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OUR POSITION
STATEMENTS
by Dawn Bunch, Chairperson
We Intend to Implement Peer Support Programs in High Schools to Promote Adolescent Mental Health
Evidently, peer support is an extremely promising method of promoting mental health and emotional wellbeing. Peer support supplies both providers and recipients with supportive and progressive interpersonal relationships and role models, and encourages empathic listening, self-reflection, and consideration of alternatives (Morey et al., 1993). These programs empower participants through reciprocal and supportive relationships, cultivating the participant’s ability to take charge of their mental health independently.
Because of the documented success of peer support programs in bettering high school students' mental health and emotional wellbeing, our organization is establishing a national program with the purpose of implementing these programs in high schools.
Because the majority of cases of mental illness begin developing between the ages of 14 and 24, and adolescence is often accompanied by stress and emotional turmoil, we believe that promoting mental health in high school- aged youth will cause adolescents to be better equipped to manage their mental health throughout their lives. High school peer support programs have also been found to help students adjust to a school’s environment, allowing them to be more successful socially and academically (Morey, et al. 1993).
Poor mental health is also known to increase students’ likelihood of dropping out of school, using alcohol and drugs, and engaging in other self- destructive behaviors. According to the National Alliance on Mental Illness, about 50% of students aged 14 years or older with a mental illness end up dropping out of high school, and that 70% of youth in state and juvenile justice systems have a mental illness. Research has shown that peer support programs in high schools lead students to decrease their drug and alcohol use, stay in school, and avoid other self-destructive behavior.
As mentioned in the Research section of our website, Wassef et al. (1996) demonstrated that when peer support programs are implemented in high schools, they are extremely effective in bettering students’ perceptions of their mental health, self esteem, and overall attitudes towards life. This study also demonstrates that high school peer support programs significantly lessen student substance abuse and prevent students from dropping out of school. As such, by promoting mental health through the establishment of high school peer support programs, student populations could experience less emotional distress and learn to adopt healthy coping mechanisms.
In general, peer support programs can provide adolescents who struggle with poor mental health and emotional distress with a reciprocal, constructive support system that uses different approaches from conventional mental health treatment, allowing them to ultimately learn to better take control of their mental health.
On a larger scale, given the nature of peer support, the further implementation of these programs could very well equip younger generations with skills in helping themselves, helping others, and practicing care for society. Involving adolescents in peer support through high school programs would systematically teach compassion, empathy, and healthy coping mechanisms, and would involve them in a constructive activity rather than in destructive ones.
Certain Best Practices Should be Followed when Implementing Peer Support Programs in High Schools
With consideration of the widely acknowledged principles of peer support, research has outlined some of the most effective practices for peer support programs in high schools. As the pioneers of widespread peer support programs for adolescent mental health, our organization will adhere to the following best practices, as well as those identified in our National Discussion, in the training of peer supporters within APSL school programs.
Morey et al. (1993) found that, while high school peer counseling theoretically provides support through empathic listening and consideration of alternatives, other research (Barnett & Harris, 1984) claimed that students preferred when peer counselors provided instrumental responses (giving advice and suggestions) over empathic responses (reflecting on thoughts and feelings). However, Wassef et al. (1996) yielded extremely high levels of satisfaction with peer counselors who had been instructed to engage in empathic therapy. Because of this inconsistency in students’ preferred styles of helping, we will encourage the use of both instrumental and empathic responses in our programs, and intend to collect public opinions on support style via our National Discussion. Likewise, in these settings, peer supporters should be instructed to learn which helping style their peer responds best to, and adapt their helping style appropriately.
Morey et al (1996) also found that students considered “a climate of caring and concern” to be “a prerequisite within the relationship [between a peer supporter and a peer], which then allows for movement toward dealing with concerns and problem solving”. Therefore, we find it imperative to emphasize the importance of fostering a strong emotional bond between a peer supporter and a peer, which provides a background of emotional safety, trust, and understanding, and allows for a more effective exchange. In this study, students also detailed that peer supporters who appeared prepared and put-together were more impactful. Therefore, professionalism, neatness, and punctuality should will also be emphasized during APSL peer support training.
Please see "The Role of a Peer Supporter" for more on best practices.
The Role of a Peer Supporter
First, it is important to note that APSL-affiliated peer supporters are not professional psychologists, they are high school students. Peer supporters do not claim to possess clinical knowledge on mental illness, and if they feel that an individual needs to see a professional, they are obligated to notify the school's program supervisor, who would be a school administrator.
Peer supporters primarily serve as someone to talk to, and encourage healthy perspectives through inspiring hope, teaching problem-solving techniques, empathic listening, self- reflection, consideration of alternatives, facilitating access to valuable opportunities, and encouraging their peers to better take control of their mental health. Likewise, because peer supporters are not licensed professionals, they should be mostly non-directive in their approach. Instead, they are encouraged to offer empathic support (reflecting on thoughts and feelings), allowing people to recognize personal solutions within themselves. The extent to which a peer supporter uses a more directive approach (giving advice and suggestions) should depend on what their peer responds best to and is most comfortable with.
We believe that peer support is most effective when the experience is mutual and reciprocal. Both parties involved are on the road towards better mental health. It is important to note that the peer supporter should not be placed above their peers. Rather, both parties share in exploring solutions together.
Established best practices for peer support indicate that it is imperative that both parties in a peer support relationship have a clear understanding of what emotional safety means to the other. Therefore, practicing confidentiality, demonstrating empathy, establishing boundaries, and remaining non-judgmental are crucial to maintaining a successful peer relationship.
During the National Discussion, we will also take feedback from students and professionals as to how we can continue to shape the role of an adolescent peer supporter.
