RUTLAND – Implementing mutual peer support as a staff person at a traditional mental health provider was a key topic in an interview with two peer support workers acting in newly created positions at Rutland Regional Medical Center’s inpatient psychiatric unit.
For Thelma Stout, the fact that she’s a hospital employee makes it appropriate to share her strong support for the use of medication with patients on the unit.
“I’m a peer, but I’m not a peer who hates meds,” she said.
She said she has seen drugs work, including for herself – and including for those who receive them involuntarily.
Asked if some might suggest she isn’t functioning as a true peer supporter if she advocates a particular medical treatment model, she said that to the contrary, she feels more able to share her own experiences because of being part of a hospital.
“It’s a [job] position in the hospital,” she said, where medication as part of treatment is the norm. As a result, “I can have these conversations [about the benefit of medication] and it’s OK.”
Stout said she’s been in community peer group meetings where her views are in the minority.
“All I can say is, it’s worked for me. That’s what I can speak to, from my personal experience” when sharing with patients, she said.
Akbar Abidi takes a different perspective of how being a hospital employee informs his role as a peer specialist.
“I don’t think that affects how I can function,” he said. “My priority is the patient.”
He cited an example of a patient who wanted to be completely off all medication but whose doctors’ position was that they needed to be on meds.
Abidi said he brought the patient’s concerns to the treatment team and was “able to come to a compromise to titrate [the drugs] to a much lower dose.”
He saw himself as facilitating the conversation and “mediating a middle ground” on behalf of a peer.
Abidi said he sees his primary role as a peer supporter is to be someone who can just listen, In addition, “I give my experience that there is hope, that there is wellness.”
The hospital developed the positions and job descriptions based on research and input from an external consultant and extensive discussion with its Community Advisory Committee, according to Lesa Cathcart, director of nursing for the inpatient psychiatric unit. The planning process began two years ago.
“It has been nothing but positive,” she said of the new positions. Other staff have “embraced them as part of the team,” and patients are very receptive. The hospital held focus groups with patients before starting the program, and they were “really excited about it,” she said.
Both Felt ‘It Fit’ as Job
Stout and Abidi came to the new positions at the hospital from very different backgrounds.
Stout, a resident of Vermont for 34 years, has been active in peer support roles for years, including as a peer facilitator for 10 years at Evergreen House in Middlebury through Counseling Services of Addison County.
She also has been a facilitator for the NAMI Vermont Connections groups for many years, including heading up the first Connections group in the country to take place on an inpatient unit, at RRMC.
She learned about the position even before it was posted, through a NAMI colleague on the RRMC Community Advisory Committee. She reflected that it was her peers, not staff, that she had benefited the most from in her own history of hospitalizations.
Stout said she thought, “It fits.”
Abidi first came to Vermont only two years ago when he became a resident at Spring Lake Ranch in Cuttingsville while coping with addictions, bipolar illness and depression, he said.
“I fell in love with Vermont,” he said. Spring Lake is a licensed therapeutic community residence with staff in the role of informal listeners who are simply there to support clients. He became an intern in such a position, he said.
“People would come to me as a safe space” for initiating conversations, he said.
It “planted a seed” for wanting to continue in work that could create that kind of informal access as someone who could just listen, he said.
“If I didn’t have that experience in my own recovery” – access to a person who could just spend time talking – “things may not have gone the same way,” Abidi said.
After deciding he wanted to take on a job that offered that to others, he applied to RRMC for a psychiatric tech position and the peer position “but thought that [the peer position] would be a better fit” and was glad to be offered it.
In his role, Abidi said he lets patients know that he isn’t interested in focusing on what brought them to the hospital or what their diagnosis is. “It’s whatever you want to talk about.”
The value he brings as a peer specialist is that a person may be more comfortable talking with someone if they think, “Oh, this person can relate,” he said. If the conversation reaches that depth, he will share more of his own history.
Finding Value in Roles
Abidi and Stout each shared a memorable experience that made them feel their roles had value.
For Abidi, it was a patient who has similar diagnoses to his own as well as a parallel to an abusive relationship he had experienced.
He saw that “a lot of things would trigger [the patient],” he said, and he simply asked, “Want to talk?”
He shared his experiences and told the patient that “it doesn’t mean it’s the end” – that “instead of the disease taking control of you,” a person can retake control of their life.
