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Peer Coaching Used to Combat Mental Illness
01/03/2014   Reported By: Patty B. Wight

It may be hard to imagine life without a phone, but imagine not having someone to answer your call. That's how some people with severe and persistent mental illness feel when they're in distress: as if there's no one they can call for help. As a result, they turn to local ERs, and some individuals check in more than a hundred times per year. As part of the MPBN News series, Mental Blocks, Patty Wight meets a man whose job is dedicated to cutting down these ER visits just by picking up the phone.

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Ben Skillings

Ben Skillings (l.), lead coach of the peer coach initiative, and Mark Wheeler (r.) meet for coffee a few times every week to prevent Mark from going into crisis.

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Ben Skillings starts his day with a cup of coffee. But it's more than just a cursory detail to his morning routine. It's an important part of his job.

"Yeah, I'm here at Coffee By Design here on Congress Street, meeting with Mark here," Skillings said.

For two years now, Skillings has been meeting Mark Wheeler here at least three times a week. It's a chance to check in and see how he's doing because not so long ago Wheeler was paying a large number of visits to a local emergency room.

"About 165 times, 170 in the same year," Wheeler said.

He is a recovering alcoholic who said he has major depression, PTSD from childhood trauma and panic attacks. About two years ago, his girlfriend committed suicide.

"I was kind of like a zombie," Wheeler said. "It was kind of like my whole heart was ripped out my chest. I was shaky. I couldn't leave my house."

Except to go to the ER because Wheeler himself started to feel suicidal. He became one of dozens of mentally ill individuals who visit Portland's ERs multiple times a week or month. It's been a problem for years, and it got people at Amistad, a Portland-based mental health organization, thinking.

"Our belief was that they may not need to be there, but it's nobody's job to figure out proactively how else we can meet their needs without having them go to the ER," said Peter Driscoll, Executive Director of Amistad.

"So our belief was if we had somebody working with them, who was really interested in forming a relationship with them, kinda outside the traditional medical model, we might have success in getting their needs met," Driscoll said.

The Peer Coaching Initiative was born, and for two years, Ben Skillings has been the sole employee. He started by handing out his cell phone number to a half dozen of the highest frequency users of ERs and telling them his expectations.

"Um, we have to come to some sort of agreement that when you feel like going to the hospital or emergency department to call me first and we will try to meet and work it out and I will try to be as responsive as I can," Skillings said.

Now, he actively works with about 20 people, and at least a few dozen more have his phone number. Skillings works Sunday through Thursday, about 9 to 5, though sometimes his job extends into the evening. His days are a mix of fielding phone calls, to pre-arranged check-ins, like getting coffee with Mark Wheeler, to introducing himself to new peers. The program is covered through a private grant, so Skillings isn't bound by insurance requirements to bill and fill out paperwork. It gives him a freedom that most others who work with the mentally ill don't have.

"Ya know, it's easy to give up on somebody," said Skillings. "I've seen it happen. So basically they're saying, This person is too difficult. They're not getting any better, and they don't fit in with our model."

Peter Driscoll said Ben Skillings gives his clients what they can't get elsewhere, an authentic relationship.

"He's not asking about their diagnosis," Driscoll said. "He's doesn't expect them to follow a treatment plan. He's meeting them where they are. And he's a peer, so he's had the same lived experience that they've had, so that really is the basis for their genuine relationship."

The cost to run the the Peer Coaching Initiative is about $100,000 per year. Driscoll said in its first year, the program cut participants' ER use in half. For Mark Wheeler, it's been even more effective. In the past year, he's gone to the ER only a couple of times, for medical reasons. But Wheeler said Ben Skillings has done more than just help reduce his ER visits. He's helped him envision a future.

"I'm trying to go back to SMCC and try to be a social worker and stuff like that," Wheeler said. "Ya know this wasn't even in the realm of possibility a few years ago? I was just fighting to stay alive every day."

Ben Skillings said being a lifeline for people with severe and persistent mental illness may seem overwhelming, but it's actually pretty simple. He said, he treats people the way his mother taught him to. He just gets paid to show up and do it.

Photo by Patty Wight.



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