There’s a Problem
Mental health problems are increasing in severity and frequency; unfortunately, access and availability are not increasing to meet the demand. [1-3] Data from the U.S. National Institutes of Health (NIH) Health Risk Survey shows that 18–25-year-old individuals have the most need for mental health support and services but are the least likely to receive mental health support and services. The rates of individuals seeking mental health support has significantly increased over the past few years and dramatically increased further due to the COVID-19 pandemic. 
How can we address it?
The growing need to identify solutions to the heightened mental health crisis has led the World Health Organization (WHO) and United Nations to promote the expansion of mental health services beyond the traditional psycho-medical and psycho-pharmacological methods to include peer support services. The WHO’s Comprehensive Mental Health Action Plan 2020-2030 helps provide frameworks for improving mental health care to be more individual centered, rights-based, and recovery focused. [5-6] Additionally, the action plan identified peer support services as a valuable expansion of mental health services because they can provide benefits to quality of life, increase mental and physical health outcomes, lead to positive behavior changes, and offer cost effective options. The predominant methods of mental health care have focused on diagnosis, medication, and symptom reduction with less concentration on many other wide-ranging determinants of mental health. The WHO also recognized that many worldwide mental health systems operate with significant resource restrictions, outdated legal and regulatory systems, and an overreliance on clinical treatments. These challenges create a scenario where established mental health care services are unlikely to meet the expanding need for improved access. 
Governments have recognized the value of peer support programs. There is currently a bill in the US Senate to expand federal resources to improve frameworks for incorporating peer support programs into primary care. This bill has been supported by the National Association of State Mental Health Program Directors (NASMHPD), Mental Health America (MHA), the Depression and Bipolar Support Alliance (DBSA), the National Association of Peer Supporters (N.A.P.S) and the Association for Behavioral Health and Wellness (ABHW).  The US Surgeon General’s 2021 Report also identified the need for programs that can be added on to existing mental health services to help youth and young adults.  The NIH’s Substance Abuse and Mental Health Services Administration has also encouraged the development of peer support systems.  The American Psychological Association has also endorsed the development of peer support programs. 
Mental health problems present in a wide range of severity and for many reasons. Not all mental health difficulties are clinical in nature. Many individuals experience mental health challenges that do not rise to the severity of a clinical disorder, but still struggle in a manner that needs external support.  Peer support services can help in these circumstances. An individual’s goals for seeking support may not require diagnosis or symptom reduction, but a focus on goal attainment. [13-17]
It’s important to recognize that something can provide therapeutic benefits without being a clinical intervention. Healthy dietary changes and exercise can lead to clinical improvements in heart health; however, it is important to note that diet and exercise are not clinical treatments or prescriptions. Similarly, working in a less toxic environment can lead to substantial improvements in depression and anxiety, but getting a new job is not a clinical intervention. [18,19]
Coaching as a solution
Healthy Gamer’s coaching program was not created in isolation. It is the result of multiple calls to action from institutions like the World Health Organization, further spurred by the US Office of the Surgeon General and the growing body of evidence that peer support programs are valid and effective. [20,21] We are committed to scientifically studying the effectiveness of our coaching programs through research studies approved by an Institutional Review Board (IRB), which includes an independent, third party ethical review.
Coaching is a peer support service that focuses on principles of recovery, positive psychology, mindfulness, and motivational interviewing to help individuals achieve goals, enact positive behavioral changes, generate solutions, and utilize their own resources. Coaching focuses on attaining achievements through a client’s own actions, rather than decreasing symptoms or treating a disorder. Coaching is a complement to clinical practice and can help an individual focus on making changes to factors and determinants of mental health that do not require clinical intervention. [22,23]
Healthy Gamer Coaching utilizes skills from recovery and life coaching to work in tandem with an individual to help achieve goals. Coaches are peers that get to know an individual as equals, facilitate goal setting, provide an external perspective that can help with self-reflection and self-awareness, and promote self-efficacy. Recovery programs focus on moving forward, not treatment.  Coaches are not licensed or trained to diagnose or treat medical conditions.
What tools do coaches use?
