Hello. I'm so happy to moderate this panel, which is titled Supporting the Diverse Peer Support Workforce. This panel will address the lived experience of peers from diverse groups and help you learn how to better support them in your work. You'll be hearing from two wonderful panelists. As you listen to the presentations, feel free to enter any questions or comments in the chat function. We'll have time for Q&A at the end of the session. Chris Johnson is the Director of Communications for the Georgia Mental Health Consumer Network, where he is responsible for disseminating information about recovery and wellness opportunities to behavioral health peers and providers across the state, as well as grant writing, public speaking, and supporting the development of programs, curricula, and organizations. Since joining the Georgia Mental Health Consumer Network, Chris has contributed to the significant expansion of the outreach and impact of the organization at the local, state, and national level. Karis Myrick is the Co-Director of the Strategic Impact Initiative for Mental Health, housed at the Jed Foundation. She's a podcast host, a board member, and policy liaison for the National Association of Peer Supporters, and advisor for the APA App Advisor Workgroup. She worked previously for the Los Angeles Department of Mental Health as Chief of Peer and Allied Health Professionals, and at SAMHSA CMHS as Director of the Office of Consumer Affairs. She's a former NAMI board member and president. Hi, my name is Chris Johnson, and I'm a person in long-term recovery. And what that means for me is that mental health and substance use concerns have not defined or limited my life for over 12 years now. Today, I am an active and contributing member of my family, my workplace, my community. I vote, I pay taxes, I pay bills, I walk and feed my dog every day, I walk and feed myself every day. Today, I have a full and good life. A big part of that life is the work I do as the Director of Communications for the Georgia Mental Health Consumer Network. As director, I have a staff of three, me, myself, and I, and we stay very busy. Every day is a real mix of sort of high-level thinking stuff like internal policy and advocacy and curriculum development, but also making sure the 100 or so employees of the network all have business cards with accurate credentials and phone numbers delivered to their accurate home addresses. Every day, some new and unexpected thing happens. And every day, I get the opportunity to learn something new about myself and the world of people who make up my life. I don't always benefit from that opportunity. I spend much less time in self-reflection and meditation than I certainly should. But every once in a while, some lesson or realization or truth will present itself so dramatically and unequivocally that even someone as neglectful and inattentive as I frequently am must see it and hear it and know it to be true, to be truth. During the summer of 2020, there was a lot going on here in Atlanta. Beyond the pandemic itself, there was a marked period of social unrest and civil disturbance and streets empty of cars but thronged with protesters, for many of whom social justice appeared to mean more in that moment than social distancing. And it was profoundly uncomfortable for me as a native Georgian to see and feel and hear all of the distress here. Where I live in the heart of Midtown, there was also this curious inversion of the noise schedule, where during the daytime, there were long stretches of silence and near silence, when there should have been the cacophony of the heart of a major urban center with people cranking and churning out those units of productivity. And at night, when it should have been silent, there were drag racers tearing through the streets of Atlanta, like incredibly loud and motorized bats out of hell. This is the Krispy Kreme I can see from the front stoop of my building, and those are the donuts in the intersection, made fresh every night in the middle of the night. If any of you are wondering if all of the drivers attempting to leave their mark on the intersection have the skill to do so, I can tell you they certainly did not. There were frequently accidents, some of them really horrible, and it wasn't just surreal or dreamlike, though it certainly was those things. It felt like a place of dis-ease, as well as disease. It felt wrong, it felt uncomfortable, and it did not feel like home. During the protests of the deaths of George Floyd, Ahmaud Arbery, Breonna Taylor, and others, 71 people were arrested and one person was shot on the evening of May 29, 2020, near the CNN Center in Fulton County. While the protests continued on June 12, 2020, Rayshard Brooks was killed by City of Atlanta police in a Wendy's parking lot, and the widely disseminated video recordings of the incident sparked further protests, culminating in the burning of the Wendy's and the death of an eight-year-old girl, Sequoia Turner, who was shot by protesters while in a car with her mother. The exact number of thousands of individuals involved in the protests and associated property destruction may never be known as a result of the week's long duration of the protests and their scattered locations throughout Fulton County throughout the summer of 2020, but their intensity and extent speak to the underlying conditions for civil unrest that have been present here for decades. Racial, ethnic, minority, and marginalized populations with experiences of poverty and inequality exacerbated in recent years by the gentrification of historically Black neighborhoods, racial strains with law enforcement, funding for schools, housing, and public transportation, and access to health care, behavioral health care, legal representation, and economic opportunity. And yet when I say those things, if I don't connect them to Atlanta, how would anyone know where I'm talking about? Is there any major city or minor city or small town even where most, if not all, of those things are true? Maybe, but even that question that maybe we can discover that access to legal representation is easy for people of color in Sioux Falls or that people of color in Ann Arbor have ready access to high quality, affordable, culturally and linguistically appropriate health and behavioral health services and supports, that search for exceptions proves the rule to me that America has a pervasive race problem. Not just Atlanta or Georgia or any of the places that experienced social unrest and civil disturbance last year. Just because a window wasn't broken doesn't mean there wasn't someone who wanted to break it or break them all. The pictures you've seen here were taken by me on May 30, 2020, one day after CNN Center here became the target of protesters. And it's kind of amazing how quickly they cleaned up that CNN sign. But they had to, of course, because rage and disruption are also highly contagious. At the Georgia Mental Health Consumer Network, we were having ongoing conversations about not just how to do what we do, support people, advocate for people, create change in people's lives and communities in the middle of this pandemic, when Atlanta's streets were still mostly empty and businesses closed. How do we connect with people whose suffering is visible in these broken windows? And how do we as an organization create change or begin to create change in the systems and institutions and processes and traditions that build and sustain the inequality and the inequity, the injustice that are enmeshed in those systems and has been for generations? And not just the change to prevent windows from being broken, but to eliminate the rage, that discontent that propel those bricks and those rocks through those windows. Looking at the resources available to us as an organization, we realized that the greatest opportunity we had available to us was our relationship with Dr. Ben Dress and his fantastic team at the Southeast Mental Health Technology Transfer Center and the Rollins School of Public Health at Emory University. The pandemic put an end to our travels around the Southeast, but presented us with this new opportunity for a new content track, you know, and everyone on the team was very supportive of us exploring this thread that came up multiple times while we at the Georgia Mental Health Consumer Network were doing our own organizational self reflections around racism, and that was the prevalence of racism within the behavioral