Peer Support Workers Research Articles

Engaging with peers to integrate community care: Knowledge synthesis and conceptual map.

Engaging with peers is gaining increasing interest from healthcare systems in numerous countries. Peers are people who offer support by drawing on lived experiences of significant challenges or 'insider'knowledge of communities. Growing evidence suggests that peers can serve as a bridge between underserved communities and care providers across sectors, through their ability to build trust and relationships. Peer support is thus seen as an innovative way to address core issues of formal healthcare, particularly fragmentation of care and health inequalities. The wide body of approaches, goalsand models of peer support speaks volumes of such interest. Navigating the various labels used to name peers, however, can be daunting. Similar terms often hide critical differences. This article seeks to disentangle the conceptual multiplicity of peer support, presenting a conceptual map based on a 3-year knowledge synthesis project involving peers and programme stakeholders in Canada, and international scientific and grey literature. The map introduces six key questions to navigate and situate peer support approaches according to peers' roles, pathwaysand settings of practice, regardless of the terms used to label them. As a tool, it offers a broad overview of the different ways peers contribute to integrating health and community care. We conclude by discussing the map's potential and limitations to establish a common language and bridge models, in support of knowledge exchange among practitioners, policymakersand researchers. Our team includes one experienced peer support worker. She contributed to the design of the conceptual map and the production of the manuscript. More than 10 peers working across Canada were also involved during research meetings to validate and refine the conceptual map.

Examining Youth Flexible ACT Model Implementation in the Netherlands

Model adherence is a key indicator of mental health care quality. This study investigates the degree of model adherence, as well as content and staging of care, among the first Youth Flexible Assertive Community Treatment (ACT) teams in the Netherlands. Model fidelity was assessed in sixteen teams with the Youth Flexile ACT model fidelity scale (2014 version). Mental health workers completed a ‘content of care questionnaire’ to map the interventions applied in the teams. Model fidelity scores revealed that twelve teams adhered to the Youth Flexible ACT standard with ‘optimal implementation’ (≥ 4.1 on a 5 point scale) and four teams with ‘adequate implementation’. Most disciplines were well integrated within the teams; however, several items regarding the involvement of specific disciplines and the availability of treatment interventions (peer support worker, employment and education specialist and programs, family interventions, integrated dual disorder treatment) scored below the optimum. Frequency of contact during ACT and the use of Routine Outcome Monitoring instruments scored below the optimum as well. The ‘content of care’ data showed that most clients received an individual psychological intervention, and nearly half of the client sample received scaled-up / intensified ACT care. The findings indicate a predominantly successful translation of care from the theoretical Flexible ACT framework into practice, covering both ACT and non-ACT functions. Further room for improvement lies in the incorporation of specialized disciplines in the personal and social recovery domains, including the peer support worker and employment and education specialist, as well as in specific protocolled interventions.

Legal Needs Arising in Mental Health Settings and Staff Capability and Support to Respond.

Legal issues are known to affect and be affected by mental health. But to what extent do legal issues surface in mental health settings and what do staff feel they need to support clients experiencing these issues? These questions were explored by a national mental health service interested in the potential for health justice partnership with local community based legal services. A survey of 999 frontline staff of a national mental health organisation. 146 staff (15%) responded from 70 service sites across Australia, including peer support workers (47%), support workers (20%), team leaders (17%) and clinicians (15%). Staff identified a wide range of legal issues experienced by their clients (commonly referred to by staff as consumers), most commonly credit, debt and social security issues, housing, family law and family violence. Two-thirds (67%) of respondents indicated that they spent around 50% or more of their time 'responding to these types of issues'. Respondents indicated that they need more support to address legal issues facing their clients, particularly more knowledge of other services, connections with professionals in other organisations and connections with community. They also felt they could benefit from additional processes, tools, and resources, and time to manage their case load. While there is an emerging field of research exploring the legal capability of citizens, this study explores what mental health service staff feel they need to support consumers experiencing legal issues that can interact with mental health.

Maddening Post-Qualitative Inquiry: An Exercise in Collective (Mad) Theorising.

