A theme for September’s Recovery Month is “Recovery is for Everyone.” It sounds nice, but is it really true? We’re all impacted by mental health and substance use conditions in some way, whether we live with them or know someone who does. But with 74 million adults and 5 million adolescents in America living with a mental health or substance use condition,[1] is recovery really for everyone?

Where do you stand?

Do you think recovery is possible for a person given a diagnosis of schizophrenia? Is recovery possible for someone in active heroin addiction?

If you think recovery is possible for them, do you expect recovery for them?

Think about it for a minute.

Recovery for me

I am a person in recovery. At the beginning of my journey, I was a teenager with a bright future ahead of me who had been given a mental health diagnosis. It was easy for others to hold hope for me because my accomplishments were a recent memory. Recovery was possible and expected for me.

Today, I have a successful career, an advanced education, a home, and a deep connection to my community. It’s easy for people to expect recovery for me because I’ve proven it’s possible.

But in the middle of my story is endless years of pain and despair. My teenage accomplishments quickly became overshadowed by more diagnoses, hospitalizations, failed medication trials, and a disability determination. The longer my struggles continued the harder it was for me and the people around me to believe my recovery was possible. An expectation of recovery was replaced with low expectations of my abilities, personal responsibility, and chances for a meaningful life.

The irony is that these low expectations quickly became more distressing for me than any symptom I was experiencing. It was the lack of expectation for recovery in my life that brought the soul-crushing despair that nearly ended my life.

Measuring down

My experience is not isolated. It is common to determine someone’s ability to recover based on internal and external factors and then act accordingly. These factors may include a person’s income, education history, employment, housing, support system, family culture, ethnicity, and geography; the number of times they have been in rehab or failed medication trials; and the number of diagnoses, type of diagnoses, drugs used and number of physical health comorbidities. The list could be endless.

Now let’s go back to the scenarios above and add a few more details:

Do you expect recovery for the man you pass at the bus stop who is experiencing homelessness, who hears voices and who has no education?

What about the woman you see at the park who uses street drugs, whose kids are in foster care and who is unemployed. Do you expect recovery for her?

Recovery for everyone in action

Expecting recovery for everyone requires an unwavering commitment to the belief that recovery is possible for every person, no matter their diagnosis, treatment history, or current and past circumstances. The next step after believing recovery is possible is taking action on that belief through communicating with hopeful, empowering language, encouraging risk-taking in the pursuit of recovery, and focusing on strengths versus perceived deficits.

At the systems level, expecting recovery for everyone means:

• Providing equitable recovery opportunities through services and supports, including beyond traditional treatment delivery systems
• Outreaching to engage Black, Brown, LGBTQ+ and other marginalized communities
• Transforming practices and environments to reflect recovery-oriented principles

If we all believed that recovery was for everyone, it would radically change our communities and service delivery systems for the better. It would send a message of hope and save lives during a time when suicide rates in the U.S. have increased 30% from 2000 to 2020.[2]

Imagine what would change if we believed recovery was for everyone.

Join the conversation

We are pleased to host a free webinar, “What I would tell my younger self: Conversations about hope, recovery and the “S” word,” on Wednesday, September 14, 2022, at 3:00 p.m. ET. Register today to hear our presenters share the advice they would give to their younger selves to better navigate mental health and substance use challenges, and engage in the conversation!

Visit MagellanHealthcare.com/Recovery for resources to use and share this Recovery Month and beyond.

[1] Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health

[2] National Institute of Mental Health, “Suicide” information

While mental health, wellness, and self-care have been trending topics for years, more of us are prioritizing these critical aspects of our lives as the pandemic stressors continue. Change and new challenges are guaranteed in the new year, requiring a full-on commitment to wellness in 2022.

My awakening to the need for improved wellness coincided with a significant mental health crisis. The standard things I had been told to do to feel better for my emotional health were not working. I began the journey to incorporate meaningful wellness practices in all areas of my life. As I learned more about myself and developed a clearer vision for my future self, new facets of my wellness became apparent. I eventually experienced mental health recovery as a result of the shift to a holistic and multi-dimensional focus on wellness.

