Hearing Their Voices: Engaging Certified Peer Specialists in Dialogues About Racism and Recovery

Structural racism has long been recognized as an insidious force within the behavioral health system, affecting people with psychiatric disorders and mental health care providers (1–3). Certified peer specialists (CPSs) are important members of the behavioral health workforce who may be uniquely situated to call attention to and help address mental health inequities and racial injustice. The peer movement began in the 1960s and 1970s after deinstitutionalization, when people with psychiatric conditions who formerly resided in mental institutions began organizing and advocating for their voices and experiences to be heard (4, 5). The peer movement was influenced by the civil rights and disability rights movements, which emphasized the need to ensure that people from all backgrounds and people with disabilities have equal rights (6). Because of the organizing efforts of peers, CPS training programs were developed, and CPSs became integrated into the behavioral health workforce. Recovery-oriented peer support services are effective in engaging people in mental health care, reducing emergency department use and hospitalization, and supporting people in reaching and maintaining recovery (7, 8).

After the murder of George Floyd galvanized the growing movement to address racial injustice in the United States during the summer of 2020, more attention was focused on how the interacting forces of COVID-19, structural racism, and mental health inequities were taking a heavy toll on the health and well-being of members of oppressed and marginalized communities (9, 10). Such racial trauma affects mental health care providers from these communities, who grapple with their own experiences while providing healing spaces for others in pain (11). However, few opportunities for CPSs and their colleagues to discuss and process racism in their workplaces may exist.

The Southeast Mental Health Technology Transfer Center (MHTTC) and the Georgia Mental Health Consumer Network (GMHCN) developed and implemented an event series to provide space for CPSs and other mental health care providers to discuss racism in the behavioral health system. In this column, we describe the series and key themes from its evaluation.

Racism and Recovery Event Series

The Racism and Recovery series consisted of six events, held monthly from September 2020 to February 2021: a listening session, a webinar to share findings from the listening session, and four facilitated conversations. All sessions were delivered by Zoom videoconferencing software and facilitated by two CPSs from GMHCN (R.H. and C.J.). (Table S1 in the online supplement to this column provides additional details about each event.)

The first event, “Hearing the Truth About Racism in Recovery: A Listening Session,” was run in a town hall format, which allowed CPSs to share their personal experiences of racism in the behavioral health system. The full group was asked questions about the presence of racism in the behavioral health system, whether participants had witnessed racism, and how empowered they feel in their workplace to address racism. Participants then went into virtual breakout rooms facilitated by representatives from GMHCN. After the breakout session, a participant from each group presented a brief summary of their group’s discussion.

The second event, “Race and Recovery in the Peer Support Workforce,” was a direct follow-up to the listening session. This webinar equipped participants with language to better describe racism in the behavioral health system and discussed how racism creates barriers to wellness and recovery. The facilitators also shared a summary of the information gathered from the listening session. The webinar ended with a discussion about immediate actions that CPSs could take to recognize and remedy barriers to recovery created by racism.

The next four events were 90-minute peer-led dialogues titled “Continuing Conversations: Race and Recovery in the Peer Support Workforce.” Each conversation provided a supportive environment for discussing the effects of and solutions to racism in the workplace and focused on a specific topic. The topics, in order, were how racism affects recovery supports in the community and the behavioral health system; what efforts are being made to address racism in two state departments of mental health, featuring speakers from the departments; how racial disparities in health care affect recovery and wellness; and how to build the resiliency to face racism in the peer support workforce.

After each event, participants were asked to complete the online Government Performance and Results Act survey required by the Substance Abuse and Mental Health Services Administration (overall response rate=67%, N=239 of 356 total participants) and specific Southeast MHTTC questions with Qualtrics (overall response rate=60%, N=213). Descriptive analyses were conducted for the quantitative items (e.g., demographic characteristics, satisfaction with the event). Responses to the open-ended questions were coded by a public health graduate student on the basis of common topics under each question (e.g., what was most useful, suggestions for improvement, ways information could be used). Themes within and across events were identified from the coded segments by the coder (L.H.) and Southeast MHTTC evaluator (E.R.W.). The Emory University Institutional Review Board determined that this evaluation did not need a protocol review.

A total of 356 participants took part in the Racism and Recovery events (listening session, N=31; webinar, N=162; conversations, N=20–53 each, with total N=163). Participants included CPSs (N=77 of 239, 32%) and other mental health care professionals, who attended from 31 states and the District of Columbia. Participants mainly identified as Black (24%–36% across the listening session, webinar, and conversations) or White (48%–76%) (see Table S2 in the online supplement for demographic characteristics of participants by event). In the evaluation surveys, most participants reported high satisfaction with the events, that the events enhanced their knowledge and skills, and that they would use the information to change their current practice.