health system itself. We wanted to find out how prevalent is it? So we asked the people that we thought would know best. Peer specialists who have been, and in many cases continue to be, recipients and providers of behavioral health services. They have a unique and uniquely broad, if not comprehensive, understanding of behavioral health systems, and I don't know how many certified peer specialists you know, but as a group we tend to be vocal advocates for ourselves and others. It's usually part of our job description, and importantly peer specialists very frequently establish early and lasting trusting relationships based on mutuality with the peers we support. We hear things other people don't hear. So on Tuesday, September 15th, we held an online listening session where we invited participants to share their lived experience of racism in the behavioral health system, and I'm now going to switch over to those data slides and share those results with you. Okay, so race and recovery in the peer workforce. This work was done through the Southeast Mental Health Technology Transfer Center. Me and my friend and colleague Rosalind Hayes facilitated the listening session where the information I'm presenting here was gathered, and the listening session was held Tuesday, September 15th, 2020, and however any of us may feel about this little triangle here, I hope that all or at least most of us can agree that we humans need to feel at least some measure of safety in order to do the things typically helpful in a behavioral health setting, such as be honest about our truest selves with relative strangers who typically tell us nothing about their truest selves. The data here is obviously limited in a number of ways, at no point were there more than 100 people on the webinar. People self-selected to participate in a webinar titled Hearing the Truth About Racism in Recovery, a listening session that was promoted with text that included language such as we will gather data from the lived experience of certified peer specialists to document where we are in our efforts to eliminate racism as a barrier to recovery. People could and did answer certain questions and not answer others, either by accident or by choice. Demographic data was only gathered on those participants who voluntarily completed the online evaluation after the webinar, which as you might rightly imagine was not most of them, but this listening session was held at a moment in time that felt incredibly contentious. There was then, and I believe there is now, but to a lesser degree, the sense that we are living in a moment of profound change. There was then, and I believe now to a lesser degree, as we have moved away from some of the more atrocious murders, an immediacy that called upon many of us to take action, to do something. And that's why I spent some time here refreshing everyone's recollections of December and fall of 2020, when we had so little control over so many aspects of our lives, that when we saw the opportunity to create or contribute to some positive change, we did what we could do. We asked peer specialists to tell us their experience of racism, and we listened, and we recorded it, and now I'm going to share much of it with you. So, how much do you believe racism impacts the ability of peers to receive the support they need? 89% responded that they believe racism impacts the ability of peers to receive the support they need somewhat, or a great deal, while 11% said it impacts that ability a little. No one reported that racism has no impact. On a scale from 1 to 7, how present is racism in the behavioral health treatment delivery system? We did not define what entirely present means, but 35% of respondents chose it, and 21% indicated that while it might not be entirely present, it is as close as it can get, and if we collectively consider responses 5 through 7 as more present than not, as compared with 1 through 3, collectively considered as closer to not present, 75% believe it is more present than not. On a scale from 1 to 7, how present is racism in community supports outside the behavioral health treatment delivery system? Here we were talking about those places where peer specialists frequently accompany peers in the community, such as DFACS, the DMD, the Social Security Office, and we provided those examples to participants, but again, we did not define entirely present, but 33% chose it, and 30% chose the closest marker to it. So, overall, more present in the community than in the behavioral health treatment delivery system, but not by much. Slide 7, how many times have you witnessed overt or implied racism within the behavioral health system? This is one of those questions where I really wish we had the opportunity to follow up, especially with the 23% who said more times than I can count, because I want to know, was it one or two people who you witnessed over a period of years, or a whole bunch of people in a system where casual racism was just acceptable, or, you know, what? I would like to know. Slide 8, do people of color feel equally welcomed in your behavioral health system? Only 27.5% said absolutely, and while we didn't say this explicitly during the listening session, to me personally, somewhat welcome is not the same as welcome, you know, and that 12.5% where they said not at all, and 22.5% where they said a little, together, that's 35% of peer specialists saying the system where they work and or receive behavioral health supports does not really welcome people of color. Slide 9, as a certified peer specialist, how empowered do you feel in your workplace to address racism? This is a tricky one, because advocating for peers is typically part of our job description, right? Yet 15% say they are only a little empowered, or not at all empowered, to address racism in their workplace. Only 24% say they are fully empowered to do what could be considered by some to be a part of their job. It is not really surprising, though, that 33% indicated that it depends on the circumstances. If I need my job, and I believe addressing racism is going to or might endanger my job, that will likely have an impact on my decision-making process. Slide 10, how has your organization responded to recent social unrest surrounding racial injustice? We knew there was a wide range of responses to this question, and we wanted to capture as much of it as we could, and as you can see, we got a wide range of responses. A, my organization has done nothing. 20%. B, my organization has provided internal, external communication. 16%. C, my organization is in the process of gathering information, providing communication, but has not made meaningful change. 18%. D, my organization meaningful change. 32%. E, my organization has thoughtfully responded and made meaningful change. 9%. And finally, F, my organization has thoughtfully responded and made impactful changes and is in the process of continuing to gather information. September 15th is not that far away from the dates of some of the protests, and there were protests continuing at the time, so it is not surprising that some organizations may have taken a minute to get to that place where they've made impactful changes. But thinking about that 20% that did nothing, not even send out an email to employees saying anything, I would really like the opportunity to follow up. Like, does your organization never send out emails, like, after events that might impact employees and or program participants? Like, did they ignore September 11th or the emotional and mental strain of COVID in their internal and external communications? I would like to know. I don't think we have a complete picture here of how organizations responded to social unrest in 2020, but we have a lot. The notes on the following pages were transcribed from breakout groups facilitated by George Mental Health Consumer Network and the Southeast Mental Health Technology Transfer Center staff during the listening session. Over 150 responses were recorded. The responses presented here mostly represent common themes, though a couple are included for their singular nature. What racial barriers to recovery and wellness exist in your organization? Organizations don't understand the daily struggle of being a person of color. When I was at a statewide nonprofit and a Black person said that she wanted to open a center, she was told, you know, that's very expensive, and oh, you read so well. They knew nothing about her education and what