Thanos first stepped into the peer cafe across from the bus station in downtown Raleigh looking for his friend — and the promise of a free coffee. What keeps him coming back months later is a community of people and group sessions that have supported his substance use recovery.
“Everybody in this room is recovering from something traumatic in their past,” he said, “and now we’re trying to navigate life with the mindset that we have now.”
Thanos, his preferred name, is 28 and has been in recovery from crystal methamphetamine use for four years. When he first started hanging out at the cafe, he was unemployed and without stable housing. The cafe, which has free activities throughout the day like meditation, book club and addiction recovery groups, is run by Promise Resource Network, a Charlotte-based nonprofit that is led by people who all have dealt with mental health challenges and/or substance use issues throughout their lives.
Thanos credits the peer support specialists — people with this kind of experience and professional training on how to support others — at the cafe with helping him break old patterns. They encouraged him to apply for the two retail jobs he now holds, and they helped him find an apartment.
“I could resonate with them, because you can tell when somebody's been through something, because they're more emotionally aware,” he said. “They’re authentic. You could tell that they love themselves, and they’re protecting their energy, and they’re in a certain space where I’m trying to get to.”
While the idea of getting help from people with similar past experiences is not new, peer support has become more and more professionalized and integrated into the mental health system in recent years. In North Carolina, a small number of programs similar to the peer cafe have existed for years on shoestring budgets, sustained largely by the determination of a few individuals.
Now, government funding is beginning to follow, and more programs are opening across the state.
Different kind of space
Walking down the stairs to the peer cafe in Raleigh, there are string lights over patio tables with purple umbrellas. By the door is a free vending machine filled with sterile injection supplies and naloxone, the opioid overdose reversal drug. Inside the cafe, there’s music playing and maybe a dozen people in a room outfitted with stylish velvet furniture, cool posters and exposed brick walls.
There’s a call for those interested in the “creative self” class where participants are learning to crochet. A few people head into the classroom where the leader demonstrates with some pink yarn and a hook.
“This is very therapeutic for me. It gets the world out of my head,” she told the group.
“I bet,” a participant responded, “Because this is all I can focus on right now.”
Outside the classroom, a peer support worker and a regular of the cafe are having a one-on-one peer support session. The next group session is SMART recovery, for those working through addiction recovery. One participant talks about how he’s learning to let go, trying not to control other people’s decisions. Another talks about how he’s gotten off hard drugs recently and is using THC products to cope.
Elliott Brooks manages the Raleigh peer cafe, which opened in the fall of 2025. Books said a lot of the people who come for the cafe’s classes, activities and community have engaged with the mental health system in the past and had negative — or even traumatizing — experiences. Now they want something different.
“They’re looking for a safe space where they can come and be themselves and get access to support that they’re not going to get anywhere else,” Brooks said. “They get classes that embrace them, embrace wellness holistically, that are not focusing on illness and pathologizing. They’re able to walk in and see this is a different space.”
A growing body of research over the past decade suggests that peer support programs can play a meaningful role in helping people manage mental health crises and reduce reliance on emergency services. Reviews of studies from the U.K., Australia and elsewhere have found that people who visit peer programs often report improved mental health, reduced isolation and a greater sense of control over their care. Researchers note that these spaces offer a nonclinical alternative to emergency rooms, which many people describe as intimidating or ill-suited for caring for someone who’s severely depressed or hearing voices or experiencing another form of mental health crisis.
Several studies documented declines in emergency department visits and calls to the police after people engaged with peer support programs, with some reporting reductions of more than 40 percent in three years.
Participants of peer programs find that peer workers are welcoming and foster trust, understanding and a sense of solidarity — all while modeling that mental health recovery is possible, according to a review of several studies published in the Community Mental Health Journal. While such outcomes are promising, the researchers said access to peer-run spaces across the globe is limited, and there is a need to further integrate peer support into the broader mental health system.
Slow, but steady progress
Peer support services have come a long way in North Carolina over the past decade or so. While peers have been hired to support patients alongside clinicians in medical settings for a while, it took much longer for funding to reach organizations that were independent of health systems. Some of the most successful programs are run entirely by peers.
Promise Resource Network, founded by Cherene Caraco in 2005, has led the state in the expansion of peer-run programs. With the support of state dollars, the organization opened two peer-run respite houses in Charlotte and Raleigh in the past five years and is in the process of opening a third in Cabarrus County.
A respite is designed to be a voluntary alternative to hospitalization for people in mental health distress; it allows the person space and time to de-escalate their crisis outside of the traditional health care system. Completely staffed by peer support specialists, respites are peaceful, home-like settings where people can stay and get help from trained peers who are on their own recovery journeys.
