The Pattern
Marcus had been in the peer specialist role for eight months when the panic attacks started. Not at home. Not during his off hours. Right there on the hospital floor, standing in the medication room, his heart hammering as a patient’s story collided with memories he thought he had processed years ago.
His supervisor meant well. “You’re doing great work,” she’d say during their monthly check-ins. But those sessions never touched what Marcus was actually experiencing. How the lack of clear boundaries left him answering texts from clients at 10 p.m. How the clinical staff kept asking him to do “just this one assessment” because they were short-staffed. How he couldn’t find words for the exhaustion that felt different from anything he’d known before.
Marcus isn’t alone. Across the United States, organizations are recognizing the profound value that lived experience workers bring to behavioral health, child welfare, substance use recovery, and social services. The research is clear and compelling. Peer specialists reduce hospital readmissions by 56 percent. One county found they help cut involuntary hospitalizations by 32 percent, generating nearly two million dollars in savings in a single year. The evidence keeps mounting.
But something is breaking in the space between that recognition and the reality workers like Marcus face every day.
When Speed Outpaces Safety
Last week, a leader in the lived experience space shared a metaphor with me that I continue coming back to. It captures a consistent pattern I have observed across child welfare, juvenile justice, and the broader social service sector. Too often, well-meaning stakeholders throw individuals with lived experience “into the fire, figuratively and sometimes literally.” Systems recognize the value of lived experience without understanding its burden, rushing implementation without considering the support needed to protect those doing the work.
The behavioral health field has learned to hire lived experience workers quickly. A short training program. A certification process. Add them to the team. National peer workforce guidance suggests the infrastructure can be built more quickly than other workforce pipelines.
What the field has not learned is how to build the support systems at the same speed.
Research reveals a troubling pattern. Organizations often hire peer workers before establishing clear policies and procedures. They bring people on board without conducting readiness assessments that best practices explicitly recommend. Job qualifications, functions, and pay grades are determined after hiring begins, if at all. Supervision structures and organizational policies are still being drafted while workers are already carrying caseloads.
The numbers tell a sobering story. In one study, 91 percent of peer supporters identified challenges to being effective in their roles. The top challenges were excessive workload, inadequate time, and personal stress. These are not minor inconveniences. They are symptoms of systems that skipped the preparation work necessary to protect the people they recruited.
Sarah, a peer recovery worker in a substance use treatment program, describes the reality. “They hired me on a Monday. By Wednesday, I was carrying a caseload of twelve clients with complex trauma histories. My supervisor had never supervised a peer worker before and wasn’t sure what questions to ask. I had a list of people to see and no real guidance on how to navigate situations that felt overwhelming.”
The Hidden Cost of Emotional Labor
The exploitation at the heart of this dynamic is rarely intentional. Organizations are not deliberately trying to harm the workers they hire. They are trying to do better, to be more responsive, and to incorporate perspectives that have been excluded for too long. The harm emerges from the gap between good intentions and inadequate preparation.
Consider what research tells us about the unique vulnerabilities lived experience workers face. Approximately 70 percent of therapists working with trauma clients are at high risk for secondary traumatic stress. About 38 percent of social workers experience moderate to severe secondary trauma. For peer workers, who often lack the formal clinical training and protective distance that comes with professional roles, the risk compounds. When peers have trauma histories similar to their clients, which is often the foundational qualification for the role, the risk of re-traumatization and over-identification increases dramatically.
One peer worker explained: “Every story I heard had echoes of my own. My supervisor kept telling me I was ‘using my lived experience well,’ but nobody ever checked whether I had the support I needed to manage what that was stirring up in me.”
The research on secondary traumatic stress makes clear that it affects every domain of functioning. Social relationships suffer. Work performance declines. Family connections strain. Sexual health impacts emerge. Psychological wellbeing deteriorates. The emotional and physical toll becomes comprehensive. For lived experience workers whose roles are explicitly tied to their own recovery, the stakes feel impossibly high.
The Supervision Gap
Buried in the research is a finding that should alarm every organization employing lived experience workers. Many supervisors receive no formal training in supervision skills. People responsible for supporting workers in one of the most emotionally demanding roles in behavioral health often have never been trained to provide supervision.