Both post-qualitative inquiry and Mad methodologies sit on the fringes of qualitative health research, although their potential for creating new knowledges and practices is increasingly recognised. In this article, we explore the possibilities created by bringing these approaches together within research led by, or centring, mental health service users and survivors. We outline and reflect on a workshop undertaken with peer support workers to map affective intensities within mental health assemblages. We suggest the tensions between post-qualitative and Mad research approaches hold potential for mental health research, and qualitative health research more broadly, bringing together theory and the experiences of service users/survivors to think-feel-become otherwise in relation to health care, peer support, and activism.

The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review

BackgroundPeer support for mental health is recommended across international policy guidance and provision. Our systematic umbrella review summarises evidence on the effectiveness, implementation, and experiences of paid peer support approaches for mental health.MethodsWe searched MEDLINE, EMBASE, PsycINFO, The Campbell Collaboration, and The Cochrane Database of Systematic Reviews (2012–2022) for reviews of paid peer support interventions for mental health. The AMSTAR2 assessed quality. Results were synthesised narratively, with implementation reported using the CFIR (Consolidated Framework for Implementation Research). The protocol was registered with PROSPERO (registration number: CRD42022362099).ResultsWe included 35 reviews (426 primary studies, n = 95–40,927 participants): systematic reviews with (n = 13) or without (n = 13) meta-analysis, or with qualitative synthesis (n = 3), scoping reviews (n = 6). Most reviews were low or critically low (97%) quality, one review was high quality. Effectiveness was investigated in 23 reviews. Results were mixed; there was some evidence from meta-analyses that peer support may improve depression symptoms (particularly perinatal depression), self-efficacy, and recovery. Factors promoting successful implementation, investigated in 9 reviews, included adequate training and supervision, a recovery-oriented workplace, strong leadership, and a supportive and trusting workplace culture with effective collaboration. Barriers included lack of time, resources and funding, and lack of recognised peer support worker (PSW) certification. Experiences of peer support were explored in 11 reviews, with 3 overarching themes: (i) what the PSW role can bring, including recovery and improved wellbeing for service users and PSWs; (ii) confusion over the PSW role, including role ambiguity and unclear boundaries; and (iii) organisational challenges and impact, including low pay, negative non-peer staff attitudes, and lack of support and training.ConclusionsPeer support may be effective at improving some clinical outcomes, self-efficacy, and recovery. Certain populations, e.g. perinatal populations, may especially benefit from peer support. Potential strategies to successfully implement PSWs include co-production, clearly defined PSW roles, a receptive hierarchical structure and staff, appropriate PSW and staff training with clinical and/or peer supervision alongside safeguarding. Services could benefit from clear, coproduced, setting specific implementation guidelines for PSW. PSW roles tend to be poorly defined and associations between PSW intervention content and impacts need further investigation. Future research should reflect the priorities of providers/service users involved in peer support.

Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries.

Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.

Diagnosis and management of tuberculosis infection in inclusion health populations in London

BackgroundTuberculosis in the UK is more prevalent in people with social risk factors– e.g. previous incarceration, homelessness - and in migrants from TB endemic countries. The management of TB infection is part of TB elimination strategies, but is challenging to provide to socially excluded groups and the evidence base for effective interventions is small.MethodsWe evaluated a TB infection screening and treatment programme provided by a peer-led service (Find&Treat) working in inclusion health settings (e.g. homeless hostels) in London. IGRA (interferon-gamma release assay) testing and TB infection treatment were offered to eligible adults using a community-based model. The primary outcome was successful progression through the cascade of care. We also evaluated socio-demographic characteristics associated with a positive IGRA.Results42/312 (13.5%) participants had a positive IGRA and no one had evidence of active TB. 35/42 completed a medical evaluation; 22 started treatment, and 17 completed treatment. Having a positive IGRA was associated with previous incarceration and being born outside of the UK.DiscussionProvision of TB infection diagnosis and management to this socially excluded population has several challenges including maintaining people in care and drug-drug interactions. Peer-support workers provided this service safely and effectively with appropriate support. Further work to generate data to inform risks and benefits of treatment for TB infection in this group is needed to facilitate joint decision making.

