Sept. 3, 2009, was a date that was 14 years in the making for Air Force veteran Kevin Cook.
He first entered a Department of Veterans Affairs medical center for help treating his depression and alcohol and drug use in 1995.
“I would come into treatment, I would get all of this help and everything and then I would leave back out the door thinking that I can do this on my own,” Cook says. “And it never dawned on me that this is ... a lifetime change and this is something that you have to stay engaged in.”
Eventually, Cook was able to recover. He hasn’t used drugs or alcohol since Sept. 3, 2009. Now he helps other veterans struggling with the transition back to civilian life.
“There was a doctor that was in charge of my mental health care at the time and he saw something in me that I didn't see in myself, and he asked me if I was interested in becoming a peer specialist,” Cook says.
The VA defines a peer specialist as a trained veteran who has recovered or is recovering from a mental health condition. They’re meant to serve as examples of how recovery is possible, even as they teach veterans how to navigate the VA and access community resources.
Cook started working as a peer specialist with the VA St. Louis Health Care System five years ago. He currently supervises other peer specialists there.
A bill signed into law by President Trump earlier this month, the VA Mission Act, expands the peer specialist program. The expansion calls for at least two peer specialists in primary care settings at 30 or more VA medical centers around the country.
The move was championed by Sen. Roy Blunt, R-Missouri, who last year co-sponsored a bill with Sen. Richard Blumenthal, D-Connecticut, that’s the basis for the new requirement. Blunt’s bill would have required 50 VA medical centers to have peer specialists in primary care settings.
“Well, honestly, 50 is just scratching the surface of what's needed and so, you know, less than that is unfortunate, but 30 is more than zero,” says Allen Doederlein, executive vice president of external affairs for the Depression and Bipolar Support Alliance.
Doederlein says he’s encouraged that the VA Mission Act will require the VA to deliver reports to Congress on the effectiveness of peer specialists. If Congress finds the program to be effective, he says, it could expand it further.
Peer specialists are not a new idea. The VA St. Louis Health Care System adopted peer support programs 10 years ago, according to Dr. Fredric Metzger, its associate chief of staff for mental health services.
VA research health scientist Matthew Chinman says the programs took off nationwide after President Obama issued an executive order in 2012 requiring the VA to hire 800 peer specialists. Now, the VA employs 1,090 peer specialists at inpatient mental health units and intensive mental health programs for veterans with serious mental illnesses, including substance use disorder and PTSD.
The Kansas City VA Medical Center has four peer support specialists, says spokesman Dwayne Rider.
Chinman says peer specialists are especially effective because they have struggled with mental health issues themselves and are living examples to other veterans that things can get better.
“People with serious mental illnesses and substance abuse disorders are often demoralized by their illness and see no hope for getting better,” Chinman says. “Having peer specialists around just first and foremost shows that people can recover. And so that provides hope and that is one of the main ingredients that sets the stage for recovery.”
Cook says if peer programs had been in place when he started seeking treatment, it would have taken less time for him to get sober.
“It would've given me someone to look at and want to pattern myself after,” Cook says. “When I was struggling with my issues, I really never had anyone that I could look at and say, ‘Well, man, if he did it, maybe I can try,’” Cook says.
Mark Salzer, a professor of rehabilitation sciences at Temple University, says the idea of peer specialists was met with “overt hostility” 30 years ago. When he was training to be a psychologist, he says his professor dismissed the idea.
“He would laugh at it and say, ‘How could you expect somebody who can't even figure out their own life or can't even get their own act together -- how could they possibly help somebody else?” Salzer says.
Chinman says the same skepticism existed at the VA when it first rolled out the program.
“There was hesitancy around, oh my god, these people are, you know, they’re mental patients. Why are we having mental patients come into our system and become providers?” Chinman says.
He says the VA did a lot of work to address that concern.
“It's night and day in terms of the leadership in mental health, their understanding of what peer specialists are and their acceptance of them, and that took a bunch of work,” Chinman says.
Cook says there was some resistance when he started, too.
“I had to somewhat, I guess you could say, prove what I was capable of doing and also what I was not capable of doing as well,” he says.
Now, Cook says, the staff at the VA St. Louis Health Care System sees the value of peer specialists.
It’s been almost a decade since Cook has been in recovery. He’s now able to provide the support to veterans he wishes he received.
“I'm learning new things about recovery. I'm learning new things about myself,” Cook says. “But having someone that can look at me and say, ‘Hey, I want to get what you have. I want to try to model myself after you.’ I mean that's powerful for me.”