Alliance Alert: Among the most important and impactful policymakers, advocates and educators in the US over the past 30 years, Ron Manderscheid has always used his considerable influence to put peer support at the top of almost every discussion. The following is a powerful distillation of the way he views peer support as an essential disruptive innovation to public systems and policies that cry out for disruption!
Peer support is also once again at the top of this year’s Alliance Annual Conference program to be held this September 23-25, at the Albany Marriott. We’re featuring 11 presentations specifically on peer support and it shows up many other of the other 50 sessions.
Don’t wait to register: the Marriott is sold out, but we’ve made arrangements
with several area hotels to offer our discounted rates:
see more at https://tinyurl.com/3av8dwjd!
Peer Support Is Not a Behavioral Health Add-On: It Is Foundational
Ron Manderscheid, PhD Adjunct Professor Johns Hopkins University & University of Southern California
August 31, 2026
For decades, behavioral health operated on a familiar assumption: professionals diagnose, professionals develop treatment plans, and professionals determine whether people are getting better. The person receiving services was expected to participate—but largely in a system designed, defined, and controlled by others.
Peer support challenges that assumption at its core.
Its message is simple, but disruptive: people who have experienced behavioral health challenges possess knowledge that professionals cannot acquire from a textbook, clinical rotation, or credential. That knowledge is not a substitute for clinical expertise.
But neither is clinical expertise a substitute for lived experience.
If we are serious about resiliency, recovery, and self-determination, peer support cannot remain an option at the edge of the behavioral health system. It must be part of its foundation.
Why Peer Support Matters
A psychiatrist can diagnose depression. A psychologist can teach coping strategies. A social worker can connect someone with housing, employment, or benefits. Each can be indispensable.
But a peer can say something fundamentally different: “I have been there. I know what it feels like. And I found a way forward.” That statement carries a form of credibility no professional credential can confer.
Consider someone leaving a psychiatric hospital after a first episode of psychosis. The discharge plan may be clinically excellent. Yet the person’s most urgent question may be very different: “Is my life over?” A peer who has experienced hospitalization and subsequently returned to work, school, relationships, and community life can answer that question in a way no discharge summary can.
Peer support changes the conversation from one based primarily on professional authority to one that also incorporates mutuality, shared experience, hope, and personal agency. Instead of asking only, “What services does this person need?” peer support introduces the more consequential question: “What kind of life does this person want to build?”
That is self-determination.
For Youth: Finding a Voice Before the System Defines You
Young people entering behavioral health services can quickly acquire labels: troubled, oppositional, high-risk, seriously emotionally disturbed, noncompliant. Sometimes the label starts becoming the identity.
A 16-year-old experiencing depression, for example, may suddenly find herself surrounded by adults discussing diagnoses, medications, school accommodations, safety plans, and treatment goals. Everyone may be trying to help. Yet she can easily become the least powerful person in the room. Youth peer support can interrupt that dynamic.
Young people who have navigated mental health, substance use, trauma, foster care, or other systems can help other youth understand that receiving behavioral health services does not mean surrendering control over their future.
Peer relationships also create space for questions young people may hesitate to ask adults: “What will medication mean for me?” “How do I tell my parents what I need?” “How do I talk to my friends?” “Can I disagree with my treatment plan?”
That last question matters enormously. If we teach young people that receiving treatment means surrendering their voice, we should not be surprised when they disengage from treatment.
Self-determination does not magically begin at age 18. We need to teach it, respect it, and support it much earlier.
For Adults: The Goal Is Not to Become a Better Patient
The adult behavioral health system still too often confuses successful treatment with compliance. Did the person keep appointments? Take medication? Follow the treatment plan? Avoid hospitalization? These are important questions—but they are not enough.
What does the individual want? A job? A relationship? An education? A home? Greater independence? A meaningful role in the community?
Imagine two people who have avoided hospitalization for a year. One remains isolated, unemployed, and dependent on services. The other has reconnected with family and friends, started working part time, and joined a community organization. Traditional measures might count both as clinical successes. From the perspective of recovery and self-determination, however, their experiences are profoundly different.
Peer support helped drive the recovery movement precisely because it rejected the idea that people with serious behavioral health conditions should simply become compliant, well-managed patients. The goal is not lifelong excellence at being a patient. The goal is having a life.
Peer specialists can help people advocate for themselves, navigate complicated systems, identify their strengths, develop wellness strategies, and see recovery possibilities beyond their diagnosis. Sometimes their most important contribution is simply demonstrating, through their own presence, that recovery is real. That is resiliency in action.
For Seniors: Preserving Agency When It Is Most Vulnerable
Peer support remains particularly underdeveloped among older adults.
Seniors experiencing depression, anxiety, substance use conditions, grief, isolation, cognitive changes, or major life transitions frequently encounter systems that unintentionally diminish their autonomy. Family members and professionals may gradually begin making decisions for them rather than with them.
Consider an older adult who loses a spouse, stops driving, becomes increasingly isolated, and develops depression. The clinical response may appropriately include screening, therapy, or medication. But an older peer who has navigated bereavement and rebuilt social connections can address another dimension entirely: how to construct a meaningful life when the life you knew has changed.
Older-adult peer support can confront isolation, bereavement, stigma, changing physical abilities, and fears about losing independence. Just as importantly, it reinforces a fundamental principle: Age does not eliminate the right to self-determination.
Stop Calling Peers “Nice to Have”
Here is where behavioral health needs to confront its own contradictions.
- We say peer support is important. Then we underfund it.
- We celebrate lived experience. Then we exclude peers from consequential decisions.
- We put a peer on an advisory committee and call that “consumer engagement,” even when every important decision has already been made.
- We hire peer specialists and then place them at the bottom of organizational hierarchies designed almost entirely around professional credentials.
- And sometimes we “professionalize” peer support so aggressively—with rules, certifications, documentation requirements, and clinical expectations—that we risk stripping away the very qualities that made it transformative.
Peer specialists should be appropriately trained, compensated, supported, supervised, and integrated into care teams. But integration should not mean assimilation. If we simply teach peers to think, talk, document, and behave exactly like everyone else in the system, we have missed the point. A peer specialist is not a cheaper clinician. Their distinctive contribution must be protected.
From Tokenism to Power
The next stage of peer support must move beyond simply adding peer positions to existing programs.
Behavioral health systems should establish peer support as a routine component of services across the lifespan—from youth programs through adult services and older-adult care. But peers also need meaningful roles in program design, quality improvement, governance, research, evaluation, and system reform.
That means bringing peers into the room before decisions are made, not asking them to endorse decisions afterward.
It also means measuring outcomes that matter to the people receiving services. Symptom reduction, hospitalization, emergency department use, and treatment adherence are important. But so are hope, autonomy, social connection, employment, education, meaningful activity, community participation, and progress toward self-defined goals.
The ultimate test of a behavioral health system is not simply whether it reduces symptoms or prevents hospitalization. It is whether people emerge from that system with more control over their lives, greater confidence in their own abilities, stronger connections to others, and genuine hope about their futures. Peer support helps make that possible.
It is time to stop treating lived experience as inspirational decoration around the edges of behavioral health care. It is expertise. It deserves authority, investment, and a permanent place at the center of the system.
We cannot build a genuinely recovery-oriented behavioral health system without it.
© 2026 RW Manderscheid
Link to article:https://www.linkedin.com/pulse/peer-support-behavioral-health-add-on-foundational-manderscheid-phd-chbwe