The Effects of Australia's First Residential Peer-Support Suicide Prevention and Recovery Centre (SPARC).

Aim: This paper reports preliminary evidence of the impacts of Australia's first residential peer-support service for people at risk of suicide. Methods: Psychological distress was measured preintervention, postintervention, and after 3 months and analyzed using paired t tests. Interviews were held postintervention and were analyzed using thematic analysis. Results: Psychological distress significantly improved from preintervention to postintervention (n = 16, d = 1.77) and at follow-up (n = 5, d = 1.12). Interviews (n = 10) indicated that participants experienced improvements in mental well-being and feelings of connectedness, respite, and confidence to engage with other services. The peer-support workers were key. Some participants felt that the location was too remote, too little information was given, and a longer stay would have been preferable. Limitations: The study did not include a control group, the sample was relatively small, and participants may have been subject to socially desirable answers. Conclusions: These findings indicate that residential peer-support services potentially offer a valuable alternative to conventional inpatient treatment for people at risk of suicide.

“We’re Not Miracle Workers”: An Examination of the Relationship Between Community Violence Intervention Workers and Their Participants

Community violence intervention (CVI) programs are civilian-led, locally oriented efforts that center around street intervention work, which involves proactive community engagement of individuals at high risk of violent victimization or perpetration. CVI professionals are peer support workers who use their experiential wisdom to mediate violent conflict and prevent victimization through engaging high-risk individuals in social services. The study comprehensively examines the relationship between CVI workers, their clients, and challenges associated with their outreach and engagement via qualitative interviews conducted among 35 CVI workers and their supervisors in Chicago. Thematic analyses identified the challenges experienced by the workforce as “work as mission,” “tethered healing,” “tethered harm,” and “falling back.” The results also lend support to firearm violence reduction potential of this professional field.

Perspectives of key informants before and after implementing UPSIDES peer support in mental health services: qualitative findings from an international multi-site study

BackgroundPeer support is an essential part of recovery-oriented care worldwide. Contextual factors have an impact on the implementation of peer support work. However, research has paid little attention to similarities and differences of implementation factors in settings varying by income-level and cultural values. The aim of this study is to assess the factors influencing the implementation of a peer support intervention across study sites in low-, middle- and high-income countries in line with the Consolidation Framework for Implementation Research (CFIR).Method6 focus groups with a total of 54 key informants with relevant contextual (organisational) knowledge regarding implementation facilitators and barriers were conducted at six study sites Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be’er Sheva (Israel), and Pune (India) before and 1.5 years after the start of UPSIDES peer support. Transcripts were analysed using qualitative content analysis.ResultsAcross study sites key informants reported benefits of peer support for service users and peer support workers as implementation facilitators. At study sites with lower resources, reduced workload for mental health workers and improved access to mental health services through peer support were perceived as implementation facilitators (CFIR Domain 1: Intervention characteristics). The degree of engagement of mental health workers (CFIR Domain 3: Inner Setting/Domain 4: Individuals involved) varied across study sites and was seen either as a barrier (low engagement) or a facilitator (high engagement). Across study sites, adequate training of peer support workers (CFIR Domain 5: Implementation process) was seen as animplementation facilitator, while COVID-19 as well as low resource availability were reported as implementation barriers (CFIR Domain 2: Outer setting).ConclusionsThis study highlights the importance of considering contextual factors when implementing peer support, including previous experience and perceived benefits. Particular attention should be given to organisational benefits such as workload reduction and the allocation of sufficient resources as key drivers in LMICs. In HICs, the potential of organisational benefits for successful implementation should be further investigated and promoted.

