Youth mental health is the defining public health crisis of our time.

                                               -Vivek Murthy, US Surgeon General

There is a crucial need for more mental health care support in our country. Today, 157 million Americans live in areas with a shortage of mental health providers. (1) Limited provider capacity means that of the 46% of young adults who have diagnoses of substance abuse or mental illness, 55% of them receive no care. (2) And for historically underserved communities, including BIPOC and LGBTQ+ populations, finding a culturally sensitive provider can be even more challenging. (3)

I’m a doctor. A doctor’s toolbox includes medical education and training, a license to diagnose, and the ability to prescribe treatment. So, when a colleague suggested that unlicensed folks with lived experience might be as good or even better at meeting the needs of people who are struggling with mental health, you might think that I’d be skeptical.

As I looked at the literature on peer support, I realized that the model of connecting those who have lived through the same struggles has been helping people for decades outside of clinical settings. Communities for people who are mutually struggling with grief and addiction (4), for example, are trusted and commonplace. No one can better understand what it is like to lose a loved one or to hit rock bottom than someone who has been there, too. It’s why groups of people continue to gather week after week, year after year, in church basements and recreation centers, to support each other in ways that friends or doctors never could. It’s why people living with mental illness connect online to support and empower each other. (5)

Lived experience is a tool only a peer has in their toolbox—and it can be as valuable as a doctor's diagnosis or prescription when it comes to mental health. Research has proven peer support to be an evidence-based practice that can significantly improve mental health outcomes, especially among college-age students and individuals from historically underserved communities (6), including Black, Transgender, and first-generation college students. Research from Mental Health America (7) shows peer support leads to increased hopefulness and sense of well-being, ongoing engagement with care, decreased substance use and depression. It can also reduce the overall cost of health care by decreasing hospitalization, use of emergency departments, and recidivism (8)(9)(10).

Realizing the value of peer support put me on the path to co-founding Flourish Labs. We are a mental health service for adolescents and young adults ages thirteen to thirty. We are growing the workforce by hiring people with the experience of mental health challenges and training them to become certified peer supporters who deliver support on our telehealth platform, Peers.net.

My time in the Champion Provider Fellowship taught me that to make lasting change, I need to partner with the communities we work in. With that in mind, we at Flourish Labs have established key priorities that engage our communities in advocating for policy and system focused interventions.

Community partnerships: To meet the needs of the most vulnerable youth, we designed Peers.net with extensive youth and young adult participation. Peers.net represents a powerful example of co-creation in action, demonstrating how young people's voices can lead to innovative and impactful solutions for their mental health needs. We also share this resource in partnership with community-based organizations across the country including Boys and Girls Clubs, YMCAs, and national non-profits such as Active Minds and the Trevor Project.

System Change: Medicaid and commercial insurers are inconsistent in reimbursing peer support, and the system needs education and advocacy to integrate this specialized workforce into the mental health system appropriately.

Policy Advocacy: Policy changes are also required to provide a future path for growing the peer support workforce, including efforts to develop national standards for training and certification, continuing education, and supervision, as well as policies to help ensure the future of mental health service delivery as a telehealth service, the preferred platform for many adolescents and young adults.

Approximately 75% of mental health issues present before the age of 24. (11) With early and effective treatments, we can prevent years of suffering, difficulties holding a job or supporting a family, and deaths by suicide. We believe that by working with stakeholders in the community, health care system, and policy settings, we can help build a future where all young people can access the support they need to thrive.

Dr. Kim Newell Green is the Chief Medical Officer and Co-Founder of Flourish Labs and an adjunct Associate Clinical Professor of Pediatrics at UCSF. Prior to taking on these roles, Dr. Newell Green was a practicing physician for over 15 years and a senior executive at Kaiser Permanente San Francisco, serving as Chief Healthcare Innovation Officer and Chief of Physician Health and Wellness. She is working to transform healthcare by leading and supporting innovations in digital technology while keeping humanity at the center of health and healing.

1. KFF. (2019, November 21). Mental Health Care Health Professional Shortage Areas (HPSAs). The Henry J. Kaiser Family Foundation. https://www.kff.org/other/state-indicator/mental-health-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22

2. SAMHSA. (2021). 2021 national survey of drug use and health (NSDUH) releases. Www.samhsa.gov. https://www.samhsa.gov/data/release/2021-national-survey-drug-use-and-health-nsduh-releases

3. New York City behavioral health challenges | McKinsey. (n.d.). Www.mckinsey.com. https://www.mckinsey.com/industries/public-and-social-sector/our-insights/addressing-the-state-of-behavioral-health-in-new-york-city

4. Erickson, M. (2020, March 11). Alcoholics Anonymous most effective path to alcohol abstinence. Stanford Medicine News Center. https://med.stanford.edu/news/all-news/2020/03/alcoholics-anonymous-most-effective-path-to-alcohol-abstinence.html

5. Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2016). The future of mental health care: Peer-to-peer support and social media. Epidemiology and Psychiatric Sciences, 25(2), 113–122. https://doi.org/10.1017/s2045796015001067

6. Richard, J., Rebinsky, R., Suresh, R., Kubic, S., Carter, A., Cunningham, J. E. A., Ker, A., Williams, K., & Sorin, M. (2022). Scoping review to evaluate the effects of peer support on the mental health of young adults. BMJ Open, 12(8), e061336. https://doi.org/10.1136/bmjopen-2022-061336

7. Peer Support: Research and Reports. (n.d.). Mental Health America. https://www.mhanational.org/peer-support-research-and-reports

8. Peer support: Its impact on Behavioral Health Recovery - Optum. (n.d.). https://www.optum.com/content/dam/optum3/optum/en/resources/white-papers/PeersImproveOutcomes.pdf

9. National analysis of Peer Support Providers: Practice ... (n.d.-a). https://behavioralhealthworkforce.org/wp-content/uploads/2019/10/BHWRC-Peer-Workforce-Full-Report.pdf

10. Peers for progress: Peer support around the world. Peers For Progress | Peer Support Around the World. (n.d.). https://peersforprogress.org/

11. National Alliance on Mental Illness. (2021). Mental Health Conditions | NAMI: National Alliance on Mental Illness. Nami.org. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions