WASHINGTON, DC—Some individuals in distress may be more comfortable sharing their struggles with a peer than with a mental health counselor. Formalized peer-to-peer support programs seek to capitalize on that by training peer supporters to provide guidance and resource links to fellow colleagues who are struggling.
As part of an effort to explore how to most effectively apply peer support in the military environment, the Defense Centers of Excellence For Psychological Health and Traumatic Injury (DCoE) reviewed 16 peer-to-peer counseling and mentoring programs in its report, Identification of Best Practices in Peer Support Programs: White Paper. “Peer-to-peer programs represent a promising avenue for preventing suicide and psychological health difficulties, as well as for decreasing dependence on provider care,” said Monique Moore, PhD, who serves in DCoE’s Resilience and Prevention Directorate and who moderated a DCoE webinar on best practices in peer-to-peer support programs.
Various peer-to-peer programs already are in use in the military and civilian communities. DCoE’s paper noted that peer support provides benefits to the individual participant, peer supporter, healthcare provider community, and surrounding community.
Peer supporters can often help reduce stigma in seeking care and provide education on coping skills to those who are seeking help. In addition, they can facilitate referrals of individuals needing help to mental health providers. Through the efforts of a peer supporter, the healthcare community can reach individuals who may not have otherwise opted to use their services.
Peer support programs may lend themselves well to military use because the military culture emphasizes taking care of one another. In addition, in a recent behavioral health survey of more than 28,000 active-duty military personnel, talking with friends and family was the second most common coping strategy for dealing with stress, with 73% responding to using that strategy frequently or sometimes, according to the paper.
Programs Use Peer-to-Peer
During a recent DCoE webinar on peer-to-peer support officials presented information on two peer support programs it reviewed, the Police Organization Providing Peer Assistance (POPPA) and a program used by the UK military called Trauma Risk Management (TRiM). Both programs were highlighted during the webinar due to their approaches and because they targeted leadership support to create a culture where seeking the assistance of peer supporters is accepted and encouraged.
Bill Genet, a veteran of the NY City Police Department, founded POPPA in 1996 in response to the suicide crisis experienced by the department in the mid 1990s. The program is an independent, confidential voluntary peer-based assistance program for NYPD officers. The program works in partnership with the NYPD. “One of the unique differences between POPPA and other [programs] is that we operate outside of the agency, thereby ensuring the confidentiality that seems to be the main block of resistance to this population getting assistance,” he said.
As part of the program, volunteer police officers are trained to assist and link those in need of further help to the appropriate assistance. The volunteer officers staff a helpline that fellow officers in distress can call. The officers calling the helpline not only have an opportunity to meet in person with the POPPA police officers, but if needed, the officers will link them to further mental health assistance. Since police officers, like servicemembers, often fear that seeking help will hurt their career, the program provides an avenue for officers to seek help in a confidential way. The helpline has had over 12,000 calls since 1996. Program officials said that over 80 officers who used the program have stated they would have committed suicide if it were not for their use of the program.
Frank Dowling, MD, medical advisor for POPPA, said that the fact that the program is staffed by fellow police officer volunteers and is a program that is entirely independent of the police department helps foster trust for the program among officers. “The trust factor is tremendous there.”
The other peer-to-peer support program highlighted during the webinar, TRiM, is used by the UK military. This program uses a system of peer delivered support to identify those at risk for developing mental health problems after exposure to potentially traumatic experiences, including combat.
This program trains servicemembers to be TRiM practitioners and TRiM team leaders. The TRiM practitioners conduct a risk assessment
after an event to assess how personnel are coping in the aftermath of the incident. TRiM practitioners can then identify those who may need additional help and recommend other possible sources of help. Servicemembers who participate in an assessment are assured their responses are confidential, unless they reveal they are a danger to themselves or others.
TRiM support is available where troops are deployed. “By making TRiM a part of standard operating procedures, peer pressure is used to encourage personnel to accept help at an early stage irrespective of rank and role,” said Lt Paul G Youngman, who is with the Defence Academy of the United Kingdom. “Personnel can have confidence that good leadership practice endorses mental health support and by doing so promotes a resilient organization.”
Their research indicates that military personnel surveyed favor peer support over other types of support.
TRiM is designed as an immediate response after an event and is not recommended for use as a delayed response to an event.