Integrating Peer Support Workers into Mental Health Programs

Objective: Canadian Mental Health Association - Calgary Region (CMHA Calgary) works to reduce the impact of mental illness and addiction in the community. This is actioned through mental health programming focused on education, prevention, and early intervention. The organization places high value on the inclusion of lived experience in mental health programming in the form of Peer Support (PS). CMHA Calgary’s five-year strategic plan included a goal to formally integrate Peer Support Workers (PSWs) into all established programs with thought and intention. Research Design and Methods: CMHA Calgary integrated peers into mental health programs using a collaborative and developmental approach. The project team developed an evaluation framework as a guide to collect feedback and understand the impact of the pilot initiative. Results: This approach allowed for real-time responses and data collection, which lead to rapid action to improve the approach before it was spread to other programs. The project allowed for the development of program materials for future application. Conclusions: This project provided CMHA Calgary with tangible, actionable information on how to integrate PSWs into all of their programs.

Exploring the Experiences of Compassion Fatigue Amongst Peer Support Workers in Homelessness Services

Peer support workers have lived experiences of the challenges their clients face. While research has shown peer work can benefit recovery, the negative consequences have not been clearly addressed. This study aimed to explore the experiences of compassion fatigue amongst peer support workers in homelessness services, and the coping strategies used. An explorative qualitative design was adopted. Six peer support workers, in homelessness services, were recruited via snowball sampling. Data was collected using semi-structured interviews and analysed using thematic analysis. Five themes were identified: relentless nature of working in homelessness services, change, making meaning of past experiences, organisational support, and personal coping strategies. There were two novel findings: (1) multiple clients recounting traumatic experiences, and (2) being unfairly blamed for lack of progress, exacerbating compassion fatigue. The findings of this study furthers limited research on compassion fatigue and can be used to develop protocols and practices for organisations that utilise peer support.

The Poetry of Recovery in Peer Support Workers with Mental Illness: An Interpretative Phenomenological Analysis.

This study was conducted to investigate and understand various aspects related to participants' experiences in peer support activities, with a particular focus on their personal growth and the influence of these activities on their lives. In this qualitative study, peer support workers with mental illness were the main subjects, and they were recruited from G Metropolitan City, South Korea. The study used purposive sampling, guided by recommendations from peer support worker support organizations. A total of five participants were selected using purposive sampling to ensure maximum variability in the sample. Data collection involved semi-structured individual interviews, and data analysis was conducted using the interpretative phenomenological analysis (IPA) method. Following the IPA procedure for data analysis, the study revealed six themes that encapsulated the recovery experiences of peer support workers with mental illness: (1) Facing confusion and challenges, (2) Rising and refining myself, (3) Navigating the paths of relationships, (4) Gazing at the desired horizons, (5) Awakening the inner hero, and (6) Standing as a person who cherishes life. This research underscores the positive impact of peer support activities on individuals who have faced mental health challenges. It emphasizes the significance of self-discovery, the development of supportive relationships, and the aspiration for a brighter future. These findings contribute to the expanding body of knowledge regarding the benefits of peer support in the context of mental health recovery.

Optimising Online Peer Support for People with Young Onset Dementia.

People with Young Onset Dementia (YOD) can be hesitant to engage with online peer support. This work aims to explore (1) why people are hesitant to engage in online peer support, (2) how to get more people involved in online peer support, and (3) what makes online peer support work well. Nine interviews with people with YOD were conducted on MS Teams. Participants were recruited through purposive sampling. Data were analysed thematically. Reasons for being hesitant to engage with online peer support include being unsure what to expect and concerns about seeing others in more advanced stages of dementia. Additionally, it can be difficult to identify groups that suit one's needs and interests. Group facilitators of online peer support groups should provide a detailed description of their group so that people can better assess whether the group would suit them. The insights obtained from this study will be used to develop a Best Practice Guidance on online peer support for people with YOD. Moreover, the findings can be useful for further research exploring how to support people with dementia in general in accessing online health and social care services.

Recovery-oriented treatment and peer support in psychiatry

The concept of recovery in the care of mentally ill individuals is now firmly established both nationally and internationally. While clinical recovery focuses on ameasurable ultimate goal based on the expression of symptoms with the intention of returning individuals to apremorbid state, personal recovery implies aprocess of personal development. The three key pillars are salutogenesis, resilience and empowerment. Collaborating with peer support workers is essential for the authentic expansion of therapy offers in line with the principles of recovery. These individuals have their own experiences with psychiatric care, which they utilize to support individuals in their unique recovery journey. The implementation process of recovery-oriented services presents arange of challenges and requires openness and areorientation on the part of professional treatment teams.

