Reaching patients with serious mental illness (SMI) has historically been a challenge for the medical community. Despite the prevalence of these conditions, only 64.5% of individuals with SMI received mental health treatment in the past year, according to the National Institute of Mental Health (NIMH). One of the most significant barriers is trust. Many patients with SMI have experienced mistreatment or misunderstanding by healthcare providers, leaving them hesitant to seek care. This has created a gap in treatment that has persisted for decades. A new company called firsthand is addressing this challenge through peer support mental health, an innovative approach designed to engage patients in a way traditional care often cannot. By leveraging specialists with lived experience of SMI, firsthand creates a bridge between patients and care providers. Samir Malik, CEO of firsthand, told Behavioral Health Business, “Often it’s because trust has been broken. Providers have mistreated them, and so they’re not always inclined to want to seek care. And where the magic of the peer comes in is the ability to say, ‘I am a living example of recovery.’” This model places human connection at the center of mental health treatment.
How Firsthand’s Peer-Support Model Works
At the heart of firsthand’s approach are peer-support specialists, known as firsthand guides. These guides have personal experience with SMI and are trained to provide peer support mental health services in the field. New York-based firsthand also helps its guides obtain state certification if they do not already have it. This ensures professional standards are met while maintaining authenticity and empathy that patients can relate to.
Unlike traditional healthcare models, which often require patients to visit a clinic, firsthand guides go directly to the patient, whether that is a shelter, group home, church, or private residence. Many patients with SMI have experienced trauma or negative encounters with healthcare systems, making trust-building essential. Patrick Hendry, vice president of peer services at firsthand, emphasized, “We have to establish a feeling of safety… part of the trust-building process is being extremely transparent about why we’re there, who pays us, what information we have, and then what we can provide to them in terms of value.” By meeting patients where they are and focusing on transparency, firsthand ensures that engagement starts with trust.
Personalized Support Beyond Peer Engagement
Once patients engage with firsthand guides, they are connected to community resource guides, who help them navigate benefits such as health insurance, housing support, nutrition assistance, and transportation. Rebecca Williams, a community resource guide, explained, “It’s not one size fits all. We’re going out and finding out what the barriers are and what’s going on with that individual because it’s unique and different to each one.”
Patients also connect with health guides, nurse practitioners who assess holistic health needs, including both mental and physical health. This ensures care addresses the full spectrum of well-being. Digital tools support program management and track outcomes, but Malik stresses that firsthand is a technology-backed provider, not a tech company. The human element—through peer support mental health services—is always central.
The Business Model: Value-Based Care
Founded in 2021, firsthand currently operates in Tennessee, Ohio, and Florida, with plans to expand into seven markets by the end of the year. The company focuses on the Medicaid sector, where the need and cost are highest. According to SMI Advisor, the economic burden of SMI exceeds 300 billion dollars annually. Firsthand employs a value-based care model, which reduces costs while improving outcomes.
Malik explained, “These individuals who are unengaged and struggling with serious mental illness, they cost you 30,000 dollars on average last year. For every one that we engage and start finding a pathway to recovery… if they cost you 20,000 next year, let us share in that savings.” This model allows firsthand to reinvest in initiatives like in-person outreach, transportation, and training peer specialists—all of which enhance peer support mental health engagement and outcomes.
The focus on value-based care highlights a straightforward principle: improving engagement and outcomes benefits patients, providers, and payers. “If we do that and plug them into the right services and the right supports, and help them all along the way, then their outcomes improve considerably. The cost of care comes down materially. And as a result, we can invest in what we’re doing,” Malik said.
Emerging Players in Peer Support Mental Health
Firsthand is part of a growing wave of innovation in peer support mental health care. Other companies are developing unique approaches to address gaps in SMI treatment:
- Vanna Health, founded by Dr. Thomas Insel and Dr. Giovannia Colella, uses a community-based, for-profit approach to SMI care, emphasizing accessibility and engagement.
- Amae, based in San Francisco, focuses on integrating physical, mental, societal, and community wellness into care for patients with SMI.
These organizations represent a broader shift in healthcare: moving away from a purely clinical model to one that emphasizes trust, community, and personalized care. Peer support mental health plays a key role in these innovations, providing patients with guidance from people who understand their experiences firsthand.
The Future of SMI Care
The work that firsthand and other innovators are doing represents a transformative moment in mental health care. By meeting patients where they are, prioritizing trust, and integrating peer support mental health specialists with professional guidance, firsthand is providing a blueprint for more effective and humane care. This approach addresses the unique barriers faced by patients with SMI while improving outcomes and reducing costs.
As the prevalence of SMI continues to rise, peer support mental health models like firsthand’s offer a promising solution—one that combines human connection, practical support, and professional oversight. By centering care around patient experiences, these models create a path toward recovery, empowerment, and lasting improvement in quality of life.
