Stand by me: The value of peer-to-peer support (2024)

For years, Mary Lawal endured the dismissive remarks. She’s just a moody teenager. It’s just the hormones. She’s acting out for attention. Someone must have gotten her period. None of the adults in her life seemed to understand that her flashes of anger, intrusive thoughts, and even her attempts to take her own life were signs of a serious mental health condition.

But there were people who understood, plenty of them, other young people who had gone through similar experiences. And after what she describes as “so many years of struggle,” Lawal found them, on YouTube and all over social media. Her journey to recovery began there, with a sense of connection to people whose stories sounded like hers and who had found help. “I didn’t feel as alone,” she says. “I felt like someone saw me.”

Now 22, the college student living in the Washington, D.C., suburbs in Maryland is in treatment and recovery for bipolar and borderline personality disorders that had gone undiagnosed for years. She has become a mental health advocate, sharing her story with audiences and leading youth peer support groups, and she is working toward a psychology degree.

Like Lawal, many young people are turning to social media to share their mental health struggles and seek advice. It’s one form of peer-to-peer support gaining attention as a much-needed missing link between people with mental health needs and professional care. At high schools, on college campuses, on social media, and even within online video gaming platforms, young people are finding — and offering — support. Research is recognizing that peer support can be an important first step in overcoming barriers to care, including social isolation, mistrust of formal health care, and difficult home environments and other challenging circ*mstances.

Schools, nonprofits, and other types of community-based organizations, including Rotary clubs around the world, are tapping into that potential. “We need to focus on our youth,” says Dr. Geetha Jayaram, a professor of psychiatry at Johns Hopkins University School of Medicine and a member of theRotary Action Group on Mental Health Initiatives. “That spirit of wanting to do something for somebody else, our youth have it, and I don’t think we’re harnessing it enough.”

Last fall, Jayaram’s club, Howard West in Maryland, and six other Rotary clubs in the area organized a youth mental health summit for students throughout the area. In an auditorium at Howard Community College, outside Baltimore, dozens of young people listened to speakers addressing topics related to peer support: suicide prevention; how to recognize, prevent, and find treatment for depression, anxiety, and substance use disorders; and how to administer naloxone, the opioid overdose reversal medicine.

The COVID-19 pandemic has had profound and lingering effects on young people’s mental health, throwing millions into isolation at a time when their development depends on interacting with their peers. Jayaram says the full impact of that may not even have emerged yet, since it can take years for mental health problems to manifest in ways that push someone to seek professional help.

In the U.S., about 20 percent of surveyed teens reported symptoms of major depressive disorder in 2021, the first full year of the pandemic, but fewer than half of those who needed treatment received it, according to an analysis of survey data published inJAMA Pediatrics. Adolescents belonging to racial and ethnic minority groups had the least access to treatment.

Lawal says that for a long time when she was growing up she didn’t realize mental health care was an option for an African American girl. There were no answers to be found in her schools, where guidance counselors, she says, were focused solely on academics.

Left:Lawal (left) testifies at a 2023 U.S. congressional hearing in support of a bill related to mental health services in schools.Right:Lawal (second from right) poses with House members and other participants in the hearing. She also testified before the Maryland Legislature in support of a bill related to the 988 crisis hotline. Images courtesy of Mary Lawal.

There were also barriers in her own family. She was only 8 years old when she first tried to take her life. Yet, she struggled to get her parents to understand what she was going through, a battle exacerbated by being shuttled between her father’s home in Nigeria and her mother’s in the United States. “They didn’t really understand,” she says. “Because of our cultural background, they had difficulties accepting my mental health struggle, so they would tell me to pray it away, to use my faith to overcome it,” she says. They also didn’t want her to talk about it with anyone outside of the house — they believed such things were best kept in the family.

Things reached a turning point at the start of the pandemic. “For two weeks, there were a lot of tears and I said, ‘If I’m your daughter and you love me, you should get me the help I need.’” Eventually, they understood, and she found a psychiatrist, who prescribed therapy and medication and taught her coping skills. Today, Lawal is an active advocate nationally, serving on a 10-member young adult advisory group at theNational Alliance on Mental Illness, as well as in her community. She also has testified before the Maryland Legislature and the U.S. Congress in support of bills related to the988 crisis hotlineand mental health services in schools.

Examples of peer support in mental health go back several centuries with the periodic practice of hiring recovered patients as staff members at psychiatric hospitals. The concept has expanded globally in recent decades with a focus on young people, a vulnerable population that has been particularly hard to reach. As a result, peer support is showing up in some unexpected places.

Twitch, the livestreaming platform focused on video gaming, is home to a variety of channels hosted by young people who have experienced mental health challenges and who chat and exchange stories with others. One channel, called Anxiety Tonight, lightheartedly bills itself as “live mental breakdowns nightly.”

Nonprofit organizations also offer and promote peer-to-peer support groups. One of them,Youth Era, trains young people who have their own experiences of either drug use or issues like depression and suicidal ideation to reach out to other young people who may be suffering in isolation.

Martin Rafferty, the group’s founder, says the organization holds online forums and actively goes out to find at-risk groups, rather than waiting for people to come seeking help. “It’s scary out there right now for young people,” he said in a recent interview with KOIN-TV news in Portland, Oregon. “A lot of adults can understand that they didn’t grow up in the same world that young people are growing up in today. School shootings, addictions, climate change, these are things that are on the minds of all high school students, all middle school students. Our message is really clear: Don’t go it alone.”

And on TikTok and other popular social media platforms, influencers focused on mental health are practicing their own brand of peer support, offering viewers everything from advice on surviving breakups to personal accounts of depression narrated with wry humor.

In formalized programs, peer support specialists go through many hours of training. But even with the informal sharing communities online, the benefits seem to outweigh the risks, which include exposure to misleading information or hostile comments. For instance, people interacting online can remain anonymous if they choose, shielding them from the fear of judgment in face-to-face encounters.

Ultimately, peer sharing should be seen as a bridge to formal, professional care, cautions Dr. Karen Swartz, a Johns Hopkins professor of psychiatry and another of the presenters at the Rotary clubs’ youth mental health summit in September. Most young people will experience some periods of depression or anxiety, but when they recur frequently enough to affect a person’s lifestyle and choices, that is when they need to seek out professional help, Swartz says.

She notes that, without treatment, a depressive episode could last months. “In that time, you maybe decided you were not a good student, you were not a good athlete, maybe you shouldn’t try to do that program in college, says Swartz. “So it can change the trajectory people are on, change how they feel about their future.” Having a peer recognize the signs of struggle and encourage treatment could have a huge effect.