The Patient Perspective of an Inpatient Addiction Medicine Unit Implemented in an Urban Northern Acute Care Hospital in Ontario, Canada.

An Addiction Medicine Unit (AMU) represents a promising approach to enhancing hospital care for individuals who use substances, but there is limited research to understand patients' perspectives on AMUs. Therefore, the study objectives involved exploring patients' experiences with the AMU. Qualitative semi-structured interviews were conducted with 17 patients to gather their perspectives about the AMU. The AMU offers specialized inpatient addiction support, integrating medical and psychosocial interventions while facilitating connections to community supports to stabilize patients and manage addiction-related issues using a harm reduction philosophy. Factors identified by patients that lead to positive experiences with the AMU included: efficient access to high-quality acute medical care, specialized addiction care, and additional support for non-medical needs. Patients emphasized the benefits of having peer support workers on staff, the overall positive interactions with staff, and how different these experiences were from their hospital admissions outside of the AMU. Factors identified by patients that should be considered in an AMU included: the ease of access to substances, negative interactions with other patients, and self-stigma/internalized discrimination. Also, the patient perspective reflected varied views on harm reduction. Patients' perception of the impact of an AMU overall reflected that the AMU is an effective way to deliver comprehensive treatment, to address the needs of PWUS, both medical and substance-use-related issues. They identified that the unit's intentional harm reduction philosophy facilitated access to care and positive patient-staff interactions, emphasizing the unit's progress in reducing fear and judgment and rebuilding trust in the healthcare system. The introduction of a new AMU in a Northern urban acute care hospital in Ontario has yielded positive patient experiences. The AMU model shows potential to re-establish trust between patients and providers, but ongoing efforts are needed to address underlying stigma to be more effective.

The Living Well, Living Longer program: an integrated care strategy to improve the health of people living with severe mental illness.

Living Well, Living Longer (The Program) is an integrated care strategy to improve the physical health of people living with severe mental illness within a public mental health service. The significant life expectancy gap experienced by this cohort is largely attributed to higher rates of cardiovascular disease and modifiable risk factors. The Program addresses this by guiding people through the four stages of screening, detection, treatment initiation, and ongoing management of coexisting chronic health conditions. The Program adopted an integrated care approach to ensure the provision of appropriate and coordinated care across hospital and primary care services. Key care pathways include a cardiometabolic health assessment clinic, shared care with general practitioners, oral health services partnership and employment of peer support workers, dietitians, exercise physiologists, and smoking cessation to provide targeted community support and interventions. There has been strong engagement with the care pathways introduced since The Program's inception in 2013 and evaluation is currently underway to consider the impact on cardiometabolic health outcomes for participants. Critical to The Program's effectiveness has been engagement with lived experience expertise, multidisciplinary collaboration, and strong executive support. However, significant challenges persist amid an Australian public health crisis characterised by reducing rates of free primary healthcare access for people living with severe mental illness and enduring communication challenges between primary and secondary health services. With the implementation of MyMedicare and the imminent Single Digital Patient Record across NSW Health, we stand at a critical juncture. It is imperative to establish robust systems to enhance care for this vulnerable population.

Partnering with People with Lived/Living Experience of Mental Health and substance Use in Participatory Evaluation of an integrated virtual navigation support service for people experiencing substance use challenges.

