“When you’re weary, feeling small, when tears are in your eyes, I’ll dry them all.
I’m on your side, oh, when times get rough, and friends just can’t be found.
Like a bridge over troubled water, I will lay me down.
Like a bridge over troubled water, I will lay me down.”
      — “Bridge Over Troubled Water,” Simon and Garfunkle; lyrics by Paul Simon

By Valerie Neff Newitt

Most patients struggle to keep newly sober heads above water in the rapids of recovery. They may think sobriety is mythic and feel ill-equipped to navigate out of the murky depths of addiction or mental unrest.

At Eagleville Hospital, bridges over these very troubled waters can be found in the form of peer support specialists. As individuals who have “been there, done that,” they help patients to plan for a successful landing on the shores of sobriety.

A Quick Encounter

On a recent wintry afternoon, a patient was struggling to print a document from one of the computers in the Peer Center located in the cottage nestled behind the Price Building on the Eagleville Hospital campus.

Katie Latshaw, certified peer support specialist, came to his aid, and some brief congenial chatter followed. She happened to notice how many steps were recorded on her Fitbit, and mentioned that she could get more steps in if it weren’t for her love of playing World of Warcraft, a sedentary video game.

In that instant, the patient found “a bridge.” His eyes brightened and he broke a smile. “Really? You like video games? Me too,” he began. And from there a connection was made between Latshaw and someone who had been frustrated only moments ago. After brief game banter, he left the center, print-outs in hand, and called back, “See ya.”

Was that a typical ice-breaking interaction? “Very much so,” said Latshaw. “It’s a matter of finding something in common with a patient – something they can relate to.”

In her role for a year, Latshaw said that while she has never had an addiction, she has struggled with mental health issues – depression and anxiety – resulting from having been raised in a home with an alcoholic father. “At first patients may think I can’t understand what they are going through, but when they hear my own history, they say, “I was wrong. You really do understand what it’s like. You can help me.”

A Dedicated Space

The Peer Center (People Empowering and Engaging in Recovery) is relatively new to the Eagleville campus, in operation for about 18 months. “Because we know that people who are involved in planning their aftercare are more likely to follow through with it, we wanted to have a resource center for patients,” explained Denise Kitson, Director of Counseling Services. “We envisioned a place where patients could go to use computers to look for services – a doctor, a recovery house, meeting locations, etc. — available in their home community for aftercare. We wanted a place that would help give patients a sense of control and empowerment to help them when they leave Eagleville. Fortunately, we got immediate support from our board,” said Kitson, noting funds were quickly forthcoming for six computers and phone lines.

Unused space in the cottage provided a central location, and the maintenance team repurposed unused partitions to construct individualized computer stations allowing privacy for research, Skype interviews and more.

“The center was stocked with pamphlets for all sorts of support groups,” said Erin McCarthy, Patient and Family Advocate and former Clinical and Peer Coordinator. “Information about recovery houses and various common themes that come up in recovery for mental health issues or addiction are available there. In August 2015 the center opened its doors, and we are proud to say that we are one of the only facilities that have one.”

Kitson said patients make good use of the center, and “”¦ do amazing things there. They’ve done their income taxes, applied for college courses, and one person even maintained an online business while in treatment.” The Peer Center even became a hub for patient voter registration prior to the presidential election.

Latshaw not only monitors patients for appropriate computer use at the center, she also conducts WRAP (Wellness Recovery Action Plan) sessions there. “Patients come to talk and let their guards down. They may mention important personal issues – like hoping to regain custody of a child,” she explained. “In addition, we talk about key recovery concepts — hope, personal responsibility, education, self-advocacy and support. We discuss things that can help make them well, as well as the triggers and early warning signs indicating that things are breaking down.” These insights help each person to create a crisis and post-crisis action plan. “A WRAP is a living document, almost like an advanced directive,” Latshaw said. “It tells patients’ families or friends what to do — who to contact for support, which meds work best, etc. — if patients are going down a destructive path.”

Support of another Kind

Steve Miller, another peer support specialist at Eagleville, works on a co-occurring unit with patients presenting with both mental health and drug or alcohol issues.

“We have had people come in who have done PCP and their brains are just fried – extremely psychotic,” said Miller when asked if there is ever drama on the job. “But thankfully that is the exception, not the rule.” The normal shift is more often helping to calm patients in the midst of squabbles or angry outbursts, or reassuring those who experience bouts of paranoia or other delusional thoughts. “Sometimes patients lose orientation in reality, and I just need to reorient them. But if they think they are relaxing on a beach, I let them enjoy it,” Miller added with humor.

“Most people who come in have overdosed, or have admitted trying to kill themselves. They end up here on a locked unit, and they are very unhappy about that,” said Miller, who shared that he himself is in recovery and has dealt with mental issues as well. “When I see someone is struggling, I offer my support. And it is the offer that matters to patients – whether they take advantage of it or not.”

While peer specialists offer support, it is not done in vacuum. Patients know that the specialists are vital liaisons to other staff members, and sometimes issues surface that must be reported back to the recovery team. Miller recalled having overheard a patient telling someone on the other end of a phone conversation, “Don’t forget that ”˜thing’ I want you to bring.”

“It sounded shady,” said Miller. “That phrasing seemed encoded. I was thinking to myself, ”˜What thing? Is this a drug drop off?’ I went right to the nurses…”

Yet the primary purpose remains support. “Just today I ran a group and handed out slips of paper and asked each person to write down their ”˜aha’ moment when they knew they needed help,” Miller detailed. “At the end of the session I asked if there were any questions, and someone said, ”˜Yeah, what was your ”˜aha’ moment?’ I was able to share that it was when I found myself homeless. I told them I never wanted that to happen again. The people in the group responded well. Knowing that someone else had walked a mile in their shoes counted for something. It was powerful.”

