His name is Nate Rockitter. He lives and works in Denver and holds a master’s degree in counseling from the University of Colorado in Boulder. On June 8 he rode the train all night to attend the Mental Health America’s annual meeting in Washington, D.C.—a young man with a mental health mission, a young man who had lost a brother with schizophrenia.

Back in 1987 Rockitter’s brother was in the basement getting some milk. He passed out, then died. The immediate cause of death was a heart attack, doctors said.

Rockitter had counseled youngsters before his brother died, but after that event, he started working with adults, and then, partly because of his brother’s experience with schizophrenia, decided that he wanted to train persons with mental health problems to help other persons with such problems, that is, as "peer counselors" or "peer specialists."

Rockitter wrote a training manual to meet his goal. In 1993 he went to a program manager for a mental health center in the Denver area. She sent him to a local mental health consumer group, and he tried out his idea of peer counseling on the members. They were enthusiastic, and some of them signed up to be trained by Rockitter as peer counselors.

Although the counselors trained by Rockitter were not accredited, that is, their training was not backed by a college degree, a woman working at a mental health carveout in the Denver area—Behavioral Health Care Inc.—decided to hire several of them anyway. Since then, three more of the peer counselors trained by Rockitter have been hired by another Denver mental health carveout, Access Behavioral Care, which serves the Medicaid population in the Denver area. Thus, it was to promote the concept of "peer counselors" at the Mental Health America meeting that Rockitter had hopped on the night train to the nation’s capital.

But what exactly does a "peer counselor" do? One of those trained by Rockitter and working at Access Behavioral Care, "Dee," explains what her job entails:

"When I took Nate’s course, I came in twice a week for two hours. In those two hours we talked about confidentiality, our feelings and emotions, and what the difference is between being a peer counselor and a therapist. We do not do therapy; we don’t go beyond our expertise. We say, ‘Hey, I had the same sort of issue. This is how I got through it—I went to therapy, I had to take meds for a while,’ you know, whatever. We share our experiences, and we share our strengths, and we give hope to other patients that they can get through what they are going through."

Now, why would mental health carveouts, which are known more for trying to save money than for showing compassion, be willing to hire peer counselors like Dee? Dee has an answer: "In the long run, peer-to-peer specialists have saved Access Behavioral Care money. The reason is that I become a mentor, a friend, to some of the people Access services. Then they don’t have to go running to a hospital every time a crisis comes up. I actually have three clients who, in the year and a half I have been working with them, are no longer homeless, and one has been hospitalized only once, whereas before she was hospitalized every three months."

Access Behavioral Care in Denver now employs 13 peer counselors—three trained by Rockitter and 10 trained by other people, Scott Utash, a parent-family advocate with Access, told Psychiatric News.

Although Colorado may be the only state where managed care companies are putting mental health patients on the payroll to assist other patients, the phenomenon of persons with mental troubles succoring others with them certainly isn’t limited to Colorado.

For instance, the Mental Health Association of the Heartland, which is headquartered in Kansas City, has been providing a telephone service to persons with mental illnesses in Kansas and Missouri since February 1999. It is officially called "The Compassionate Ear" and informally is known as a "warm line" to distinguish it from a "crisis line." The service is staffed by some 30 volunteers who are recovering from a mental illness or who are struggling with a mental illness. They were trained how to handle calls when people call the service and now take several shifts a month. They listen to callers’ problems, share their own mental health struggles with the callers, and, in this listening and sharing, bolster the callers.

The service is available from 5 p.m. to 10 p.m. seven days a week, 365 days a year. It gets an average of 110 calls a month.

"It is very, very successful," James Glenn, vice president of the Mental Health Association of the Heartland and a social worker, said in an interview. Staff has learned, mostly through word of mouth, that "people are saying that they are getting fewer crisis calls because they are able to refer a lot of the people who are calling, who just need to talk with somebody, to this warm line. . . .We are in the process of trying to measure how it has diverted crisis calls and prevented future crises from happening."

The warm line, Glenn added, also benefits the mental health patients who staff it: "What I have seen, as a professional, is that this has really been therapeutic on both ends. People really get a good feeling from volunteering on this line, and it builds their self-confidence when they can help other people. . . .And of course it is therapeutic for the person who calls in because he is getting help from somebody who has been there."

Patients are also giving each other a leg up, so to speak, in New Jersey. A program jointly run by the Mental Health Association in New Jersey (headquartered in Montclair) and an organization called "Consumer Connections" trains people with a history of mental illness to work in one of 22 self-help centers throughout the state or to help their confreres find employment or housing. During the program’s three years of existence, some 300 people have graduated from it. They come from diverse racial and ethnic backgrounds and different levels of education—there have been high school dropouts, a number of people with master’s degrees, a few lawyers, even a psychiatrist.

The training in this program is reputedly so first-rate that even people who never experienced a mental illness sometimes try to sneak into it, said Sarah Thompson, director of adult mental health services for the Mental Health America in Washington, D.C.

What is even more interesting, Thompson explained in an interview, is that the state of New Jersey was developing PACT (Program for Assertive Community Treatment) teams to treat persons with mental illness, and said that if a team wished to receive state money, it had to have at least one mental health consumer on its team. Presto! The PACT teams provided jobs for some of the patients trained by the Mental Health Association in New Jersey and Consumer Connections.

Patients are helping each other all over Los Angeles County, which has six million inhabitants. The project there is called "Project Return" and has 73 clubs run by patients. Some clubs are purely social, others more self-help. Project Return also operates what it calls a "Friendship Line"—a warm line where patients can talk with other patients. It likewise includes a center where persons who have had mental illnesses help those with them return to the community.

Said Bill Compton, director of the project: "We have about 80 consumers who work for Project Return. We are totally consumer run. I am a consumer; I’m diagnosed schizophrenic."

In fact, the patients-helping-patients movement is starting to pick up momentum. Said Glenn about the Kansas-Missouri warm line: "We would. . . like to expand to an 800 number in the Heartland [since] we serve a lot of little counties in Kansas and Missouri. We would also like to expand the time, from 6 till midnight."

"Warm lines are something that I have been hearing more and more about just within this past year," attests the Mental Health America’s Thompson. "I think that is going to be the next new wave."

One of the things that is particularly exciting, explained Jennifer Miller, training director for the Mental Health Association in New Jersey, is that the drug company Eli Lilly, through the Mental Health America, is sponsoring a "Partners in Care" project that involves the New Jersey mental health consumer program. In brief, six mental health projects throughout the United States have been cited for excellence, and one is the New Jersey program, and money will be made available to replicate these outstanding projects in other geographic areas.

"We have already spoken with folks in Cincinnati. We have gotten a high level of interest from people in Montana," Miller said. "So it is really an idea, I think, that is beginning to take off. We may even become a national program at some point."

"Mental health consumers helping other consumers is such a powerful tool," Utash contended. "I think it is going to be the trend, more than a fad. I think it is the evolution of where things are going in behavioral health."