kind of money she has. I work in mental health and drug court, and one of the individuals that I serve showed me a picture of himself dressed in the robes, KKK, and makes racist comments. My organization says that we have to meet people where they are, and I try to do this, but it is hard. I told him that we would have to disagree on this issue. I find that I do not want to help him as much as the others because he is such a racist. The leadership team at my organization does not reflect the population of the staff. Our agency has doctors that deal completely differently with people of color than they do with Caucasians. Most times, it is quite obvious. What racial barriers to recovery and wellness exist in your community? Racial barriers in housing. People find it very difficult to find decent housing. The agency does not address this as it should. Fear of interfacing with police in the community. Defects showing blatant racism. I have heard from Black peers that ministers and family members told them that they were not praying hard enough or else they would not have mental health issues. There are not enough people of color in mutual support groups. What experiences of racism have you encountered in your behavioral health care system? Excuses are made to not provide services to many people of color. I have seen people of color given excuses as to why they were not seen in a timely manner or why they cannot get answers to some of their questions. It is as though they do not exist. Or how dare you question someone in authority? White peers talk about how they are afraid of police and are treated poorly by the police. The white peers say you are delusional. That is not true. Y'all are making that up. Continuing with what experiences of racism have you encountered in your behavioral health care system? I was working in the hospital when a Hispanic woman was brought in by emergency. The emergency staff said you don't even belong here. Then staff were cussing and saying terrible things to her without asking if she spoke English. I came to realize that she did speak English. And it broke my heart that she had understood the names they were calling her. They were also poking at her head. It makes me sick even now to talk about this incident. I worked at a community service provider where peers were coming out of jail. People of color were sent back to jail at a much greater rate than whites for the same behaviors. When I asked about this, the person in charge of sending them back said that she was following the director's orders and that she needed to keep her job. She was a Black lady and said that she felt very badly every time she sent back someone. I left that job as soon as I could. And so did she. How does your organization respond to experiences of racism? My organization responded with an email. Black lives matter and equality matters. But when asked by Blacks in the organization if they could change a Confederate holiday to another holiday, management said they would have to take that up with the legislature. Our organization was afraid to put out any communication about Black Lives Matter until after the legislative session was over because we were afraid that if some legislators associated us with BLM that they would cut more funds to our programs. When racial injustices occur, nothing is done or said. It is just swept under the rug. I have seen so many of my co-workers promoted that don't have the qualifications that I have time and time again. It is a very disheartening feeling that you don't have the support of the administration. At some point this is going to have to be dealt with. It is very demoralizing. Continuing with how does your organization respond to experiences of racism? I know of several incidences of racism that were reported and none of them got any further than the initial report. This has happened time after time. So most times people have simply stopped reporting incidences because we all know nothing will happen. People of color do not have the support of the administration. This is really sad, but it speaks to the state of affairs in the country. People seem to not want to confront the issue of racism, which is best left untouched. Diversity committee meets weekly. They have discussions on how to improve. If there is a peer that wants to link up to someone on the committee, they can set that up for the peer so the peer can feel heard. At Rise, which is a recovery community organization here in Atlanta, a fantastic place, she has a space where people can create. It was essential that they could create using those feelings and express them in safe places. They started a creative protest where they could take their creations and have a voice there at Emory. The organization responded to a vendor who displayed racism by not continuing to do business with the vendor. What changes need to be made to remove racism as a barrier to recovery in your behavioral health system? We have to first acknowledge there is a problem. We have to be honest about the events that have happened and those that continue to happen. We need to have diversity training on an ongoing basis. We cannot continue to ignore racism. It is killing people and it is killing our people and it has to end. An advisory council made up of peers who have used the services for their feedback. First thing would be for acknowledgment and openness about racism. There is no discussion, so no change. There is good literature to read, but we have to meet people where they are. Most do not understand white privilege. Training is very important. What changes need to be made to remove racism as a barrier to recovery in your community? We have to acknowledge there is a problem. We have to be honest about the events that have happened and those that continue to happen. Economic changes need to happen for more opportunities and options. Step in when you see or need to respond. Listening sessions, town halls, communication. So what did I learn the day of the listening session? I learned a lot about racism in the behavioral health system for sure. It had been many years since I was naive enough to believe only people who share my ideal values and beliefs pursue careers in health and behavioral health, or that higher education removes bias, fear, and hatred from people in helping professions. And yet, I was still surprised by the casual way in which people discuss the horrific things that have been said and done to themselves and others in the behavioral health setting. What to me was shocking was obviously commonplace and no big surprise at all to them. I learned that despite being a cultural competence trainer since December 2015, I still have much to learn about the experiences of people who are different from me. If you are someone who works with or employs people of color or anyone with lived experience very different from your own as peer specialists, remember that even though they chose this occupation, they may still have trauma or challenges related to their own experiences receiving or providing mental health treatment or support. Earlier, I mentioned how in the summer of 2020, the city of Atlanta felt wrong, uncomfortable, and not like home. And I think about peers and peers who provide them support, working together to build recovery and wellness in an environment that might make them have similar feelings of discomfort and disease. I want to close by sharing a little publication with you. I discovered it in grad school when I was getting my MFA in interior design. It's by Jack Masser, who is a researcher at The Ohio State University. It's called Visual Quality by Design. And it really transformed the way I think not just about design, but the world itself, because it led me to environmental psychology, which really just fascinated me and continues to fascinate me. The way we can shape space to create memory and places of meaning and how memory itself works and just what it means to be a human existing in a room. But there are two things from that little booklet. It's only 48 pages with lots of nice pictures that stand out to me as being particularly relevant to the conversation we're having about supporting a diverse peer workforce. The first, our thoughts about a place are not the same as our feelings in a place. I can understand and say and even believe that a place or a type of place is safe and good and healthy. But if I've had negative experiences in that place or type of place, I may not feel