by Rachel Lebovic

Graphic design by Qingyue Guo

“Hi there. My name is Rachel, and I’m with the peer support team. We check in on anyone who comes into the department between the ages of 16 and 29 because we know the emergency department can be an overwhelming and uncomfortable environment, especially for young adults, so our job is to check in, see how you are doing, and see if there is anything we can do to make your time here a little easier”. As a peer support worker, this is how I introduce myself to patients at the Mount Sinai Hospital (MSH) emergency department (ED). 

Soon after starting my PhD at the Institute of Medical Science (IMS) studying suicide prevention, I was looking for a hands-on opportunity to complement my research, allowing me to better understand the systems and serve the populations I hope to work with in my future. Given that my research and career aspirations are largely driven by my lived experience navigating mental health care, peer support felt like the perfect option. 

The RBC Pathway to Peers (P2P) program^1,2 launched at MSH in May 2020. In his work as an emergency medicine physician, Dr. Bjug Borgundvaag, Director of the Schwartz/Reisman Emergency Medicine Institute (SREMI), noticed an increasing number of young patients were presenting to the MSH ED with mental health and substance use concerns. Dr. Borgundvaag was likely not the only ED physician across the province who noticed this, as from 2006 to 2017, there was an almost 90% increase in ED visits for mental health reasons in youth.³ Recognizing the limitations of what the ED could offer these patients, yet wanting to better meet their needs, the RBC P2P program was created. Dr. Borgundvaag and Dr. Shelley McLeod, both researchers at SREMI and faculty members in the Department of Family and Community Medicine at the University of Toronto, have led the development, implementation,⁴ evaluation, and now expansion of the RBC P2P program to Michael Garron Hospital. 

What is Peer Support? 

Peer Support Canada defines peer support as a “form of service provision, a philosophy, and a movement.”⁵ In simple terms, peer support refers to an individual with a lived experience providing support to another in a similar situation. Founded from the consumer/survivor and drug user activist movements, where those who were mistreated by the healthcare and criminal justice systems advocated for better mental health and substance use care, peer support is based on the core values of: 

• Hope and recovery
• Self-determination
• Empathetic and equal relationships
• Dignity, respect, and social inclusion  
• Integrity, authenticity, and trust
• Health and wellness
• Lifelong learning and personal growth

Through these values, peer support emphasizes person-centred, trauma-informed, culturally sensitive, and harm reduction approaches informed by anti-racism and anti-oppressive principles. In our interactions, we aim to reduce power imbalances and empower patients in a confusing, limited system, where trust is often lacking. 

The RBC Pathway to Peers Program

While peer support is not a new concept, it is believed that the RBC P2P program is the first of its kind in Canada in which peer support workers are fully embedded into the ED setting. As non-clinical members of clinical teams, peer support workers are uniquely positioned to enhance patient care. Due to the flexible nature of our role, we can spend extended periods of time with patients, providing them with much-needed emotional support. This can be as simple as getting them a sandwich and a blanket or engaging in a more in-depth conversation. 

For patients presenting with a mental health or substance use health concern, support often centres around empathizing with a shared experience. For example, I had a patient who was a university student in the ED for stomach pains. From her chart, I could see she had a mental health history, but my experience guided me not to assume those were related. I introduced myself and asked if I could get her anything. She said she was ok, but looking nervous, I asked if she would like a stress ball to play with while waiting. Upon return, I explained that while we check on everyone who comes into the ED in our age range, we have expertise when it comes to mental health, driven by lived experience, and if she wanted to talk about anything, I would be more than happy to listen. This started a conversation that lasted close to two hours. She shared that she had never spoken to someone before who had been through it too, someone who gets it. She got emotional as I told her how proud of her I was and how confident I am that she has a bright future ahead. 

While we prioritize seeing patients who present with mental health and substance use health concerns, we understand that any young person presenting to the ED may need support, and I have often found myself spending significant time with patients in the ED for reasons relating to chronic illness. One patient I saw had been struggling with neurological symptoms for a significant period and had not had success with treatment. She explained how living in a rural area, it is very difficult to get appointments with specialists and many of the providers she has seen have dismissed her symptoms as psychosomatic. I could see the fear and desperation on her face as she described how her symptoms have impacted her day-to-day life and wondered if they would ever get better. I asked how I could best support her. At the patient’s request, I spoke with the neurology resident before she assessed her, providing a brief overview of the situation and explaining that the patient’s biggest fear at the moment is being dismissed. The patient also asked me to stay in the room while the resident did their consultation for moral support. After the resident left, I asked the patient how she felt it went. She shared that having me there, even though I didn’t say or do anything during the consultation, gave her confidence. Just knowing that someone in the room was on her side empowered her to advocate for herself, which she did amazingly. 

The interaction that I believe has been my most impactful was with a patient who was in the ED for domestic violence and sexual assault. We spoke for hours. At times the conversation centred on her relationship and what happened, while at other times we focused on distractions, talking about school and life goals. We discussed what comes next, collaborating with social workers to ensure she had somewhere to go and resources for support after leaving the ED. I spent my entire shift with her that day; she didn’t want to be alone. In the structured chaos of an ED, a nurse, physician, or social worker has very limited time they can spend with a single patient. As a peer support worker, I was able to spend hours with her keeping her company, helping her process what happened, and making her feel safe. 

I have seen firsthand the impact the RBC P2P program has on young adult patients in the ED. Yet while I may be impacting these patients, they are also impacting me. Each interaction I have, every story I hear, contributes to my understanding of healthcare that I will take with me throughout my education and into my career. 

References

1. RBC Pathway to Peers [Internet]. [cited 2025 Oct 22]. Available from: https://sremi.ca/rbc-pathway-peers

2. Peer support program supports youth through mental health and addictions crises in the ED [Internet]. [cited 2025 Oct 22]. Available from: https://dfcm.utoronto.ca/news/peer-support-program-supports-youth-through-mental-health-and-addictions-crises-ed

3. Chiu M, Gatov E, Fung K, Kurdyak P, Guttmann A. Deconstructing The Rise In Mental Health–Related ED Visits Among Children And Youth In Ontario, Canada: Study examines the rise in mental health-related emergency department visits among children and youth in Ontario. Health Aff (Millwood). 2020 Oct 1;39(10):1728–36. 

4. McLeod SL, Thomas R, Dunning A, Chalmers C, Figueiredo S, Nikoo M, et al. Implementation of a patient-centered, peer support model of care for young adults presenting to the emergency department with mental health and substance use challenges. Can J Emerg Med. 2025 Sept 4;s43678-025-00978–3. 

5. National Peer Supporter Certification Handbook [Internet]. Peer Support Canada; [cited 2025 Oct 22]. Available from: https://pscportal.ca/wp-content/uploads/2023/12/National_Peer_Support_Certification_Handbook.pdf