Brief Peer Support Specialists

More than 121 million Americans reside in a mental health professional shortage area, which is defined as a shortage of behavioral health professionals relative to the population. As states consider strategies to address behavioral health workforce shortages, peer support specialists play an important role in educating clients about their conditions, advocating for patients, coordinating care and providing social supports to achieve recovery goals.

Peer support specialists draw on their personal knowledge and experience to provide mental health or substance abuse services, such as education and connection to other services. The Substance Abuse and Mental Health Services Administration defines a peer support specialist (also called a "peer provider") as someone who "uses his or her lived experience of recovery from mental illness and/or addiction, plus skills learned in formal training, to deliver services in behavioral health settings to promote mind-body recovery and resiliency." Peer support specialists work in partnership with licensed providers, who may refer patients to them. Similar to community health workers, they are considered clinical supporters and community care workers because they extend the reach of clinical settings into community-based settings. Peer support specialists must disclose their experience with a mental health or substance use condition as part of their training and employment. Peer support specialists often provide additional support services specifically in mental health and addiction. 

Peer support specialists' unique role and lived experience contribute to a holistic approach to health care, improving behavioral health outcomes and providing empathy during recovery. Research demonstrates that peer support interventions can lead to reductions in psychiatric hospitalizations and improvements in overall mental well-being. The trusting and collaborative relationship peer support specialists provide may lead to increased patient compliance with treatment plans.

States may bolster the behavioral health workforce by leveraging a variety of provider types, including peer support specialists. Policymakers can integrate peer support specialists into the health care system through certification, training, continuing education, financing and reimbursement of services.

California made peer support services eligible for coverage under Medi-Cal, the state's Medicaid program, as of 2020. Counties may opt-in to cover peer support specialist services under their Specialty Mental Health Services, Drug Medi-Cal or Drug Medi-Cal Organized Delivery Systems. Alabama approved covering peer support services under its Medication Assisted Treatment benefit in the Medicaid state plan in 2021. Illinois required peer support services be added to the state Medicaid plan, effective Jan. 1, 2023.

Some states require separate certifications for peer support specialists focusing on substance use or mental health. Other states require one certification for either or both. Hawaii currently offers only mental health peer certification, and New Hampshire and Vermont offer only substance use peer certification.

Most states require 40-46 hours of educational training for certification, though the number of approved educational hours varies from state to state. For example, Mississippi training requirements are three hours of online courses and a four-day training program, whereas Illinois requires 110 hours of training.

Other certification requirements may include prerequisites such as a degree, supervised work experience, assessments or continued education. Arkansas requires peer support specialists working in substance use or mental health to complete a certification including 46 hours of training, 500 hours of supervised work experience, a 75-question test and eight hours of continuing education annually. Certification requirements for certified recovery specialists in Pennsylvania include 78 hours of training, passing a test, a minimum of a high school diploma or GED, statement of lived experience and 18 continuous months of personal recovery experience.

Several third-party organizations offer peer support specialist certification. For example, the Association for Addiction Professionals and Mental Health America both offer national peer support specialist certifications that may be recognized across various states, but the specific recognition may vary depending on state-specific standards. Alcoholism and Substance Abuse Providers of New York State offers training and separate certification pathways for peer support specialists wanting to work in either substance use or mental health recovery. Georgia Mental Health Consumer Network and Georgia Council on Substance Abuse offer trainings and certifications for peer support specialists.

Razan Amira Badr is a policy analyst with NCSL's health program.

This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $875,000 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.