August 18, 2020

Dr. Edwin B. Fisher

Dr. Edwin B. Fisher

In a recently published research paper and accompanying editorial, Edwin B. Fisher, PhD, professor of health behavior at the UNC Gillings School of Global Public Health, shares findings on how telephone-based peer support can provide emotional and tangible resources for people at high risk for mental health problems.

Peer support has long been recognized as a promising strategy for reaching people who may not use conventional health care services, especially because these individuals value the advice of someone who has “walked in their shoes.” Given the success of in-person peer support, there is a drive to offer the service more broadly through health systems and community programs, and the telephone offers an easy delivery method.

Fisher, who also directs Peers for Progress, worked with colleagues from that organization — Megan Evans, MSPH, Patrick Y. Tang, MPH, and Nivedita Bhushan, MA — and others from the Rutgers University Behavioral Health Care National Call Center for Peer Support to evaluate whether telephone support provided by trained peer staff is effective for high-risk groups. The researchers examined support programs focused on veterans, police, mothers of children with special needs and child protection workers — all groups that are known to experience unique and substantial stressors.

From 2015 to 2016, peer supporters in the Rutgers University program made 64,786 contacts with a total of 5,616 callers. About half of these contacts were phone conversations and the rest were scripted voicemail messages.

The peer supporters, all of whom belonged to the same social/work groups as their callers, experienced three main categories of calls: people who needed referral to professional treatment for a specific problem; people who wanted a one-time, in-depth conversation about their concerns; and people who asked for routine phone calls to maintain contact while they tackled enduring challenges.

“The telephone programs provides peer support for police (Cop2Cop), veterans (Vet2Vet) and others,” Fisher explains. “Our report shows varied and flexible types of contact, from one-off calls for a quick referral to ongoing support lasting more than a year. Ultimately, about 80% of those who used the service reported some kind of concrete benefit.”

These concrete benefits include assistance with basic needs, including connections to social, medical, financial and housing services. Callers also reported reduced feelings of isolation and increased positive sensations like stress relief, peace and even joy. They especially appreciated having their experiences be normalized by peers who had lived through similar situations, and they found value in speaking with someone who was not, as one interviewee put it, a “sterile provider.”

When the original paper on telephone peer support was accepted by Translational Behavioral Medicine in April, the researchers had the idea to also interview some of the peer support staff about how their work had been influenced by the COVID-19 pandemic.

In an editorial published in the same journal issue, Fisher and co-authors discuss the additional problems callers are facing now due to the novel coronavirus. Police offers and child protection workers, for example, are dealing with stress posed by regular potential exposure to the virus through their work.

At the time of the interviews, 23 New York City police officers had died of COVID-19, matching the number killed during 9/11. The absence of funerals complicates mourning for lost colleagues, and the lack of work-related gatherings eliminates a base of group support.

Child protection workers, who are not generally considered front-line workers, felt disappointed by the quality of personal protective equipment they received. They also faced emotional distress over their shared sense that child abuse is likely on the rise but being underreported because children are not in school.

Parents of children with special needs, meanwhile, are experiencing all the standard family pressures of isolating at home with kids while continuing to work — but minus the services and therapies their children usually receive.

The trained peer supporters shared that most callers are trying to “just get through” this difficult period, but Fisher and others worry that they — like first responders in 9/11 — will experience delayed emotional distress six months or more after the acute pandemic ends.

In the meantime, the value of simply having someone available to listen and empathize holds true: Peer supporters continue to validate callers’ experiences and reassure them that everyone is struggling, and they are doing enough.

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