safe or comfortable there. If I'm verbally attacked or physically assaulted in a dentist's office, it might be obvious why I do not want to go to the dentist. But not all harms and hurts are so obvious. Some are subtle, some are silent and sneaky. I may not be able to articulate or explain my feelings or even know why I feel them. But understanding how different the experiences of a diverse peer workforce can be from our own experiences can help us to better understand and support the work peers do. And the second appearance is reality. If I walk into a derelict looking truck stop in the middle of nowhere and I see flooring and countertops that are scratched and faded with age and wear and there are unfamiliar smells that are unpleasant to me, I'm going to perceive that space is dirty regardless of how clean it may actually be. And if I'm at the restaurant of a luxury boutique hotel where the air is filled with those amazing scents that are packed in through the HVAC and I see staff wiping down the tables in the restaurant, I'm going to perceive it as clean even though I have no real idea how filthy that rag may be that they're using to wipe the tables. And if my employer is one of those 20 percent of organizations that did literally nothing in response to the social unrest of the summer of 2020, however that appears to me will become my reality or at least part of my reality in my workplace. We cannot choose how anyone understands silence or inaction, but we can start a conversation, build trust, ask peer workers what we need to feel safe, to feel supported, so that we can best do the job you hired us to do. So how do you support a diverse peer workforce? For the most part, like any other diverse workforce, go through the diversity and inclusion training, implement the practices, put the theories to work, have a staff and executives that reflect the community they serve, provide opportunities for enrichment, growth, wellness, and advancement, and you are well on your way to supporting the peers that are a part of that workforce. But what about them specifically? How does supporting peer workers differ from supporting other workers? Two things. One, the peer worker's diagnosis or disability is a part of their job description. Most everyone has experienced a mental health crisis or emotional crisis at some point in our lives, but that is not part of all of our job descriptions. People are not generally encouraged, either directly or indirectly, to think about or talk about the mental well-being of someone because of their role at work. What this means practically in many settings is that if a peer worker starts showing up late for work or tired, for instance, colleagues will begin to consider and talk about the possible decline of their mental health instead of the countless other reasons everyone else in the office might show up late for work, like crying baby or traffic. The diagnosis can become the default explanation for everything a peer does or doesn't do. Think about how you might react if after someone at your workplace made an error, someone provided the explanation for that error by saying, well, she is a woman, maybe it has something to do with that, or maybe there's some gay thing happening with him. In most workplaces, it just wouldn't be countenanced, and yet in behavioral health settings, of all places, we see stigma, frequently disguised as concern, normalized through the peer specialist. And second, while many other signifiers of diversity, such as religion or ethnicity, may have their detractors, they also have those that celebrate and honor them and seek them out. You see employment ads all the time encouraging Black, Asian, minority ethnicities to apply. I've yet to see one encouraging people in recovery from a mental health concern to apply for any job other than a certified peer specialist. And while personal ads and dating apps have folks looking with extraordinary specificity for every size, shape, and color human, I've yet to see one that says, must be bipolar or desperately seeking a schizophrenic. There's no culture in the modern world where people with mental health diagnoses are honored above others by society, are sought after, or encouraged to run for president or governor or dog catcher. Most minorities have a place where they can go to feel safe and secure, respected and connected to one another. But those places for people with mental health concerns are rare. And for peers working in mental health, safe spaces are incongruously even more scarce. And for peers who have experienced discrimination or even trauma related to their race or any aspect of themselves as consumers of mental health services or who live in places like Georgia, where the signs and symbols of structural racism are embedded in our communities, the effort to maintain personal recovery and wellness while providing quality peer support can be challenging. That is why in addition to the diversity and inclusion efforts that shouldn't be part of every organization, peers working in behavioral health need allies. We need allies on the inside. There will most likely never be as many peers working in a behavioral health center as there are degreed and licensed clinicians whose mental health struggles, if any, are not part of their job description. We will remain a minority. Until the value and potential and needs of peer workers are fully realized, we need allies at every level of the organizational chart. So what is an ally? I'm going to share a personal story with you. In the fall of 2007, I was in my second semester of teaching interior design at Georgia Southern University. I was the newest and most junior faculty member, so of course I had the worst possible caseload. The technical courses students hated most that were also among the most difficult to teach. The vast majority of my students were 17 to 20-year-old white sorority girls. In every class, it seemed like there were at least two Brittneys and two Meghans, and every single one of them spelled her name in a unique and special way and would be deeply offended if I got their name or spelling wrong. It was a challenging time in my life. However, near the end of the semester, I received an email late one evening from one of my students. Her name is Quintel, and I got permission from her to share this story with you here today. For whatever reason, and I don't know that even she knows, Quintel reached out to me to share that she was preparing to drop out of school, like immediately. I want to give you a little background. Quintel was not one of my sorority girls. She was a young, single Black mother trying very hard to succeed in a major that is shockingly difficult and labor-intensive. I got my MFA in interior design from the Savannah College of Art and Design, and the architecture students were always saying, like, we don't know how you do all of that. Because of accreditation stuff, interior design programs program wanted really an at least five-year course of study in four years. The students and faculty really suffer for it. One of the things that got me through my interior design degree was the camaraderie that I was able to establish, because even as a non-traditional student in my 30s, I was still able to hang out in the studio all night and build that shared secret language of inside jokes and very practical shared knowledge of, like, use this key to save 20 minutes. The relationships that develop among the members of a studio cohort can be critical to the success of individual students. A cohort with healthy competition where students share information and resources can produce fantastic designers who may have only been moderately successful designers if they've been part of a different cohort. And Quintel understood this. She was one of the smartest students I ever taught. She spoke fluent Japanese. She was amazing. She was able to quickly grasp and adapt complex and enmeshed design and environmental psychology concepts. She wasn't just smart, she was funny and charming. And so it blew me away to receive this email where she shared with me that she was preparing to quit the program because she had been rejected by her cohort. Not able to go out drinking with math for class and stay up late in the studio night after night like I had done, she was not part of them. And as she looked forward to a career that is created largely from relationships, she could not see how she would ever be a part of. I had a choice in