This blog is part of Perspectives, our blog series where Institute leaders, partners, and subject matter experts share their insights on the most pressing challenges—and opportunities—in behavioral health and substance use care.
Today, we call them Peer Support Specialists. When I got into this work at 22 years old, that title didn’t exist.
But there were lots of people just like me doing this work—in recovery, dealing with past run-ins with the criminal justice system.
At The Effort, now WellSpace, in Sacramento, I leaned on my own experiences—childhood trauma, addiction cravings, legal involvement—to help people, just like me, in opiate and stimulant detox programs and residential treatment.
Karen Larsen at The Effort with a client.
The connection with clients was deep, and critical to being able to offer help. I knew what they were going through—the sometimes unsaid struggles with sobriety. And in turn, they felt seen by someone who had once been in their shoes. I spent more time with clients than I did my own family.
Now, decades later, I lead the Steinberg Institute and am focused on transforming California’s mental health and substance use systems. Yet, as we work toward a future when everyone who needs care has access to it, I find myself thinking back to my early days in that small office—lending that support. I remember so many of these clients fondly and love it when I run into them unexpectedly at a yoga class or the grocery store.
It saddens me that our support for California’s current transformation effort (the Behavioral Health Services Act) has caused division in the behavioral health space. The tension that has arisen between the peer support movement and those of us who supported Proposition 1 needs to be addressed – because we are all working toward the same goal.
I find this deeply disheartening—not only because of the personal strain it creates, but because of what it means for the work itself. When connection breaks down among those trying to improve the system, progress slows for the people and communities who depend on it most.
Why Prop 1 and Peers are aligned
One of my all-time favorite authors, Johann Hari, writes about addiction and mental health, and one of his ideas resonates deeply with me: “the opposite of addiction is connection.”
I believe lack of connection is one of our greatest challenges in this digital, post-COVID age. It hampers our ability to transform broken systems and undermines the outcomes we want for people living with mental health and substance use conditions.
It is from this understanding of connection—and the role peers play in creating it—that I see clear alignment between Proposition 1 and the peer movement.
Proposition 1 is built around priority populations that evidence shows benefit most when their treatment teams include peer support services.
In 2020, the Steinberg Institute co-sponsored Senate Bill 803, requiring the state to set up a process for certifying peer support specialists. It also enables counties to be partially reimbursed by the federal government for the services they provide. Today, peers continue to be among the strongest responses to our workforce challenges and should be integrated wherever possible because of their impact on recovery and outcomes.
Peers are especially critical to the successful implementation of Prop 1. When we think about the priority populations within Prop 1—justice-involved, unhoused, child-welfare-involved, those who have been conserved or hospitalized—we know that peers who have lived experience with mental health, substance use, and these systems are the best equipped to support individuals in their recovery goals.
Moving forward together
Despite this alignment, there are rumblings that county behavioral health departments are threatening to cut peer programming as part of their BHSA implementation. This sets up another us vs them moment.
To be clear, there is nothing in Prop 1 that calls for reducing peer services. In fact, Full Service Partnerships—35% of the funding—require peers as part of the treatment team. Housing supports—30% of the funding—are primarily provided via the peer workforce. And community services and supports—the remaining 35%—center around outreach and engagement, case management, and outpatient services, all of which are supported by our peer workforce.
Framing the BHSA and peers as competing priorities presents a false choice. The BHSA cannot succeed without peers, and the peer movement stands to be strengthened—not diminished—by its full and faithful implementation.
We all must be committed to ensuring that peers remain a key part of California’s behavioral health future.
At its core, our work has always been about connection—and the future of California’s system depends on how well we stay connected to one another.