If not for Nan
Peer program honors its namesake by helping teenagers feel less alone
It was unseasonably warm in early April as the first years at Wayland High School trickled into the morning class. The 15-year-olds from suburban Boston were dressed for the 85-degree weather, with girls in unburied denim cutoffs and boys sporting their lacrosse uniforms, untucked jerseys swallowing up the team’s youngest players. Teenage chatter hummed through the room, softening into whispers at the sound of instructions from the day’s guest presenter. Amid the babble, a few stared silently straight ahead.
No one spoke once John began his story. At the front of the classroom, he stood before the band of students, their desks arranged in a wide U-shape around him. At his waist, he held a white stack of paper—his script—although he rarely looked down except to turn the page. He had been about their age when he started abusing drugs, he said. A talented soccer player and actor, he attended Cambridge Rindge and Latin School, one of Massachusetts’ esteemed public high schools—much like Wayland. Many in the room had probably taken the 30-minute drive to his alma-mater to compete in sports matches and debate tournaments. They might have friends who go there.
What started as a tool to socialize more comfortably with his peers quickly became a crutch for John. “I thought substances would give me more control, but they did the opposite,” he said. By the time he realized drugs were his way of coping with symptoms of depression, he felt stuck. He attempted suicide shortly after matriculating at Boston University, waking up in the hospital to find his mother by his bedside. While the two had drifted apart over the course of his substance use challenges, she was there for him throughout his recovery, helping him rediscover passions for fitness, music and drama.
He only wished he reached out sooner. “[My substance use] took some valuable years I could have used to put my life together,” he said. “Remember, asking for help means you are brave.”
Since 2020, 33-year-old John Oxenford has been sharing his recovery story with students of all ages as a Peer Mentor with The NAN Project. Based in Lexington, Mass., the suicide prevention organization hires young people, typically recent high school or college graduates, with a history of mental health challenges to craft narratives about their experiences and present them to audiences across the northeast. This approach aims to elevate discussions of mental health by centering voices of those who have suffered, and begun healing, from emotional issues that continue to burden countless youth today. Peers offer what they wish they had known about mental health and help-seeking to those who have the time, and need, to learn from them.
Peer-to-peer programming is the flagship work of the NAN Project, founded by Ellen Dalton and Jake Cavanaugh in 2016, after they lost their daughter and younger sister Nancy “Nan” Cavanaugh to suicide in 2012. At 24, Nan died while enrolled in graduate school, a month before she would have earned her Masters of Social Work degree. “The thing was that we were just taken by surprise,” Ellen said of her daughter’s passing. “It seemed like everything was good on the outside.” Despite struggling with obsessive-compulsive disorder (OCD) throughout her life, Nan remained high functioning until the end—a spirited friend, accomplished athlete and honors student.
Ellen believes it was stigma that killed Nan. When Nan’s symptoms of depression and anxiety worsened during high school in Beverly, Mass., her family steered her toward treatment. While she conceded to taking medication, she rejected therapy time and again. Asking for help was always difficult for Nan, Ellen said, due to fear of being judged or ostracized. That fear silenced her so effectively that not even Ellen, who was senior vice president of Eliot Community Human Services, a large Boston-based health nonprofit, could see through the mask. “I know kids. I know mental health. I know behavioral health. And this still sort of slipped through my fingers.”
Unfortunately, Ellen’s experience happens all too often. Even as stigma around mental health has receded overall, young people dying from suicide and keeping their struggles to themselves remains a disturbing phenomenon. The Centers for Disease Control and Prevention's (CDC) latest Youth Risk Behavior Survey shows nearly a quarter of female high schoolers and 12% of male ones reported making a suicide plan. Suicide is the second leading cause of death among college students. This past academic year alone, North Carolina State University lost seven students to suicide and another two to overdoses.
From Nan’s suicide came her family’s commitment to creating space for young people to talk about mental health and become comfortable asking for help. The prevalence of suicide among teens shocked Ellen, she said, “because back then, we didn't talk about it. That was the ‘S-word.’ And even mental health was not something that people felt safe talking about.” As she and her son Jake strove to cut through the discomfort that shrouded what few discussions of suicide and mental health she found did exist, Ellen said they wondered, “How do we start the conversation and bring it above a whisper?”
The decision to pursue a peer-to-peer model emerged from a series of consultations with professionals, including teachers, school counselors and other clinical experts, as well as focus groups with students. Nan’s brother Jake, who is now the executive director of The NAN Project, said he and his mother Ellen met with “whoever would sit down with us.” Through their research, they began to pick up on what strategies and voices could carry the most weight or promise the greatest impact. “It just became clear that the way to do that is not an adult standing up there saying, ‘This is what you need to know,’” Ellen said. “It was peers talking to students.”
