Effectiveness and Cost Effectiveness of Peer Mentors in Reducing Hospital Use (Project PEP)

• Service use [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  Via self-report from the participant
• Service Use [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  Via self-report from the participant

• Psychiatric symptoms [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  Measured using the Symptom Distress scale and the Paranoia and Psychoticism subscales from the Symptom Check List-90 (SCL-90)
• Quality of life [ Time Frame: 3 month ] [ Designated as safety issue: No ]
  Measured using Lehman's Brief Quality of Life scale
• Community inclusion [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  Measured using Mancini's Community Connections Inventory
• Psychiatric symptoms [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  Measured using the Symptom Distress scale and the Paranoia and Psychoticism subscales from the Symptom Check List-90 (SCL-90)
• Quality of Life [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  Measured using Lehman's Brief Quality of Life scale
• Community Inclusion [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  Measured using Mancini's Community Connections Inventory

The current study, through a randomized controlled design, will evaluate the effectiveness of peer support, as compared to usual care and to an equivalent amount of support offered by peer case managers and non-peer recovery mentors, in reducing hospital days and readmissions and in promoting recovery and community inclusion among adults with mental illnesses with histories of multiple hospitalizations. The current study evaluates the cost-effectiveness of adding peer support to the array of services available to persons with serious mental illnesses who have histories of multiple hospitalizations and will test a theoretical model of the active ingredients of peer support, focusing specifically on the roles of 1) instillation of hope through positive self-disclosure; 2) role modeling of self-care and exploring new ways of using experiential knowledge; and 3) a trusting relationship characterized by acceptance, understanding, and empathy with conditional regard.

• Behavioral: Community Connector
  The participant randomized into this arm of the study is invited to work with a person trained as a community connector, someone who is trained in Intentional Peer Support but does not have a lived experience of mental illness.
• Behavioral: Peer Recovery Mentor
  A participant randomized into this arm of the study is offered the chance to work with a Peer Recovery Mentor, who is trained in Intentional Peer Support.
• Behavioral: Peer Case Manager
  A participant randomized into this arm of the study is offered the chance to work with a Peer Recovery Mentor, who is trained in Intentional Peer Support.

• No Intervention: Treatment as usual
• Experimental: Community Connector
  The participant randomized into this arm of the study is invited to work with a person trained as a community connector, who is trained in Intentional Peer Support but does not have a lived experience of mental illness.
  Intervention: Behavioral: Community Connector
• Experimental: Peer Recovery Mentor
  A participant randomized into this arm of the study is offered the chance to work with a Peer Recovery Mentor, who is trained in Intentional Peer Support.
  Intervention: Behavioral: Peer Recovery Mentor
• Experimental: Peer Case Manager
  If a participant is randomized into this condition, they are offered the chance to work with a Case Manager, who is trained in strengths-based case management.
  Intervention: Behavioral: Peer Case Manager

Inclusion Criteria:

• 2 or more psychiatric hospitalizations in the past year
• A diagnosis of serious mental illness

Exclusion Criteria:

• Dementia or other organic condition limiting ability to provide informed consent