photo by: Mackenzie Clark

Bill Reilly, peer support program manager for Bert Nash Community Mental Health Center, shares some of his life experiences with Douglas County commissioners at their work session on Wednesday, March 6, 2019.

Bill Reilly got a bit emotional as he shared his story with Douglas County commissioners on Wednesday.

He told the commission that he “entered the system” as a 2-year-old kid. Over the decades since, he’s been a foster child, a patient in rehab and mental hospitals, and he’s survived suicide attempts. He said he’s been “every person and every role that you can possibly be throughout the system.”

“Those things can be viewed as a negative until you turn that conversation around and ask, ‘How can this be helpful to another person?'” said Reilly, peer support program manager for Bert Nash Community Mental Health Center. “And to me, that’s where the urgency comes into the work that we’re doing, because a clinical relationship is one thing, but a peer support relationship is something different.”

Reilly was one of several leaders in local behavioral health programming to join Bob Tryanski, the county’s director of behavioral health projects, at the table with county commissioners at a work session on Wednesday.

photo by: Mackenzie Clark

Leaders of Douglas County and of local behavioral health programming came to the table at the County Commission’s work session on Wednesday, March 6, 2019, to discuss a proposed peer fellows program. Facing forward, from left to right, are Interim County Administrator Sarah Plinsky; Derrick Hurst, director of the Integrated Crisis Team at LMH Health; Bill Reilly, peer support program manager for Bert Nash Community Mental Health Center; Sandra Dixon, director of behavioral health services at DCCCA; Bob Tryanski, Douglas County’s director of behavioral health programs; and Douglas County Commissioner Nancy Thellman. Facing away from the camera are Douglas County Commission Vice Chair Patrick Kelly and Chair Michelle Derusseau.

Tryanski is proposing the Douglas County Peer Fellows Program, a multifaceted effort that would train and place peer support specialists within the emergency department at LMH Health. It would also use an approach he likened to Teach for America or an internship in order to prepare the peers for their next steps in life.

How it would work

The program would start with six peers focused in the emergency department and would grow to support 12 at a time. First-year costs to provides stipends to the peers would be up to $170,000, Tryanski told county officials. Peers would work 20 hours per week, roughly split into 16 hours spent in the ED and four spent in training for leadership, mental health first aid and other strategies to help those with mental illness.

“In addition to giving folks the opportunity to have the work experience in an environment where we need peer support, we would wrap around those peers with training, professional development, with coaching and support in an ongoing way,” Tryanski said, “so that they could become real robust, huge resources, not just to the emergency department but in our community as this workforce were to grow.”

Program coordinators would aim to work with community partners and other agencies that aren’t yet using peer support or that need more peers in place so that after the peer fellows have been in the program for roughly a year, they can move into other organizations. Tryanski said the goal would be to have peers move in and out on a rolling basis, so that some more experienced peers would be on board alongside the new ones.

photo by: Mackenzie Clark

Bob Tryanski, Douglas County’s director of behavioral health projects, speaks about the new peer fellows program he was proposing to county commissioners at their work session on Wednesday, March 6, 2019.

Interim County Administrator Sarah Plinsky told commissioners that the program’s workforce development aspects could provide a double value to the county as it begins to build — and, eventually, staff — the planned behavioral health crisis center at Second and Maine streets. The peer fellows could naturally flow into roles at that center.

In jobs that are completely unrelated to behavioral health, too, Tryanski said the peer fellows’ abilities to help co-workers who are experiencing stress, anxiety and emotional challenges could be a valuable skill to those who might hire them.

In the emergency department

The county has supported various behavioral health initiatives that have launched in the past year or so and that Tryanski said aim to achieve a specific goal: “to build an integrated system of care that moves from crisis and illness as the norm to recovery and prevention as a practice.”

One of those initiatives is the Integrated Crisis Team, which aims to improve people’s experiences when they come to the LMH Health emergency department for behavioral health crises. The ED also now houses full-time behavioral health crisis clinicians who help those patients begin treatment and have better experiences during the frightening early moments of their stays.

Tryanski said he got to shadow some of the behavioral health crisis clinicians in the ED, and what struck him was how much time patients spend by themselves in their rooms. He said that time is a unique opportunity for peer support specialists to be there with people in the midst of a difficult moment, and could even get more information than those in crisis might be willing to offer to other hospital personnel.

Reilly said he has worked in various peer support jobs, been a sponsor in Alcoholics Anonymous and trained peer support folks all across the state, but the experience of working in the ED was entirely different. He described an interaction comforting a woman who had just tried to take her own life — “watching the tears stop, watching her eyes start to spark up a little bit” — and he said nothing compares to seeing the impact firsthand.