Back to the Future

Making similarly good use of human bonds and shared experiences was once the hallmark of recovery treatment, yet it almost seemed to drift out of favor when the need for masters-prepared therapists emerged in the face of deepening patient co-morbidities and complex health issues.

Charlie Folks, Director of Community Integration and Strategic Partnerships, recalled a time when peer support was the primary recovery component at Eagleville. “Eagleville started with the treatment of alcoholism. But in the late 60s, when drug use was starting to become a real problem, it was decided to treat drug addicts and alcoholics in the same program. It was unheard of at the time,” Folks recalled. “The alcoholics tended to be older and the drug addicts tended to be younger. So they did a lot of generational work in groups; alcoholics were somewhat parenting the drug addicts, and the drug addicts were helping the alcoholics understand what their kids were going through. It is a widely accepted practice now.”

Folks explained that in the early ”˜70s after patients at Eagleville received treatment, they typically stayed on for a longer-term program that involved employment, usually in housekeeping, nutrition services, etc. “Many of those people went on to get a job here when they left the program,” Folks noted. “The typical path included a job as a group live-in worker – the equivalent of a mental health tech or nursing assistant now. Eventually they would work their way up to therapist. There was no requirement for a degree of any kind.”

With the expansion of managed care in the late 70s and early 80s, pressure increased to maintain better medical documentation and heightened diagnostic skills to allow for authorization of payment by insurers. In the area of alcohol and drug addiction, payment for long-term care was usually only approved for patients with very serious complications and repeated failures in treatment, Folks explained. “So as the patient population became more complicated, the staff needed a higher level of skill,” he said.

Kitson said that while that prescribed level of education holds many benefits to care, “It also worked to disenfranchise therapists who had come through the peer recovery movement.”

Things have come full circle, however, as today insurers press facilities to provide peer support as a necessary component to recovery programs. “For quite some time they have been emphasizing more use of peer and community supports, and integration of peer support into treatment whenever possible,” said Folks. “Some insurance companies consider this an evidenced-based best practice and believe this is what we should be doing — because it works. If we’re not integrating peer support at all, insurers are going to be skeptical of us. I’d like to see us do more of it.” It is not only payers who value peer support on campus. It is vital to patients as well. “There is a core belief among many patients that in order to get help from someone, they must have had a similar struggle,” commented McCarthy. “Our degreed therapists may not have been in recovery, so peer staff adds an important piece in support of patient therapy.”

Kitson agreed, “Not everyone can have a shared experience with a patient, but when someone does, it’s an instant connection. It’s a recognition that, ”˜Oh, you’ve been in my place. You know how I feel.’”

Folks believes that a peer team can add depth to a recovery program. “The peers bring a unique strength to a program because they help to instill hope in people,” he said. “A strong peer leadership presence can be involved in program design, content of programming, and delivery of content. There is a saying you’ll hear from the peer recovery community, ”˜Nothing about us without us.’ People with recovery experience should be as involved as possible.”

A Win-Win

Peer support specialists are trained and certified prior to assuming their role at Eagleville, however the process does not require a degree. Instead, the requisites are two years in recovery, specific training, a year of shadowing other peers in the field, then certification.

“Patients often get inspired while they are in treatment and working with peer staff,” said McCarthy. “They will sometimes go over to the peer center and find out what steps they can take to become peer specialists themselves. I’ve heard people say things like, ”˜I’ve had other careers but now recovery is my life. I won’t be fulfilled unless I am helping other people”¦’” As such, the impact of peers marches forward.

Patients at the peer center were recently asked how the peer support at the center had helped them. “I have a missing family member, so I am very upset,” said one patient. “When I need help the [peer support specialist] is always there.”

Another patient mentioned that he had been “stressing out” about aftercare plans. But the creation of a WRAP, and gaining access to important information with peer assistance helped him to get the information he needed and the best plan in place.

I’ve had a rough time finding myself and learning more about my situation. Katie’s neutral; she listens without telling me what to do, but at the same time she is honest — brutally so.”

Eagleville’s peer support specialists find their interactions with patients benefit them, as well. “Am I making a difference?” asked Miler reflectively. “Yes, and it is gratifying. I can honestly say that I want to come to work when I get up in the morning. Sure, there are some patients who may be more combative and more challenging. But I feel like I am helping. And I get great feedback and validation from the staff, which is so important to me.”

The work also has an impact on Miller’s own health. “It helps me in both the mental health and drug/alcohol areas. It makes me stronger, accountable; it gives me a sense of purpose,” he said. “I see the pain that people experience when they relapse after they’ve had clean time; it’s tragic. I see them in group and watch as they cry; it makes me realize how much I do not want to ”˜go there’ again. It could be a trigger for some people, I suppose. But for me, it keeps me grateful that I am where I am today.”

Latshaw, too, proclaimed, “I love my job. It’s the best job I’ve ever had, because I feel like I am helping someone to become more self-reliant. Instead of ”˜taking care of’ someone, I am helping them learn to take care of themselves. When a patient is discharged, I assure them they can still connect with me. I tell them, ”˜I will always be here for you. You can call me any time.’ And they do call me – usually to let me know they are doing OK. Still, I make sure I tell them again, ”˜I’m here whenever you want to talk.’”

“When you’re down and out, when you’re on the street,
when evening falls so hard, I will comfort you.
I’ll take your part, when darkness comes, and pain is all around.
Like a bridge over troubled water, I will lay me down.
Like bridge over troubled water, I will lay me down.”
      — “Bridge Over Troubled Water,” Simon and Garfunkle; lyrics by Paul Simon