Abstract
PurposePeer support is increasingly being introduced into mainstream mental health services internationally. The distinctiveness of peer support, compared to other mental health support, has been linked to values underpinning peer support. Evidence suggests that there are challenges to maintaining those values in the context of highly standardised organisational environments. The purpose of this paper is to describe a “principles-based” approach to developing and evaluating a new peer worker role in mental health services.Design/methodology/approachA set of peer support values was generated through systematic review of research about one-to-one peer support, and a second set produced by a UK National Expert Panel of people sharing, leading or researching peer support from a lived experience perspective. Value sets were integrated by the research team – including researchers working from a lived experience perspective – to produce a principles framework for developing and evaluating new peer worker roles.FindingsFive principles referred in detail to: relationships based on shared lived experience; reciprocity and mutuality; validating experiential knowledge; leadership, choice and control; discovering strengths and making connections. Supporting the diversity of lived experience that people bring to peer support applied across principles.Research limitations/implicationsThe principles framework underpinned development of a handbook for a new peer worker role, and informed a fidelity index designed to measure the extent to which peer support values are maintained in practice. Given the diversity of peer support, the authors caution against prescriptive frameworks that might “codify” peer support and note that lived experience should be central to shaping and leading evaluation of peer support.Originality/valueThis paper adds to the literature on peer support in mental health by describing a systematic approach to understanding how principles and values underpin peer worker roles in the context of mental health services. This paper informs an innovative, principles-based approach to developing a handbook and fidelity index for a randomised controlled trial. Lived experiences of mental distress brought to the research by members of the research team and the expert advisors shaped the way this research was undertaken.
Highlights
An established sociological literature on role change in the workforce suggests that there are innovation and early implementation stages at which system-wide role adoption remains in doubt (Bernard, 1976)
The final version of the ENRICH peer support principles, stating that mental health services, training programmes, practice guidelines or interventions that are based on or include peer support should, in their development, delivery and evaluation, is as follows: 1. Support the building of safe and trusting relationships based on shared lived experience as fundamental to peer support: Where that lived experience is appropriate to the service or community context in which peer support is given and received, reflecting and respecting the full diversity of lived experience that people bring
Ensure that the values of mutuality and reciprocity underpin peer support relationships: Mutuality in this context includes the qualities of empathy and mutual respect, a fundamental sense of equal value, and a connection to communities defined by the diversity of culture and experience
Summary
An established sociological literature on role change in the workforce suggests that there are innovation and early implementation stages at which system-wide role adoption remains in doubt (Bernard, 1976). The introduction of peer workers into mental health services as an organised approach to providing mental health care – in the UK and many other countries – seems to be past those tenuous early stages. The authors affiliations can be found at the end of this article. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health
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