Peer Counseling’s Critical Role in Psychosis Treatment

If a journey of a thousand miles begins with a step, what is better than having someone along with whom to share it? That is the philosophy behind the peer counseling program at McLean Hospital’s Division of Psychotic Disorders.

“A lot of people with these conditions have difficulty working outside the house, living independently,” said Dost Öngür, MD, PhD, chief of the Division of Psychotic Disorders and the William P. and Henry B. Test Professor of Psychiatry at Harvard Medical School. “This isn’t because the person is into doing their own thing. It’s because the help that’s available hasn’t really been enough, it hasn’t been up to the task.”

Enter peer counseling, which takes form in three separate programs at McLean, including Waverley Place, a community-based rehabilitation program that offers coordinated care and support for adults with chronic psychiatric illness; McLean OnTrack™, which specializes in treating young adults ages 18 to 30 who have experienced their first episode of psychosis; and the Program of Assertive Community Treatment (PACT), a “hospital without walls” with community-based clinical services and social supports.

“Our expertise as a peer specialist is lived experience with a mental health issue,” said Yale Hicks, CPP, CPS, a program coordinator who first came to Waverley Place as an intern as part of his personal journey with bipolar disorder. “Living in recovery, modeling recovery. Our goal is to walk with, support, and guide folks in recovery.”

Psychotic disorders include schizophrenia, bipolar disorder, and other related conditions. Öngür noted there are many medications and psychotherapies that offer partial success but also unwanted side effects.

“The model usually was ‘let’s take care of the symptoms, let’s treat the illness, and the rest of it will take care of itself,’” he said. “But really, it’s become clear that first of all, we’re not very good at treating the symptoms. We just don’t have the treatments that we should have, but also, somebody walking a path with you is much more effective.”

Peer counseling is a popular option in treating diseases such as cancer and diabetes, to name just two. The concept has now expanded into psychiatric care.

“In the past few decades, the notion has grown of peer specialists, people who have lived the experience of these problems themselves, who have managed to rise above it and have a life that they’re happy with and who can then turn around and help others who are afflicted with the problem,” Öngür said.

Waverley Place is located not far from McLean’s main campus, where its office walls and hallways are lined with artwork from members. Participants are generally ages 18 and up and come from a broad spectrum of life, including those with strong family support and those with little to none. They come and go as they please, taking part in art classes, cooking sessions, and group therapy.

“It’s a place for them to just be themselves, to talk, to converse, to be social,” said Hicks. “When you’re isolated at home, it’s hard to be on the recovery journey. But when you get the social support—which is a big part, not all of it—it can really help the recovery journey and the recovery process.”

Participants come from McLean’s inpatient programs and can self-refer from the community. Surveys conducted with transitioning patients found overwhelming support for the concept, with 89% of respondents saying they felt more hopeful after hearing peer specialists share their own stories.

“It’s a hard and difficult journey,” said Hicks. “It’s not just ‘I’m going to wake up tomorrow and everything’s going to be OK.’ It takes a lot of hard work.”

“At Waverley Place, you can be yourself, feel at home, and be accepted,” Öngür echoed. “In our field, so often people come up with either/or thinking. I think the success of Waverley Place is that it offers various different things, and that it’s integrating these different types of approaches.”