that moment. There were any number of ways to respond or not respond, to engage, dismiss, defer, refer away. No one would have blamed me for sending her the number to the academic success center or student wellness center, but I didn't do that. My first thought really was to share my own lived experience about how at the age of 20 in the middle of an emotional crisis, I left the University of Georgia in the middle of the academic term with two terms to go before graduation, parked my car in short-term parking at the Atlanta airport, bought a one-way ticket to New York with a check that bounced, and spent most of my 20s making a life for myself in New York, but really wishing I had that degree. In short, I was going to make it all about me and how my life experience should matter to her. But she came to me very specifically as a single Black mother facing obstacles I hadn't faced. I remember in that moment thinking about how when I was 17 and locked away in the adolescent unit of a private psychiatric hospital in Atlanta after a suicide attempt and sitting with clinicians with their wedding bands and engagement rings and pictures of their happy families talking to me about the bright future I had because I was academically gifted. I was learning how to manage my mental health at a young age, and I remember thinking what idiots they were. This was 1987. The best hope for a 17-year-old gay man was that he might not die of AIDS. That was it. You know, the gay marriage or adoption, none of that was on the horizon. And I lived in Georgia where they were steady arresting people for being gay. LGBTQ folks who bother trying to report hate crimes were usually told you should be grateful it wasn't worse. Privilege has a way of limiting us. We assign our rights, our privileges, our experiences of the world, our truth to others. Having experienced this life-washing where people wash away my life and fill it in with their own, I chose not to do that. So before I began to respond to Q's email, I sent an email of my own. There was a very nice lady who served on the advisory board of the interior design program where I taught in Florida for a year. She owned her very own successful interior design firm, and I emailed her, briefly explaining Q's struggles and asking if she would be willing to be contacted by her. This was not without risks. I had a total of two, maybe three brief interactions with this lady while I was teaching in Florida, and they were the most banal sort of surface conversations you can imagine. She was of a certain age and everything about her was impeccable. Her manners, her gestures, her tailored skirt suits, her jewelry was all just flawless. You know, it was like she stepped off the set of a soap opera. She was incredibly gracious, but we were not friends. I did not know this lady. All I really knew about her was that she appeared to be Black, though I had never heard her refer to herself that way, and that she was a very successful interior designer. And really, even though she was incredibly gracious in our interactions, there was nothing about her that indicated she might welcome this sort of email coming from out of nowhere from some white guy she barely knew. However, she responded quickly and succinctly and said to please have the young woman contact her. I spent the next couple of hours drafting what was probably the best thing I've ever written and sent it over. He received it. They spoke the next day. She stayed in school. She graduated. Today, she has her own namesake firm, Quinn Gwynn Studios, in Charlotte, North Carolina, with seven young Black women working for and with her to create spaces and places of meaning for their community. A couple of semesters later, another young Black woman came to my office in tears in almost the same circumstances. I reached out to Q. Q mentored her. That young lady not only graduated, she went on to graduate school as an architect. And then another who fell in love with green design and is one of those dreamers and doers who's been working to reimagine and rebuild Detroit. And there are several other young women participated in this very informal mentoring. It was incredibly valuable to them to be able to talk to someone who looked like them, who sat at the same drafting tables, who worked at the same computers, who shared this lonely part of their experience together. If I cannot see myself in your story, your story will not help me. It will not resonate. It will not inspire me to think a different way, consider a better possibility, to have hope, to take action. When the world has told me since I could hear that I am different, that I am other, less than, but not equal to, don't expect me to be able to look for and see the similarities, not the differences. If you do not share my story and you want to be my ally, listen to my story, hear my story, accept my story. And when you have the opportunity to support me, to have my back, to connect me to resources I need, then do that. Now let me back up for just one moment and be clear, I do not take any personal credit for the success of these young women. They did all the work. They are still doing all the work. And while there was certainly a risk Quintel may have actually followed through on her desire in that moment with school, I believe she emailed me because she wanted to stay. And if I hadn't given her the right words or motivation to stay at school, she would have found them elsewhere. All I did was realize my limitations as her ally and connect her and her future students to one another. But there was value in that small piece. When I reached out to her to explain what I was trying to accomplish here and to ask if I could use her name, she said, share my name and our story, please. I needed you and you showed up for me and I've never forgotten it. You were a great professor to me and intervention at a critical moment in my life. Please spare no detail. I hope my experience and the way you supported me helps someone. Tell them they can call me. Why did I tell you this story from academia instead of once in my time providing behavioral health services? A couple of reasons. First, I love the story, my very small part of it. Second, it demonstrates that you don't need any special training to be an ally. You don't need to work in behavioral health. You don't even really need to have behavioral health. When I responded to Q's email, I was near the end of a personal years long behavioral health crisis, but I had moments of clarity and a vision of purpose. And generally speaking, I was mostly able to pull it together, the things that mattered to me and Q mattered. When Ben first talked to us about this presentation today, I was taken back to the years I spent in New York at the height of the AIDS epidemic and how important allies were. When Princess Diana shook the hand of a man living with AIDS in front of news crews, she purposely and skillfully began a campaign to destigmatize HIV AIDS, but it took thousands, tens of thousands, perhaps hundreds of thousands of allies around the world doing what they could, when they could, to make the progress we have made. One of my personal favorites was a New York society doyen named Judy Peabody. She was the very best sort of socialite who really wielded her privilege and wealth and status like weapons. After a good friend of hers died of AIDS in the mid 1980s, she began volunteering at the Gay Men's Health Crisis Answering Phone. Eventually she became a care partner there, someone who accepted personal responsibility for helping an AIDS patient at a time when most of them were dying. She led support groups for loved ones and caregivers. She raised money. She gave her own money. But my favorite thing about her is when I heard how she would shut down anyone making an AIDS joke. Calling someone out just really isn't done in polite society, you know, no matter how crass the humor, but she did it. Remember AIDS jokes? We heard them everywhere, on the school bus, on the radio, on television. How many AIDS patients can you fit into a telephone booth? All of them. It was funny because it was happening to them. We don't hear COVID jokes. They haven't been written yet. I met her once, Ms. Peabody, at the annual holiday party of Robert Woolley, an auctioneer at Sotheby's, who threw this lavish party each year. And as a reward, invited people who had made significant contributions to fighting HIV AIDS that year. And I can still picture her with her