Peer Support Workers Research Articles

Work-Life Boundary Management of Peer Support Workers when Engaging in Virtual Mental Health Support

Work-Life Boundary Management of Peer Support Workers when Engaging in Virtual Mental Health Support

Employment interventions to assist people who experience borderline personality disorder: A scoping review.

Employment is an important social determinant of health and is associated with positive health outcomes. However, individuals who have been diagnosed with borderline personality disorder (BPD) are significantly underrepresented in the workforce. Whilst there is an array of evidence based therapeutic interventions, there remains a gap in knowledge regarding the most effective ways to enhance employment outcomes for people with a diagnosis of BPD. To explore employment interventions for people with BPD, map the available evidence and identify key concepts and knowledge gaps. A scoping review was conducted to identify and map the relevant literature. Findings were summarised using a narrative approach. Consultation was provided by a reference group including peer support workers with lived experience of BPD and mental health clinicians. Seven articles met the inclusion criteria, including non-randomised and case study/series designs and a randomised controlled trial protocol, with participant numbers generally low. All programmes combined a psychotherapeutic component with work related goals; however, there were notable differences in relation to the conceptual/theoretical approach of the psychotherapeutic component and delivery of the work-related components. Barriers and enablers to programme participation and success are explored. This review provides important insights into the characteristics of vocational rehabilitation interventions for people diagnosed with BPD. The findings will inform the co-production of approaches to support people with BPD to engage in employment.

The Impact of an Expressive Writing and Storytelling Program on Ex-Offenders: A Pilot Study.

While storytelling or expressive writing has been studied in prisoners, little is known about the impact of these art interventions on ex-offenders. This study aims to evaluate a 6-week expressive writing and storytelling program in a group of nine ex-offenders who attend a peer support group. Quantitative data, including psychological recovery, well-being, hope, social support, and loneliness, was collected at baseline and post-program. Individual interviews were conducted at post-program. Results revealed a significant increase in participants' psychological recovery as measured by the Recovery Assessment Scale-revised at post-program with an effect size of 0.56. Three themes about participation in the program emerged: safe space for processing and expressing inner feelings, relating to and connecting with peers, and adjusting the way of thinking. Findings showed this program has the potential to improve ex-offenders' psychological recovery, and provide them with skills to desist from crime and be better serve as peer support workers.

Understanding the use of peers for mental health care: A meta-synthesis of qualitative evidence

Objective: We aim to synthesize evidence of facilitators and barriers pertaining to implementation of peer led interventions for mental health. Methods: In November 2017, we conducted an electronic search of two academic databases: Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed. A comprehensive search strategy comprising of search terms including ‘peer’, ‘volunteer’, ‘Mental Health’, and ‘Qualitative Study’ was utilized to search these databases. Results: A total of six studies were included in this review. We have identified 22 first order constructs in the selected studies. These are all responses of the respondents in each individual study. Key constructs are recruitment and training, supervision, role of Peer Support Workers (PSWs), motivation, challenges and barriers. Second order constructs are researchers’ interpretations of included studies. Conclusions: We identified 26 second order constructs. These constructs are very similar to first order constructs and grouped under similar themes that were used for first order constructs. Additional constructs included insufficient training, uniformity of training, terms and conditions for PSWs.

Predictors of resilience for people with spinal cord injury over two periods of COVID-19 social distancing restrictions: a 12-month longitudinal study using structural equation modelling

