Can Clinical Match the Power of Peer Supports?

hands reaching outGenerally, people ask the opposite question looking to researchers to examine the outcomes of peer supports and comparing them with established clinical best practices. Consider, though, the school shooting that was averted due to the actions of a peer. How would we clinicians have done in her shoes?

August 24 marks the one-year anniversary of a school tragedy that didn’t happen, thanks to an Atlanta bookkeeper named Antoinette Tuff. On that day in 2013, she was confronted by a young man with an AK-47 and nearly 500 rounds of ammunition at a Decatur, Georgia elementary school. We know how she interacted with the young man because of a 24 minute 9-1-1 call, during which he leaves twice to go to the front of the school to fire off his weapon towards police.

The call is terrifying and hard to listen to. There are long periods of silence. Once, Antoinette considers fleeing, but realizes the consequences could be dire. At the end of the ordeal, the woman who has seemed so calm throughout the crisis breaks down in tears to the 9-1-1 dispatcher as the young man is taken into custody.

CNN and others rightly hailed Antoinette a hero, but her heroism was in sharing and connecting with the young man as a peer. I doubt the young man would have felt that she “met him where he was at.”  She didn’t come down to his level; rather, she shared. She talked about her painful divorce and her subsequent suicide attempt, describing how she’d recently been where he was, and she connected with him. She fearlessly engaged and maintained no walls between herself and the young man who was threatening both the school and law enforcement.

After Tuff persuaded the young man to surrender, and shortly before the police secured the scene, she told him she loved him. “It’s gonna be alright sweetie,” she said. “I just want you to know that I love you, though, OK? And I’m proud of you. That’s a good thing. You’ve just given up. Don’t worry about it.”

I recently joined Recovery Innovations as Deputy CEO. Their mission statement is “to create opportunities and environments for people to recover, to succeed in accomplishing their goals, and to reconnect to themselves, others, and meaning and purpose in life.” This is facilitated through a focus on hope, empowerment, choice, recovery environments and language, and spirituality, and is founded on the belief that everyone can recover and that peers are key to making this happen. Everyone can remember who they are, and use their strengths to become their best. It starts with hope and empowerment.

In 2005, researchers from Columbia and Rutgers interviewed crisis center supervisors and silently listened in to thousands of crisis telephone calls. They monitored the outcomes both during the call and with two-week follow-ups, and they used factor analysis to determine what worked. The crisis center supervisors reported in interviews that their teams did not engage in self-disclosure. However, despite policies at various call centers to the contrary, the researchers actually observed that self-disclosure was a common occurrence. Furthermore, they were surprised to see a correlation between self-disclosure and the strongest outcomes of any activity on the calls. Genuine personal connections made a difference.

Nearly thirty years ago, I visited a nutrition “doctor” who used a simple muscle test to determine my health. Of course, at the time, I had no idea how this parlor trick worked. He had me extend my right arm and applied a gentle pressure to my wrist while checking for various issues. If my arm stayed up, I was healthy. If the arm fell, it indicated I had an infection, poor health, or food sensitivities (which could be alleviated with a month-long prescription of supplements that I could purchase on the spot). The first time indicated health, but the second time the “doctor” pressed on my right arm, it fell. Naturally, I was suspicious of his “diagnosis.”

I’ve since learned the secret behind this trick, the principle of which is actually taught in the New Employee Celebration curriculum at Recovery Innovations: it’s the power of language. Include a positive statement — “David, you’re looking strong today!” — and your arm will stay strong and resist the gentle pressure. But include the slightest negative statement — “David, you look tired today.” — and your arm is likely to weaken and fall.

The 1990s were called the decade of recovery, and yet we continue to look on peer supports and recovery somewhat like I looked on the nutrition “doctor” some thirty years ago…skeptical that it’s real, or that it works. But walking into an agency where 60% of the staff are peers, where people talk about their own “lived experience,” where those experiences are considered expertise, and where people believe everyone can recover, this is the equivalent of positive statements embraced by your subconscious that makes your arm strong.

In contrast are services where peer staff are non-existent or limited to administrative or janitorial tasks, where recovery is considered rare for those with Severe Mental Illness, or where only clinical professionals engage. It’s the equivalent of a negative message; your subconscious believes you’re weak, so your arm falls.

Professionals can be torn. Their gut instincts may tell them a peer approach won’t work. Hope and empowerment and recovery isn’t really possible, is it? I think it is. Everyone can use their strengths to find recovery and maximize their best selves, and we in behavioral healthcare have a powerful role in lifting people up or holding them back. Such risks and vulnerabilities might make us nervous. We might consider such approaches well outside our comfort zone.

But we might ask ourselves: would the outcome have been different if one of us counselors, social workers, nurses, or psychiatrists had been sitting in that bookkeeper’s chair last August? I have confidence we would have mustered all the empathy within us, but this isn’t the same as actual lived experience. I can guess what it feels like to feel depressed and suicidal, but only someone who’s actually lived it will know what someone else is feeling and be able to connect to him and give hope in a way a professional simply cannot.

Would the situation have ended peacefully? I honestly don’t know, but listening to the full recording is a great insight into the power of human connection and the hope and strength that can be shared. Someone else has been in desperate pain, has survived… and cares. Perhaps on the anniversary of a tragedy that didn’t happen, we should reflect on the power of one person connecting with another.

Note: I would like to acknowledge the team at Recovery Innovations, including Gene Johnson, Lori Ashcraft, Chris Martin, and Gloriana Hunter, for the inspiration and stories in this blog. This organization and its amazing leaders have been sharing recovery around the world since Gene was inspired by Dan Fisher’s message of hope nearly 15 years ago (www.recoveryinnovations.org). 

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