Research scientists led by Johanne Eliacin, PhD, of the US Department of Veterans’ Affairs (VA) and Regenstrief Institute, have developed PARTNER-MH, an innovative, peer-led patient navigation programme to support racially and ethnically minoritised veterans seeking mental healthcare, regardless of the types of mental health services needed or their mental health diagnoses. In two peer-reviewed, published papers they report significant improvements in mental health outcomes and high participant satisfaction with the programme.
PARTNER-MH, developed for VA mental health outpatient clinics, is delivered by peer support specialists to help patients more productively engage with mental health services. It supports patients in identifying their own health and healthcare priorities, communicating more effectively with clinicians, and more actively participating in treatment decision-making so patients’ voices are heard and outcomes improved.
“PARTNER-MH holds promise to be applicable to patients seen in many healthcare systems. Minoritised veterans share many experiences with civilians of minoritised backgrounds. Their experiences with mental health services are not that different in terms of some of the struggles they experience in communicating with their clinicians, accessing services, and engaging in treatment,” said Dr Eliacin. “There are a lot of contributions that the PARTNER-MH programme could potentially provide to similar populations or groups outside of the VA.”
In the pilot study of PARTNER-MH, 50 racially and ethnically minoritised veterans seeking mental health services in the VA were randomised to a control group or to peer navigation. Peer facilitators are veterans who themselves are in recovery either from a mental health condition, substance use condition, or military trauma. They use lessons learned and lived experiences in addition to specialised PARTNER-MH training to support other veterans on their journey to better mental health.
The PARTNER-MH programme is administered over a six-month period. Designed for in-person interaction, the pandemic required transformation into a telehealth format. Peers interacted regularly with study participants including assessment of unmet social needs, navigation of VA mental health services, personalised counselling, and coaching via telephone.
“We recognise that social determinants of health can be major barriers to accessing services and engaging in care,” said Eliacin. “Some patients may have difficulties getting to their appointment or prioritising their mental health if they are worrying about their next meal or where they’re going to sleep at night. We don’t wait for a patient to reveal that they are struggling,” she added. “At their initial meeting, the peer does an assessment so they can connect the veterans to appropriate VA resources and inform the patient’s clinician. The peers don’t try to solve problems for their patients, but they are great connectors and they follow-up.”
About 70% of participants in the PARTNER-MH pilot study self-identified as African-American or Black. Other participants were Hispanic, Asian, or Native American. All were veterans receiving or waiting to receive services in a VA outpatient mental health clinic. The study found significant improvement of self-reported mental health and depression among those in the peer navigation group compared with those in the control group at both six months and nine months.
“In the US, patients of racially and ethnically minoritised backgrounds have less access to mental health services, lower satisfaction with mental health treatment, and poorer health outcomes than White counterparts,” noted study senior author Marianne Matthias, PhD, a VA and Regenstrief research scientist. “PARTNER-MH is a step toward making mental healthcare more accessible and equitable.”
Evaluation of satisfaction with the PARTNER-MH programme showed that 80% of study participants interviewed reported satisfaction with PARTNER-MH and viewed the programme as beneficial. The researchers wrote that PARTNER-MH was described as “a valuable service that provided a ‘lifeline’ in time of great need, and that made them feel ‘seen’ and cared for”.
Participants had a wide range of mental health diagnoses, including post-traumatic stress disorder or PTSD (46%) and substance use disorders (23%). Some had more than one diagnosis. 77% self-identified as Black. 69% of participants had some college education. For some participants, being engaged in their own mental healthcare meant showing up for the appointment to meet with the clinician. For other participants, engaging in treatment meant working in collaboration with their clinician on a treatment plan and talking openly about their concerns.
“Many PARTNER-MH participants highlighted for us that the takeaway they got from this programme was that they needed to be engaged in their mental healthcare in order to really benefit from the treatment that they are receiving,” said Eliacin. “They appreciated the opportunity to discuss with the peer what that engagement could look like for them.”
Participants were asked why they volunteered for the study and what kept them engaged over the six months. Many indicated that they liked the idea of working with a peer. Others said they believed the study was important because of its focus on minoritised patients, and the need for research on and provision of services to this population.
During exit interviews, others said that they were struggling to navigate mental health services and could use help, having tried unsuccessfully in the past. They also said that it was helpful to have a programme just for them, and to have a programme where they were working with a peer who looks like them, who shares the same background, and who reminds them of a family member or people in their community.
“Participants felt that PARTNER-MH opened the door of communication,” said Eliacin. “They could be themselves; they could express themselves the way that they wanted to and they feel heard. They connected with someone who made them feel at ease, but also really understood them and encouraged them, motivating them to seek mental health treatment. Working with the peer was the highlight of many of the participants’ experiences.”