When Googling wellness, you will find endless lists of tips that would overwhelm just about anyone. So where do you start? Cue the Eight Dimensions of Wellness.

The Eight Dimensions of Wellness model

Over the years, I have found the Eight Dimensions of Wellness model to be beneficial in prioritizing my own wellness and helping others. This model was developed by Dr. Peggy Swarbrick in the 1990s and has been adopted by the Substance Use and Mental Health Services Administration (SAMHSA) and countless academic and healthcare institutions around the world, including in multiple healthcare disciplines and settings. The 8 dimensions provide a solid framework for us to understand wellness and make meaningful changes to improve our health, happiness, and quality of life.

I had the opportunity to ask Dr. Swarbrick about feedback she receives on real-life application of the model, and she shared that:

“So many people around the country have told me that the Eight Dimensions of Wellness model has been so very practical for them both personally and professionally. I appreciate hearing about how people use the model to view themselves more positively and build on their strengths to accomplish goals and overcome some formidable life challenges.”

An interconnected framework for a wellness focus

Each of the 8 wellness dimensions in the model has an impact on the others. For example, I have experienced the profound interconnection of my occupational health with my spiritual health. I have been amazed by the degree to which my physical health impacts my emotional wellness. If I go a week without practicing Pilates or rowing, my mood worsens, and I am less interested in life activities.

Utilizing a dimensional framework for wellness helps in identifying the greatest needs and desires for focused attention. Without focus, we can end up investing time in wellness activities that don’t impact the area(s) we are trying to improve. For example, if an extra hour of restful sleep is what your body and mind need for wellness, then taking an hour-long bath may not contribute to the desired return on investment.

Learn more to prioritize your wellness in 2022

In 2022, we will be exploring the Eight Dimensions of Wellness through free live webinars and resources to help you dig deeper into your wellness journey and provide you with the tools to support patients, clients, peers, and loved ones in doing the same.

We kicked it all off with a continuing education credit-eligible webinar, “Wellness in 8D: A lens to build resilience,” presented by the Eight Dimensions of Wellness creator, Dr. Swarbrick, on January 27th. If you missed the live event, you can watch the recording here and still earn CE credits. Sign up here to receive emails on our wellness events series and new resources throughout the year.

We hope you will make the choice to prioritize wellness in 2022 and let us join you along the way!

Visit Magellan’s Center for Recovery and Resiliency for announcements about upcoming events, new resources, and links to more free continuing education-eligible training opportunities and information.

For July Black, Indigenous and People of Color (BIPOC) Mental Health Awareness Month, we are pleased to share our e-interview with Dr. Tonicia Freeman-Foster, Ed.D, CDP, CHES®, PMP, co-founder and principal consultant at Kusudi Consulting Group, and change specialist at Change Matrix, on mental health for Black people and African Americans

Magellan: What are some sources of stigma related to mental health treatment in Black communities?

Dr. Freeman-Foster: One source of stigma stems from slavery where Blacks and African Americans were deemed to be strong so that they could do the work. There were adverse consequences, including death, for those who were deemed to be weak. Because of this, in so many ways we have internalized strength to mean that you have to be able to do the work. You must be able to always put on a smile, even when you are sad or not feeling well. We have internalized this to the point of when we are not feeling well, we feel the judgment of it as a weakness or being lazy. This is why the message “it’s okay not to be okay” is critical, and it’s critical that we as Blacks and African Americans say it, practice it, and live it. Mental health is health too.

Another huge factor is the intersection between mental wellness and faith. There is some belief that if you are feeling sad, then you probably did not pray enough, or you do not believe in God enough, or that you do not have enough faith. The belief that overall, you are weak spiritually. No one wants to be seen as weak, and so as a result we do not seek help. It’s important that we understand that we can do both simultaneously. We can seek earthly help for our mental wellness AND we can pray too.

