The professional experiences of peer specialists in the Georgia Mental Health Consumer Network

Peer Perspectives on Challenges Encountered During a Multi-Site Digital Mental Health Intervention Project

Peers are individuals with lived experience of mental health challenges trained to provide support to others with similar challenges. Help@Hand was a multi-site project that integrated peers into digital mental health intervention (DMHI) implementation. This study uses the Consolidated Framework for Implementation Research (CFIR) to frame challenges reported by peers when implementing DMHIs. Individuals leading the local peer workforce completed quarterly online surveys about perceived challenges to DMHI implementation. Biannual interviews probed for details on survey-reported challenges. 103 quarterly surveys and 39 bi-annual interviews were collected from key informants at 11 Help@Hand sites between Summer 2020 and Fall 2022. One challenge was tied directly to DMHIs; namely, device distribution. Several related to the Implementation Process, including challenges with recruiting qualified peers and integrating peers into DMHI implementations; communication and collaboration; and translation. Challenges in the Individual domain included unclear peer roles and multi-tasking across various projects. Inner Setting challenges included structural barriers to hiring peers, issues with communication and project management, and workforce turnover. Outer Setting challenges related to environmental technology readiness, COVID-19, unclear decision-making processes across the collaborative, and uneven communication between sites' peers. Funding uncertainty bridged the Inner and Outer Settings. Using the CFIR model to frame challenges to DMHI implementation yielded useful lessons, especially when peers are engaged as partners in planning and implementation process. Successful implementation will be enhanced by ensuring adequate environmental readiness for tech-based interventions, clear role definition, streamlined peer hiring processes, and well-delineated lines of communication locally and across sites.

Changes in attitudes of mental health care staff surrounding the implementation of peer support work: A qualitative study

BACKGROUND

The integration of Peer Support Workers (PSWs) in mental health settings may encounter resistance due to the attitudes of Mental Health Workers (MHWs). At the same time, PSWs may initiate changes in the attitudes, as well as in the larger institutional culture. This paper addresses the question of which changes happen and how they occur.

METHODS

This work is part of the ImpPeer-Psy5 study, funded by the German Innovation Fund, which examines the nationwide implementation of PSWs in health insurance-funded mental health care. Data were derived from two qualitative sub-studies: QUAL1encompassed 57 problem-centered interviews conducted with PSWs, MHWs working together with PSWs, and service users; QUAL2 consisted of one focus group and five interviews only with MHWs. Qualitative data were analyzed using a modified thematic analysis adapted to a collaborative research approach.

RESULTS

The main findings included that working with PSWs makes MHWs better integrate lived experience insights into their caregiving, pay more attention to life contexts, advance towards a more appreciative language, use diagnostic categories more flexibly, and show more openness towards their own affectedness. These changes are reported to be mediated by the simple presence of PSWs, their "role model" function for other staff, or more direct forms of feedback and critique.

CONCLUSION

Overall, staff attitudes changed as a result of reflexive processes induced by their interactions with PSWs. This poses a dilemma as changes in MHWs and larger institutions are expected to occur prior to the implementation of peer support work to facilitate their integration. Further research is needed to evaluate whether and how staff training can facilitate the implementation of PSWs by targeting MHWs' attitudes.

Facing the paradox of professionalizing peer roles in MH services: how addressing self-disclosure with self-determination theory might help

Peer Support Workers (PSWs) play a crucial role in recovery-oriented mental health services. They offer support and hope by sharing their personal experiences and recovery journeys. However, transitioning from voluntary self-help roles to paid positions within statutory systems is not merely a technical shift. This change creates inherent tensions and conflicts, stemming from the integration of a peer model within a medical framework. I refer to the interface between these models as the "Professional-Peer Paradox" (PPP). At its heart, this paradox questions whether and how PSWs can integrate a role that relies on self-disclosure of shared lived experiences within a system rooted in professional knowledge norms delivered unidirectionally to service recipients. Using a whole organizational approach, I propose leveraging the autonomy-supportive environment concept from self-determination theory (SDT; Deci & Ryan, 2000) to promote self-disclosure in mental health services. I highlight the complexities involved in Peer Support Workers' (PSWs) use of self-disclosure (lived experience) within statutory mental health (MH) services. I suggest that PSWs can better commit to their unique roles by structuring multiple peer roles with varying levels of self-disclosure and creating a culture that fosters peer practice. Overall, applying a SDT systems' framework to the practice of self-disclosure can enhance the occupational identity of PSWs, establishing their unique position within the spectrum of mental health professions globally.

