rick Weaver said. Clients may sometimes feel more comfortable sharing personal information with a peer, too.
Peer counselors serve the full spectrum of acuity: There's a "peer bridger" role, where they work with people admitted to the hospital to help prevent readmissions.
Comprehensive does not yet have a bridger program in Yakima, but hopes to soon, Weaver said.
"Our employees, non-peer counselors, love it; I have people clamoring, 'Can I get a peer counselor for my program?'" he said. "As we design newer programs as we move forward, that's something we think about. When we opened Bridges (for inpatient evaluation and treatment), that was one of the first things."
"It's not for every single program, but particularly for those programs were people are longer term or more severely ill" — in crisis or inpatient programs — "those are all natural places for peers," he said.
Scofield serves on the rehab team, with clients who have persistent and chronic mental illnesses that cause serious disruptions in their daily life, such as homelessness and hospitalization.
Those folks often have difficulty communicating with others and advocating for themselves, Roger said.
"When there are voices in your head interfering with your thinking process, it's really hard to follow through on appointments or learn things like riding the bus or telling your story to your family doctor," she said.
Since bringing peer counselors onto the team eight or nine years ago, Roger said, clients seem more willing to comply with recommended medications and treatment planning. And there are fewer hospitalizations.
Whether accompanying clients to the doctor or stressing the importance of taking their meds and getting a good night's sleep, "It's an encouragement on many, many levels," she said.
It's great for the counselors, too. Scofield says he's learned a lot about his own condition and recognizing early warning signs. And he's learned to be grateful.
There was about a five-year period in his own life where he never felt he would get better. His disorder cost him a couple of jobs and a relationship. For a while, he says, he was "a real mess."
Peer counseling would have made a big difference in his own experience, Scofield said.
"I think the biggest thing that (clients) face is hopelessness. I think if you can instill in somebody the hope that things will get better, then there's a much greater chance of that happening," he said.
"So that's one of the things that I try to do, is to work with people and help them understand that this is something they can get a handle on."