Peer-Based Education Regarding the COVID-19 Pandemic.

People with psychiatric disabilities show inordinate rates of co-occurring physical illnesses including morbidities in most major organ systems that may cause them to die 15–30 years younger than their same age cohort [1, 2]. Research shows this group also has higher rates of infectious diseases [3, 4] and respiratory disorders [5, 6]. Pandemics like that caused by COVID-19 may thus further increase morbidity and mortality for people with psychiatric disabilities. Of further concern, prevention practices necessary to avoid infection lead to stress and social isolation. Psychiatric disabilities are often defined by a stress vulnerability; i.e., the mental illness of people with serious psychiatric conditions are likely exacerbated by genetically endowed hyper-sensitivity to stress [7, 8]. These are further worsened when people are distanced from their support system [9]. Hence, COVID-19 practices related to staying safe may exacerbate existing mental health symptoms [10]. Therefore, people with psychiatric disabilities must address three key questions to withstand the pandemic. First, what precautions should people take to avoid infection? (remaining safe) Second, what kind of a clinical care should individuals who are positive for the virus pursue? (dealing with infection) Third, what resources might people pursue to promote wellness and mental health? (treating mental illness).

Research has identified several factors that account for this worsened pattern of health with absence of health literacy; namely, people with psychiatric disabilities are frequently unaware of the breadth and depth of symptoms related to mental and physical illness, evidence-based treatments to impact these illnesses, and practical strategies to engage in these treatments [11, 12]. Promoting health literacy is even more difficult when standards for prevention and practice rapidly evolve or are provided in confusing ways that undermine confidence in making appropriate health decisions [13]. This is especially problematic in many countries where elected officials are using the pandemic to promote personal political agenda rather than public health.

Psychoeducational programs have been developed to enhance health literacy and corresponding health and wellness behavior; namely, teaching people how to make sense of mental and physical health symptoms and corresponding evidence-based interventions [14, 15]. Psychoeducational programs are adapted to address the cognitive and social disabilities that undermine skill learning [16, 17]. Hence, psychoeducational programs are needed to help people answer the three key questions.

Peer Program Facilitators

Peers with lived experience of recovery from serious mental illness have an important and unique role in psychoeducational programs specifically as program facilitators. A comprehensive review of research on the impact of peer services uncovered nine randomized controlled trials [18]. Findings showed peer psychoeducation led to improvement in a variety of personal goals of psychiatric service recipients [19-26] with two studies specifically showing positive impact of peer psychoeducation on the health and wellness goals of this population [14, 15]. Empirical research [27-29] and consensus statements [30, 31] suggested key ingredients to peerness including disclosure related to hope and exposure to vulnerability; modeling based on the peer’s journey; and trust that emerges from shared experience. Note that increased trust is especially important for promoting COVID-19 literacy given frequently uncertain health messages.

Pandemics are filling us all with uncertainty and desperation. Peer supporters once again become a major resource for promoting hope and empowerment. Rehabilitation providers need to specifically determine how peer providers can develop and implement curricula that help the person manage staying safe, dealing with infection, and treating mental illness.