“The work that we do, it transforms people’s lives,” he said. “… I could talk all day about how important it is.”

Derrick Hurst, director of the ICT, said he can vouch for the potential for peers to create a different experience for patients. For example, he saw one of the peer specialists employed at Bert Nash Community Mental Health Center accompany a patient in the ED, and he said the peer was able to speak with a better understanding from personal experience, which ultimately affected the patient’s treatment plan.

Hurst said that as the ICT fell into place last year, no one was quite sure exactly how it would look in practice. But since then, he said he’s heard reports from administrators that some medical personnel in the ED have said that they wouldn’t want to work in the department without the behavioral health crisis clinicians on board.

If the county approves the peer fellows program, Hurst said that once it starts up, “pretty quickly, we’re going to realize exactly how it fits, and exactly why it works, and why we can never live without it again.”

‘Been there, I’ve lived it’

Sandra Dixon, director of behavioral health services at DCCCA, spearheaded a peer-supported program within that agency to help those in need access social detoxification services in this region. DCCCA has partnered with programs in Johnson County, Salina and Wichita in addition to its own facilities to help provide people in substance use crisis a safe and supportive environment to get clean.

photo by: Mackenzie Clark

Sandra Dixon, in the foreground, director of behavioral health services at DCCCA, tells Douglas County commissioners about a program that the agency has put in place that uses peer mentors to help those in substance use crises during the commission’s work session on Wednesday, March 6, 2019. Behind her is Bill Reilly, peer support program manager for Bert Nash Community Mental Health Center.

“The intent was to certify peer mentors to go into the emergency room to work with the medical staff and to talk with a patient who has very similar experiences that peer used to have and help that person make a decision to start a recovery process,” she told the commission.

She said it’s one thing for doctors or social workers to try to talk to individuals who are in substance use crises — but “It’s really, really different when someone like Karma (Lohrenz, DCCCA peer support specialist) walks in the door and says, ‘Been here, I’ve lived it, and I’m going to help you take your first step.'”

DCCCA’s peers don’t just send people on their way to social detox, Dixon said. They stay engaged and help facilitate access to treatment. Since the program took its first call March 2, 2018, Dixon said that 73 percent of the people that DCCCA has placed in social detox have successfully completed it. She said the national average is about 45 to 50 percent.

“The data tell us one story, but the important story is that people’s lives are changing because of the work that you all are funding and that we’re doing in the community,” Dixon told commissioners. “And I think the opportunity to expand that skill and commitment that peers have in other areas could have an amazing impact.”

Building a ‘robust system of care’

Tryanski’s proposal for the peer fellows program will come back to seek the county commission’s approval at one of its meetings in the next couple of weeks, once he has a budget finalized.

If approved, the goal would be to hire and start training peers in the second quarter of this year, have the first six fellows working by the third quarter, and have the second six fellows hired by the end of the year, according to a timeline provided in the Douglas County Commission’s meeting agenda.

“We are doing some real bold collaboration, we’re doing some bold resource sharing and we’re doing some piloting and incubating and experimenting with small-scale projects that we hope we’ll be able to scale and be sustainable,” Tryanski told commissioners, “so that five years from now, when we look back on where we are, we’ll have that robust system of care in place.”

As it aims to make big waves, the program would face challenges, which Tryanski listed for the commission. One is state licensing requirements, which differ for peer support specialists depending on whether their focus is on mental health or substance use. Ideally, peers would be able to do both, but there would be hurdles to jump in Topeka before that could happen. Another challenge is expanding a limited community understanding of the impact of peer support training, Tryanski said.

Commissioner Nancy Thellman asked about what sort of support would be in place for the peers themselves, as this type of work will take an emotional toll. Reilly said it would definitely be built into the program — he understands from experience how important that is — but it hasn’t yet been determined exactly what that support will look like.

One more challenge is securing a stable and sustainable funding source. Funding for the program’s first year would come from an equipment reserve fund of $670,000 that they approved on Jan. 9. That money was left over from the county’s fiscal year 2018 budget for behavioral health projects, and the reserve fund allowed it to remain available this year for startup costs of related initiatives.

“I’m not proposing any additional dollars; what I’m proposing is we allocate (earmarked behavioral health project) dollars in particular ways over the next two years to provide stipends for those positions at a cost not to exceed $170,000 in year one,” Tryanski told commissioners.

Recruiting qualified candidates is not a concern for Reilly — “I’m pretty good at it,” he told commissioners, drawing a laugh. He said he already knows of about 15 people who would be interested in the program.