Peer supports is the key to transformation of mental health systems and the start of a bonafide social movement, akin to the revolutions we've seen with the disability community.

1. What If…
Everyone Embraced Recovery
DAVID W. COVINGTON, LPC, MBA
CEO & PRESIDENT, RI INTERNATIONAL
ADELAIDE 2018

2. “No, You
Can’t.”

3. What Does It Mean…
To Live in Community

5. HiringPeerStaff
“No, You
Can’t.”

6. HiringPeerStaff
“No, You
Can’t.”

7. HiringPeerStaff
“No, You
Can’t.”

8. HiringPeerStaff
“No, You
Can’t.”

9. HiringPeerStaff

10. What If…
I Don’t Move to the
Back of the Bus

11. What If…
I Am Not
Afraid

12. What If…
My Answer is…
Yes, I Can

13. “[In the disability empowerment
movement] we don’t have a token seat
at the table. We lead the table.”

14. Celebrate the 25th Anniversary
of the Americans with
Disabilities Act

28. Same Struggle
Different Difference

29. What If…
I Don’t Move to the
Back of the Bus

30. What If…
I Am Not
Afraid

31. What If…
My Answer is…
Yes, I Can

32. Polling Question #2The Americans with Disabilities Act
gives civil rights protections and
guarantees equal opportunity in
public accommodations, employment,
transportation, government services,
and telecommunications. The ADA
also applies to Mental Health.
A. True
B. False

34. “We stand on the doorstep to make
momentous progress in advancing
the cause of this new civil rights
struggle started by the work of
President Kennedy over 50 years
ago.”
New Civil Rights Struggle

35. What If…
Everyone Embraced Recovery

36. What If…
I Don’t Move to the
Back of the Bus

37. What If…
I Am Not
Afraid

38. What If…
My Answer is…
Yes, I Can

39. Do things TO people
Do things FOR people
Do things WITH people
Few peer leaders & care
Peer driven system
1
2
3
4
5

41. The First Support Groups
Alcoholics
Anonymous
The 12-Step program of substance
recovery founded in the early ‘30s
provided a demonstration of the
power of self-help and support from a
“peer” although the “peer” was called a
“sponsor.” There is evidence Native
Americans were doing something of
the same as early as 1772.

42. A Mind That Found Itself
Clifford Beers
Galvanized the mental hygiene
reform movement and founded the
organization that would later become
Mental Health America, which led to
systematic reforms and continuous
advocacy presence

44. I Am Not
Afraid
Judi Chamberlin
“On Our Own”

45. National Council on
Disabilities Report
“Patient privileges, such as
the ability to wear their
own clothes, leave the
confines of psychiatric
facility, or receive visitors,
should instead be
regarded as basic rights”

46. Primary Era: 2000 - present

47. First Clubhouse Model
John Beard (Fountain House) in
New York revolutionized the
old “day treatment” programs
to a new approach where
those served were “members”
and not “patients,” and given
meaningful roles in the
clubhouse and community.

48. Center for Psychiatric Rehab
William Anthony &
Boston University
“There is a revolution brewing in the
field of severe mental illness… It is a
revolution in vision – in what is
believed to be possible… It will be up
to consumers and family members to
lead this [recovery].”
In 1973, 13 leaders formed Psychiatric
Rehabilitation Association (PRA)

49. WRAP
Mary Ellen
Copeland
First structured tool for self-help
for individuals with mental
health challenges.
The key concepts of WRAP
(hope, personal responsibility,
education, self-advocacy, and
support) laid the foundation for
self-help recovery.

50. On June 22, 1999, the US
Supreme Court held that
unjustified segregation of
persons with disabilities
constitutes discrimination in
violation of the Americans
with Disabilities Act and stated
that people with psychiatric
disabilities are legally entitled
to live in communities of their
choosing
Lois Curtis

52. Peer Support as Science
Surgeon General’s Report on
Mental Health
Introduced “self-help groups” and
peer supports as an emerging
evidence based practice and
chronicled the history of the
recovery movement

53. Medicaid-billable Service
Wendy Tiegreen &
Larry Fricks
Georgia was the first state to have
peer supports approved by CMS
(Arizona followed the next year) and
laid the ground work for a national
sea change with more than 20 states
following suit. Recovery Innovations
began using the phrase “Peer
Support Specialist” in 1999.