Not everyone shared Ellen’s confidence. “It was really banging on doors,” Jake said of early efforts to spread their message, which often didn’t take. School officials expressed concerns about exposing young people to conversations about mental health. One principal told Ellen that Peers from The NAN Project could present to his students so long as no one ever uttered the word “suicide.” “Well, that's why we have such a huge problem on our hands,” she said.
The founders caught a break in the summer of 2016, when, through Ellen’s connections at Eliot Community Human Services, she made contact with staff at Everett High School. They were interested in participating in one of The NAN Project’s other programs, professional development workshops, which teach school personnel how to recognize signs of a student in distress and how to respond. From there came an opportunity for the team to put on the first of what has become its signature Peer presentations for members of Everett’s health staff.
Now, The NAN Project has presented to students at around 50 schools, reaching several thousand students annually in recent years. For not only students and educators but caregivers and first-responders, the organization offers a variety of educational programming, including the Peer presentations, professional development workshops and QPR (Question, Persuade, and Refer) suicide prevention training. For young people who may need additional support beyond a one-time Peer visit, there are also SEL (Social-Emotional Learning) Circles, a six-week curriculum run by Peer Mentors and a licensed mental health clinician.
“We're at the point where we're getting calls every week. Can you do this for my community group? Can you come into this school?” Ellen said. She credits the traction to the influence of the Peer presentations. “It's about the young people telling their story to young people and making that connection and allowing the students to open up about their questions or their thoughts. It's amazing the conversations that go on after these Peer Mentors present their stories.”
The Peer presentations have remained largely the same since their inception. For finding Peers, the primary recruiting source continues to be the Department of Mental Health, specifically its own Peer Mentor training program, called Gathering Inspiring Future Talent (GIFT). NAN Peers then start by participating in a four-day training course to help them craft their “comeback stories.” These are the hope-forward narratives that track the origins of their mental health challenges and their paths to finding and maintaining recovery. To appeal to each of the various age groups, the Peers pen multiple iterations of their stories.
The impact their presentations can have on students is also what keeps long-time Peers like Lizzie MacLellan part of the fold. Lizzie, now assistant director of the organization, joined the team right after receiving her undergraduate degree in psychology from University of Massachusetts Boston. Five years later, she sticks with this work, in part because of how she's seen her story of anxiety, panic attacks, and self-harm resonate with young people. “I've had a number of experiences where a student afterwards made a beeline to me and, in some cases, is physically reaching out and being like, ‘You are me. Oh my God, you just said everything that I'm thinking all the time,” she said.
“What we're going through is a really common thing and so many people go through it. But you don't know until you hear somebody else say it. And in those situations I've been able to say, ‘Okay, well, you heard what I just said—that I wish I had reached out to somebody sooner. Who do you talk to?’” Lizzie said. Sometimes, she’s comforted to hear that the student who connected with her already has a support system in place. Other times, she ends up making the “warm handoff” to a school counselor, who tells her later that no one knew the child in question had been struggling.
Another draw of working at The NAN Project is the unique support system that comes with it. “Something we pitch to the Peers is you become part of a community of folks who've been through similar things, but, unlike working at Stop & Shop, you'll get support as part of that,” Nan’s brother Jake said. Given that mental health challenges brought them all together, they not only don’t need to hide their pasts but find solidarity in them. Clinical director Donna Kausek even performs regular clinical check-ins with the Peers. According to Jake, “If they have to step back because they're having a tough day or anxious, we get that, and that's perfectly okay, whereas some work places might not be quite as accommodating.”
Still, it’s important that Peers have reached a point in their recovery where they can handle sharing the rawness of their background. Donna said the main criteria she looks for in aspiring Peers are twofold: whether they’re far enough along in the healing process to deliver their story and whether they have support systems in place to help. After all, logistical issues can crop up from a policy of accommodation for staff when they have a bad day or need a break. “There's no repercussions for that ever, but it also means that they call out all the time,” Jake said. “That's why I pay them 50 bucks just to show up [to each presentation].”
For John Oxenford, the presenter at Wayland, the ten hours per week he works as a Peer Mentor for The NAN Project are an opportunity to nurture his longtime love of acting—with one major difference. “It's not like doing the monologue. It's like being on a team. So I can connect with these people, and we all support each other so that everything can go well and we can help people,” he said. “Rather than worrying so much about what I do, I can also rely on some people around me.”
“Especially when a kid really connects with it on a personal level, it’s so empowering,” Lizzie said. “It's almost like every time you say your story, you get to say, ‘And that's not me anymore.’”
“What we show them is light at the end of the tunnel,” John said.