Magellan: Tell us about your presentation Equity as an Expectation on August 30th at 2:00 p.m. ET.

Dr. Freeman-Foster: With Equity as an Expectation (information and free registration under Upcoming Events here), we will explore strategies to create an environment where people, no matter their demographics or life experiences, can expect that they will receive culturally responsive services in an equitable manner and have equitable outcomes.

The reason that equity is missing in a lot of our programs and services is because it has been allowed to be optional. I compare it to a grocery store. You have young adult services on aisle five, HIV services on aisle six, mental health services on aisle seven, substance use services on aisle eight, physical health on aisle nine, and then equity on aisle three. If we truly want to make a positive impact in all our interactions, then equity must be the shopping cart. It must be the first thing that you come in the door with, and the thing that everything builds on top of. It is about interweaving equity practices into everything that we do, versus having equity as an optional standalone practice. There must also be accountability measures in place for all team members, and a consistent process for reviewing progress, outcomes measures, and follow-up actions.

Dr. Tonicia Freeman-Foster has over 20 years of experience in cultivating hope, resiliency, and wellness through her work with underserved persons and marginalized communities. She is passionate about her work in assisting organizations and leaders in understanding how their beliefs and actions impact diversity, equity, inclusion, belonging, and justice for staff, clients, and communities. Dr. Freeman-Foster possesses extensive experience in matters related to mental health, substance use, child welfare, HIV/AIDS, and LGBTQ+, youth and young adult, women, Black, Indigenous, and People of color (BIPOC) populations. 

Dr. Freeman-Foster is the co-founder and principal consultant at Kusudi Consulting Group, and she also currently serves as a change specialist at Change Matrix. In these roles, she provides training, technical assistance, and coaching to individuals, communities, and organizations throughout the nation. In her previous role, Dr. Freeman-Foster served as project director of the Florida Healthy Transitions program and led the development of an innovative peer-to-peer behavioral health model for youth and young adults. Dr. Freeman-Foster possesses a Bachelor’s degree in Health Science Education (Community Health) from the University of Florida, a Master’s degree in Human Services (Organizational Management and Leadership) from Springfield College, and a Doctorate degree in Education (Organizational Leadership) from Argosy University. Dr. Freeman-Foster is a Certified Diversity Professional, Certified Health Education Specialist, Certified Courageous Conversations About Race™ Practitioner, and Certified Project Management Professional.

This is an excerpt from the Magellan Healthcare eMpowered for Wellness July 2021 newsletter. To read the full article, go here. For more information and resources to support BIPOC mental health, and to register for Dr. Freeman-Foster’s continuing education credits-eligible webinar, visit MagellanHealthcare.com/BIPOC-MH

For November National Family Caregivers Month, we are pleased to share our e-interview with Pat Hunt, executive director of the Family Run Executive Director Leadership Association FREDLA, on family support organizations and how they help families who are dealing with mental health issues.

Magellan: Pat, so glad to have you with us today. Tell us a little about how you came to the work of family leadership.

Pat Hunt: It’s always a pleasure to spend time with folks at Magellan. Like family leaders across the nation, my lived experience has continued to shape the pathway. As a parent, I didn’t want anyone else’s child to struggle the way mine did – or for other parents to have a similar experience as mine. I was so fortunate to have the benefit of allies in my state – other parents, people in state government, providers – all willing to be courageous and develop solutions together. I worked with 16 families across my state to develop a statewide family network with a vision toward positive change. As a family leader, I applied what I had learned from my experience as an advocate – which may be a misunderstood word today – to help other families understand the impact of policy on service array, practice, access, quality, etc. and to have the information, opportunities, skills and resources to effectively participate. This foundation took me to national organizations, such as the Federation of Families, Magellan and FREDLA.

Magellan: You became the executive director at FREDLA almost two years ago. What are you passionate about in your work at FREDLA?

