The Next Layer: What Therapy’s Growth Tells Us About the Future of Peer Services
Natasha Faruqui, Healthcare Strategy at Peerakeet
There is a pattern in how behavioral health expands. It rarely happens all at once, and it rarely comes from a single breakthrough. It happens in layers. Each new workforce layer extends reach, unlocks access, and solves constraints the previous layer could not.
That pattern is one of the most useful lenses available today for understanding where peer services are headed.
How Therapy Became a Scaled Industry
For much of the twentieth century, mental health treatment was largely synonymous with psychiatry. Care meant seeing a physician, often a psychiatrist, and access was correspondingly narrow. Limited supply, high cost, and the stigma attached to seeking psychiatric care kept support out of reach for many people.
The growth of the therapy profession changed that.
Licensed clinical social workers, counselors, marriage and family therapists, and psychologists expanded the behavioral health workforce well beyond physicians alone. That shift widened access, increased training pipelines, and created a broader care infrastructure capable of meeting rising demand.
Just as importantly, reimbursement followed. As states built licensure frameworks and payers recognized these professionals, Medicaid and private insurers increasingly covered therapy services at scale.
The result was not simply more demand being met. It was the creation of a new industry. The U.S. behavioral therapy market is now estimated at roughly $28 billion annually, with strong recent growth. The behavioral health workforce now includes hundreds of thousands of licensed therapy professionals, while mental health and substance use counseling roles are projected to continue growing well above the national average over the next decade.
That growth was not driven by need alone. Need had long existed. It was driven by the structural conditions that made scaling possible: credentialing, reimbursement, workforce pipelines, and growing cultural legitimacy.
That history is not just background. It is a roadmap.
Peer Services Are a Distinct Workforce Layer
Peer services should not be understood as a cheaper substitute for therapy. They serve a different function.
Therapists and clinical counselors operate within a diagnostic and treatment-oriented framework. They assess, treat, document, and deliver structured interventions within clinical boundaries. That work is essential, but it is also necessarily bounded by schedules, settings, caseloads, and reimbursement structures.
Peer support operates in a different part of the care journey.
A certified peer specialist brings lived experience of recovery and the trust that often comes with it. Peer support can happen in the community, by phone, through text, during transitions of care, after discharge, during moments of ambivalence, or before someone is ready to engage with formal treatment at all.
Where therapy often centers treatment, peer support often centers engagement, continuity, motivation, navigation, and sustained connection.
That difference is not a weakness. It is precisely why the model matters.
Peer services can reach people who are not yet in care, who have disengaged from care, or who need support between clinical encounters. In many cases, they strengthen the effectiveness of the broader system by helping people actually connect to it and stay connected.
The Same Structural Pattern Is Emerging
The forces that helped therapy scale are increasingly visible in peer services today.
1. Credentialing Creates the Conditions for Scale
Therapy became broadly billable and employable once licensure systems matured. Employers knew who they were hiring. Payers knew what they were reimbursing. States had frameworks to regulate quality and scope.
Peer services are moving through a similar stage.
Most U.S. states now recognize or reimburse some form of peer support, and Substance Abuse and Mental Health Services Administration released National Model Standards for Peer Support Certification in 2023 to promote consistency and reciprocity across states.
As certification becomes more standardized, hiring, portability, and reimbursement become easier to scale.
2. Reimbursement Is the Real Unlock
The biggest accelerant in therapy’s expansion was not awareness. It was payment.
Once Medicaid and commercial insurers paid for services, organizations could hire staff, invest in operations, and build sustainable delivery models.
Peer services are earlier on this curve, but the same shift is underway. Medicaid programs across most states now reimburse peer support in some form, and annual spending has grown meaningfully over time.
The next phase is not proving whether peer support has value. It is improving how reimbursement works: clearer pathways, better rates, simpler billing, and operational systems that make delivery feasible at scale.
3. Integration Creates Distribution
Therapy grew when it moved beyond standalone practices and into hospitals, community mental health centers, schools, primary care systems, and employer benefits.
Peer services are beginning the same process.
Today, peer specialists are increasingly embedded in crisis response, substance use treatment, emergency department transitions, recovery community organizations, care management programs, inpatient discharge planning, and community-based settings.
Every integration point expands access and creates a new channel for growth.
Why This Matters Now
From a market perspective, peer services appear to be in an earlier version of the transition therapy completed over past decades.
Demand is not the question.
The real question is whether the infrastructure exists to meet that demand efficiently and sustainably.
That infrastructure includes:
- modern credentialing systems
- standardized reimbursement pathways
- workforce management tools
- documentation and billing workflows
- training and supervision systems
- technology that supports engagement across settings and geographies
- data systems that demonstrate outcomes
Across many organizations today, peer workers still rely on spreadsheets, manual documentation, fragmented communication tools, and disconnected workflows. That creates friction for a workforce whose value often depends on responsiveness, continuity, and relationship-based support.
As the workforce grows, those operational gaps become more consequential.
The Opportunity Ahead
Behavioral health has already shown that it can absorb and scale a new workforce layer when the right structural conditions are in place.
Therapy was one example.
Peer services may be the next.
The conditions are increasingly visible: expanding certification, broader reimbursement, rising policy support, workforce demand, and growing integration into care delivery systems.
If that trajectory continues, the defining question may not be whether peer services scale.
It may be who builds the infrastructure that allows them to.
References
Association of Social Work Boards. (2024). Where it began: A short history of social work regulation. https://www.aswb.org/wp-content/uploads/2021/02/Your-Association-2021.pdf
IBISWorld. (2024). Behavioral therapists in the US: Market size statistics. https://www.ibisworld.com/industry-statistics/market-size/behavioral-therapists-united-states/
Substance Abuse and Mental Health Services Administration. (2023). National model standards for peer support certification (Publication No. PEP23-10-01-001). U.S. Department of Health and Human Services. https://library.samhsa.gov/product/samhsas-national-model-standards-peer-support-certification/pep23-10-01-001
Toward Healthcare. (2025). U.S. behavioral health market size, share, and forecast 2026–2035. https://www.towardshealthcare.com/insights/us-behavioral-health-market
U.S. Bureau of Labor Statistics. (2024). Strong growth projected in mental health-related employment. https://www.bls.gov/opub/ted/2024/strong-growth-projected-in-mental-health-related-employment.htm