BackgroundThe novel coronavirus (COVID-19) pandemic is disproportionately impacting the health of people with disability. Resilience has remained an important health promoting characteristic during periods of social distancing restrictions. Factors promoting resilience for people with disability under the context of the pandemic remains poorly understood. Studies have yet to investigate evidence-based factors that promote resilience over multiple periods of restrictions for people with disability.MethodsA longitudinal study developed via a collaborative partnership between peer-support workers with lived experience of spinal cord injury (SCI) and university researchers was undertaken to fill knowledge gaps around factors promoting resilience for people with SCI during two periods of stringent social distancing restrictions within Victoria, Australia. Over 12-months, participants with SCI completed two surveys, towards the end of two lockdown periods. Evidence-based factors associated with resilience were measured. The Impact on Participation and Autonomy Questionnaire, the International SCI Quality of Life scale, and the 10-item Conor Davidson Resilience Scale, respectively measured autonomy and participation limitations, life satisfaction and psychological health, and resilience. A structural equation modelling (SEM) approach established factors directly and indirectly associated with resilience.ResultsA model with excellent fit was produced. During two extended lockdowns over the 12-month period, increased family role limitations and favourable psychological health were respectively, negatively (Lockdown 1 [n = 127]: β = -.251, p < .01, Lockdown 2: β = -.400, p < .01) and positively (Lockdown 1: β = .601, p < .01, Lockdown 2 [n = 65]: β = .430, p < .01) associated with resilience. Indirect negative associations between resilience and increased outdoor autonomy limitations (Lockdown 1: β = -.195, p < .01, Lockdown 2: β = -.255, p < .01) and social life limitations (Lockdown 1: β = -.217, p < .01, Lockdown 2: β = -.142, p < .05) existed, and these relationships were moderated by psychological health.ConclusionsPsychological health, and participation and autonomy are determinants of resilience during periods of crisis. Health and social care providers and public health departments should prioritise programs promoting these domains, to counter the negative impact of social distancing.

Recovery-oriented nursing service for people with schizophrenia in the community: An integrative review.

The recovery-oriented service concept has been recognized for its impact on mental health practices and services. As the largest group of mental healthcare providers, mental health nurses are well-positioned to deliver recovery-oriented services but face challenges due to role ambiguity and identity issues. Therefore, clarifying the role and principles of mental health nursing is essential. This study aimed to identify essential nursing practices for individuals with schizophrenia in recovery-oriented mental health services. The study utilized a five-step integrative review approach, including problem identification, literature search definition, critical analysis of methodological quality, data analysis, and data presentation. Multiple databases, such as ScienceDirect and Scopus, as well as online libraries and journals/publishers, including Sage journals, APA PsyNet, SpringerLink, PsychiatryOnline, Taylor & Francis Online, and Wiley Online Library, were searched. The search spanned from the inception of the recovery-oriented services concept in 1993 to 2022. Content and thematic analysis were employed to analyze and synthesize the findings from the included studies. Twenty-four articles met the inclusion criteria. Two themes were identified: 1) Direct nursing care, consisting of six sub-themes: therapeutic nurse-patient relationship (TNPR), psychoeducation (PE), coping skill training (CST), cognitive behavioral techniques (CBT), interventions to improve medication adherence (IMA), and social functioning (SF); and 2) Indirect nursing care. This study highlights the crucial role of nursing and nursing practices in recovery-oriented services. Mental health nurses prioritize person-centered care, therapeutic relationships, and collaboration with peer support workers to enhance treatment effectiveness. In addition, they focus on improving medication adherence, providing coping support, and promoting social capabilities, ultimately improving individuals' quality of life. Aligning actions with recovery-oriented principles, mental health nurses emphasize empowerment and holistic care. Further research in this area will enhance the healthcare system and better support individuals on their recovery journey.

Improving Collaboration Between Youth Peer Support Workers and Non-peer Colleagues in Child and Adolescent Mental Health Services