Pat Hunt: Family-run organizations across the nation are the bloodline of the family experience – flowing from the heart of every family they serve. THEY touch lives in amazing ways. FREDLA is here to nourish and support their work – to ensure they have the tools and support they need to be successful, viable and sustainable. That means we also help states, counties, practitioners, health plans and management organizations by providing consultation and training – because they are interdependent in achieving the positive outcomes for children, youth and their families.

Magellan: What should we be looking forward to in the next year on developments in the family support field?

Pat Hunt: 2020 has taught us that the efforts of peer family support partners have been nothing short of herculean during the most challenging of times. They are innovative, dedicated and resilient. The results of FREDLA’s recent national survey will be released soon and used to inform workforce development, technical assistance, national advocacy efforts and research programs. In March, we will be hosting a national event to respond to the needs of parent peer support providers, their supervisors and the funders and management of their programs. Stay tuned, and we hope your audience will as well.

Pat Hunt is the executive director of FREDLA, the national Family Run Executive Director Leadership Association, a non-profit union of leaders of grassroots family-run organizations across the nation. Along with her lived experience as a parent, Pat brings over 25 years of experiences as an advocate for children with behavioral health needs and their caregivers. During this time, she had extensive experience overseeing both federal and state grants and served as the founding director of a family-run organization.

Pat’s experience includes over 10 years in a corporate leadership role at Magellan Healthcare to advance best practices for children, youth and their families, and to ensure that their experiences informed policies, practices and program development. She previously held a senior leadership position as a conduit for local grassroots experience to inform national policy decisions at the Federation of Families for Children’s Mental Health. She has served as a VISTA Volunteer, directed a federally funded rural substance abuse prevention project, managed a statewide family-run organization, served as president of the Maine’s mental health planning council, and was the only non-state employee member invited to the Governor’s Children’s Cabinet.

 This is an excerpt from the Magellan Healthcare eMpowered for Wellness November newsletter. To read the full article, go here.

This month we are sharing an earlier Thought Leaders interview with Patricia Smith about compassion fatigue, given the significant impact COVID-19 continues to have on caregivers across the spectrum, from hospital staff to family caregivers. We are reminded of Patricia’s interview and wanted to share it at a time when it could be so helpful to so many.

Patricia graciously agreed to us re-running her 2017 feature article, and was kind enough to write a new introduction. Many thanks to Patricia for her continued contributions to the field and in caregiver communities! Now, let’s hear from Patricia about compassion fatigue in today’s caregiver climate.

As I write this addition to the 2017 interview on compassion fatigue and caregivers, our world is in the grips of COVID-19. This pandemic has created worldwide confusion, anger, pain and suffering. My work over the past 20 years has been focused on caregivers in all of the helping professions, and family caregivers, as well. Now, with the trauma created by the virus, I consider all of us caregivers. Who hasn’t run errands for their elderly parents? Who hasn’t shopped and delivered the groceries to their elderly, ill or disabled neighbors? Who hasn’t sewn masks to be given out to their community members? Who hasn’t worked diligently in lockdown to prepare nutritious meals for themselves and their family members? Who hasn’t advocated what’s right and life-affirming on Facebook, Twitter and other social media? These, and many more actions and behaviors, define care-giving. It is more important than ever that each one of us begin our healing process. As difficult as that is in the eye of the hurricane, it is imperative if we hope to return to a healthy level of wellness, happiness and good health. Find time in each day for authentic self-care. Take a walk in nature, paint a picture, meditate, practice yoga, listen to music that stirs your soul, bake a cake and give half to someone who is weathering the storm alone, plant a vegetable garden, or sit in silence and be thankful for the good that remains in your life. All of these strategies define and promote healing.

Stay safe. Patricia

2017 Thought Leaders Interview with Patricia Smith on Compassion Fatigue

Magellan: Thank you for taking the time to participate in our virtual interview. Can you share with our readers some background regarding your interest and leadership in the area of compassion fatigue and burnout in the mental health and wellness field?

