In Georgia, peer providers bring lived experience and a focus on recovery to the behavioral health workforce.

Change:  On the campus of the old Central State Hospital, in Milledgeville, Georgia, peer mentor Cathy Wrighton (right) and program director Gena Garner have seen the state’s approach to mental health care change dramatically in recent years.

Change: On the campus of the old Central State Hospital, in Milledgeville, Georgia, peer mentor Cathy Wrighton (right) and program director Gena Garner have seen the state’s approach to mental health care change dramatically in recent years.

LEADING TO HEALTH

Beyond Twelve Steps, Peer-Supported Mental Health Care

Like a ghost town of psychiatry’s past, the abandoned buildings on the old campus of Central State Hospital, in Milledgeville, Georgia, tell a story of pain and progress. Patients once arrived by train at the small Victorian-style depot (now being repurposed into a museum) and checked in at the Powell Building, which mimics a capitol with its white brick, stately columns, and black dome and cupola. When Cathy Wrighton worked there in admissions a couple of decades ago, she pushed open a heavy window seeking fresh air and heard patients screaming from the floors above.

The Powell Building faces a grassy quad with a pecan grove, lined on either side by red-brick buildings with white pillars and porches. The paint is peeling, windows are boarded up or agape with broken-out glass, but the grass stays neatly mowed. At its peak in the late 1950s, Central State Hospital—once called the Georgia Lunatic Asylum—housed more than 12,000 patients, making it the largest such facility in the world.

Its decay reflects the fundamental transformation of mental health care from institutional to community-based services. Georgia has been at the forefront of this change—as the state at the heart of the groundbreaking Supreme Court case, Olmstead v L.C., brought by two women with mental illness and developmental disabilities. In 1999 Olmstead established the right of people with disabilities to receive state-funded services in the community.1

In that same year Georgia became the first state to receive Medicaid reimbursement for services delivered by “peers,” or people who use their personal experience with mental illness to help others. The role of nonclinical peer support is now a core part of the behavioral health workforce nationally, as forty-eight states and the District of Columbia have or are developing a system of certifying peer specialists. Peers join care teams in varied settings, from emergency departments and crisis centers to community programs.

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Article by Michelle Cohen Marill and photos by Duane Stork. Published June 2019

Gregory Fortunato