Evidence Grows for Peer-Led Mental Health Wellness and Education Interventions

Most of us in community mental health are aware that peer delivered services and supports make good sense. In recent years, research has supported this view (Cook, 2011). Indeed, evidence for the benefit of peer-led programs continues to build as rigorous studies are conducted in our field.

As part of its self-determination mission, the University of Illinois at Chicago’s National Research and Training Center conducts randomized controlled trials (RCTs) of peer-led wellness and education programs. To date, our findings indicate that two well-regarded programs are effective at improving important recovery-oriented outcomes.

Wellness Recovery Action Planning (WRAP), developed by Mary Ellen Copeland and colleagues, helps people to identify resources or “wellness tools.” Participants learn how to use simple, safe, and free or low-cost self-management strategies like healthy diet, exercise, social support, and leisure activities to promote their wellness. They also learn how to plan for difficulties they might experience on the road to recovery, and how to effectively deal with these challenges. The value of peer support is emphasized throughout WRAP.

Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES) was developed by people in recovery and mental health advocates in Tennessee. BRIDGES is a 10-week course that provides basic education about the nature of mental illness and effective treatments, self-help skills, and recovery principles. The program’s philosophy is to empower participants to take an active role in their own treatment and recovery, while building hope for achieving personal dreams and goals. The WRAP facilitators and BRIDGES instructors for our studies were certified, trained peer-educators and were paid for leading sessions in our research.

Study Designs
One of our WRAP studies took place over a three-year period in five regions of Ohio. A total of 519 people were randomly assigned, with their consent, to either an 8-week WRA intervention group meeting once a week for 2.5 hours, or to a services as usual control group. Control group member were guaranteed a chance to receive WRAP at the end of the study. The BRIDGES study took place over three years in eight locations of rural, urban, and suburban Tennessee. A total of 428 individuals were randomly assigned to one of two groups. In the intervention group, participants attended BRIDGES course meetings once a week for 2.5 hours over two months. Control group participants received services as usual while they waited to receive BRIDGES at the end of the study.

In both studies, participation was completely voluntary and did not influence other services or supports participants received. Control and intervention participants were interviewed three times: when they entered the study, at the end of the interventions, and 6 months following the interventions. They were also paid for their time. Outcomes included self-perceived recovery, emotional well-being, hope, self-confidence, empowerment, self-advocacy, social support, service utilization, and quality of life. Study advisory committees with significant consumer representation (>50%) provided input into study design and helped interpret the results.

WRAP and BRIDGES Study Results
Findings to date indicate that, compared to the control group, WRAP intervention participants experienced the following outcomes:

• Greater reductions in depression, anxiety, and overall symptom severity
• Greater improvements in self-perceived recovery, hopefulness, and quality of life
• Greater likelihood of engaging in self-advocacy with service providers

Analyses to date indicate that BRIDGES participants achieved these positive outcomes:

• Higher levels of empowerment and self-perceived recovery
• Improved self-advocacy skills
• Greater hope for their future than control group participants

These results were maintained over time and held true even when controlling for the site where the interventions were taught.

Results of our research provide compelling evidence of the effectiveness of mental health peer-led self-management and education programs. Analyses of different subgroups of participants and how they benefitted from these two programs are currently underway.

Also Worth Noting…
WRAP is now recognized as an evidenced-based practice in the U.S. Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Registry of Evidence- Based Programs and Practices (NREPP).
BRIDGES is a recipient of the 2012 National Council for Community Behavioral Healthcare’s Reintegration Award (sponsored by Eli Lilly) as an exemplary program for improving the lives of people with mental illness.

References:
Cook J. A., Copeland M. E., Hamilton M., et al. Results of a Randomized Controlled Trial of Mental Illness Self-Management Using Wellness Recovery Action Planning. Schizophrenia Bulletin, Epub, DOI: 10.1093/schbul/sbr012 (2011).
Cook, J. A., Steigman, P., et al. Randomized Controlled Trial of Peer-Led Recovery Education Using Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES). Schizophrenia Research, DOI: 10.1016/j.shcres.2011.10.1016 (2011).
Pickett, SA, Steigman, P, et al. Consumer empowerment and self-advocacy outcomes in a randomized study of peer-led education. Community Mental Health Journal (in press).
Cook, J.A. Peer-Delivered Wellness Recovery Services: From Evidence to Widespread Implementation. Psychiatric Rehabilitation Journal, 35(2), 87–89 (2011).
Jonikas, J. A., Grey, D. D., et al. Improving Propensity for Patient Self-Advocacy Through Wellness Recovery Action Planning: Results of a Randomized Controlled Trial. Community Mental Health Journal, DOI: 10.1007/s10597-011-9475-9 (2011).

*Funded by the US Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR), and the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services