Patricia Smith: I first learned about compassion fatigue as the training and development manager at Humane Society Silicon Valley. After many years as a journalist, I decided I wanted to work with animals. Within the first two weeks in my new job, the executive director asked me to create a shelter-wide compassion fatigue training. I had never heard the term, and the only information I could find was the academic work of Dr. Charles Figley, who was then the director of the Traumatology Institute at Florida State University. I contacted Dr. Figley and he brought me through the process of understanding exactly what compassion fatigue is and how to address the symptoms. At that same time, I took the Professional Quality of Life Self-Test (https://www.proqol.org/ProQol_Test.html) created by Dr. Beth Hudnall Stamm, who also became a mentor. The test revealed that I suffered from very high levels of compassion fatigue. This started me on a journey that has lasted the past 20 years. After several years on my own personal healing journey, I created the Compassion Fatigue Awareness Project in hopes of helping others in the helping professions to understand compassion fatigue and how high levels can devastate a caregiver’s life. The scope of my work has grown beyond anything I could have imagined.

Magellan: You have done a great deal of work looking at aspects of compassion fatigue and burnout. What have you learned over the course of this work, and what recommendations would you make to peers to support their own wellness and to avoid compassion fatigue?

Patricia Smith: My own work has dovetailed with the amazing work being accomplished by professionals such as psychiatrists and psychologists in the field of traumatology and neuroscience. Powerful new information has come about from studies of the effect of trauma on our Wounded Warriors. Post-traumatic stress disorder is now a common phrase and the understanding of trauma on the human body, mind and spirit is widespread. These studies have branched out to include brain studies and how traumatic events impact our brains – and, more important, what we can do about it.

If, indeed, a caregiver suffers a high level of compassion fatigue, which is a secondary traumatic stress syndrome, the best path to take for healing is authentic, sustainable self care. The practices that promote wellness encompass the Standards of Self-Care: nutritious food, exercise, restful sleep, highly functional relationships and replacing toxic habits (smoking, alcohol, drugs, overeating, pornography, etc.) with healthy, life-affirming habits.

Magellan: Your studies/work around compassion fatigue and personal wellness are of particular interest to our readers, given their work in peer support. How can we influence modifiable lifestyle behaviors to improve individual well-being and battle compassion fatigue?

Patricia Smith: Re-wiring our brains to successfully improve the quality of our own lives takes work – lots of work. Healing is an inside job. We must go back in time to heal the wounds we have endured throughout our lives; one of the main causes of compassion fatigue is holding unresolved pain and suffering within. This takes a toll emotionally, but is well-worth the journey. The work involved in healing our wounds is nothing compared to the time, energy and emotional pain it takes to hold them at bay. Everything that has ever happened to us lives within. Pushing down the memories or ignoring them constantly elevates levels of compassion fatigue. Every time we experience additional trauma in our lives, which today is perpetrated everywhere – Facebook, TV news, newspapers— the new trauma hooks into the trauma that already exists. This pattern continues day after day in the helping professions and, eventually, a caregiver will become paralyzed with compassion fatigue. Businesses and organizations can do their part in helping caregivers to modify their lifestyles by educating their employees about compassion fatigue and putting healthy alternatives into place. This could include an edict wherein no business (emails, texts, phone calls) is conducted on weekends or evenings, encouraging mandatory vacations, providing healthy food alternatives in the cafeteria or vending machines, creating walking or biking groups, and other positive encouragement to promote wellness.

Patricia Smith is a certified compassion fatigue specialist with 20 years of training experience. As founder of the Compassion Fatigue Awareness Project©, she writes, speaks and facilitates trainings nationwide in service of those who care for others. She has presented to caregivers in numerous helping professions including social work, health care, law enforcement, chaplain services, suicide prevention and education, among many others. She has authored several books and training materials for caregivers, including the award-winning To Weep for a Stranger: Compassion Fatigue in Caregiving. She served as the caregiving expert for Spry magazine for several years. In September 2016, she presented a TEDx talk on the subject. Additionally, she was the 2012 and 2013 recipient of a writing fellowship at the Helen R. Whiteley Center, in Friday Harbor, Washington, a scholarly research center sponsored by the University of Washington in Seattle.

