Lynn Patrone, M.Ed., for the GAINS Center
The concept of peer support behind bars may summon images of an inmate assisting another person who may experience difficulty walking across the yard or a cell block neighbor talking with someone having a difficult day.
The Pennsylvania Department of Corrections (DOC) is providing cutting-edge services to address the increasing needs for mental health services for inmates by instituting one of the first comprehensive Certified Peer Support Specialist (CPS) programs in a prison setting in the United States. The DOC, under the leadership of Secretary John Wetzel, has made significant strides toward improving mental health care for incarcerated individuals with mental illness. Implementation of the CPS program has far exceeded expectations and is in part responsible for changing the culture around how incarcerated individuals are viewed.
Through the lived experience of peers and the recovery they model, the CPS initiative inspires hope that recovery can happen. The service is designed to promote empowerment, personal responsibility, self-determination, coping skills, and resiliency through mentoring and providing support. This allows individuals struggling with mental illness, emotional difficulties, and co-occurring disorders to achieve personal wellness and cope with the stressors and barriers of incarceration and the challenges encountered from their symptoms. Most importantly, peers provide support and empathy that comes from having experienced mental illness and now being in recovery while living in a very challenging environment. As the mental health prison population increases, this service is becoming an invaluable tool in meeting the needs for those living behind the walls.
Of particular importance is the unique support a peer provides in a crisis. When an individual reaches a level of near-crisis, a peer may be asked to engage with the individual to de-escalate the situation. This intervention has proven to benefit both staff and the individual in need of the support through a person-centered and strength-based process that might otherwise have involved a security-based intervention. Additionally, a CPS may facilitate groups for topics such as personal hygiene, life skills, and specific reentry issues.
To date, the DOC has trained 500 certified peer support specialists who are helping thousands of inmates. Realizing the benefit to those who experience mental illness, the use of peers has expanded to the entire prison population to support those who may have experienced a difficult time, loss of a loved one, or a negative parole action.
The DOC launched its pilot program in six institutions in 2012, securing Federal Recovery Act Justice Assistance Grant (JAG) program funds. Most of the funds were earmarked specifically for CPS training for inmates at the pilot sites across the Commonwealth and for delivering a supervisor’s training to institutional staff who would have oversight of the peers. The remaining funds were used for peer support specialist wages until each institution was able to build this cost into operational budgets. The peer program has continued to expand from its first few pilot institutions. In 2015, with the appointment of the agency’s first director of the Office of Mental Health Advocacy, the program reached a new level. Now the certified peer support specialists are engaged in all but one of Pennsylvania’s 25 institutions, which is the Quehanna Boot Camp, where inmates serve much shorter sentences than at other institutions.
Initially there was resistance from superintendents and security personnel, but as staff saw the benefits, it became clear that peer work began to transform the inmates and those they support. Today, 5 years later, administration and front-line staff alike now embrace the program and find tremendous value in the CPS work.
Now the DOC ensures that all CPSs are trained in evidenced-based programs, including Mental Health First Aid; Question, Persuade, Refer (QPR) Suicide Prevention training; and Wellness Recovery Action Plan (WRAP©). Additionally, peers are used in all of the DOC's Therapeutic Communities, which are the equivalent of the private sector’s inpatient non-hospital residential drug and alcohol treatment centers.
CPSs are required to meet specific criteria, of which the most vital is self-identifying as a person experiencing mental illness who is now in recovery.
In addition to the criteria of lived experience, a CPS must
- Have had mental health services while incarcerated or in the community
- Have fulfilled evidenced-based personal recovery
- Not have had any assaultive misconducts in the prior year
- Have a high school diploma or GED
- Be 2-3 years from their minimum release date
- Not be on a waiting list for substance use disorder treatment in a Therapeutic Community (as this could interrupt not only the training process but also pull the inmate peer from assigned duties and keep them from maintaining their certification).
In an effort to promote healthy well-being and support, a small percentage of the candidates that met eligibility requirements have been selected from the “lifer” population. A common statement heard from this population is that becoming a CPS has given their life purpose.
The DOC's Office of Mental Health Advocacy recently assessed the needs of the population the peers were working with to determine if there were specialized needs prevalent within the institutional setting. Overwhelmingly, peers were supporting fellow inmates who experienced traumatic events in their life. Capitalizing on this proven resource where inmates could be supported with their mental illness through the help of CPSs led to the creation of a program to train peers to understand trauma and the impact of trauma, to recognize its signs and symptoms, and most importantly how to support their fellow peers who have experienced trauma.
The DOC partnered with SAMSHA's GAINS Center. This is of critical importance as the impact of trauma and re-traumatization can lead to an increase in mental illness symptoms and behaviors in an individual, especially when incarcerated.
CPSs are supervised by certified CPS supervisors who also provide mentoring and day-to-day oversight of the program. Supervisors are part of a CPS Committee which meets regularly to monitor the program, seek improvements, and identify unique initiatives that benefit the institution. One such example is the creation of Mental Health Awareness Challenge. CPSs have been offered an opportunity to create an initiative during Mental Health Awareness month to promote an environment that recognizes the importance of mental health.
While no research studies have been completed yet, anecdotal evidence suggests that having peer specialists in a correctional setting reduces the number of misconducts, limits the use of administrative segregation, and improves staff/peer relationships. Simply put, this approach works because those who are certified as peer specialists experience personal gratification by helping others in their recovery journey while also gaining a sense of positive self-worth.
Given that 90 percent of state prison inmates will return to the community one day, the certification process affords all successful participants the opportunity to become a CPS recognized by the Pennsylvania Department of Human Services and the Pennsylvania State Civil Service Commission. Certification offers the potential for employment in a peer support setting after release from a state correctional facility.
The benefits are invaluable and define the concept of what recovery truly is for the individual providing the support and the person receiving it.
Lynn Patrone M.Ed. is the director of the Office of Mental Health Advocate in the Pennsylvania Department of Corrections. Amy Worden is the DOC press secretary.