Peer-led group support offers a way out of our mental health crisis

Group approach is effective and addresses cost and provider shortage issues

WE ARE LIVING through an unprecedented, pandemic-fueled, mass-scale crisis of behavioral health. Deaths from suicide and alcohol and substance use increased 20 percent during the pandemic. Rates of depression and anxiety increased 25 percent across all age groups, demographics, and geographic locales.

In response, Massachusetts lawmakers and Gov. Charlie Baker enacted the Mental Health ABC Act: Addressing Barriers to Care in August, a groundbreaking law designed to dramatically expand access to behavioral health treatment and services. Health insurers are now required to cover the costs of an annual mental health wellness exam comparable to that of an annual physical exam, and regulatory agencies have been given additional resources to enforce existing mental health parity laws. We should be grateful to live in a state where our policymakers jump into action to address crises like this.

But we are going to need more than this new law to meet the moment we’re in.

Experience has taught us that wide scale mental health screening is ineffective if it cannot be paired with actionable referrals for service. Recent studies of adolescents, cardiovascular patients, and pregnant women who were screened for mental health disorders demonstrate low rates of subsequent treatment, much less treatment that is effective.

There are many reasons for this. There is a shortage of skilled clinicians. Little good comes from identifying patients in need of mental health care when they cannot get a referral to a therapist who is taking new patients. Those who can find a therapist with openings are often stymied by the costs of care. Due to low rates of insurance reimbursement, many therapists require patients to pay in full, out of pocket. This can result in weekly fees of $200-$400, which are out of reach for most people. Meanwhile, despite the progress made through the efforts of high-profile celebrities like Simone Biles and Michael Phelps—who have shared their battles with mental health challenges in hopes of making it easier for others to seek treatment—the stigma associated with mental illness remains a potent deterrent to care.

We urgently need to increase capacity for easily-accessible treatment while keeping costs low and quality high. The way to do this is by embracing group-based mental health support as a tool. Frequently confused with generic support groups or highly facilitated didactic group therapy, group-based mental health support is neither. Instead, it utilizes evidence-based therapeutic interventions such as cognitive behavioral therapies and mindfulness-based stress reduction in a group setting where participants learn from each other with guidance from a peer specialist who is well-trained in group dynamics.

A growing body of evidence shows that this form of care consistently reduces feelings of loneliness, anxiety, and depression and increases feelings of hope. Studies show that it has been effective with populations as diverse as parents dealing with postpartum depression, residents of rural areas living with chronic conditions, health care professionals who’ve made mistakes resulting in harm to patients, people living with schizophrenia, and people dealing with substance use disorder. It has also been shown to be more cost effective than traditional models of care. 

Despite its effectiveness, group-based mental health support is not yet integrated into our institutional systems of behavioral health, which remain focused on more traditional medical-based models. The state’s new mental health law creates an Office of Behavioral Health Promotion. Workforce development and mental health parity will surely be two priorities of this new office. Championing group-based mental health support as a way to fill essential gaps in services should be a third.

The use of peer-led, group-based mental health support long predates the pandemic. But this form of care is ideal for addressing the systemic inequities in treatment and services laid bare by our response to COVID-19. It is just as effective when delivered online as in person. It can be easily tailored for culturally and linguistically diverse communities when groups are led by trained peer specialists who are also members of that community. This is vital for racial and ethnic minorities, people who are LGBTQ, people who are living with disabilities, refugees and new immigrants, and others who do not often find themselves openly represented in the ranks of mental health care professionals.

Finally, the healing that occurs during mental health group support is rooted in emotional connection with others who are facing similar challenges. Such connection often results in shared tears—and laughter.

Meet the Author
This, more than anything else, is what we need now, and I urge those who will be overseeing the state’s new law to ensure that evidence-based, trauma-informed group support is a part of its implementation.

Liz Friedman is co-founder and CEO of Group Peer Support, a Northampton-based company that assists communities experiencing trauma in creating accessible and culturally responsive, evidence-based  peer-led group support. She is also a member of the Massachusetts Commission on the Status of Women.