cotton candy spun hair, the only woman in the room, perched on the edge of a sofa, leaning forward to really be able to hear and listen to each person as we came forward to thank her for what she had done for us, our community. She could have just written a check, but she showed up. She understood the power of someone of her position performing the work she did. She understood privilege and she used it. What do you need to be an ally for a diverse peer workforce? Understanding every peer worker is unique, just like everybody else you work with. And their symptoms, if any, and what they use to manage them are going to be different. And they may or may not want to share this information with you, which brings me to trust. In listening sessions we conducted that I talked about before, we heard countless times about the discrimination and trauma peer workers have experienced as consumers and providers of behavioral health services. Creating trust is going to require effort. It is going to require listening. It may require sharing something with a peer worker that you might not have shared with other colleagues. Taking a risk, being vulnerable, which brings us to resources. Being an ally always costs something. Maybe time, maybe effort, maybe the sort of intangible workplace capital where I know I can put my foot down and get my way over my superior's objections maybe once or twice a year without being labeled as a troublemaker. Finally, self-awareness. We need to understand who we are and not just our biases and all that icky stuff we learn through self-discovery. We need to know practically how much influence, how much power, how much energy, how much time can I devote to this ally work? Remember, Judy Peabody was an incredibly wealthy woman. She did not have or need a real job. Most of us do. I would be surprised if most of the people participating in this conference had even an hour, possibly even a half hour each week to dedicate to supporting the peer workforce. But knowing what that is and making a commitment to use it is important because we know how valuable peer support can be. We've seen the data, but we've also seen how many times the peer worker is able to make that first real connection, that authentic rapport, and that shared language that can be the wedge that opens the door to recovery and wellness for someone. And I will finish with this. The difference between having 11 and 12 allies is probably not especially noticeable. The difference between having no allies and having one is immeasurable. Okay. Hi, everyone. I'm Karis Myrick, and you heard me being introduced. And I thought I would talk about supporting the diverse peer specialist workforce from a somewhat radical perspective. It's really not that radical, but I like this quote from Angela Davis about radical simply means grasping things at the root. So as I think about how do we support a diverse peer workforce, how do we support a diverse peer workforce, I think about a lot of the structural things that we have to grasp at the root in order for change to happen and people to feel supported. So one of the things, you heard me introduced by my bio, but I think it's also important to know that there are a lot of different things about me. This is, yes, this is me as a little baby, and I hopefully look very cute. If you think I look cute, you can put your emoji up, thumbs up, or something like that. But I'm a sister, I'm a daughter, granddaughter, cousin, I'm African-American, I'm Muskogee Creek, I'm an army brat, I'm a global nomad, I'm human, and I'm a person. And that's my brother, he loves me so much. At first, he was, my mother says he was kissing me, and I said, oh, he was trying to suck the life out of me. And then in this picture, as we're a little bit older, he's trying to squeeze the life out of me. But quite frankly, I think it's important for people to know as a person with a lived experience of a mental health condition, that I'm all of these other things. I was all of these other things prior to getting the condition, and I'm still all of these things, of course, in my life. So when we talk about the peer workforce, again, we're not talking about just a person who has a mental health condition, who's using that lived experience or lived expertise in their role as a peer supporter. There's also all of this intersectionality. So as you heard, I'm African-American, I'm a member of the Muscogee Creek Nation, I'm female, I won't say how old I am, the gray hair should probably give some of that away. And of course, we're folks, again, with lived experience, which is an ability, and some people may also say, yes, it's a disability. So all of those things have to be taken into consideration, and each person will show up with all of this intersectionality. So one of the places I also like to start when we're thinking about the role of peers and peers in the workforce, I use this image from Nicholas Proctor, who's actually from Australia, and this is an experience that he has had in Australia, that he's noticed about what happens when peers show up in the workforce and are trying to do work to advance the system. Part of our core competencies in our training as peer workers is also advocacy. So if you wonder why we advocate for things, that's one of the reasons why, because it is a part of our training to be a part of system change. So at the top of the graphic, if you split it across horizontally at the top, the peer is saying, I'd like to create a platform for survivor voices that are excluded from mainstream mental health campaigns. And the staff, whoever those staff may be, they may be providers, administrators at the agency, say, yeah, okay, but it has to include the survivors we already hear from, and they can't be critical of services or dominant mental health narratives. Also, they must be people who communicate using formal, unemotional language. So you see the guy's face. He's kind of excited initially when he comes, and then he kind of gets this interesting response. And so he summarizes the response in this way, and you notice his face is not very happy. And so he basically says, so you want a platform for survivors that doesn't prioritize marginalized voices. You want people to be positive about services and dominant medical narratives. And then you want them to say it politely during a formal meeting. And they all are in agreement. Well, yeah, duh, of course, that's exactly what we want. And then we can give them 10 minutes and we'll give free tea and biscuits. We'd like them to tell us what color they think the wall should be painted. And we really value service user involvement. And we can say peer involvement, service user involvement. So ew, yeah, no, that's not what we want. And what do we call that? So a lot of us understand microaggressions and understanding what microaggressions are. And I like to also bring that up as far as what does it look like when you're a person with lived experience and you're in the workforce as a peer provider? So in many cases, we know that microaggressions are hidden messages that may invalidate a particular group identity or experiential reality of that particular person. It can demean them on a personal or group level. It can communicate that they are lesser human beings, suggest they do not belong with the majority group, threaten and intimidate or relegate them to inferior status or treatment. So that's what it can look like when you're a peer provider and you're trying to be a part of, advocate for, co-design with, partner with other providers and or the system at large. So what does that look like kind of concretely? So it can look like not including peers in routine meetings, in client case management meetings, strategic meetings or board meetings, relegating peers to advisory positions instead of working committees, forgetting to communicate about new policies to the peer staff or not asking for input, asking peers all the time, do you feel okay? Are you okay? Are you okay? And I always say, it's always good to ask if people are okay, but to make sure you're asking everybody, are they okay? Because there are times when all of us feel not so well and it would be really nice if somebody would ask if we're okay. So also excluding peers from something because there's a feeling that it's too stressful or demanding and I can speak from personal experience. You know, my most recent roles have been in administration. I was a CEO of a very large peer run