The Value of Peer Specialists in Primary Health Care

Public primary health care portals such as federally qualified community health centers, rural health clinics, and emergency rooms are used at a higher rate by those who have a mental illness than by those who do not. If no primary health care portals are available or used, individuals may become involved with the judicial system when mental illness symptoms lead to infractions of the law, such as disorderly conduct or worse. Primary health care portals such as community health centers should and do refer these same individuals to community mental health centers (called Regional Boards in Kentucky), but the process may not always be seamless or successful. This is especially critical due to the fact that public primary health care facilities as well as Regional Boards are often the gateway to care for low income populations. Factors affecting the lack of success in referral to Regional Boards include lack of access to care, stigma of mental illness, or even social norms. Furthermore, mental health issues are not under the umbrella of services at many primary health care facilities, except for some of the milder conditions. The result is that individuals with severe, persistent mental illness may not receive the services they need, in spite of the fact that physical health and mental health are inter-related. This leads to behavior among individuals with mental illness that is destructive to their health. Hence, the care of primary health and mental health needs to be inter-related. Stated alternatively, mental health services and medical services need to be integrated, as "an artificial schism between behavioral health systems and medical systems of care,,1 exists, producing diminished accessibility and quality of care. A potential, valuable link between the two systems was created in Kentucky in 2007, with Peer Specialist Services. Peer Specialists, or Jay mental health advisors, have the ability to "communicate in the language of the people they serve, and ... recognize and incorporate cultural considerations that would usually be hindrances,,2, a description which has been applied to the physical or medical health counterpart of Peer Specialists, or lay health advisors. The importance of promoting health by using lay health advisors has been well documented.3,4, 5 Likewise, through their training and being actual consumers of mental health services themselves, Peer SpeCialists are valuable in that they help consumers (users) of mental health services attain recovery. As such, they have the potential to reduce the size of the schism that exists between mental health care facilities and medical systems. However, Kentucky Regulation (908 KAR 2:220) limits the role of Peer Specialists to Regional Boards or state operated or contracted facilities, and Medicaid will only pay for services delivered in Regional Boards or their contracted facilities. Not until Peer Specialists are communitybased rather than clinic-based as they currently are, will their potential as links, or steps towards an integration of the two systems of mental health services and medical services, be fully realized. This project will address the value of incorporating Peer Specialists into the community via their presence in primary health care portals, the goal of which is to enhance the health behavior of individuals with mental illness.