Behavioral health conditions, which include mental health and substance use disorders, are the leading disease burden in the United States. Peer-run behavioral health organizations (PROs) critically assist individuals facing these conditions by combining mental health services with assistance for needs such as income, employment, and housing. However, limited funds and staffing make it difficult for PROs to address all service user needs. To assist peer providers at PROs with their day-to-day tasks, we introduce PeerCoPilot, a large language model (LLM)-powered assistant that helps peer providers create wellness plans, construct step-by-step goals, and locate organizational resources to support these goals. PeerCoPilot ensures information reliability through a retrieval-augmented generation pipeline backed by a large database of over 1,300 vetted resources. We conducted human evaluations with 15 peer providers and 6 service users and found that over 90% of users supported using PeerCoPilot. Moreover, we demonstrate that PeerCoPilot provides more reliable and specific information than a baseline LLM. PeerCoPilot is now used by a group of 5-10 peer providers at CSPNJ, a large behavioral health organization serving over 10,000 service users, and we are actively expanding PeerCoPilot's use.

Peer-run organizations (PROs) provide critical, recovery-based behavioral health support rooted in lived experience. As large language models (LLMs) enter this domain, their scale, conversationality, and opacity introduce new challenges for situatedness, trust, and autonomy. Partnering with Collaborative Support Programs of New Jersey (CSPNJ), a statewide PRO in the Northeastern United States, we used comicboarding, a co-design method, to conduct workshops with 16 peer specialists and 10 service users exploring perceptions of integrating an LLM-based recommendation system into peer support. Findings show that depending on how LLMs are introduced, constrained, and co-used, they can reconfigure in-room dynamics by sustaining, undermining, or amplifying the relational authority that grounds peer support. We identify opportunities, risks, and mitigation strategies across three tensions: bridging scale and locality, protecting trust and relational dynamics, and preserving peer autonomy amid efficiency gains. We contribute design implications that center lived-experience-in-the-loop, reframe trust as co-constructed, and position LLMs not as clinical tools but as relational collaborators in high-stakes, community-led care.