Peter Starkey, right, executive director of the Monadnock Area Peer Support Agency in Keene, N.H., meets with staff member Sarah Harris. (Photo by Liora Engel-Smith)

Mental health professional Peter Starkey rarely brings up what most people think could be the biggest obstacle to recovery for emotionally distressed residents of New Hampshire.

Starkey agrees that residents of the Granite State, particularly those living in rural areas, need better access to psychologists and psychiatrists. He doesn’t dispute that there aren’t enough mental health beds in the state to meet the needs of people in crisis.

He just thinks the discussion shouldn’t end there.

“The conversation about mental health beds and about psychologists and psychiatrists has enough people cheering for it,” Starkey, 27, said. “And I don’t believe that there are enough people really cheering for community-based projects.”

The executive director of the Monadnock Area Peer Support Agency, a nonprofit in rural Southern New Hampshire, has made it his mission to be that cheerleader.

Named after Mount Monadnock – a peak that inspired Ralph Waldo Emerson and Henry David Thoreau and that gives the region its name – the peer support agency serves a large area, most of it rural. Some of the towns it covers are an hour away on winding, narrow roads. The agency headquarters are in Keene, a city of 23,000 about 20 miles east of the Vermont border.

The agency, which receives some funding from the state, boasts 120 members who participate in groups, social activities, and one-on-one interactions with trained peers. Not all the members are trained in peer support, Starkey said, but they are all there to help each other.

The services the agency provides aren’t medical, Starkey said, but they are no less valuable than psychotherapy or drugs. What it offers, he said, is community.

Too often discussions surrounding mental health focus on a moment of crisis – say, when a person has suicidal thoughts, Starkey said. But mental health needs don’t begin or end in acute care. Peer support can help people before the crisis escalates or after they are released from medical care.

The help peer support offers is simple yet profound, he said. It breaks the silence around mental health and builds connections.

At the yellow home that houses the agency, talking about hardship isn’t off-limits. That alone can be liberating, said 58-year-old Brian Bishoff.

Bishoff, who lives in Rindge, a town of about 6,000, has been coming to Monadnock Area Peer Support Agency for the last two years at least twice a week. Like many members, Bishoff found the organization when he was at a low point.

“My life fell apart,” he said.

Bishoff struggled with anxiety since childhood and depression since his teenage years, he said. But after an antidepressants made him hypomanic and landed him in the hospital, he started looking for other help.

He heard about the agency before, he said, but began coming in when nothing else helped. The support he receives there helps him deal with the ups and downs of mental illness.

“I noticed most people have about a three-minute limit when they ask how you are doing, and I get that,” he said. “But here, people sit down. I mean, if I ask somebody ‘how you’re doing?’ they can talk for three minutes, they can talk for half an hour.”

With the help of trained peers, Bishoff learned to identify the signs of an impending rough patch. He’s come up with a plan to deal with bad days: walking in nature helps him, he said. Sometimes, he curls up under a blanket and listens to online relaxation videos. Other members at the agency are part of his support network, he added. Bishoff knows he can share anything with them, no matter how dark.

“It’s amazing how with supportive listening, it takes some of the scary energy away,” he said.

Starkey said a lot of members express a similar sentiment. In a recent survey, Starkey said, 81 percent of members said that peer support helped them keep a mental health crisis at bay, keeping them out of the hospital.

The number of people seeking services is growing, he said. Last year, the agency helped 313 people, including members and one-time visitors, up from 178 in 2016.

Participating in programs is free, Starkey said, but the rural nature of the region poses significant barriers beyond monetary ones. Some people don’t have reliable transportation, he said, and the long, harsh winters can make driving difficult. Peer Support offers transportation to and from activities, he said, but the agency tries to bridge the divide in other ways.

They operate a “warm line”—a line where people can call to chat if they feel lonely. Starkey has also explored the possibility of adding satellite programming in the far-flung corners of the region, he said. The next step, he said, is to forge stronger relationships with people in the region.

“We really want to work more with the towns (in the region),” he said. “Because that’s their connection. People in rural communities have a big connection to their town, so that’s that support.”

Liora Engel-Smith is a journalist who lives in Keene, New Hampshire.

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