Conclusion
Peer support is an innovative, promising system of mental health support that has the potential to be incredibly instrumental in promoting adolescent mental health nationwide. Ultimately, the literature has shown that peer support systems are worth further implementation, as they have been extremely effective in fostering a positive approach to mental health within adolescents.
Peer support also teaches compassion, involves teens in a constructive and positive activity, encourages the development of healthy coping mechanisms, and equips them with the ability to deal with their own psychological problems in the future. Because of this, we believe that the further implementation of these programs will potentially be extremely instrumental in addressing the high prevalence of poor mental health in adolescent populations, which could subsequently decrease teen suicide rates, student dropout rates, instances of teenage drug and alcohol addiction, and teenage violence. On a larger scale, we believe that these programs could potentially equip future generations with both the knowledge of how to help themselves and others, and with an overall healthier perception of mental health.
OUR RESEARCH
We have done ample research on the efficacy of peer support programs in promoting mental health and emotional wellbeing, especially in adolescents. There are numerous other examples of the success of peer support, which can be found under "more evidence".
Since the 1990s, existing literature has demonstrated the positive psychological effects peer support programs. Bouchard et al. (2010) found that peer support provides people with a thoughtful and constructive process towards recovery, which encompasses self- reflection, self- observation, and evaluating outcomes, and that these processes provide both peers and recipients with improved mental health and quality of life. Davidson et al. (2012) found that “when providing peer support that involves positive self- disclosure, role-modeling, and conditional regard, peer staff have also been found to increase participants’ sense of hope, control, and ability to effect changes in their lives; increase their self care, sense of community belonging, and satisfaction with various life domains; and decrease participants’ level of depression and psychosis”. Bob Glover, director of the National Association of State Mental Health Program Directors, asserts that “when peers are involved, outcomes are dramatically better across the board” (Vestal, 2013).
Likewise, existing literature has reflected upon the economic benefits of peer support programs. Research shows that peer support specialists can help states save money by reducing the need for emergency interventions and hospitalizations, and that their efforts ameliorate the current shortage of mental health workers (Vestal 2013). Sita Diehl, head of the state policy for the National Alliance on Mental Illness, states that “because of [peers’] life experience and relatively low cost, they can provide more face time for people" than conventional mental health providers (Vestal, 2013). Migdole et al. (2011) concluded that peer support positions provide unique opportunities for both prospective mental health professionals and for people in recovery.
One striking example of the efficacy of peer support programs in addressing mental health is a volunteer- facilitated peer support group formed in a Southwestern high school in the early 1990s. In this instance, students were notified of the availability of the program and applied if they believed they could benefit from engaging in peer support. Students did not receive an incentive for joining, so their participation was completely voluntary. 250 students were then selected to partake in the program on the basis that their perceived level of emotional distress was high enough to warrant intervention, but not so high that hospitalization would be required. Throughout the 1992-1993 academic year, participants engaged in 50-minute peer support sessions once a week. After the program ended, students were asked to fill out an anonymous survey that assessed their satisfaction with the program. The following statistics were gathered from the results of the survey. (Wassef et al., 1996)
Interpersonal factors
74.38% of participants reported seeing a positive effect in their communication and expression of feelings.
67.50% of participants reported seeing a positive effect in their relations with other students.
75.83% of participants reported seeing a positive effect on their ability to support their friends.
68.91% of participants reported seeing a positive effect on their ability to help their family.
Internal factors
68.91% of participants reported that the program had a positive effect on their mental health.
76.03% of participants reported that the program had a positive effect on their perceived self- worth.
77.88% of participants reported that the program helped them discover new ways to deal with problems.
64.46% of participants reported that the program helped them better cope with stress.
School factors
60.66% of participants reported that the program had a positive effect on their attitude towards school.
General program acceptability factors
94.74% of participants said they would recommend the program to a friend.
69.75% of participants said they would join an in- school peer support group the following year.
On a five- point scale, 52.10% of participants rated their level of comfort at the end of the group a 5 (high), and 35.29% rated their level of comfort a 4 (somewhat high).
On a five- point scale, 49.58% of participants rated their perceived group success a 5 (high), and 36.13% of participants rated their perceived group success a 4 (somewhat high).
As demonstrated by the aforementioned statistics, the vast majority of participants reported that they considered the peer support program to be helpful, constructive, and highly successful for the group and the individual. Most importantly, a substantial amount of participants (68.91%) believed that the program had a positive effect on their mental health, and likewise, high percentages of participants believed that the program helped to foster a healthier mentality and better coping mechanisms.
Likewise, results indicate that these programs, in bettering the participants’ mental health, also had external benefits to the students’ lives. 19.30% of participants revealed that they had considered dropping out of school, and 59.52% of those participants stated that the program helped to prevent them from making this decision. Likewise, 62.96% of participants stated that they had previously used alcohol or drugs, but as a result of the program, 25.35% stopped using these substances, 32.39% decreased their usage, and 22.54% did not decrease their substance use but reported that they had more awareness of their usage. These statistics demonstrate that, not only is peer support highly effective in providing a path towards better mental health, but it also encourages participants to adopt healthier attitudes and avoid self-destructive behavior. This can be explained by the program’s positive effects on students’ self worth and ability to cope with stress.
This study demonstrates that, in the few instances in which peer support programs have been implemented in high schools, these programs have demonstrated high efficacy in addressing poor mental health and emotional distress in adolescent populations and have proven to be a viable alternative to conventional mental health treatment. This study also demonstrates that students involved in peer support were able to find new ways to cope and find solutions to personal problems, extending the effects of peer support beyond the length of the program. As such, this study serves as an example to future high school, mental health-focused peer support programs.