Experiences With Racism in the Behavioral Health System

Information from the listening session was shared with participants during the follow-up webinar. In response to the listening-session questions, a majority of participants acknowledged that racism exists in the behavioral health system. Most participants reported having witnessed overt or implied racism in the behavioral health system 10 or more times. Just over half of participants felt somewhat or fully empowered in their workplace to address racism, although about one-third said that their feelings of empowerment depended on the circumstances.

Listening-session participants noted several organization-level racial barriers to recovery and wellness, such as “organizations don’t understand the daily struggle of being a person [of] color” and “the leadership team does not reflect the population of the staff.” Many participants reported that their organizations were gathering information, communicating, and working toward making meaningful changes in response to the social unrest related to racial injustice. However, one in five participants reported that their organizations had done nothing to address this unrest. Participants shared that peers of color experience challenges in the community, such as when engaging with police, medical professionals, or housing services.

Addressing Racism in the Behavioral Health System

Themes from the open-ended questions in the evaluation surveys suggested actions at the individual and organizational levels that could disrupt racism in the behavioral health system and promote equity. At the individual level, the events engaged participants in critical self-reflection, prompting them to be mindful about their own biases and have the courage and the humility to be open to other perspectives. The sessions raised participants’ awareness about the effects of racism in the behavioral health system, such as “how racism truly does affect the level of treatment available, the quality of that treatment, and [why I need] to [show] compassion and empathy [toward] those I serve and serve with.” Participants noted intentions to use what they learned in the sessions to engage in difficult conversations about race and racism, “speak up when I encounter racism,” and “advocate for myself and those in my community.”

At the organizational level, participants highlighted the need for clinic leadership to foster openness and discussion, respond to instances of racism, provide training, and meaningfully engage diverse peers. Participants wrote that they themselves could “bring the issue to management for review,” offer new training sessions to staff, and integrate the information they learned into existing training sessions. Participants suggested that the event series could delineate concrete actions to promote antiracism in the behavioral health system. One participant wrote, “It would’ve been more helpful to discuss steps organizations are taking to dismantle and work through the systems and barriers in place.”

Discussion

The Racism and Recovery event series provided a space for CPSs and other mental health professionals to discuss experiences with racism in the behavioral health system. Participants appreciated the opportunity to connect with each other; to feel seen, heard, and valued; and to hear about different experiences. This approach appears to be a feasible and well-received model for engaging diverse CPSs and other stakeholders and for facilitating conversations about racism in the behavioral health system.

One aim of the series was to prompt CPSs and other mental health care providers to think about actions they could take within their organizations to combat racism. Participants expressed greater awareness of structural racism, examined their own biases, and stated their intentions to apply what they learned to better serve the peers with whom they work. Therefore, the series may have prompted participants to take initial steps to integrate antiracist approaches in their work (12, 13). However, the series was not designed to provide in-depth training in the organizational changes needed to address institutionalized racism in the behavioral health system; thus, further training sessions on this topic are important. Additional efforts are necessary to diversify the mental health workforce, amplify the voices of peers who have been historically marginalized, and advocate for policies that will enhance mental health equity (10, 12, 13). Peers must be a part of these changes, but engaging clinic administrators, mental health care providers, and staff in the process is crucial. The main responsibility for addressing racism at a systemic level belongs with leaders in the behavioral health system rather than those with less power, such as CPSs and other providers.

Participants reported experiencing and witnessing racism within their workplaces, but the evaluation data provide only a glimpse of those experiences. In future iterations, follow-up data could provide insight into the degree to which participation in the series spurred action. Most participants identified as White, indicating a need for continued outreach and engagement of individuals of color and other marginalized identities to fully understand their perspectives and experiences. Further work is needed to better understand how the intersectionality of race and mental health affects the lived experiences and recovery of CPSs of color, how antiracist approaches can be infused into peer support activities, and how behavioral health organizations can best support peers of color and foster equitable environments.

Conclusions

This pilot of the Racism and Recovery series facilitated conversations on racism and could be used for further discussions to promote equitable participation in the behavioral health system. Lessons learned from the series may also inform future training sessions for CPSs, other mental health care providers, and clinic leadership on integrating antiracist and equitable approaches to behavioral health care.