For the last 3 years, the Libraries for Health program has placed peer support specialists in nine rural libraries across Central Texas to help address community mental health needs, but it’s unclear whether this care will remain available after the program ends next June.
In communities like Jarrell, where rapid population growth has outpaced social and health services, a shortage of mental health providers makes it nearly impossible to access mental healthcare. One possible solution for rural communities like Jarrell is to supplement limited care with peer support, a model that uses people who have experienced mental health conditions or substance abuse disorders to provide emotional support, skills training and other services.
“Libraries were chosen because that’s the one thing you’re definitely going to find in a rural area,” said Ta’Kisha Moore, the Libraries for Health coordinator at ViaHope, a peer support training organization that has partnered with Central Texas grantmaking organization St. David’s Foundation and RAND, a research organization.
Ailina Aponte, a 36-year-old mother of one, worked as a program coordinator at the Jarrell Community Library and Resource Center before receiving peer support training through Libraries for Health.
“I always liked helping people,” said Aponte. “This just kind of took it to a whole new level.”
While research shows that the peer support model is effective at improving clients’ well-being, experts say that low pay makes it difficult for people to remain in positions or create livable careers. For some of the peer specialists trained by Libraries for Health, that will mean looking for other ways to make mental health care a viable career.
Peers offer a potential solution to rural mental health needs
The Health Resources and Services Administration designates over 80% of Texas’ 192 rural counties mental healthcare provider shortage areas. According to the Texas Department of State Health Services, most rural counties have no psychiatrist.
“The entire community of 25,000 has no social, human, or health services at all,” said Susan Gregurek, director of the Jarrell Community Library and Resource Center.
According to Gregurek, because many families have only one car, traveling out of town to these services is often not an option.
“A peer specialist in one of our libraries is in no way taking the place of clinician care. It’s a community-based response to make mental wellness supports more easily available,” said Abena Asante, senior program officer at St. David’s Foundation.
Mental health peer specialists use experience with mental health issues to help others currently experiencing problems. Rather than offering advice or medical diagnosis, peer specialists work to create goals for recovery. Their responsibilities range from helping update resumes to finding health providers or listening and providing emotional support.
Victoria Alaniz works as a peer specialist for the San Marcos and Buda public libraries.
While Alaniz has run programs such as support groups and adult coloring hours in both libraries, she said being able to listen and support someone going through a hard time is what she enjoys most about working as a peer support specialist.
“One of my favorite things is people walking in one way, and leaving, emotionally, 10 pounds lighter,” Alaniz said.
With the Libraries for Health program ending next summer, it’s unclear what will happen to the peer specialists, like Alaniz, whose training and salaries were funded by the program.
At the tiny Jarrell Community Library and Resource Center, which shares space in a small building with the Sonterra Municipal Utility District, Gregurek hopes to raise the funds to continue to support Aponte’s salary. That might come from another grant, she said, or it might come from using the library as a site to train more peer specialists.
San Marcos Public Library director Diane Insley said it can be difficult to find candidates for part-time peer support work, due in part to the low pay, and the library had trouble maintaining consistent specialists through the program. She’s eager to keep some of the mental health-related programming that Libraries for Health made possible, but she doesn’t imagine the library continuing to fund a peer specialist.
Low compensation challenges retention and advancement
Utilization of peer support has grown substantially in recent years. According to the Substance Abuse and Mental Health Organization (SAMHSA), the number of certified peer specialists has more than doubled in the last decade, and almost half of mental health facilities offer peer support.
Experts agree that the peer model works, but they also say that low compensation decreases the ability of peer specialists to build sustaining careers that support their own well-being.
Job postings for peer support positions, most at mental health nonprofits and clinics, list wages ranging from $10-18. Libraries for Health pays peer specialists $22 per hour, well above the state standard. A living wage for a single adult in Texas is just over $20 an hour.
There are currently more than 800 mental health peer support specialists registered with the Texas Certification Board. Certification requires completion of training and 250 hours of supervised work.
In 2017, Texas passed a bill enabling certified peer support specialists in Texas to bill Medicaid. According to a report by Peer Recovery Now, peer specialists in Texas bill Medicaid at $11.25 per fifteen minutes, compared to the national median of $13.65. According to SAMHSA, billing rates for peer specialists are lower in states, like Texas, that did not expand Medicaid under the Affordable Care Act.
Wendy Tiegreen, former director of Medicaid Coordination at the Georgia Department of Behavioral Health and Developmental Disability, said reimbursement rates for peer support matter because many people with mental health issues qualify for Medicaid.
“Medicaid is the primary vehicle through which folks who would need peer support receive support,” Tiegreen said.
Mental health peer specialists in Georgia, the first state to approve Medicaid reimbursement for the service, bill between $15 and $24 per 15 minutes. As Tiegreen points out, much of that goes to supporting the operations of the agency employing the peer specialist.
Tiegreen said creating paths for advancement is another step toward making peer support a long-term career option. Outside of nonprofits, peer specialists often have no way to advance professionally without leaving the profession.
“If a peer specialist is motivated and passionate about doing that work, I prefer them delivering peer support as long as they have gas in their tank,” said Tiegreen.
Joe Powell, president and CEO of the Association of Persons Affected by Addiction, has been involved in peer support for over 20 years. While he’s excited about the expansion of peer support roles in Texas, he said many peer specialists only stay in their roles for a couple of years, in part because of low pay.
Greg Hansch, executive director of National Alliance for Mental Illness of Texas, said that in addition to paying mental health workers a livable wage, it’s important to acknowledge the emotional strain of working with people who have had traumatic experiences.
“We just have to be watchful that we’re not putting too much on peers’ plates,” Hansch said.
Library peers face an uncertain future
As the Libraries for Health program comes to an end, some of the peer specialists hope to remain in similar positions. Others are looking at transitioning to other roles in the mental health field.
Even if the funding isn’t available to stay at the library, Aponte said she hopes to continue working as a peer specialist, at least for the next couple of years, adding that she found peer support more fulfilling than her previous position at the library.
Alaniz, currently working at the Buda and San Marcos libraries, is also pursuing a master’s degree in counseling from St. Edwards University, where she’s scheduled to graduate next summer. According to the Economic Research Institute, the average salary for a mental health counselor in Texas is $80,000.
Alaniz said that while she believes in the peer support model, the pay is discouraging, and some of her professors think that the job exploits people who are already vulnerable.
“People recruited have lived experience and have experienced hardships, and this money is good to them, but it’s not good when you think about the labor they’re doing,” Alaniz said.
Anastasia Ousaklidis, who works as a peer specialist at Sheib Mental Health Clinic in San Marcos, said that across the state, peer specialists are advocating for better compensation.
Ousaklidis, who’s also pursuing a master’s degree in counseling, said the ability to gain paid experience in a clinical setting benefits her education. Though the pay is sufficient while she’s in school, she also said that it probably wouldn’t cover everyone’s needs.
Lana Harrell, a peer specialist at Hill Country Mental Health and Developmental Disabilities Centers, echoed that despite the rewards of working as a peer specialist, it isn’t sustainable for everyone because of low pay.
“We really want people to understand our value and what a difference we make,” Harrell said. “We see our value every day in the people we work with, but we still have to live.”
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