This is an excerpt from the Magellan Healthcare eMpowered for Wellness September newsletter. To read the full article, go here.

Written by Thomas Lane, NCPS, CRPS

Every 40 seconds someone dies by suicide somewhere in the world.[1] The human tragedy of death by suicide is getting worse, with global suicide rates increasing 60% in the past 45 years.[1] Most people reading this article will know someone who has been impacted by suicide. One group of folks especially at risk for a suicide attempt are those who have tried to complete suicide previously. Data suggests that 20% of attempt survivors will make another attempt.[2]

I am one with personal experience. I am part of that 20%. As a double attempt survivor, I have haunting memories of those periods in my life when I was more fearful of living than I was afraid of dying. For me, those were the darkest, loneliest, and longest days of my life. After my second attempt in the winter of 1998, I wound up on a ventilator. I was in a coma for 12 days and when I woke up, I felt like someone was choking me. And I was angry. At the time, when I was literally regaining consciousness and coming back to the land of the living, my mom was downstairs with hospital administrators signing an agreement to discontinue life support for me.

As the saying goes, timing is everything.

After a lengthy and very shaky period, I began to get better. I was receiving good mental healthcare, redefining my circles of support, and I had a purpose. I came to believe I still had work to do. Now. On this planet. I had twice crossed the line of deciding I could not be here. Despite my best efforts, I was still here, facing my life. I decided I would seek meaning from as many of my experiences as I could. For the past 20-plus years, I have worked to build and advance peer support, particularly within the context of publicly funded healthcare systems, but also at the grassroots level and through public/private partnerships. I am more convinced than ever of the value, importance and unique perspectives folks with lived experience bring to the table, specifically those who choose to pursue careers as peer specialists. It has been and continues to be a transformative movement, even more so when we understand that many folks who make a choice to work in the peer support field, in the same delivery systems that may not have served them well, do so out of a passion for the work and to give back, to pay it forward.

I share this very personal experience as context for my next point.

In a 2016 survey of Magellan members receiving peer support services, 98% reported their certified peer specialist helps them to, both, improve their quality of life, and feel hopeful about their recovery.[3] Knowing what we do now about the effectiveness of peer support, and understanding the value of lived experience, I believe we can agree about the importance of connecting attempt survivors with peer supporters who have had similar experiences. For most, if not all, attempt survivors, there is a crucial time period after an attempt; I needed intensive support in the days following my second attempt. Sadly, intensive support is not always available, let alone offered by a peer who is also an attempt survivor. I can’t help but wonder, what would universal referral to, or at least an orientation about, peer support opportunities by and for attempt survivors, look like? Considering the COVID-19 pandemic, we have seen a rapid, albeit sometimes rocky, migration to technology-enabled service delivery. Interestingly, peer support has been “technology-enabled” for years in the form of peer-operated warmlines. If you’re not familiar with warmlines, check out the National Empowerment Center at https://power2u.org/peer-run-warmlines-resources/ for great information.

When we consider suicide, we know it is all about prevention, that is, preventing people from attempting to take their own lives. I don’t believe there is a higher calling. Many of my peers with the shared experience of being an attempt survivor have expressed to me this is the most important work they do. We see the positive impact of attempt survivors speaking out about their experiences. We see the importance of eliminating shame associated with the topic of suicide. We know suicide is preventable. We understand that prevention requires dialogue, and dialogue isn’t always comfortable. Nonetheless, the topic of suicide must be brought out of the shadows and recognized as the public health crisis it is, one that we can do something about through evidence-based prevention and education practices. We know it does not increase a person’s likelihood of attempting suicide to talk with them about what they’re feeling. Fortunately, there are many, many organizations pledged to this work. From grassroots organizations founded by survivors of suicide loss to nationally recognized organizations, the conversation is changing. We must continue to be intentional in our approach.