In the midst of the coronavirus pandemic, Promise Resource Network also launched a peer “warm” line, a nonclinical support line answered by people in mental health recovery, to offer support to people who were more isolated than ever. At the time, the organization was only operating in Mecklenburg County and never meant for the line to serve the whole state, but the demand was there. Eventually, the state helped with funding, which allowed the Peer Warmline to be a permanent part of the state’s mental health infrastructure.
“Many didn’t recognize the impact of loneliness until COVID shined a light on it,” said Amanda Martin, executive director of GreenTree Peer Support Program in Winston-Salem. “In the substance use world, we’ve been saying for years that the opposite of addiction is connection. And it’s true for mental health too. I know that when I’m connected, that I don’t hear as many voices, and I don’t have as many challenges with emotional dysregulation.”
Previously employed at Promise Resource Network, Martin was recently hired to run the newly expanded programs at GreenTree, another trailblazer in North Carolina for peer-run support. Seeing peer-run programs grow in the state has been beautiful, like watching a baby grow, she said.
“For many of us in this work, we never really had a place anywhere, and it was because of our mental health, it was because of our trauma, it was because of our substance use that we were banished,” she said.
Place at the table
People who live with mental health and substance use issues have long wanted a place at the table where decisions about mental health services are made.
A saying heard frequently in this community is: “Nothing about us, without us.”
The way Martin sees it, instead of being invited to that decision-making table, peer leaders built their own and invited officials and health leaders. She credits a handful of dedicated peer leaders in North Carolina who started programs that delivered results and built relationships with state and local leaders.
GreenTree, founded by Laurie Coker in 2012, had been operating out of a church lobby for years. It recently moved into its permanent new home on West First Street just west of downtown Winston-Salem. The new space allowed the organization to expand its Refuge program, which provides 24-72 hours of lodging and peer support for people who don’t meet criteria for psychiatric hospitalization but need some kind of care before returning home or to a homeless shelter or wherever they are staying. Peer center programming is under the same roof, Monday through Friday, and the schedule is on GreenTree’s Facebook page.
The local hospital emergency department has worked closely with GreenTree through the years and referred patients leaving the ER there for support.
“For many years I was the advocate that wouldn’t go away,” Coker said during the ribbon cutting celebration in October for the new GreenTree space. “As part of my grieving process, I wanted to do something to make a difference — turn advocacy to action.” Coker’s son died as a result of his mental illness, and she made it her mission to create the kind of mental health support she believed was missing at the time.
“Across the state with our peer support movement, this is what our communities need,” Coker said. “As the hospital systems change and mental health and health care become more industrial, we’re the folks that keep it together. You need those people to help empower folks to navigate and find what they need.
“And we know how because we’ve been there,” she said.
State and local leaders buy in
Coker told the gathered crowd at the ribbon cutting that in all her time advocating for peer-led programs, she didn’t believe anyone at the very top really understood why peer support was so important to recovery — until now.
Peer leaders have openly praised Kelly Crosbie, director of the NCDHHS Division of Mental Health, Developmental Disabilities and Substance Use Services, for her understanding and support of peer services. Crosbie is a social worker by training and has been vocal about the role peers played in the lives of her family members with mental illness, including her father, a veteran who struggled with past trauma.
“For some people [clinical treatment is] absolutely life saving, but it’s a time and a place — and what happens to the rest of your life? That’s where communities come in. That’s where families come in. That’s where places like GreenTree come in,” Crosbie said at the ribbon-cutting event. “And we need them for acceptance, for reducing stigma, so people can live full and happy lives.”
“And we really need this in the system — a place where we have people who have navigated this complex world, not just an illness,” she said.
The state has been able to fund and open an array of peer support services and other mental health crisis supports over the past two years using a $835 million investment for behavioral health needs included in the 2023 state budget.
There has been local buy-in as well. Denise Price, deputy county manager and health and human services director for Forsyth County, said she credits people like Coker for helping shape her understanding around the need for peer support. Forsyth County has supported GreenTree and employed peer support specialists for some time, including a unique role: a peer support specialist based at the public library, who helps people navigate mental health services and other resources such as food and housing assistance.
Price told NC Health News that peer support delivers a great return on investment.
“At GreenTree, they allow an individual to define their crisis,” Price said. “What puts me in a crisis may be very different than what puts you in one, and oftentimes it doesn’t involve a formal support to remediate [...] and it doesn’t require therapy or an ED visit, but being able to deliver it within that space of GreenTree can certainly prevent a higher, unnecessary level of care.”
“It is very preventive, which is not a space that we traditionally fund,” she said. “We usually fund a service when you meet a need, you check mark these criteria. This is a way of preventing someone from getting to a space of needing that.
“So I think the outcomes speak for themselves.”
This article first appeared on North Carolina Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