54. CMS Guidelines

55. Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

56. WELL & WHAM
In 2001, Recovery Innovations married peer
support with education by creating WELL
(Wellness and Empowerment in Life and Living)
as a new self-help approach to the former case
management approach of compliance and
monitoring of “activities of daily living.”
In 2012, the Center for Integrated Health
Solutions (SAMHSA/HRSA) created WHAM
(Whole Health Action Management)
 2-day, in person peer support training
 Set whole health and resiliency goals
 10 Health and Resiliency Factors

57. Don Berwick
What ‘Patient-
Centered’ Should
Mean: Confessions
Of An Extremist

60. Towards a Recovery System of Care
Perspective Stage 1 Stage 2 Stage 3 Stage 4 Stage 5
Traditional Psychosocial Rehabilitation
Philosophy/Continuum
Peer-Driven
Care
Peer-Driven
System
Motto Done to Done for Done with Done by
Character-
istics
Clinical team
identifies goals and
develops service
plans. Compliance
with directives is
point activities.
Strong dependence
on system & artificial
(paid) supports with
no individual risk
taking or family
engagement.
Genuine voice and
participation with
some support for
individual risk taking
& engagement in
natural supports.
Self-directed care is
core value with peers
holding some
leadership and
advocacy positions
within the system.
Many roles filled by
peers, including
workforce,
governance, etc.
a token gesture.
Core Value
Clinically sound
professional
services & stability
Safety and security
with a goal of
stability
Personal recovery
through
collaboration
Personal recovery
through self-
directed care
Culture change
through peer
leaders and
staffing
Person(s)
Compliant Dependent Respected (Voice) Leader Empowered
Subservient Institutionalized Involved Advocate Leaders
Staff Member
Prescriptive Caretaker Partner Consultant Peers
Directive Protector Guide Support Advocate
Organization
Clinically driven Protective Collaborative Recovery driven Peer-driven
Provider is expert Risk Averse Engaging Person is expert Peer-staffed
Risk Taking Discouraged Blocked Supported Encouraged Expected
1950
Compliance/
Directive
1980
Dependent/
Care Taker
2010
Voice &
Participation
Present
Action &
Leadership
Future
Peer-Driven
System

61. Which of the following are reasons a
peer staff at a Community Mental Health
Center should be terminated?
A. Sleeping with a client
B. Not showing up to work the first day
C. Stealing from the organization
D. Being re-hospitalized for mental health
E. Reporting hearing active hallucinatory
voices

63. Difference

64. DifferenceDifference

65. Difference
Bluegrass
Fan
Father
Son Difference
Husband
Brother
Uncle

66. Difference
Bluegrass
Fan
Father
BossSon Difference
Husband
Clinician
MBA
Business
Owner
Brother
Uncle
Employee

67. Difference
Biker
Bluegrass
Fan
Father
Boss
Friend
Son Difference
Husband
Clinician
Speaker
MBA
Business
Owner
Brother
Southerner
Uncle
Runner
Employee

68. Difference
Biker
Bluegrass
Fan
Father
Geek
Boss
Traveler
Friend
Gamer
Son Difference
Sports Fan
Husband
Clinician
Speaker
MBA
Business
Owner
Brother
Southerner
Uncle
Runner
Employee

69. Difference
Contribution
Biker
Bluegrass
Fan
ConnectedFather
Geek
Boss
Traveler
Friend
Gamer
Son Difference
Sports Fan
Husband
Clinician
Speaker
MBA
Business
Owner
Brother
Southerner
Uncle
Runner
Employee

70. Difference
Contribution
Biker
Bluegrass
Fan
ConnectedFather
Geek
Boss
Traveler
Friend
Gamer
Son Difference
Sports Fan
Husband
Clinician
Hopes
&
Dreams
Speaker
MBA
Business
Owner
Brother
Southerner
Uncle
Runner
Employee

71. Difference
Contribution
Biker
Bluegrass
Fan
ConnectedFather
Geek
Boss
Traveler
Friend
Gamer
Son Difference
Sports Fan
Husband
Clinician
Hopes
&
Dreams
Speaker
MBA
Business
Owner
Brother
Southerner
Uncle Citizen
Runner
Employee

72. Disability/
Difference

73. Recovery/
Ability

74. Lived
Expertise

77. Me too

78. What If…
I Don’t Move to the
Back of the Bus

79. I Am Not
Afraid
What If…

80. My Answer is…
Yes, I Can
What If…

83. 1. Organizational commitment
2. Quality training pre-employment
3. Recovery training for all staff
4. Job-specific peer support roles
6. “Tipping point” critical mass
7. Develop career ladder
8. Parity for peer workers
9. Remember, it’s real work, not
sheltered work or therapy

84. Traditional Language Recovery/Opportunity
Consumer Guest
Sub-acute Psych Inpatient Living Room
23 Hour Observation Retreat
24/7 Crisis Walk-in Front Lobby
Crisis Center Recovery Response Center
Crisis Opportunity
Intake Recovery Partnership
Assessment Getting to Know Each Other
Psychosocial History Telling My Story
Treatment Plan Recovery Solutions

85. What If…
I Don’t Move to the
Back of the Bus

86. What If…
I Am Not
Afraid

87. What If…
My Answer is…
Yes, I Can