Transitioning from inpatient services to outpatient treatment is both difficult and anxiety-inducing for many individuals with serious mental illnesses. While peer support has addressed this through a variety of means of support, the oldest and most reproduced program is known as the “peer bridger” model. It was first introduced in 1994 by the New York Association for Psychiatric Rehabilitation Services (NYAPRS) to provide support for individuals with long or repeated psychiatric hospitalizations as they made the transition back to their home communities. It is a manualized model that focuses on:
1. Outreach and engagement;
2. Crisis stabilization;
3. Wellness and self-management skills; and
4. Community support.
The certified peer specialist first meets with the individual while they are in the hospital and begins to develop a trusting relationship. They work together as a team to develop a series of goals and a plan of action for when the person is discharged. A significant number of psychiatric services patients have a high frequency of hospitalizations, and the strongest indicator of likelihood of readmission is the number of previous hospitalizations. When peer bridgers are available to continue to work with the individual post-discharge, rates of readmission are dramatically reduced. Returning to their communities can be highly stressful, and while the hospitalization may have been effective in supporting the individual through crisis, the same stress factors that were present at the time of admission are frequently still there upon discharge. If desired by the individual, the peer bridger may work with the person’s family members to help support recovery. The presence of a well-trained certified peer specialist can be critical in assisting the individual to overcome the barriers facing them upon discharge. There are similar models of peer support, including programs that begin during short-term crisis inpatient stays, which is increasingly being utilized.
To learn more about innovative models of peer support services in behavioral health to reduce preventable acute hospitalization and readmission, please read this assessment from the U.S. Department of Health and Human Services.