organization. I worked at the federal government in a directorship position. And a lot of times people would tell me, well, I don't know if you really ought to be doing that, but it seems like it would be really stressful and maybe harmful to your mental health. And I would have to say, if I'm actually not in a stressful, very challenging job, that is really stressful for me. And actually that impacts my mental health. My brain has to be very, very busy, engaged in solving very complex problems. And that's actually what keeps me well. So what people had thought would be harmful for me actually was quite helpful for me. So I think that's really important to understand. Again, it's based on the individual and what the individual needs and wants. And then also understanding when you're thinking about who's being invited to the table and how that's happening, a lot of times what I've noticed as well is that if we look at peer leadership across the country, peer leadership looks predominantly white, predominantly, I think it's predominantly male. Sometimes it's about 50-50, but it's very hard to find peer leaders of color, which means that there's something else going on there relative to all of our roles in lifting up and supporting peers to be leaders, especially those of color. So a lot of us are working on structural competency. So what are structural competencies and how do we understand what are structural issues? So again, in a lot of our training and a lot of diversity, equity, and inclusion training, we talk a lot about cultural competency, but what is a structural competency? And so structural competencies look at the root causes of social inequities and health disparities that are really those structural factors. So you see that things supposedly are equal because everybody's starting at the same line, but for the woman of color, she's got to carry a weight, she's got to go through all of these obstacles, all of the obstacles, et cetera, are those structural competencies. And our work really should be not just helping people at the individual level to kind of understand what some of these things are and how to address them in their own wellbeing. This is the people that we serve, but I think from a peer perspective, we also want to address those structural competencies to see in what way we can dismantle those barriers. So how can we also look at dismantling these barriers for peers of color, peers with a diverse workforce who are entering into the workforce who have to deal with things that, you know, I think other providers do as well, but there also may be some differences. So let me give you an example. This was a actual peer support salary, a national survey that was done back in 2016. I'll be at a little dated. It's the only one that we have at the national level and I'm really using it to explain a couple of things. So when you think about how peers enter into the workforce, many people who go into peer work are folks who were former and may still be recipients of public mental health services. So when you're a recipient of public mental health services, you have to either be on disability or of course you have to meet some type of criteria, mainly criteria about being at a certain poverty level. So when you're on disability, there are a lot of restrictions about what you can do and what you can't do in order to ensure that your benefits aren't impacted. So if you think, for example, about how much money you can earn, which is capped, otherwise you start to have to have a payback and then you have to come off disability. There also may be some housing subsidies, food subsidies and transportation subsidies. So a lot of times when people are exiting or going on that off ramp from disability into employment, they may do it in a way that they're coming from either part-time work into full-time work and some people move straight into full-time work. When they do that though, they may have, this may not be so for everybody, but there may be a lot of debt and other complex issues that are structural for them. So when you think about peer support specialists, if you look at some of the salaries, $14 an hour, $15 an hour, $60 an hour, on average back in 2016, it was $15.42 an hour. You're really talking about low wage workers. When you're talking about low wage workers, you're talking again about lots of structural implications about some of the things that low wage workers have to work with within their life. And I'm talking about their at-home life that we can't ignore will come into the workplace life. So the other thing I think that we have to pay attention to is that, which was really shocking, is that when the study was done, males were earning on average $16.76 per hour, while females were earning $14.70 per hour. So some of the things that we actually see in society at large, oddly or interestingly, I don't know which way to put that, carry over into our peer workforce to see that females are making less money than males was really kind of striking. We don't understand why, but certainly it may be some of the things that we also see in society at large as far as differential in pay between men and women. The other thing that I want to bring to our attention is I was reading a wonderful article from February 2014 by Dr. Jonathan Metzl and Dr. Helena Hansen called Structural Competency, Theorizing a New Medical Engagement with Stigma and Inequality. And what I was really struck by in that article is that there was a study that was done with primary care providers and pediatricians in particular, was a Robert Wood Johnson study that basically asked folks to respond to this question around how much do you agree, or do you agree that unmet social needs are leading directly to worse health for all Americans? So 85% of those physicians said, yes, that is actually so. And so what they also responded is that they don't feel confident in their capacity to meet their patient's social needs and in their failure to do so, it also impedes their ability to provide the best care. So though physicians increasingly are citing structural factors such as restrictive insurance policy or lack of time with the people they serve as reasons to leave clinical care, their clinical practice, this is also some of the things that peers are also trying to work on. And we're talking about allyship, how can we do this together? We're all trying to save this, trying to solve the same issues. How can we do that better together and collaboratively? Also, how can we recognize that peers also may be struggling, especially peers of color, with some of these very institutional and structural issues in their day-to-day life and also in their employment setting? So one of the things when we talk about allyship and working better together, I like to provide people with a way of thinking how to do that. My educational background is in industrial organizational psychology. So basically I like, and I have an MBA, but don't hold that against me, okay? But anyway, I like to think a lot about using social media to help people understand I like to think a lot about using system design theory and system design practices to help people think about how can you create opportunities for intentional strategic partnerships? And a lot of times, if we're working on these issues together, and especially as we're working on them for the people we serve and working on them to ensure that the systems in which we all work are reducing inequities, disparities, and structural barriers, then we need to think about how can we do this together using a co-design process? And so in a co-design process, what we're looking at is, I call this sort of the co-co-co-co, I don't know how else to put it, but basically it's creating ways to do co-production, co-design, co-evaluation, co-delivery, and co-planning and how to do that together such that we're building capacity, prioritizing relationships, using participatory means, and most importantly, sharing power. So the power isn't by nature of the role that you have in the organization or the number of letters that you have behind your name, but it's sharing power across the organization equally, and also recognizing that there will be people in peer support roles. Those are the people you know have lived experience. There are also gonna be providers and staff within organizations and agencies that have lived experience that may not be open about it. So I think that's another way to think about