Peer support has been occurring naturally for a very long time in many unique ways. Whether it is in the form of several friends gathering to play dominoes and commiserate about aches and pains, a grieving widow being comforted by another who has also lost a spouse, or a person attending a 12-step meeting, there are endless examples of the healing power of sharing lived experiences with one another. Mental health and substance use programs have further developed such powerful exchanges of support, leading to the peer workforce.

Due to the evolution and growth of the peer workforce, many options now exist to learn how to use one’s recovery story and experience, as well as other tools, in a more systematic fashion in order to offer hope and support to others. This generally involves attending a training and then taking and passing an exam that measures mastery of specific competencies. With this evolution, many states now include peer support as a Medicaid billable service. For those states, training and certification process are now a requirement. Ideally, training also ensures that peer specialists have the complementary skills to work well as partners with other team members, including clinicians.

The peer workforce has evolved greatly over the years. Larry Fricks, Director of the Appalachian Consulting Group and Deputy Director of the SAMHSA-HSRA Center for Integrated Health Solutions operated by the National Council for Behavioral Health, is a forefather of the peer support movement. In this interview, Larry shares his experiences, perspectives, and some inspiration as the movement continues to evolve.

Employment Settings

Peer specialists are found in many different settings throughout the country. These settings can include providing outreach to many unique individual experiences, including among people who are homeless, within transitional or long-term housing programs, acute and longer-term hospital settings, employment programs, Clubhouses, jails and prisons, diversion programs, outpatient treatment programs, recreation programs, Assertive Community Treatment teams, warm lines and hotlines, and even in Primary Care settings. The United States Department of Veterans Affairs employs Veteran peer specialists at every facility throughout the country. These are just some of the many different settings in which a peer specialist can be found, and this list is expanding steadily as the workforce grows. Most frequently, peer specialists work as paid employees, although some choose to offer their services as volunteers.


Wages can vary greatly, beginning with a local minimum hourly rate, to a salary with benefits, depending on where a person is employed and the experience they bring to the position. Recently, a national study was conducted of over 1,600 peer specialists about earnings.

Integrating a Peer into the Treatment Team

The development and growth of the peer workforce in the mental health system has provided a catalyst of change towards the recovery model. While this change is very positive, the process of adding any new team member to a system can provide challenges and opportunities for growth. As peers are added to more treatment teams and healthcare systems throughout the country, more lessons are learned about how to make this important transition. As the field grows, more resources become available on integration and supervision of a peer. Further information and resources are available in the Organization section.

Learn more about the experience of a peer provider On the Job.