Stand by me: The value of peer-to-peer support
On TikTok and on campus, students with mental health struggles are finding support among each other
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.
Mary Lawal, a 22-year-old psychology student, had to advocate for herself to access treatment for bipolar and borderline personality disorders that had gone undiagnosed for years. Today, she’s a mental health advocate, sharing her story with audiences and leading youth peer support groups.
Image credit: Richard Williams
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 circumstances.
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 the Rotary 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 in JAMA 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 the National 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 the 988 crisis hotline and 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.
Convention spotlight: Youth mental health
On the mainstage and in breakout sessions, several speakers at the 2024 Rotary International Convention in Singapore will address mental health topics, including those concerning young people.
Freddie Almazan, a motivational speaker, will deliver a message of inspiration and hope about learning to grow after trauma. At age 13, Almazan was shot in the head and left paralyzed on one side of his face and body. It was one of several traumas he endured when he was a child growing up in California. Almazan overcame despair, depression, and thoughts of suicide to live a “ridiculously good life.” In his talks to teens and young adults, Almazan shares tools for overcoming adversity, developing self-esteem, and building resiliency.
Register for the Rotary International Convention, 25-29 May in Singapore
Freddie Almazan, seen here at the 2023 International Assembly, will speak at this month’s Rotary Convention. Image credit: Monika Lozinska.
Though young people are successfully sifting through social channels to find credible mental health information, including from doctors explaining specific disorders and symptoms, the electronic devices can also decrease in-person connection. And persistent use has potential negative effects from “doomscrolling” and exposure to distressing images and other content. Nina Mezu-Nwaba, a longtime Rotarian and a pharmacist who demonstrated how to use the opioid overdose treatment at the September youth summit, says that during the pandemic she was advising young people to take breaks from the news and social media. “I’d have people call and say, ‘I’m crying, this is just too much, I can’t take it anymore, people are dying everywhere.’” Too much time spent on digital media or media multitasking are behaviors that friends and family in peer support roles can be on the lookout for.
It can be hard, however, for parents to spot signs of depression. Experts say that in young children, it can be especially difficult, since anxiety or depression can manifest itself in ways parents might not equate with mental health issues: headaches, stomachaches, not wanting to go to school, acting out in class, or fear of being away from their most trusted people.
Fellow students who are aware of the signs can help. At a basic level, these skills don’t require hours and hours of professional training. The Rotary Action Group on Mental Health Initiatives, for instance, developed a toolkit for use in schools called Wellness in a Box.
Through videos, workshops, and group discussions, Wellness in a Box presents information to students, parents, and teachers about depression and suicide, activities to foster coping skills, and how to seek help.
Left: Dr. Geetha Jayaram, a professor of psychiatry at Johns Hopkins University School of Medicine and a member of the Rotary Action Group on Mental Health Initiatives. Image credit: Richard Williams. Right: Last fall, Jayaram’s club, Howard West in Maryland, and six other Rotary clubs in the area organized a youth mental health summit. Dozens of young people listened to speakers addressing topics related to peer support, including suicide prevention and how to recognize signs of depression and anxiety. Courtesy of Geetha Jayaram.
Consulting psychologist Rita Aggarwal, an officer of the action group and a member of the Rotary Club of Nagpur, India, has applied the toolkit in her hometown. A community assessment carried out by members of the action group and a study published in the Indian Journal of Psychological Medicine both found that mental health literacy among young people in India was very low.
The project, which led to Aggarwal’s selection this year as one of Rotary’s People of Action: Champions of Impact, created a curriculum for 14-year-olds that covered depression awareness and ideas for coping. “Many of the students were unaware of counseling and how it works,” Aggarwal says. “But they had a desire to speak out, share, and be heard.” The project taught teachers counseling skills and educated parents, and 100 young people have volunteered for further training as peer mentors.
Lawal says that even after she was in therapy, her mother didn’t always seem to accept that her illness was real. It was only after hearing similar stories from other young people, including other young African American women, at Lawal’s speaking events that the idea finally seemed to click, she says. “She hadn’t understood that it’s something that can happen to anyone.” Some of her speaking engagements are focused on audiences of parents for just that reason.
Today, Lawal, who loves swimming, posting photos on Instagram, and podcasting, is planning to become a clinical psychologist. She is open about her mental health journey and says that she continues to rely on support. She sometimes calls 988 or texts the Crisis Text Line (741741 in the U.S.) when she needs help, someone to talk to, or a reminder about how to de-escalate.
Her biggest wish is to reach even just one young person at a support session or speaking event with words that could help them through their journey. “I want my story to be the difference.”
Most of all, she wants them to see in her a real-life example of recovery, to know it’s possible. “I tell them to know that you have a reason why you’re on this earth, you have a purpose, you have a plan, and your story isn’t over yet.”
This is an abridged version of a story that originally appeared in the May 2024 issue of Rotary magazine.