Introduction/Background: This presentation shares how the Mid-West Toronto-Ontario Health Team (MWT-OHT) in Toronto, Canada involved patients and partners in the design, implementation, and evaluation of the “In Your Corner Program” to support people with substance use challenges. The experience of embedding the voices of people with living/lived experience in co-designing and evaluating the program will be shared.
 Who is it for? The “In Your Corner” program represents the actualization of key recommendations from people with lived/living experience with substance use challenges in MWT-OHT that identified a need for service navigation supports that helps to close transition gaps. The ‘In Your Corner’ program necessitated the MWT-OHT to take a collaborative, team, and consensus-based approach to coordinating services across the region, re-designing care pathways that better meet the needs of a dynamic and diverse population within the constraints of existing resources and structures.
 Who did you involve & engage with? The MWT-OHT brings together partners across health and social sectors in the mid-west downtown region of Toronto Canada to work together for better, more integrated care. In 2019, MWT-OHT completed co-design work with people with living/lived experiences of substance use and mental health focused on improving the care experience and outcomes for people with challenges related to substance use. The In Your Corner program was implemented in 2021 through a 5-month implementation funding and extended for an additional 4 months through in-kind support from implementation partners. During this time, a participatory evaluation approach was employed with partners as well as clients and providers of the program to inform next steps, scale, and sustainability.
 What results did you get? What impact did you have? Initial implementation findings of the program demonstrated that the model of care capitalizes on existing programs and was able to create a more robust scaffolding for integrated care for the clients served by the program. The opportunity to embed Peer support workers into the model was highlighted along with the need for follow-up supports over a longer period. The program was a first step toward working together with people with living and lived experiences from design to evaluation from a partnered approach that is hoped to be embedded in how the MWT-OHT approaches all initiatives.
 What is the learning for the international audience? The learnings from this program demonstrates the processes and supports needed to meaningfully embed the voices of patients and providers from design phase through implementation, evaluation, and scale at various points in the journey from a systems perspective. Considerations for scale are important, as well as minimizing and preventing tokenism and supporting true partnering.
 What are the next steps? Next steps identified from the co-design evaluation sessions with clients and providers of the In Your Corner Program have informed how to leverage, change, and scale the program to reach more people in the region with substance use challenges. More importantly, this process has become a blueprint for the MWT-OHT in how to embed the voices of patients, families, and caregivers in the designing and evaluating initiatives.

Implementing peer support work in mental health care in Germany: The methodological framework of the collaborative, participatory, mixed-methods study (ImpPeer-Psy5).

Starting in the 1990s in the United States, individuals with lived experience of mental health crises and recovery have been employed as peer support workers (PSWs) internationally. However, the implementation of PSW in clinical contexts remains challenging. This manuscript presents and discusses the methodological framework of the ImpPeer-Psy5 study on the PSWimplementation in the German mental healthcare sector. This study used a mixed-methods and collaborative research approach, as well as participatory research strategies. After describing the study design, populations, teamworkand assessments, the epistemic challenges of its methodological framework will be critically discussedand how it has iteratively shaped the object of study. The healthcare, policyand funding context of PSW implementation as well as the study's methodological framework have differently influenced the ways in which the implementation of PSW has been conceived in this study. The choice of a collaborative or participatory methodological framework is advised to better align research questions and procedures to the specific needs and challenges of PSWs and other stakeholders concerned with PSW implementation. The research team of the ImpPeer-Psy5 study was collaboratively staffed by a portion of researchers who also identify as users or survivors of psychiatric services. A nonprofit organization for the training of PSWs served as a practice partner throughout the research process. Different participatory formats involve a significant number of diverse stakeholders relevant to PSW implementation.

Peer Support Work in Hospital: A First Person and Lived Experience Guide.

Abstract This article is a first- person and lived experience account on providing peer support in a mental health unit. The intertwining of process (a lived experience and first-person account by someone with schizophrenia) and subject (the therapeutic value of peer support) leads to greater knowledge and insight into peer support for people with mental health problems in an inpatient environment. It focuses on the meaning, value, processes, emotions, themes and outcomes of Peer Support Work. Ben has a diagnosis of schizophrenia and psychosis. Matt has lived experience as a peer support worker/ supervisor and team leader. This article is drawn from a co-produced and lived experience evaluation conducted by the Peer Support Workers (PSWs) as a Lived Experience Evaluation Team (LEET). The article finishes by highlighting barriers to peer support in psychiatric hospital and so provides a guide to challenges for prospective and current PSWs. It should be noted that this first-person account and lived experience article expresses the perspective of the first author (Ben). It does not necessarily reflect the views of the co-author (Matt), the Peer Support Team or the NHS Trust.