Across the country, the US Department of Veterans Affairs has made peer support an integral part of mental healthcare. Vermont is no exception.
Nationally, the Veterans Health Administration employs about 1,400 peers. Joshua Gerasimof, a supervisory peer specialist, oversees a team of nine in the VA White River Junction Health System, which includes not just the hospital itself but also clinics in Burlington, Rutland, and New Hampshire.
Peer support lets veterans “know that recovery is possible and that this is what it can look like,” Gerasimof said. “I think peer specialists are so effective because it’s relatable.”
Gerasimof served as a soldier in Afghanistan. After he came home, conversations with other veterans showed him the therapeutic power of peer-to-peer connection.
“I got out of the military and went through those readjustment issues of getting back to the civilian world,” he said. “I just remember waking up and being like, ‘Wow, what just happened? The past years in service – maybe that wasn’t normal.’”
“I took a long walk on the Appalachian Trail, and I met with other veterans,” Gerasimof recounted. “And unbeknownst to me, I was doing peer support and learning from other veterans who were having the same readjustment issues, the same struggles that I was having.”
Gerasimof vowed then to make a career of helping other veterans. At Johnson State College, he studied clinical mental health, having never heard of “peer specialist” as a job title.
“If I would have known that that was an avenue,” he said, “I probably could have saved the VA a little bit of money, because they ended up paying for my education.”
After earning a masters degree in counseling, Gerasimof worked in community mental health for a crisis team.
“I felt like I was able to connect more with the people that were in crisis through my own personal experience,” he remembered. “That’s when – I think it was probably 2014 – I learned about this peer support profession, and I dove right into it.”
In Gerasimof’s telling, the VA’s “big push” to expand peer support began with an executive order by the Obama administration in 2012. By the following year, the VA had hired 815 new peer specialists. Today, it’s the nation’s largest employer of peers.
And it hasn’t let up. Gerasimof noted that, recently, the VA has added more peers to the Veterans Crisis Line, which callers can access by dialing 988 and then pressing 1.
The VA requires that its peer specialists complete a certification course, but the state of Vermont doesn’t offer one. Gerasimof earned certification in Florida before applying for a job at the VA in Vermont.
Peers continue to travel out-of-state to fulfill the requirement. According to Gerasimof, the VA usually hires peers in Vermont as apprentices before sending them on a one-week trip to complete the in-person component of a certification course elsewhere.
At the VA, in addition to typical support groups, peers help coordinate a range of activities that don’t look much like traditional mental health services, from ski trips to jam sessions.
“I have a great peer specialist where music was a huge thing of his recovery. So he’s self-taught, and now he runs a guitar group,” Gerasimof said. “It’s called Vets Rock, and they get together and they teach people who want to learn how to play guitar. And then a lot of them already know how to play guitar, but it’s just connecting them with other veterans.”
“And it’s kind of providing just that carrot,” he continued, “because we all know there’s that unfortunate stigma. It’s like ‘Let’s go to a self-help group.’ ‘I don’t want to do that.’ ‘Well, let’s go to a guitar group.’ ‘OK, let’s do that.’”
Gerasimof also hosts what he calls coffee socials.
“The only criteria to be there is to be a veteran,” he said. “And they come and then they learn, oh, maybe my sleeping habits are not that great. Or maybe what my spouse is saying about being hypervigilant or feeling down – we may talk about those things, and then they realize, ‘Oh, I could reach out for help.’”
When a veteran chooses to engage with clinical mental healthcare, peers are there to help them navigate the system.
“We work with the individual and kind of explain different options for treatment. And traditional therapy might not be one of them, but we like to explore all options and know what’s out there,” Gerasimof said.
As a supervisory peer specialist, Gerasimof gets to play a role in shaping the broader landscape of mental healthcare within the White River Junction system.
“I’m one of the managers for the mental health team. I have a seat at the table along with the psychiatrist, the psychologist, the social workers,” he said. “When they make decisions, I bring in the veteran perspective. Sometimes medication management isn’t going to work for somebody, and I feel validated when I speak up for that.”
Having a peer by their side can help a veteran “take control of their own recovery,” as Gerasimof put it.
“If they’re having issues with their treatment, we’ll go to appointments with them and we’ll sit there with them and encourage them to advocate for themselves and find what they need,” he described.
According to VA Public Affairs Officer Katherine Tang, Gerasimof’s ability to relate to other veterans has served to connect them not only to mental healthcare but to healthcare in general. Employees like Tang and Gerasimof often attend community events to let veterans know about the VA’s offerings.
“We were at the Champlain Valley Fair, and I could be talking to a veteran, and I’d gladly let Josh take over. I can see that I’m losing the veteran because they’re like, ‘Oh, she’s just another government employee,’” Tang said. “He is one of our best at outreach because he speaks their language.”
As a former community mental health provider, Gerasimof knows that not every Vermonter has the same access to diverse, well-funded, peer-based mental health services that veterans do. He hopes that’ll change.
“We have a lot of these modes of treatment that the regular community does not, and I wish they did,” he said. “The VA is very, very rich in what they have for treatment options, and I feel guilty about that at times, but I also feel very, very lucky.”