National Suicide Prevention Awareness Month helps shine a light on this often misunderstood and taboo topic. Let’s keep the conversation going for the other eleven months of the year. As peers, let’s renew our commitment to offering support, speaking out and holding the hope for someone until they are able to hold it for themselves. As fellow human beings, let’s take inspiration from Emily Dickinson, and tap the eternal hope perched in all of us.

“Hope is the thing with feathers, that perches in the soul

And sings the tune without the words

And never stops…at all.”

For information about Magellan events during Suicide Prevention Awareness Month, suicide prevention downloadable materials and more free resources, visit our suicide prevention website.

[1] https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

[2] https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1317-z

[3] Magellan Peer Support Services Outcomes in Pennsylvania, 2016

This month, we are sharing thoughts and insights on the importance of peer support services in healthcare, as well as other systems where peer supporters can be integrated. As the impact of the COVID-19 pandemic continues to be felt across the U.S. and around the world and folks struggle with the fallout, we are seeing an increased need for mental health and substance use disorder services and supports.

COVID-19 mental health impacts  

For many, the virus has taken a terrible toll. Family and friends have been lost. Millions of jobs have been lost. Our collective and individual sense of what is “normal” has been lost.

In a May 14, 2020 news release, the United Nations called for a substantial investment in mental health services to avoid a “massive increase in mental health conditions in the coming months.”

World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus said this:

“It is now crystal clear that mental health needs must be treated as a core element of our response to and recovery from the COVID-19 pandemic. This is a collective responsibility of governments and civil society, with the support of the whole United Nations System. A failure to take people’s emotional well-being seriously will lead to long-term social and economic costs to society.”

Focus on prevention

Public health experts, media and a growing number of policy makers are urgently emphasizing the critical necessity to take a preventive approach to this crisis, urging people to wear masks in public, practice physical distancing and increase testing. If we don’t embrace prevention, we will not beat this disease.

It’s not just infectious diseases like COVID-19 that require a robust, full court press preventive public health response. We need to get serious about prevention in mental health. A 2015 research article, Preventing Mental Illness: Closing the Evidence-Practice Gap Through Workforce and Service Planning stated:

Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in policy dialogue and service delivery, the prevention of mental illness remains a neglected area.

Note the reference to “evidence-practice gap” in the article title. What does that mean? Here’s a great, succinct description from a 2014 article published in PLOS Medicine.

Health research promises societal benefit by making better health possible. However, there has always been a gap between research findings (what is known) and health care practice (what is done), described as the “evidence-practice” or “know-do” gap.

Peer support contributions

So, what are the implications to the peer support workforce I mentioned at the beginning of this article? How does prevention apply to this discussion? Why is there still an “evidence-practice” gap with regard to peer support?

There are 200+ articles published in the literature on peer support. Peer support has long been recognized as an evidence-based practice. In fact, there are several peer-developed, peer-delivered models grounded firmly in the principles of recovery and resiliency, choice and self-determination, and an understanding of a holistic approach to wellness. And these models have been shown to have a positive impact on traditional outcomes, predominantly measured in behavioral health, including significant reductions in hospital admissions, fewer re-admissions and decreased spending on high-cost, restrictive settings like psychiatric inpatient. While peer support is not a clinical service, it has been shown to impact clinical outcomes. Beyond this, folks receiving peer support services express very high degrees of satisfaction with those services and report improved quality of life.

This is an excerpt from the Magellan Healthcare eMpowered for Wellness July newsletter. To read the full article, go here.

