Peer support

Legislators advance bill to boost mental health, addiction services

Denise Peterson—at ease in the Iversen Wellness & Recovery Center’s activity room—has received counseling from, and works as, a peer provider.

Denise Peterson—at ease in the Iversen Wellness & Recovery Center’s activity room—has received counseling from, and works as, a peer provider.

Photo by Evan Tuchinsky

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When Denise Peterson describes what she was like 10 years ago, the contrast between then and now couldn’t be more striking.

In 2009, as a 34-year-old married mother of four, she suffered depression that often proved all-consuming. “At that time, my 9-year-old child was raising their younger brother and sister, who were 1 and 3 roughly—while I was on the couch trying to exist,” Peterson recalled. She also struggled with the eating disorder anorexia.

Looking back, Peterson said she’d been suffering from depression for 25 years.

“I remember thinking, There has got to be something better than all of this,” she told the CN&R.

Peterson got an indication of what that might be after she “demanded” a divorce: “Amazingly enough, I got my appetite back that very day, and for the first time in months I could eat without being nauseous.” More signs came when the therapist seeing one of her children started counseling Peterson as well.

When she began confiding in peers—including a therapist who’d survived a bad marriage—Peterson experienced significant changes.

“There’s just this understanding that somebody has from walking a very similar path,” she said. With the first therapist, Peterson would try to explain her circumstances but, not having a comparable experience, “she just wouldn’t get it.” With a peer, “I barely had to explain anything, because she got it.”

Peterson received free counseling at two local agencies specializing in trauma that utilize peers as providers. She joined a group supporting families and friends of alcoholics. Then, around seven years ago, Peterson went to the Iversen Wellness & Recovery Center, a peer-led facility for adults with chronic mental illness and substance abuse issues, where she soon became a group facilitator.

Peterson now works full-time at the Iversen Center as outreach coordinator for peer support services. Her degree from Chico State is in English; however, in working for Northern Valley Catholic Social Service (which operates Iversen) and the Butte County Department of Behavioral Health, she’s received extensive training to conduct peer counseling.

She appreciates helping others the way she’s been helped. Particularly satisfying are moments when someone shares a troubling experience she understands and is able to assure them “it makes total sense you would be feeling this way … responding this way.

“Just the sigh of relief [that] somebody gets it, it’s palpable.”

California has thousands of peer providers like Peterson—6,000 at last count, in 2016. Considering the shortage of professionals for mental health and addiction recovery, particularly in rural areas such as the North State, they’re filling a gap that 48 states recognize by certifying peer providers and drawing on federal Medicaid funds for their work.

The exceptions: California and South Dakota. But California may join the rest if legislation that’s stalled twice finally becomes law.

Senate Bill 10 would create statewide certification for “peer support specialists” by July 1, 2020, and establish billing for services through Medi-Cal, the state’s Medicaid program. The Senate Appropriations Committee considered the bill last Thursday (May 16) and advanced it to the Senate floor for a full vote.

Sen. Jim Nielsen, a Republican whose district includes Butte County, co-authored SB 10. The principal author, Sen. Jim Beall (D-San Jose), wrote a similar bill that then-Gov. Jerry Brown vetoed last year, SB 906. A previous attempt, SB 614, in 2015, got tabled in the Assembly after passing the Senate.

With a new governor—Gavin Newsom, who has made public promises and budgetary commitments to support mental health—peer advocates feel more confident about SB 10.

“It has had nothing but support from the mental health community and friends,” Nancy Zinman, executive director of CAMHPRO, said by phone. The California Association of Mental Health Peer-Run Health Organizations, based in the Bay Area, champions provider groups across the state.

“It’s defining the role, having standardized training, valuing what people are doing,” she added, “which is so important.”

The previous attempts received unanimous support from legislators. SB 906 passed every committee and floor vote in both houses of the Legislature without a no vote; Brown’s veto statement asserted that “peer support specialists are used as providers in Medi-Cal without a state certificate” and the “costly new program” would exclude some providers. Peterson said some agencies and counties do bill Medi-Cal, but standardization would enable every organization and provider to participate, should they meet the standards established.

In 2015, backers ultimately abandoned SB 614 when the state Department of Health Care Services pushed amendments that altered the core concept of peer providers. That’s according to Adrienne Shilton of the Steinberg Institute, a nonprofit founded by Sacramento Mayor Darrell Steinberg (a former state legislator) that advocates for public policies to improve mental health. The institute co-sponsored SB 10, which so far has passed through committees without dissent.

“From both a policy and fiscal perspective, it just makes sense,” Shilton said by phone. “Peer providers are part of our workforce now but aren’t utilized to their maximum capacity. The training programs vary widely across the counties and the nonprofits that train them—there really isn’t a standard, core set of skills that peers have. So there’s an issue to bring parity across the state, and there’s the fiscal issue … that we’re actually leaving federal money on the table by not billing for these services.”

Proponents say this could ease the burden on a mental health system that’s already overwhelmed.

Said Peterson: “In all reality, I’m surprised the bill hasn’t passed before.”

A spokesman from the Department of Health Care Services told the CN&R by email that it’s “still analyzing SB 10 and does not currently have a position on the bill.” He did not comment on the earlier legislation.

Zinman, from CAMHPRO, said SB 10 has provisions that account for current providers’ experience when they seek certification. She cited as a benefit “portability”—having a license recognized beyond where the provider received training. Peterson agreed, mentioning the U.S. Veterans’ Administration, in which peer providers can transfer nationwide.

Moreover, Peterson added, SB 10 “invites Californians to continue discussion if the certification process is working and what changes need to be done—allows it to grow and evolve as our understanding of peer services evolve.”