The involvement of youth peer workers (YPSWs) in child and adolescent mental health services (CAMHS) stimulates hope, destigmatization, and more culturally and developmentally appropriate support. Nevertheless, the collaboration between YPSWs and non-peer colleagues remains challenging, as it requires services to embed a new type of expert into practice. To stimulate the involvement of YPSWs in practice, this study reports on 27 semi-structured interviews with YPSWs and non-peer colleagues to provide insight into the barriers and facilitators in the collaboration process. The study took place in the Netherlands. A total of 10 interviews with YPSWs, and 17 interviews with non-peer colleagues in different healthcare occupations in CAMHS were conducted. Overall, the participants perceived relatively more barriers compared to facilitators in the collaboration process. Barriers to operate efficiently with YPSWs in multidisciplinary teams included: condescending attitudes and professional stigma towards YPSWs; concerns for YPSW boundaries; bureaucratic and clinical language usage by non-peer colleagues; conflicts due to different sets of expertise; and, lack of role clarity and guidelines for YPSWs. To improve the partnership between YPSWs and non-peer colleagues, participants described the importance of supervision and monitoring of YPSW activities. Moreover, participants also stressed the need for clear guidelines, and introduction and evaluation sessions to facilitate the collaboration process. While YPSWs seem to be an asset to CAMHS, there are a number of barriers to overcome. To overcome these barriers, organizational commitment, supervision (especially from peer colleagues), flexibility by non-peer colleagues, training non-peer staff to support YPSWs, and consistent evaluation of the implementation of YPSWs in services is recommended.

Cost-effectiveness of peer-supported self-management for people discharged from a mental health crisis team: methodological challenges and recommendations.

Mental health acute crisis episodes are associated with high inpatient costs. Self-management interventions may reduce readmission by enabling individuals to manage their condition. Delivery of such interventions by Peer Support Workers (PSWs) may be cost-effective. CORE, a randomized control trial of a PSW self-management intervention compared to usual care, found a significant reduction in admissions to acute mental healthcare for participants receiving the intervention. This paper aims to evaluate the cost-effectiveness of the intervention over 12 months from a mental health service perspective. Analysis methods of increasing complexity were used to account for data missingness and distribution. Participants were recruited from six crisis resolution teams in England from 12 March 2014 to 3 July 2015 (trial registration ISRCTN: 01027104). Resource use was collected from patient records at baseline and 12 months. The EQ-5D-3L was collected at baseline and 4 and 18 months, and linear interpolation was used to calculate 12-month values for quality-adjusted life-years (QALYs). The primary analysis of adjusted mean incremental costs and QALYs for complete cases are calculated separately using OLS regression. Secondly, a complete-case non-parametric two-stage bootstrap (TSB) was performed. The impacts of missing data and skewed cost data were explored using multiple imputation using chained equations and general linear models, respectively. Four hundred and forty-one participants were recruited to CORE; 221 randomized to the PSW intervention and 220 to usual care plus workbook. The probability that the PSW intervention was cost-effective compared with the workbook plus usual care control at 12 months varied with the method used, and ranged from 57% to 96% at a cost-effectiveness threshold of £20,000 per QALY gained. There was a minimum 57% chance that the intervention was cost-effective compared to the control using 12-month costs and QALYs. The probability varied by 40% when methods were employed to account for the relationship between costs and QALYs, but which restricted the sample to those who provided both complete cost and utility data. Caution should therefore be applied when selecting methods for the evaluation of healthcare interventions that aim to increase precision but may introduce bias if missing data are heavily unbalanced between costs and outcomes.

THU-203 - Utilising peer support workers in hepatitis C screening in emergency departments: a pilot study

THU-203 - Utilising peer support workers in hepatitis C screening in emergency departments: a pilot study

‘You Just Treat me like a Human Being’: Using Lived Experience to (Re)imagine Boundary Practices in mental health settings

Abstract The personal/professional dichotomy, present within dominant notions of professional boundaries, is an ongoing source of tension within social work. Peer workers, given their positioning as both service users and workers, are uniquely placed to contribute to pre-existing efforts in unsettling this dichotomy. Our analysis, informed by dialogic sharing and theorising with fifteen peer support workers, alongside post-humanist and critical mental health approaches, considers the oppressive effects of enacting a personal/professional dichotomy within mental health settings, and conversely, the emancipatory potential of unsettling the dichotomy. Rather than conceptualising such events as boundary ‘crossings’, ‘incursions’ or ‘transgressions’, we suggest (re)imagining professional boundaries as multiple, enacted through ever-shifting socio-material relations. Our analysis supports pre-existing calls for a relational ethic of social work and highlights how lived experience and post-humanism can support the discipline’s commitment to anti-oppressive practices. We recommend further research, informed by lived experience, to explore the complex relations that constitute boundary practices and their effects for both social workers and service users.

