Peer Specialists in Federally Qualified Health Centers Enhance Access to Behavioral and Physical Health Support Services for Clients With Co-Occurring Medical and Mental Health Issues | AHRQ Innovations Exchange
Service Delivery Innovation Profile
Peer Specialists in Federally Qualified Health Centers Enhance Access to Behavioral and Physical Health Support Services for Clients With Co-Occurring Medical and Mental Health Issues
|What They Did | Did It Work? | How They Did It | Adoption Considerations|
Problem AddressedMental health conditions are a leading cause of disability, particularly for people of low socioeconomic status. Many low-income individuals with these conditions use federally qualified health centers (FQHCs) as a regular source of care for physical health issues, but those diagnosed with mild or moderate levels of disease are often unable to access behavioral health services offered by traditional community mental health centers provided by behavioral health systems. As a result, a crisis or emergency often manifests that leads to the need for expensive acute care. Trained peers can provide meaningful support to these individuals, but few FQHCs have them available.
- A common diagnosis, especially among the poor: Roughly 20 percent of adults in the United States have a mental disorder, and approximately 5 percent have a serious mental illness.1 Approximately one-fifth of individuals with mental illness also have a co-occurring substance dependence or abuse disorder.1 People in poverty face a particularly high risk of both mental illness2 and substance abuse disorders.3
- Lack of regular treatment and support: Less than half of individuals with mental disorders receive treatment for them,2 and access to care is even more problematic for people with low socioeconomic status.4While roughly two-thirds (65 percent) of FQHCs integrate behavioral health care services with primary care,5often these services are not available to those with mental health diagnoses classified as mild or moderate in nature. For example, in Michigan, these individuals do not qualify for State-funded mental health services.
- Expensive, difficult-to-treat crises: Untreated mental illness and substance abuse disorders (including those that are mild or moderate) often lead to crises that subsequently require expensive hospitalizations, intervention by the police, and/or incarceration. Many sufferers feel isolated and become desperate, leading to additional crises and a repeat of the same destructive cycle.
- Unrealized potential of peer support in FQHCs: Individuals who are in recovery from mental illness and/or substance abuse can provide sensitive, practical support to peers because of their shared experience. Such mutual support complements and enhances the provision of health services. While some private and State-funded behavioral health programs include a peer support program focused on mental illness, relatively few FQHCs have such services available.