This story is part of Made in Philly, a series about young residents shaping local communities.
James Sherrick was in jail for the third time when he was diagnosed with schizoaffective bipolar disorder, which can cause hallucinations, delusions, depression, and mania.
He’d been sentenced to 14 months in prison after breaking into a car and stealing $400 from a wallet inside. Addicted to cocaine and alcohol for years, Sherrick struggled to hold down a steady job since he left the Navy six years ago. Now, he faced a daunting diagnosis.
That’s when he was introduced to Ken Miller, a certified peer support specialist — someone who lives with his own mental illness and helps others with day-to-day challenges. Sherrick was wary at first. He already worked with a collection of caseworkers and recovery specialists. But Miller turned out to be different.
“I don’t know how much a doctor knows about being schizoaffective bipolar,” said Sherrick, now 31 and living in Downingtown. “To go through it and deal with it every day, being treated certain ways [by other people] — that’s something Ken can relate to.”
Miller also served as an inspiration for Sherrick, as the younger man considered his future.
Peer support specialists have been around for years, in settings ranging from Veterans Affairs programs to homeless shelters and outpatient facilities. It’s a model based on the informal support commonly used in addiction recovery, in programs such as Alcoholics Anonymous. But respect for the work of peer specialists and demand for their services has grown significantly in recent years. Their services are covered by Medicaid, and programs in many states grew after Medicaid expanded under the Affordable Care Act.
Last year, 1,481 certified peer specialists were employed in Pennsylvania, according to data the counties report to the Department of Human Services. Across the United States, there are an estimated 25,000 certified mental-health peer support specialists. Though the U.S. Bureau of Labor Statistics doesn't track the position, it estimates job growth for community health workers in general will increase 16 percent in the coming decade — nearly double the average job growth.
Experts attribute the increased demand to a shift in mental-health treatment from attempting to eradicate mental illness to teaching people to live successfully with it.
Pennsylvania has fueled job growth by licensing agencies to employ peer specialists and allowing reimbursement through Medicaid. But the number of peer specialists is not rising quickly enough to keep up with demand. Many who want help must wait months or years as organizations scramble to find and train more peers.
Human Services Inc., a nonprofit mental-health services provider in Downingtown, has had multiple openings for certified peer specialists posted on job-listing websites for most of the year. It's eager to hire quickly, with nearly 30 clients on a waiting list to receive peer support.
“There are a lot of people out there who are seeking the service and could benefit from it,” said Carl Nagle, supervisor of day programs and psych rehab. “But I can’t do anything about it. It’s frustrating.”
Where are the peer providers?
It’s a complex question, said Susan Chapman, a nursing professor at the University of California San Francisco who has been researching the growth of the position for years.
The requirement of having a serious mental illness narrows the pool of candidates. Plus, a willing peer must be far enough along in recovery to be able to support another person.
In Pennsylvania, peer specialists are required to have a high school diploma or GED, and to be consistently employed, volunteering, or in school for a year. Additional hurdles arise for individuals with criminal records, not uncommon among those with serious mental illness.
Many of these jobs are part time, pay poorly, and offer no career path, Chapman said. According to a 2015 survey of peer specialists, the average hourly wage in Pennsylvania is $14.72.
Many peer specialists are not treated as real professionals by their colleagues, Chapman said. Though research shows their work boosts recipients' quality of life and self-confidence, and reduces rates of re-hospitalization, some have criticized the research as biased and insufficient.
When Miller started in the profession nearly 10 years ago, “there was some skepticism as to whether a peer could function as staff,” he said. People doubted his ability to hold a steady job or have a real impact. But those biases toward peer specialists are diminishing over time, he said. When it comes to the day-to-day work of supporting others in recovery, people are realizing “your background and history is actually a plus in this field,” Miller said.
An even bigger hurdle is cost. To become certified, prospective peer specialists must undergo 75 hours of training, costing about $1,300 per person.
Human Services can’t afford that, so it hires only peers who are already certified, Nagle said.
That’s why Nagle can’t hire someone he knows would excel at the job: James Sherrick.
Still, Sherrick has been volunteering, helping three people develop extensive care plans outlining their daily routines, coping strategies, and crisis interventions — just as Miller did with him.
He’s also been leading an hour-long weekly group focused on wellness activities. One week, he created a Jeopardy!-style game, with categories such as early warning signs and triggers.
“I want to give people hope and show them it’s possible to have what I have,” said Sherrick, who has been waiting more than a year to be certified, but can’t afford it on his modest disability income.
Who will pay for training?
When peer support began in Pennsylvania 10 years ago, the state covered the cost of training.
That’s the situation in New Jersey, where 75 to 100 peer specialists are certified each year, said Robert Kley, chief operating officer of the Mental Health Association in New Jersey, which runs the training. Yet without the kind of Medicaid reimbursement for peer services that Pennsylvania has, New Jersey peer specialists aren’t in such strong demand, a situation Kley said is changing.
Meanwhile in Pennsylvania, counties are left to foot the tab.
Philadelphia and Montgomery have invested more heavily in the program, offering about four training cycles a year, while Bucks and Chester Counties offer training only sporadically, said Michael Brody, former president and CEO of Mental Health Partnerships who retired in early December. The nonprofit he headed is one of two organizations that run peer-support certification training in Pennsylvania.
Chester County, where Sherrick lives, last offered training in 2016.
"Certification gives peers a base level of training," said Kim Bowman, county director of human services. "But sometimes, we've identified that preparation for employment is still needed."
So Chester hopes to roll out a new peer training program in 2019 with more emphasis on workplace skills, as well as internship and mentorship opportunities for peer specialists.
Philadelphia also is restructuring its training program, Brody said.
Sherrick says he is eager to get going. “The more you change somebody’s life and show yourself you’re doing it,” he said, “the more you want to do it.”