[Models of peer support in psychiatric care]

[Everything can - nothing must? Peer support on acute psychiatric wards]

Peer support is recommended for improving acute psychiatric care, but research is lacking. This qualitative study examines the impact, particularly on coercive measures, through semi-structured interviews with four peers, four patients, and twelve (non-peer) staff members from two acute psychiatric wards. Analysis shows that peers experience unique opportunities and challenges in this context. Their effects include mediating between patients and the team, normalizing daily activities on the wards, promoting social interactions, fostering understanding and trust through shared experiences, as well as instilling hope and self-efficacy. Other staff members benefit from the exchange of patient information, task delegation, increased awareness of stigmatization, and promotion of a recovery-oriented mindset. While peers do not directly influence coercive measures, they contribute to de-escalation. Specific framework conditions are necessary.

[Effects of Peer Support Work in Psychiatry: A Systematic Literature Review of Reviews]

OBJECTIVE

The current systematic review summarizes reviews on effects of formalized peer support work in clinical psychiatric settings in order to obtain an up-to-date picture of the current state of evidence.

METHODS

Search in five electronic databases for relevant literature reviews regarding effects of peer support work in psychiatric settings. Database searches were complemented by a hand search.

RESULTS

16 reviews were found. They evaluate effects of peer support on clinical or psychosocial outcomes. No consistent effects are found for clinical outcomes. Small positive tendencies occur for psychosocial outcomes.

CONCLUSIONS

The authors of the reviews consistently mentioned the low quality of the primary studies. Therefore, the present results can rather be interpreted as a preliminary tendency. Further studies are necessary for evaluation of peer support in a more differentiated way.

[Occupational Stressors and Resources of Peer Workers in Social Psychiatry]

AIM OF THE STUDY

Peer Support Workers (PW) were asked about stressors and resources and how stressful or relieving they perceived them to be.

METHOD

Questionnaire-based survey RESULTS: 175 PW were included in the data analysis and identified stressors and resources in their daily work. Psychological security and autonomy are the most frequently mentioned resources, while role clarity is the least frequently mentioned. Autonomy can also be more of a burden than a resource, especially in combination with a lack of role clarity. PW rarely feel stigmatized by their colleagues. However, when they do, they find it very stressful. Relevant stressors were uncertainty about decisions made, problems with the team culture, or perceived inadequate role fulfillment by the team.

CONCLUSIONS

The lack of clarity about work processes and the roles of all participants is a significant stressor, despite the availability of relevant resources.

[Patient and public involvement at the German Center for Mental Health: achievements and challenges]

BACKGROUND

Patient and public involvement (PPI) describes the participation of patients and relatives, i.e., experts by experience (EE), in the research process. The PPI has not been widely adopted in the fields of medicine and clinical psychology in Germany and there is a notable absence of institutional support. The German Center for Mental Health (DZPG), which has been under construction since May 2023, aims to achieve nationwide and cross-center implementation of PPI, constituting one of its primary objectives. Participation of EE is to be implemented in the DZPG at all levels of decision-making.

OBJECTIVES

The article describes the origins, development and challenges associated with the implementation of participation structures and projects in the DZPG. The central political PPI committee in the DZPG, the Trilogue Center Council (TZR), developed a comprehensive PPI strategy for the DZPG in almost 3 years of work, before the beginning of the financial support of the DZPG. Among various measures, the strategy entails establishing a far-reaching representation for EE in all decision-making bodies of the DZPG, to involve EE as reviewers in evaluating research proposals, to integrate participatory elements into all studies of the DZGG and to foster user-initiated research endeavors. The implementation of the strategy is ensured by a cross-center PPI infrastructure, the Center for PPI, and scientific PPI consultants. The Center for PPI's tasks include supporting the voice of the EE and developing instruments and guidelines for participatory research, bringing together EE and researchers for joint DZPG projects as well as the documentation and quality assurance for participatory research. One of the particular challenges for the successful implementation of the PPI strategy is the limited experience with PPI in Germany in the field of mental health research and the widespread lack of structural implementation. Currently developed solution strategies include training for researchers and EE to communicate the benefits and pathways in the realization of PPI and thus enable shared decision-making and research. In addition, extensive access to knowledge and resources for EE will be created and uniform remuneration regulations for EE will be developed.

CONCLUSION

A PPI strategy at the DZPG has been successfully developed and is currently being implemented by the cross-center infrastructure Center for PPI.

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

BACKGROUND

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.

METHOD

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.

RESULTS

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.

DISCUSSION

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.

[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 a measurable ultimate goal based on the expression of symptoms with the intention of returning individuals to a premorbid state, personal recovery implies a process 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 a range of challenges and requires openness and a reorientation on the part of professional treatment teams.

[Peer Support: Utilization and Benefit in Severe Mental Illness - Results from an Observational, Cross-Sectional Study]

OBJECTIVE

Peer support is playing an increasing role in the treatment of severely mentally ill people. International findings are available on its effectiveness. However, little is known about knowledge, use and benefit assessment in Germany. This paper addresses this question and presents results from an observational study with 10 participating clinics in southern Germany.

METHODS

As part of the observational cross-sectional study with people with severe mental illness (IMPPETUS, N=359), sociodemographic and illness- and treatment-associated data were collected by trained study staff between March 2019 and September 2019. Binary logistic regression was used to analyse a possible association with peer support use.

RESULTS

38% (N=138) of respondents reported knowledge about the possibility of peer support; 15% (N=55) affirmed its use. Use of peer support varied across sites (between 6.5 and 37.5%) and was associated with household income. Significantly less frequent use of peer support was among those with high versus low household income (OR=0.20 [95% CI: 0.06-0.68], p=0.01). Of respondents with peer support use (N=55), 78% reported perceiving peer support to be helpful or highly helpful.

DISCUSSION

Peer support not only proves to be effective under study conditions with regard to various outcomes, but is also assessed as beneficial under routine conditions in a defined care region by the majority of users. However, only a few respondents knew and used the possibility of peer support.

CONCLUSION

In order to implement peer support more strongly, information about this kind of service should be provided more effectively and a dialogue about successful implementation experiences should be initiated on a regional level.

[Homelessness and mental illnesses]

Wohnungslosigkeit ist Ausdruck ausgeprägter sozialer Exklusionsphänomene und trifft besonders häufig Menschen mit seelischen Erkrankungen. Hierbei gehen die Erkrankungen meist der Wohnungslosigkeit vorweg, wobei einige seelische Störungen erst infolge der Wohnungslosigkeit auftreten. International wurde eine Vielzahl therapeutischer Unterstützungsformen für wohnungslose Menschen mit seelischen Erkrankungen evaluiert mit vorwiegend aufsuchenden Behandlungsstrategien. Dies wird häufig kombiniert mit niedrigschwelliger Zurverfügungstellung von Wohnraum. Hierbei zeigen sich gute Effekte auf die Zeit des Verbleibs in Wohnungen und auf die Verbesserung psychiatrischer Symptome, allerdings keine ausreichenden Effekte auf Substanzgebrauchsstörungen. Möglichkeiten zukünftiger Projekte liegen am ehesten im Einbezug ehemals Betroffener und in der Verwendung digitaler Medien.