The gap becomes even more pronounced with peer workers. Research shows that non-peer supervisors commonly lack knowledge of what peer support work actually entails. They are supervising roles they do not fully understand. This results in a striking disconnect: supervisors often report confidence in understanding the peer role, while peer workers report their supervisors do not actually understand what they do.
Maria, a peer specialist in a mental health clinic, captures this disconnect. “My supervisor is a licensed clinical social worker. She’s brilliant at what she does. But when I tried to explain why I needed to show up differently than the therapists on our team, she looked confused. She kept redirecting me back to clinical frameworks. I wasn’t speaking a language she understood.”
The lack of supervision infrastructure manifests in predictable ways. Supervisors are often unsure what peer specialists should actually be doing. Role ambiguity becomes the norm rather than the exception. More than half of peer workers report poor treatment in the workplace, including discrimination and microaggressions related specifically to their peer status. When supervisors do not understand the role well enough to protect it, workers become vulnerable to being pulled in directions that compromise the very thing that makes their contribution valuable.
The Training That Never Comes
Organizations that employ peer workers consistently identify training as essential to effective practice. Yet respondents across multiple studies report feeling inadequately prepared for the specific skills their work requires, particularly advocacy, outreach, and boundary navigation.
The pattern repeats. Workers are hired quickly. Training is promised. Deployment happens first. Preparation comes later, if it comes at all.
When peers do not receive training before deployment, the quality of peer support declines. Workers struggle. The people they serve receive inconsistent support. Teams become frustrated. Peer workers often internalize the dysfunction as personal failure rather than systemic neglect.
Professional development suffers in parallel, with limited access to continuing education or potential for career advancement. Despite growing evidence of impact, lived experience roles are treated as entry points rather than professional tracks deserving long-term investment.
A Delphi consultation of 110 international participants identified five core training topics with strong consensus. Yet peer worker wellbeing training, despite universal recognition of its importance, remains inadequately addressed. Organizations acknowledge what is needed. They simply do not provide it.
The Burnout Crisis
The workforce literature uses clinical language to describe what is happening. Compassion fatigue. Secondary traumatic stress. Vicarious trauma. Lived experience workers often use different words. Exhaustion. Emptiness. The feeling of having nothing left to give. Some describe reaching a point where their own recovery felt threatened by the work they were hired to do because of their recovery.
The statistics are stark. 93 percent of behavioral health workers have experienced burnout, with 62 percent reporting moderate to severe levels. 23 percent of peer recovery workers report being under stress or experiencing burnout symptoms. For younger peer workers, the numbers climb higher. Many have left their positions entirely due to burnout and traumatic experiences from the work itself.
Emotional exhaustion among peer providers strongly correlates with intent to leave the field entirely, not just to change jobs. Some peer providers are forced out due to health deterioration from work stress, citing disability-level impacts. Organizations lose experienced workers at the moment retention matters most.
James, who left his peer specialist role after fourteen months, remembers the breaking point. “I started having nightmares about clients. I couldn’t sleep. I was snapping at my partner over nothing. My doctor wanted to adjust my medications. I realized the job that was supposed to be part of my healing journey was making me sicker. So I left. And I felt like I’d failed.”
The Screening That Does Not Happen
Perhaps the most troubling gap in the research is what is not happening at all. Limited standardized protocols exist for screening peer workers for trauma history, burnout risk, or boundary vulnerability before they begin.
Consider that reality. The behavioral health field has extensive screening protocols for clinical staff. Assessment tools for therapist burnout. Guidelines for managing countertransference.
In contrast, peer workers rarely receive this protective screening. They are hired with the implicit understanding that their trauma history is an asset, with little consideration for how that same history might make them more vulnerable to specific harms.
Research shows that rejection sensitivity, often grounded in histories of loss and trauma, significantly impacts organizational attachment and turnover. Yet organizations rarely screen for this or provide support to help workers navigate it. Resilience is assumed rather than built.
The Economics of Extraction
Follow the money and the pattern becomes clearer. Organizations achieve substantial cost savings through peer services. Hospital readmission rates drop. Acute inpatient days decrease. Systems reap financial benefits.
At the same time, peer recovery workers consistently report low wages and workplace stress that leads to burnout and compassion fatigue. Pay is unstable. Roles are poorly defined. Emotional exhaustion threatens workforce stability.