Polysubstance use and lived experience: new insights into what is needed.

During the current overdose crisis in the United States and Canada, both polysubstance use and interventions involving people with lived experience of substance use disorder have grown. This review investigates the intersection of these topics to recommend best practices. We identified four themes from the recent literature. These are ambivalence about the term lived experience and the practice of using private disclosure to gain rapport or credibility; efficacy of peer participation; promoting equitable participation by fairly compensating staff hired for their lived experience; challenges unique to the current polysubstance-dominated era of the overdose crisis. People with lived experience make important contributions to research and treatment, especially given the additional challenges that polysubstance use creates above and beyond single substance use disorder. The same lived experience that can make someone an excellent peer support worker also often comes with both trauma related to working with people struggling with substance use and lack of opportunities for career advancement. Policy priorities for clinicians, researchers and organizations should include steps to foster equitable participation, such as recognizing expertise by experience with fair compensation; offering career advancement opportunities; and promoting self-determination in how people describe themselves.

The Marri Gudjaga project: a study protocol for a randomised control trial using Aboriginal peer support workers to promote breastfeeding of Aboriginal babies

BackgroundBreastfeeding protects against a range of conditions in the infant, including sudden infant death syndrome (SIDS), diarrhoea, respiratory infections and middle ear infections [1, 2]. The World Health Organization (WHO) recommends exclusive breastfeeding until six months of age, with continued breastfeeding recommended for at least two years and other complementary nutritious foods [3]. The 2017-18 National Health Survey (NHS) and 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) reported that the proportion of breastfeeding in Aboriginal and Torres Strait Islander infants (0–2 years) were less than half that of non-Indigenous infants (21.2% vs. 45%, respectively)[4]. There is a lack of research on interventions supporting Aboriginal women to breastfeed, identifying an evaluation gap related to peer support interventions to encourage exclusive breastfeeding in Aboriginal women.MethodsWe will evaluate the effect of scheduled breastfeeding peer support for and by Aboriginal women, on breastfeeding initiation and the prevalence of exclusive breastfeeding. This MRFF (Medical Research Future Fund) funded project is designed as a single-blinded cluster randomised controlled trial recruiting six sites across New South Wales, Australia, with three sites being randomised to employ a peer support worker or undertaking standard care. Forty pregnant women will be recruited each year from each of the six sites and will be surveyed during pregnancy, at six weeks, four and six months postnatally with a single text message at 12 months to ascertain breastfeeding rates. In-depth interviews via an Indigenous style of conversation and storytelling called ‘Yarning’ will be completed at pre- and post-intervention with five randomly recruited community members and five health professionals at each site” [5]. Yarns will be audio recorded, transcribed, coded and thematic analysis undertaken. Health economic analysis will be completed to assess the health system incremental cost and effects of the breastfeeding intervention relative to usual care.DiscussionEvidence will be given on the effectiveness of Aboriginal peer support workers to promote the initiation and continuation of breastfeeding of Aboriginal babies. The findings of this study will provide evidence of effectiveness and cost-effectiveness of including peer support workers in postnatal care to promote breastfeeding practices.Trial RegistrationACTRN12622001208796 The impact of breastfeeding peer support on nutrition of Aboriginal infants

Mainstream Integration of Mental Health Peer Support in Canada: A Mixed Method Study

Mental health peer support was one of the key recommendations of the Mental Health Commission of Canada’s Workforce Advisory Committee (Cyr et al., 2016 [2012]) and highlighted as one way to transform the mental health system in Canada. This mixed methods study explored the work experiences of mental health peer support workers across Canada and their perceptions of integration within mainstream mental health services. The findings revealed that role confusion, stigma, lack of support to practice authentically and peer drift challenged the full integration and participation of peer support workers within Canada’s mental health system. Recommendations to mitigate these challenges are suggested.