creating, I would say, a mental health-friendly workplace that is also centered on, with intention and strategy, race and race equity. So how do you do that? So I took something, well, I didn't take something, but Sue Bergeson and myself have used this ladder that was actually first outlined for UNICEF. It's called Heart's Ladder of Participation. What UNICEF was trying to do was seeking better ways to figure out how to involve the people they were seeking to serve in design, implementation, and evaluation. And I really like this because it helps people think about where might we involve people? How might we involve people? And there are different levels and different reasons why you might be at different levels. So for example, the bottom is, and again, we'll call it the bottom rung. And in the original, I think this was red and I got really nervous about it being red because red seemed like that's bad, stop doing it. But there actually may be reasons that folks are doing things in a particular way. You just have to understand it. That's the intention. So the bottom rung is marketing capital and entertainment. And that's when you only are using peers to tell their personal story and that's it. You're putting peers or people with lived experience in maybe your yearly, what do you call it? Your yearly strategy plans that go out to the public or something like that, or you're using it in marketing campaigns. That's a start, but what are some other things? So of course there are things like tokenism where people are doing, well, we know what a lot of these are. I'm not gonna go through all of these, but there's tokenism, job tokenism. You can involve people, peers in again, work groups or in advisory groups, but they have totally no influence. You might have peer groups that are feedback groups that are separate, but they're not equal to other groups. And then you can go all the way to the top of the rung where there is lived experience or peer workers involved at every level. It's kind of where you wanna go to. That's sort of the goal. It's not aspirational, but it should actually be a true goal. And I think one of the ways that we thought to help people think about how to do this with intention, meaning I can plan this forward. I don't have to kind of do it on the fly, but I can think about this in real intentional ways is creating, and this is called a consumer engaged organizational assessment. The other way to look at this is you can use it for any type of stakeholder engaged organizational assessment. So in this case, we're talking about a diverse peer workforce. How are you doing in areas in all of these levels of the ladder, and you can rate yourself. So just do a self rating. If you don't wanna share it with anybody, you can just do it by yourself and kind of see where you think you are as far as, so for example, consumers, or let's say peer workers, diverse peer workers contributing at all levels. We have done this on rare occasion would be just a one check mark right here, and then you would illustrate how you have done it. I would add another column and say, but I wanna do better at it and start to think about what is my plan forward, but don't get to that other column until you rate yourself in all of these levels. A lot of people find that they have high ratings for marketing capital and engagement, input and no influence and separate, but equal. So you're around here on the ladder and the goal here, meaning in the orange to the yellow, and the goal is to move to the top. So how do we do that? So I love this idea of creative maladjustment when Martin Luther King spoke to the American Psychological Association, and what is really creative maladjustment? And it's about not allowing ourselves to be content with the problems that we see in the world around us. It's not about giving in to social pressures to align the way that we think and behave to the status quo. Instead, it is being creatively maladjusted. It means finding new solutions to challenges, allowing ourselves to be different and embracing the creative contributions of all of the people, particularly who are in our workforce, including peers, people with lived experience and people of color. So this gives us sort of a way forward and to think about how can we do this with intention and create a strategy that goes beyond our first step, maybe taking some of the DEI training. The next thing you want to do is put that into action. And a lot of times people will say, what, you want to do what? And you want peers to do what? Or you want lived experience involved in what? And so that is the naysay. I call that the naysay. And so I've provided a script here. We don't have to walk through it, but a lot of times when people say no, we have to figure out how do we stand up and say yes. And so I call that, you know, when somebody says the naysay, how do you say the yaysay? Meaning you're going to say yes and, and give examples of how to move forward and say yes and. One of the things, this is sort of my creatively maladjusted, I don't know how creatively maladjusted it is, but certainly it was my way of saying there, I couldn't find people of color in leadership initially when I started working in the mental health field, especially in administrative position. And I reached out to people. I was introduced to Jackie McKinney who actually, when I first met her, I was really actually struggling and I needed to meet somebody who looked like me, who was going through what I was going through in order to actually believe that first of all, recovery was possible. Not only was recovery possible, but could I move forward as a black woman in a space that is predominantly white in order to lead and make a difference. And Jackie McKinney to me was an example of someone and she still is an example of someone who has done that. And as I've continued to do my work and reach back in, as Cherelle Bellamy says, lift as we climb, help other people to also reach into leadership positions, especially people of color, I found that we didn't know each other. And sometimes people would call me and say, oh, can you introduce me to somebody who looks like me? Can you introduce me to somebody who's been through an experience similar to what I've been through as people who are either rising leaders or current leaders in the mental health workforce. So it became very hard to keep connecting people to one another. And I said, well, heck, why don't I start a podcast? I mean, everybody's starting a podcast these days, right? So I actually started a podcast called Unapologetically Black Unicorns or UBU, because I want people to go out there and UBU in order to really put out into the world the stories and the experiences of people from diverse backgrounds, a majority who are peers or in the peer workforce or in peer leadership, being able to tell their personal stories. The other thing, and it's just not their personal stories of recovery, but it's their story of leadership. How did they get into leadership, et cetera. I've also recognized that the very issues that impact peers in leadership, especially peers of color, also impact our psychiatrists, psychologists, social workers, where they are really a very small percentage of overall providers. So for African-American psychologists, I believe it is only 4% makeup is African-American. I'm sorry, for psychiatrists, it's about 4% African-American. So on my podcast, I've spoken to two psychiatrists, you all may know them, Dr. Anel Prim and Dr. Curly Bonds. I've also spoken to psychologists who are woefully underrepresented, Dr. Arthur Evans, Dr. Jorge Partida, Dr. Ana Florence, and then also to a behavioral health director who is, he believes, the first behavioral health director who is transgender and also Filipino. So having this platform can introduce people to a broad array of folks who have lived experience, who are people of color. Some folks may not have lived experience, but they are people of color who are really trying to work towards changing systems to make it better for the people we serve and also for the people who work within those systems. So as Malcolm X says, when I is replaced by we, even illness turns into wellness, and I look forward to all of us working on these issues together. Thank you.

panel discussions

diverse peer support workforce

mental health field

Chris Johnson

racial tensions

Atlanta

Karis Myrick

allyship

structural competencies

co-design

transformative power