Abstract
BackgroundThe provision of peer support as a component of mental health care, including the employment of Peer Workers (consumer-providers) by mental health service organisations, is increasingly common internationally. Peer support is strongly advocated as a strategy in a number of UK health and social care policies. Approaches to employing Peer Workers are proliferating. There is evidence to suggest that Peer Worker-based interventions reduce psychiatric inpatient admission and increase service user (consumer) empowerment. In this paper we seek to address a gap in the empirical literature in understanding the organisational challenges and benefits of introducing Peer Worker roles into mental health service teams.MethodsWe report the secondary analysis of qualitative interview data from service users, Peer Workers, non-peer staff and managers of three innovative interventions in a study about mental health self-care. Relevant data was extracted from interviews with 41 participants and subjected to analysis using Grounded Theory techniques. Organisational research literature on role adoption framed the analysis.ResultsPeer Workers were highly valued by mental health teams and service users. Non-peer team members and managers worked hard to introduce Peer Workers into teams. Our cases were projects in development and there was learning from the evolutionary process: in the absence of formal recruitment processes for Peer Workers, differences in expectations of the Peer Worker role can emerge at the selection stage; flexible working arrangements for Peer Workers can have the unintended effect of perpetuating hierarchies within teams; the maintenance of protective practice boundaries through supervision and training can militate against the emergence of a distinctive body of peer practice; lack of consensus around what constitutes peer practice can result in feelings for Peer Workers of inequality, disempowerment, uncertainty about identity and of being under-supported.ConclusionsThis research is indicative of potential benefits for mental health service teams of introducing Peer Worker roles. Analysis also suggests that if the emergence of a distinctive body of peer practice is not adequately considered and supported, as integral to the development of new Peer Worker roles, there is a risk that the potential impact of any emerging role will be constrained and diluted.
Highlights
The provision of peer support as a component of mental health care, including the employment of Peer Workers by mental health service organisations, is increasingly common internationally
The sets of codes, categories and themes produced through this process are illustrated in (Additional file 1: Table S3) below, indicating how themes ‘cut across’ our categorical organisation of the data: As well as fulfilling our first aim – to describe the emergence of Peer Worker roles in mental health services from a range of stakeholder perspectives – the five themes serve our second aim; to develop understanding at an organisational level of some of the benefits and challenges around introducing Peer Worker roles
We begin by exploring a range of issues around the recruitment process and how potential Peer Workers were identified in our cases
Summary
The provision of peer support as a component of mental health care, including the employment of Peer Workers (consumer-providers) by mental health service organisations, is increasingly common internationally. There is evidence to suggest that Peer Worker-based interventions reduce psychiatric inpatient admission and increase service user (consumer) empowerment. A range of different approaches to employing people with personal experience of mental health problems, to make direct use of that lived experience in supporting others with similar problems (as peers), has been identified internationally [1]. A number of terms including Peer Support Worker, Peer Support Specialist and Consumer-Provider have been used to identify these roles. We will use the generic term Peer Worker throughout this paper because it does not specify or limit the range of roles under consideration while at the same time it makes it clear that we are interested in people intentionally employed to make use of their personal experiences of mental health issues in the delivery of services. Hope and strength of social networks have been indicated as important outcomes for service users (consumers) in receipt of support from Peer Workers [7,8]
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