Development of a Community-Based Training for Peer Support Workers in Youth Mental Health Settings: An Exploratory Pilot Study

Integrating peer support workers (PSWs) into mental health community programs for young people has the potential to increase their access to mental health services. However, very little research has focused on the development of training that is relevant for and readily accessible to youth and employees seeking to acquire a general overview of peer support fundamentals as applicable to youth mental health in community settings. This pilot study aimed to document the implementation fidelity of a newly developed youth mental health peer support training and its impacts on participants’ understanding and perceived ability to provide peer support in community-based youth mental health settings. A multiple-informant approach was used to develop the training which is mapped onto the existing theoretical framework for peer support (Mead, Hilton, &amp; Curtis, 2001). A descriptive quantitative and qualitative research design was used and data were collected using self-reported measures. Five participants completed the 16-hour training, which was offered online through videoconferencing. Results showed that, overall, components of the training were implemented with a high level of fidelity to the theoretical framework. Furthermore, participants reported that the training has had a positive impact on their level of preparedness and ability to provide peer support. Despite the limited sample size, this study suggests that the training developed has practical value as an introductory training tool for youth mental health PSWs. Moreover, this study is the first to provide evidence that the theoretical framework selected is relevant to inform such training.&#x0D; L’intégration de pairs aidants dans les programmes communautaires de santé mentale jeunesse a le potentiel d’accroître l’accès des jeunes aux services de santé mentale. Toutefois, très peu d’études se sont penchées sur le développement de formations adaptées et facilement accessibles aux jeunes et employé·e·s souhaitant acquérir une vue d’ensemble des principes fondamentaux du soutien par les pairs applicables en santé mentale jeunesse en milieu communautaire. Cette étude pilote visait à documenter la fidélité d’implantation d’une formation pour pairs aidants travaillant en santé mentale communautaire jeunesse et ses impacts sur la compréhension et la capacité perçue des participant·e·s à fournir un soutien par les pairs. Cette formation a été développée selon une approche multi-informateurs en s’appuyant sur le cadre théorique de la pair-aidance de Mead, Hilton et Curtis (2001). Une méthodologie descriptive quantitative et qualitative a été utilisée avec collecte des données par questionnaires autoadministrés. Cinq personnes ayant complété la formation sur deux jours, par vidéoconférence, ont pris part à l’étude. Les résultats montrent que les éléments de la formation ont été mis en œuvre avec un niveau élevé de fidélité relativement au modèle théorique. Les participantes mentionnent que la formation leur a permis de se sentir prêtes et capables d’offrir du soutien comme pairs aidants. Malgré le nombre limité de participants, cette étude suggère que la formation développée possède une valeur pratique pour la formation initiale des pairs aidants en santé mentale jeunesse. Elle révèle également que le cadre théorique utilisé est pertinent pour la formation de ces intervenants.&#x0D;

Who am I? The identity crisis of mental health professionals living with mental illness.