The inequity is palpable. Organizations capture value while making minimal investment in the people generating it. Peer workers are sidelined, siloed, or asked to perform tasks that do not reflect their role. Regardless of intent, the disconnect between value extracted and support provided represents a form of systemic exploitation.
What Harm Looks Like in Practice
The research documents recurring organizational failures.
Clinical environments lack recovery orientation. Peer workers are placed in settings where dominant cultures contradict peer values. Stigma and marginalization become part of the work environment.
Role clarity remains absent. Decision-makers do not understand peer responsibilities, yet peer satisfaction depends critically on that understanding.
Policies arrive too late. Some organizations pilot peer services while internal policies are still under development, leaving workers unprotected during the most vulnerable phase.
Leadership doubts capabilities while expanding the workforce. Administrators question whether training can compensate for a lifetime of struggle even as they continue hiring without adequate support.
A Different Path Forward
The solution is not to stop employing lived experience workers. Their contributions are too valuable. The solution is to refuse to hire without first building the infrastructure to support them.
Establishing organizational readiness:
Conducting genuine readiness assessments before recruitment begins. Establishing job qualifications, functions, and pay grades before posting positions. Ensuring supervision structures exist with supervisors trained specifically in peer support. Developing clear policies about scope, boundaries, and team integration before anyone starts work.
Protecting workers proactively:
Screening for vulnerabilities just as rigorously as for any other high-risk role. Pre-deployment assessment of trauma history. Explicit discussion of boundary challenges. Identification of potential triggers. Creation of wellbeing plans before workers encounter situations that compromise their health.
Investing in professional development:
Providing ongoing training, not just initial certification. Creating professional development pathways. Ensuring access to continuing education. Building clear career advancement structures that signal this is professional work deserving professional support.
Ensuring adequate compensation:
Paying wages that reflect both the value these workers provide and the emotional labor they perform. Translating the cost savings organizations achieve through peer services into compensation that acknowledges the role’s complexity and demands.
Building appropriate supervision:
Creating peer-informed supervision even when peer supervisors are not available. Training non-peer supervisors in the values and practices of peer support. Ensuring every peer worker has access to some form of peer-to-peer supervision or mentorship, contracted externally if necessary.
Slowing down:
The urgency to capture the value of lived experience has outpaced the commitment to protect the people providing it. Organizations must stop treating lived experience workers as quick fixes for workforce shortages. They are professionals whose wellbeing matters as much as the outcomes they help achieve.
The Moral Question
At its core, this pattern raises a fundamental ethical question. Can organizations call themselves trauma-informed and recovery-oriented while failing to protect the workers whose trauma and recovery they rely on?
Good intentions are not sufficient. Recognition of value is not protection. Inclusion without infrastructure becomes another form of harm.
Every organization currently employing lived experience workers should conduct an honest assessment:
- Do peer workers have access to supervisors trained in peer-specific supervision approaches?
- Are clear policies in place about scope of practice, boundaries, and role clarity?
- Has screening been conducted for trauma history and vulnerability factors?
- Do professional development pathways exist with clear opportunities for advancement?
- Are wages competitive with the value these workers provide?
- Is peer-to-peer supervision available, either internally or through external arrangements?
- Have non-peer team members been prepared to support and respect the peer role?
- Are workload and caseload expectations realistic given the emotional demands of the work?
If the answer to any of these questions is no, the organization is participating in a pattern of unintentional exploitation that places workers at risk.
The Fire Still Burns
Marcus eventually left his peer specialist position. Not because he stopped believing in the work, but because the foundation never materialized. He realized staying meant sacrificing his own wellbeing.
He thinks about it sometimes, the promise his supervisor made during the interview. “We’re building something special here. You’ll be part of creating a new model.” What they built, he realizes now, was a role without a foundation. A position without protection. An expectation of resilience without the support that makes resilience possible.
Organizations across the country continue making similar promises. They recognize value. They recruit with enthusiasm. They deploy faster than they prepare.
The question is not whether lived experience workers have something essential to offer. The evidence is irrefutable.
The question is whether organizations are willing to do the harder work of building systems that protect the people they ask to step into the fire. Until the answer is yes, each hiring decision risks unintentional harm, no matter how good the intentions behind it.
If you enjoyed this article, check out our foundational articles: Why Us?, Why Now?, and How? Be sure to subscribe for monthly updates and resources.