We are excited to re-introduce our Thought Leaders series with Dr. Karen L. Fortuna, one of the world’s leading researchers and activists focused on digital peer support and the role of technology in recovery. As a result of COVID-19, technology-enabled peer support has become the norm and vitally necessary to ensure continuity of care. We hope you enjoy our exclusive, virtual e-interview with Dr. Fortuna as she shares her unique insights about the transformation of peer support.

Dr. Fortuna holds a doctorate in social welfare and a master’s degree in social work. She is an Assistant Professor of Psychiatry in the Geisel School of Medicine at Dartmouth College. Her primary research interest is service delivery strategies for older adults with serious mental illnesses and chronic health conditions. Dr. Fortuna is using community-engaged research methods to develop and implement peer-supported mobile health (mHealth) intervention. Dr. Fortuna was awarded a NIMH K01 award (K01MH117496), a NARSAD Young Investigator Grant from the Brain and Behavior Foundation, the Alvin R. Tarlov & John E. Ware Jr. Award in Patient Reported Outcomes, and the Gerontological Society of America’s AGESW Faculty Achievement Award. Dr. Fortuna served on the International Standards Advisory Committee to develop the first-ever international accreditation standards for behavioral healthcare for older adults. Dr. Fortuna also serves on the American Psychiatric Association expert advisory panel on smartphone apps.

Dr. Fortuna led the development of the first digital peer support curriculum to equip older adult peer supporters with the skills and knowledge to offer digital peer support. The Digital Peer Support Certification was co-produced with Dartmouth scientists and peer support specialists and has been found to be an effective knowledge translation training that has shown to increase peer support specialists’ capacity to use digital peer support in practice (http://digitalpeersupport.org/).

And now, let’s hear from Dr. Fortuna!

Magellan: Dr. Fortuna, thank you so much for your time. Can you share what brought you to this field?

Dr. Fortuna: Thank you! My background is in social work. I went into this field because my dad had multiple sclerosis and he was very sick as I was growing up. People treated him like he was different just because he was in a wheelchair. I would say he was marginalized—but, to me, he was always just my dad—not different—not helpless—one of the most amazing and capable people I have ever known in my life. So here I am. Working with peer support specialists that may have at one point in their life been viewed as “different” or “helpless” and I work with peer support specialists to accomplish things they maybe never thought possible.

Magellan: You are recognized as one of the world’s leading researchers into the area of digitally delivered peer support. What drove your interest in pursuing this topic?

Dr. Fortuna: My initial exposure to mental health services began in the first year of a Masters in Social Work internship at the University of Pennsylvania. During this internship, I provided group-based self-management training to adults with a lived experience of a mental health condition and chronic health conditions. During this experience, I was impressed by the severity of disabilities that continued to be present for adults with a lived experience of a mental health condition despite participation in evidence-based programs. I subsequently pursued a volunteer opportunity with Dr. Mark Salzer to learn about efforts to improve the effectiveness of interventions for people with a lived experience of a mental health condition; in addition to being introduced to community-based research and peer support specialists.

As a result, I have developed an understanding of the history of the peer recovery movement, peer perspectives and theories of service delivery—and I saw recovery for the first time. I was sold! Recovery is real! This experience laid the foundation for my research career focused on digital peer support as an innovative service delivery strategy. Digital peer support is defined as live or automated peer support services delivered through technology mediums.

Magellan: One of the hallmarks of your work has been using a co-design approach, working collaboratively with persons with lived experience to inform your projects. Would you share with our readers what co-design is and why you choose this approach?

Dr. Fortuna: Co-design is a partnership in research that promotes shared decision making in all aspects of the research process. Our model, the Peer and Academic Partnership, supports collaboration, engagement, shared decision-making, principles of reciprocal relationships, co-learning, partnership, trust, transparency and honesty. We use this co-design approach because peer support specialists bring new insights and energy to our research that our team believes will lead to the next discovery in the social sciences. Plus, it’s fun! I have an amazing group across the globe that I work with!

This is an excerpt from the Magellan Healthcare eMpowered for Wellness June newsletter. To read the full article, go here.