WHAT IS KNOWN ON THE SUBJECT?: Large numbers of mental health professionals live with their own mental health challenges. Despite working in mental health care, they can experience stigma in the workplace. Mental health professionals with lived experience of mental illness can find it a challenge to integrate their identities as both mental health professional and mental health service user. There are currently limited options available to them. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is a personal reflection from a mental health nurse and lecturer, who lives with a severe and enduring mental illness. It offers a lived experience account of the identity struggles of a mental health professional living with a mental illness. This article attempts to redefine the identity of professionals with personal lived experience in a more positive manner. They can be valued and celebrated for their unique perspective on mental illness and mental health care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There remains a stigma attached to people living with mental health conditions. This article challenges some of this stigma. It will empower and encourage other health professionals with lived experience to embrace all aspects of their identity with authenticity and courage. ABSTRACT: There are growing numbers of mental health professionals with their own lived experience of mental illness. This is both in part due to increased visibility and openness, and students embarking on professional courses motivated by their own personal mental health history. The somewhat limited research in this area highlights the difficulty practitioners have in navigating this distinct identity. There are limited options, including a wounded healer, an impaired professional and professional survivor. All have their limitations. We need to revise the conceptualisation of mental health professionals with personal lived experience of mental illness. Our identity needs to be celebrated and valued, as are the roles of peer support worker and expert by experience. Through personal reflection, I describe my own challenges in negotiating my identity as a mental health nurse, lecturer, and service user. My solution is to embrace authenticity and havethe courage to stand in vulnerability and strength, embracing all aspects of myself. I call for others to do the same.

Using Behavioral Skills Training to Teach Peer Support Workers to Respond to Ethical Scenarios

ABSTRACT Peer support workers are people living with a mental illness and/or substance use disorder who use their lived experience and training to support people in recovery. Setting boundaries when faced with an ethical scenario is an important skill that peer support workers must acquire. This report from the field examined the effects of group-based behavioral skills training (BST) to teach peer support workers to set boundaries by restating their needs, saying they cannot engage in the requested behavior, and redirecting them to an appropriate resource or response. Four of five participants met the mastery criterion after BST plus supplemental experimenter feedback. Moreover, participants found the training acceptable. These results suggest BST may be useful to teach ethical skills to peer support workers within the context of a public health workforce development program.

“Understanding the journey from A to Z”: centering peer support perspectives to unveil the mechanisms and power of peer support

Purpose This study aims to gain insights from peer support workers (PSWs) on the unseen mechanisms of peer support work that may be applied to implementing a child and youth mental health peer support program in a children’s hospital emergency department (ED). Design/methodology/approach This study used a critical realist perspective with a qualitative research design. Eight participants, all PSWs in health, community and social services working with adults, adolescents and children, were recruited from Alberta, Canada. Data were collected through in-person semi-structured interviews and analyzed using Braun and Clarke’s reflexive thematic analysis. Findings The results generated interrelated patterns of meaning among PSWs that were grouped into three main themes: inside out and outside in, no one leaves empty-handed and sculpting health system softness. Research limitations/implications All participants were trained by the same organization and may have similar understandings and approaches to the peer support role. Participants were predominantly of a similar demographic; thus, participants with minoritized identities may have challenges not represented. Practical implications Using nontraditional staffing models in an acute center may facilitate a shift to meet the chronic and complex issues of the 21st century. Social implications Youth peer support roles may reduce stigma by challenging stereotypes and myths, reduce social isolation and improve meaning, connection and belonging for individuals with mental illness who are often dislocated and disconnected from society. Originality/value This study exemplified the positive impacts peer support could make by improving child, youth and family experiences; reducing stigma; providing hope and help; and embedding the recovery model directly into the ED.

Mental Health Issues for Frontline Hospital Staff During Height of Covid Pandemic 2020