Positive psychology is an important tool in a coach’s toolkit to help cultivate happiness. Coaching uses these tools to help a client identify goals, identify solutions, take actions, and learn from the process of implementing changes. [24-28]
Coaches incorporate aspects of mindfulness and promote a greater mind-body connection. Mindfulness is a practice that allows the client to observe their behaviors and catch negative thought loops. As a result, they start to understand themselves, manage their emotions and increase agency to act, which fosters lasting change in their lives. While not a clinical intervention, mindfulness has been shown to help people deal with feelings of stress, anxiety, depression, and even clinical mood disorders. [29-34]
Motivational interviewing is an evidence-based technique designed to create behavioral change in the client. Coaches empower clients to discover their reasons for creating change in their life. They accomplish this through active listening and then help the client cultivate self-reliance. [35,36]
All these methods have a proven track record for providing therapeutic benefits to individuals suffering from clinical illness, and have also been used in non-clinical settings to create substantial, positive change. These benefits include but are not limited to decreases in feelings of depression, anxiety, addictive behaviors, loneliness and isolation, and improvements in social functioning, community engagement, and physical health. [24-41]
Coaches follow the International Coaching Foundation’s standards for competence. 
- Setting a foundation
- Coach and client alliance
- Facilitating learning and growth
Healthy Gamer has and continues to develop systems for quality assurance to ensure that clients receive professional, competent, effective, and evidence-based peer support. Healthy Gamer coaches have access to a range of mental health consultants (Psy.D, PhD, LICSW, MD, etc.) to ensure all coaching conversations remain in the scope of coaching..
Therapy is a clinical practice.
Clinicians are taught and trained on the processes of diagnosing and treating illnesses.  The practice of therapy is restricted to licensed clinicians who have been trained in diagnosing and treating clinical conditions. Coaches are neither trained nor licensed to provide clinical services, such as diagnosis or treatment.
Clinical practice, including psychotherapy, includes a few key steps:
These steps are important because clinical care is about the treatment of an illness. Medical care is a tightly regulated process, with clear guidelines such as standards of care, to ensure that patients have the best chance for their clinical problems to be resolved.
Therapy can still be very helpful and help someone improve into a state of greater positive health, even after the resolution of a clinical illness. In a sense, therapists can do the work of a coach, but a coach can never do the clinical work of a therapist. Public health organizations have agreed clinical psycho-medical and psycho-pharmaceutical solutions are not enough to meet demands and address all the aspects of health a person may need help with. [5,6]
Coaching is value additive to traditional therapy and medicine. It does not replace or interfere with therapy or medical practice in any manner and has substantial evidence supporting benefits to traditional mental and physical health. [24-41]
Coaching and Therapy together
Coaching and therapy utilize some shared techniques, such as being trained in listening and asking powerful questions. This does not mean they serve a similar purpose. Therapy has additional focuses on diagnosis of pathology, treatment, and symptom reduction. Coaching is not about fixing problems; it’s about moving in a direction that helps an individual achieve goals, develop self-efficacy, and learn skills to become self-aware and self-reliant. [45,46]
Coaching and therapy can work together. Many clients work with both a coach and a therapist. There are many factors that contribute to an individual’s mental health. Achieving goals, finding meaning and purpose, making behavior changes, developing awareness, and learning to be more authentic are some of the many factors that can improve a person’s mental health. Coaching helps clients put attention on these elements to help achieve a more holistic and multifactorial approach to moving forward in life. Focusing on these elements with a coach can help an individual and their therapist put more focus on healing. 
- Wang PS, Aguilar-Gaxiola S, Alonso J, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007;370(9590):841-850
- Norris T, Clark TC, Boersma P, Schiller JS. Technical notes for early release of selected estimates based on data from the National Health Interview Survey. National Center for Health Statistics. February 2021.
- Vahratian A, Blumberg SJ, Terlizzi EP, Schiller JS. Symptoms of anxiety or depressive disorder and use of mental health care among adults during the COVID-19 pandemic – United States, August 2020-February 2021. MMWR Morb Mortal Wkly Rep. 2021;70(13):490-494.