“It opened [the patient’s] mind to treatment,” he said, and he was also able to make a referral to community support for people with a history of abuse.
At discharge, the patient told him they were “extremely happy and grateful” that he was “able to listen and understand.”
Seeing the change for that patient made Abidi recognize, “I’m doing something important here.”
Stout said she was able to help a patient “who was freaked out about ECT [electroconvulsive, or shock, therapy],” which had been recommended.
The person was “scared to death,” but Stout was able to share her experience that “it worked for me,” though “yes, I had some memory loss.”
When the patient left RRMC, it was with the plan of going to the University of Vermont Medical Center in Burlington for ECT, Stout said.
She thought to herself, “Aha, that’s why I’m here.”
Stout said the experience with a patient that made the biggest impact on her own “learning curve” as a peer specialist was around the importance of medications.
The patient received court-ordered drugs after ending up in the hospital having discontinued prescribed pharmaceuticals, she said.
“I’ve been in that position of stopping meds,” she said, noting that she had also been rehospitalized.
After the patient’s condition improved, the patient described wanting to get the experience “tattooed on [their] wrist,” because they wanted to remember the benefits of medications and their value to staying well.
“It was very revealing,” Stout said. “It helped me think about working with other people” on the high-security involuntary treatment unit at RRMC, and how she could help them reach that same realization.
NAMI Conflict Questioned
Stout was asked whether her role with NAMI and the RRMC requirement that peer support staff take the NAMI Connections facilitator training might be seen as a conflict in being a neutral support person, since NAMI has an advocacy agenda that includes specific support for a medical model and the use of drugs as essential to treatment.
“I never really looked at it that way,” she said, but instead saw her dual role as the longtime NAMI Connections facilitator on the unit as helpful. She said NAMI Vermont is not really connected to the national organization or its funding and said she believes the parent group relies less on pharmaceutical company funding than it used to.
According to the most recent figures on its web site, in the last quarter of 2017 and first quarter of 2018, an average of 42 percent of the national NAMI corporate and foundation funding was from pharmaceutical companies in contrast to media reports in the early 2000s of up to 75 percent.
Stout acknowledged that the Connections support program, training and materials were developed by the national organization.
According to the NAMI Vermont website, the model requires facilitators to agree “to adhere to the NAMI Connection Support Group model,” which, according to the national web site, includes helping participants to “recognize that mental illnesses are medical illnesses that may have environmental triggers.”
A Focus on Accessibility
The peer specialists work different shifts, including covering weekends, with the intention of creating maximum access for patients, Abidi and Stout said.
They also sometimes provide support to patients waiting in the emergency department.
“There are times that we’ll get a massive influx there” and the patients don’t know what’s going on in the process, Abidi said. When there is no pre-existing relationship, those patients often don’t want to engage, he said.
However, he said, “I’m there to listen to them. … If someone is struggling, I’ll just listen.”
Both of them had high praise for the hospital’s decision to create their positions, a move Abidi described as “being a leader, being the first in the state.”
“I think that’s really important. I’m really appreciative,” he said.
Stout agreed, saying, “I think it’s really brave of them to do it.”
Hospital Sees Benefits
Cathcart said that the initiative began after the hospital had started working on the Six Core Strategies initiative – which recommends peer support roles – to reduce restraint and seclusion. They decided it was “something we really wanted to do.”
There was no discussion of using a contract with an independent peer-run organization to provide the positions, she said, because it was not what other hospitals were doing in the models they reviewed.
“We wanted them [the peer specialists] to be a part of us,” she added.
When asked why NAMI’s facilitator training was chosen for the new staff, Cathcart said the hospital was already familiar with it because NAMI Vermont has offered a support group on the unit for several years.
She said RRMC would be open to considering another training requirement.
“Peer specialist certification is preferred,” Cathcart said. Such certification does not currently exist in Vermont. The advisory committee “talked extensively about it,” and the hospital decided to “use this as our starting point.”
An alternative, skills-based program such as Intentional Peer Support “is certainly something we can consider” in the future, she said.
NEW PEER SPECIALISTS – Akbar Abidi (left) and Thelma Stout are serving in the peer specialist positions that began this year at Rutland Regional Medical Center’s psychiatric unit. RRMC is the first hospital in the state to create peer support positions on its staff. (Counterpoint Photo: Anne Donahue)