AbstractIntroductionWhen the SARS-Cov2 virus hit the New York and New Jersey metropolitan area in Spring 2020, hospitals and hospital workers were hit hard with a new unknown pathogen that either killed people or made them very ill. There were large numbers of severely ill patients that strained resources. Hospital workers had extraordinary stress with multiple additional patients, the need to use personal protective equipment (PPE) in short supply, and faced with a pathogen that had no treatments beyond care and support initially.MethodsWe surveyed our hospital workers in late Spring 2020 to identify the main stressors and find out what measures were helpful. An online anonymous survey included questionnaires about sleep, mood, outside stressors, helpful measures, and how they coped generally. All levels of hospital workers were surveyed. Resources were provided to all respondents.ResultsOver 240 individuals responded to the survey; most respondents were women (76%). ‘Workplace stressors’ topped the chart for 98 of our respondents. The worst workplace stressor that was cited was ‘irritable workforce,’ but ‘lack of ‘protocols’ and ‘shortage of PPE’ were also cited as stressors. ‘Other’ (not described) and ‘taking care of an ill relative’ were rated highly. Those who had ‘symptoms everyday:’ Anhedonia (loss of pleasure or interest), 13%; feeling down and hopeless, 12%; sleep disturbance, 41%; low energy, feeling tired, 29%; appetite disturbance, 26%; poor concentration and attention, 15%. Respondents told us what resources they used and what was most helpful; exercise was most frequently cited as helpful.Lessons Learned and DiscussionVarious resources for formal and informal mental health support were provided to all respondents at the time of survey. Our hospital mounted its own response with support services, as did our medical school and university. A "warm line" was available through the Department of Psychiatry from late March 2020; tip sheets and online groups were widely circulated; State Department of Health provided resources. There were formal peer support sessions and workers helped each other. Medical students provided child care, shopping, and transport. We learned that extra support for workers and more frequent rest and recharge time are important. A weekly "town hall" was instituted and a weekly update about the hospital and support in healthy activities are widely circulated to employees. Those with active PTSD (some were very disturbed by the number of deceased patients) were referred to professional providers. Hospitals need to be ready to deal with epidemics and pandemics more effectively in order to mitigate stress and support workers. Being prepared, not just with equipment, but with protocols in how to proceed should another pandemic come. We learned that listening to workers is important. Workers also need to know how valued they are.FundingDepartment of Psychiatry, New Jersey Medical School

Inclusion as Assimilation, Integration, or Co-optation? A Post-Structural Analysis of Inclusion as Produced Through Mental Health Research on Peer Support.

In the last 20years, research on the inclusion of peer support within mental health settings has burgeoned, paralleling the broad adoption of service user inclusion within policy as a moral imperative and universally beneficial. Despite the seemingly progressive impetus behind inclusion, increasingly peer support workers talk of exhaustion working within mental health systems, the slow rate of change to oppressive values and practices, and ongoing experiences of workplace exclusion. Such experiences suggest differences in the way in which inclusion is produced across different stakeholder groups and contexts. In this article, we adopt Bacchi's 'what's the problem represented to be?' approach to identify how mental health research, often understood as an a-political activity, produces versions of inclusion. We argue current research predominantly produces inclusion as 'assimilation' and 'integration'. We use critical inclusion, mental health, and survivor scholarship to evaluate the effects these productions have for peer support and peer support workers, finding that both problematise peer support workers and those seeking support. We consider possibilities for more liberatory productions of inclusion, building on the notion of inclusion as 'co-optation'. Our analysis points to the need for researchers to engage with an uncomfortable reflexivity to enable more emancipatory possibilities regarding inclusion and peer support.

Lessons from the Field

Background: The aim of this research was to explore the lived experience of a mental health peer worker; the thought processes and actions, and the way relationships are built in order to support those with mental health concerns. This article reflects the research journey of a Masters student discovering the skills that underpin her practice as a Peer Support Worker within mental health services of a rural community in Queensland, Australia. &#x0D; Methods: Reflexive writing, storytelling, focus group with key informants&#x0D; Results: Seven ‘Letter to Peers’ were written by the first author, reflexively analysed, and discussed during a focus group with key informants. It was discovered that the key themes from reflexive writing and focus groups are skills used by the peer workforce and their support of people on their mental health recovery journey. &#x0D; Conclusions: Peer workers are skilled in many areas that are used to support another on their recovery journey. These skills are acquired from their own journey of recovery, through life, and on reflection on the support given to others. Underpinning the peer practice are skills such as: relationship building, validation, self-care, trauma informed practice, implementation of boundaries, and self-education.&#x0D; Key words; Autoenthnography, Mental Health Peer Worker, Recovery Journey