- Organisation for Economic Co-operation and Development, 2021. Tackling the Mental Health Impact of the COVID-19 Crisis: An Integrated, Whole-of-Society Response. OECD Publishing.
- World Health Organization, 2021. Comprehensive mental health action plan 2013–2030.
- World Health Organization, 2021. Peer support mental health services: promoting person-centred and rights-based approaches. In Peer support mental health services: promoting person-centred and rights-based approaches.
- Pathare, S., Brazinova, A. and Levav, I., 2018. Care gap: a comprehensive measure to quantify unmet needs in mental health. Epidemiology and psychiatric sciences, 27(5), pp.463-467.
- Leading mental health organizations strongly support new bipartisan peer support legislation introduced in the Senate. National Association of Peer Supporters - Peer Support Works! Retrieved February 18, 2022, from https://www.peersupportworks.org/leading-mental-health-organizations-strongly-support-new-bipartisan-peer-support-legislation-introduced-in-the-senate/
- Department of Health and Human Services (2021) Protecting Youth Mental Health. The U.S. Surgeon General’s Advisory. Retrieved from https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf
- Substance Abuse and Mental Health Services Agency (2017) Value of Peers. Retrieved from https://www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/value-of-peers-2017.pdf
- APA. Position Statement on Peer Support Services. https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-2018-Peer-Support-Services.pdf. May 2018. Accessed May 1, 2019.
- Besteher, B., Gaser, C. and Nenadić, I., 2020. Brain structure and subclinical symptoms: a dimensional perspective of psychopathology in the depression and anxiety spectrum. Neuropsychobiology, 79(4), pp.270-283.
- Shalaby RA, Agyapong VI. Peer support in mental health: literature review. JMIR Mental Health 2020 Jun 09;7(6):e15572
- Mead S, Hilton D, Curtis L. Peer support: a theoretical perspective. Psychiatric Rehabilitation Journal 2001;25(2):134-141.
- Solomon P. Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal 2004;27(4):392-401.
- Repper J, Aldridge B, Gilfoyle S, Gillard S, Perkins R, Rennison J. Peer support workers: a practical guide to implementation. ImROC Briefing Paper 7; Centre for Mental Health, London. 2013. URL: https://imroc.org/wp-content/uploads/2016/09/7-Peer-Support-Workers-a-practical-guide-to-implementation.pdf
- Burke EM, Pyle M, Machin K, Morrison AP. Providing mental health peer support 1: a Delphi study to develop consensus on the essential components, costs, benefits, barriers and facilitators. Int J Soc Psychiatry 2018 Dec 03;64(8):799-812.
- Lange, K.W., 2018. Diet, exercise, and mental disorders–public health challenges of the future. Journal of Disease Prevention and Health Promotion, 2.
- Chopra, P., 2009. Mental health and the workplace: issues for developing countries. International Journal of Mental Health Systems, 3(1), pp.1-9.
- Kent, M., 2019. Developing a strategy to embed peer support into mental health systems. Administration and Policy in Mental Health and Mental Health Services Research, 46(3), pp.271-276.
- Stefancic, A., Bochicchio, L. and Tuda, D., 2021. Peer Support for Mental Health. In Peer Support in Medicine (pp. 31-48). Springer, Cham.
- Bora, R., Leaning, S., Moores, A. and Roberts, G., 2010. Life coaching for mental health recovery: the emerging practice of recovery coaching. Advances in psychiatric treatment, 16(6), pp.459-467.
- Fortuna, K.L., Venegas, M., Umucu, E., Mois, G., Walker, R. and Brooks, J.M., 2019. The future of peer support in digital psychiatry: promise, progress, and opportunities. Current treatment options in psychiatry, 6(3), pp.221-231.
- Biswas-Diener, R. and Dean, B., 2007. Positive psychology coaching: Putting the science of happiness to work for your clients. John Wiley & Sons.
- Boniwell, I., Kauffman, C. and Silberman, J., 2014. The positive psychology approach to coaching. The complete handbook of coaching, pp.158-171.
- Grant, A.M. and Spence, G.B., 2010. Using coaching and positive psychology to promote a flourishing workforce: A model of goal-striving and mental health
- Kauffman, C., 2006. Positive psychology: The science at the heart of coaching. Evidence based coaching handbook: Putting best practices to work for your clients, 219, p.253.
- Kauffman, C. and Scoular, A., 2004. Toward a positive psychology of executive coaching
- Enkema, M.C., McClain, L., Bird, E.R., Halvorson, M.A. and Larimer, M.E., 2020. Associations between mindfulness and mental health outcomes: A systematic review of ecological momentary assessment research. Mindfulness, 11(11), pp.2455-2469.
- Gupta, S.K., 2022. Meditation, Mindfulness, and Mental Health: Opportunities, Issues, and Challenges. In Handbook of Research on Clinical Applications of Meditation and Mindfulness-Based Interventions in Mental Health (pp. 1-14). IGI Global.
- Burzler, M.A., Voracek, M., Hos, M. and Tran, U.S., 2019. Mechanisms of mindfulness in the general population. Mindfulness, 10(3), pp.469-480.
- Charbonneau, D., 2019. Model of mindfulness and mental health outcomes: Need fulfillment and resilience as mediators. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 51(4), p.239.
- Garland, E.L. and Howard, M.O., 2018. Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research. Addiction science & clinical practice, 13(1), pp.1-14.
- Li, W., Garland, E.L., O’Brien, J.E., Tronnier, C., McGovern, P., Anthony, B. and Howard, M.O., 2018. Mindfulness-oriented recovery enhancement for video game addiction in emerging adults: preliminary findings from case reports. International Journal of Mental Health and Addiction, 16(4), pp.928-945.
- Miller, W. (2004). Motivational interviewing in service to health promotion. The Art of Health Promotion, 18, A1–A10. Miller, W., & Rollnick, S. R. (2002). Motivational interviewing; Preparing people to change (2nd ed.). New York: The Guilford Press
- Moyers, T., Martin, T., Catley, D., Harris, K., & Ahluwalia, J. S. (2003). Assessing the integrity of motivational interviewing interventions: Reliability of the motivational interviewing skills code. Behavioural and Cognitive Psychotherapy, 31, 177–184.
- Hecht, J., Borrelli, B., Breger, R. K. R., DeFrancesco, C., Ernst, D., & Resnicow, K. (2005). Motivational interviewing in community-based research: Experiences from the field. Annals of Behavioral Medicine, 29, Suppl, 29–34
- Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: a meta analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–861.
- Student Minds. 2014. Grand Challenges in Student Mental Health. Retrieved from: https://www.studentminds.org.uk/uploads/3/7/8/4/3784584/grand_challenges_report_for_public.pdf
- Álvarez-Jiménez, M., Gleeson, J.F., Rice, S., Gonzalez-Blanch, C. and Bendall, S., 2016. Online peer-to-peer support in youth mental health: seizing the opportunity. Epidemiology and psychiatric sciences, 25(2), pp.123-126.
- Farkas M, Boevink W. Peer delivered services in mental health care in 2018: infancy or adolescence? World Psychiatry. 2018;17(2):222-224.
- International Coaching Federation. (2019) Current ICF Core Competencies. Retrieved from https://coachingfederation.org/core-competencies
- Consoli, A.J., Beutler, L.E. and Bongar, B. eds., 2016. Comprehensive textbook of psychotherapy: Theory and practice. Oxford University Press.
- Gagne CA, Finch WL, Myrick KJ, Davis LM. Peer workers in the behavioral and integrated health workforce: opportunities and future directions. Am J Prev Med 2018 Jun;54(6 Suppl 3):S258-S266
- Villani M, Kovess-Masféty V. [Peer support programs in mental health in France: Status report and challenges]. Encephale 2018 Nov;44(5):457-464
- Ibrahim, N., Thompson, D., Nixdorf, R., Kalha, J., Mpango, R., Moran, G., Mueller-Stierlin, A., Ryan, G., Mahlke, C., Shamba, D. and Puschner, B., 2020. A systematic review of influences on implementation of peer support work for adults with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 55(3), pp.285-293.
- Davies, N., 2019. Exploring the Value of Peer Support for Mental Health. Psychiatry Advisor, 2.