A Qualitative Exploration of Peer Supporters' Experiences of Undertaking a Co-Produced Mental Health and Emotional Well-Being Training Programme

INTRODUCTION

Peer supporters play a crucial role in mental health and support services, but their own mental health and emotional well-being are often neglected by themselves, and, frequently, their organisations. Here, we report findings from a qualitative interview study of peer supporters who completed a co-produced emotional well-being training programme.

METHOD

Ten semi-structured interviews with peer supporters working in the North East of England were conducted to explore their experiences of the training programme.

RESULTS

Thematic analysis of the data produced three overarching themes. In Theme 1, 'Increasing psychological preparedness and identifying self-care and coping strategies', we found that peer supporters improved their knowledge of how to manage sensitive topics such as aggression and suicide and felt more confident in their peer support roles resultantly. In Theme 2, 'It's good to know you're not alone', peer supporters discussed their experience of loneliness in their roles, and as a consequence realised their own need for peer support to help maintain their well-being. Theme 3, 'Toward the future: next steps', encapsulated peer supporters' willingness to continue their role development and to create a peer support network to continue to obtain mutual support.

CONCLUSION

Our findings emphasise the perceived emotional well-being benefits of a co-produced peer supporter training programme. Participants highlighted the need for co-produced training programmes that are (1) emotion-focussed, (2) provide access to other peer supporters and (3) provide future avenues for a peer supporter network of mutual support and professional development activities and training opportunities.

PATIENT OR PUBLIC CONTRIBUTION

Individuals with lived experience of mental ill health and peer support were consulted in the development of interview questions and provided feedback on the finalised themes to ensure the analysis and interpretations were congruent with their experiences.

A Model for Understanding Lived Expertise to Support Effective Recruitment of Peer Roles

Peer roles have increased within mental health and alcohol and other drug services. However, there is a lack of understanding about the 'lived experience' necessary for success in these roles and how to recruit effectively. This study explores participants' views on the essential knowledge and skills derived from lived experience to inform the design of peer roles and support effective recruitment. This qualitative study involved 132 participants employed across five multi-disciplinary organizations in the United States. Participants represent three cohorts: designated peer workers, management, and colleagues in other roles. Fourteen focus groups and eight individual interviews were conducted, with separate focus groups for peers, colleagues in non-designated roles, and management. Findings indicate essential aspects of lived experience comprise three domains: life-changing or life-shaping individual experiences (including intersectionality); common impacts of adverse experiences, identification as a peer, and understanding and application of the collective peer thinking and values; and ultimately, Lived Expertise, a unique, experientially developed knowledge base and set of skills that can benefit others. The study identifies Lived Expertise as a unique combination of individual and collectively derived experiential knowledge. Understanding what comprises Lived Expertise can guide the design of roles and improve recruitment strategies, thereby enhancing the effectiveness of roles and support for the peer workforce. This study offers a model for understanding Lived Expertise that can be readily applied in developing recruitment materials, including position descriptions.

["Change Agents" Or "Peer Washing": Can Peer Support Workers Contribute To The Transformation Of Psychiatric Institutions?]

OBJECTIVE

Peer support workers (=PSW) are expected to change the culture of a care facility. It is examined whether and how they can implement such a change mandate.

METHODS

The material is based on two sub-studies of the ImpPeer-Psy5 study, investigating the implementation of PSW in the German psychiatric care system. Data from 57 problem-centered interviews and two focus groups were analyzed using a thematic analysis.

RESULTS

PSW need courage, also as their impulses for change are often insufficiently received. This can lead to the reproduction of exclusion and to the PSWs' adaption to the attitudes of the teams.

CONCLUSIONS

To facilitate the implementation of the PSWs' change mandate, power relations and structural discrimination should be reflected, exchange spaces and a culture of critique should be established, and enough time be allowed for the implementation of PSW.

"Do I feel safe here?" Organisational climate and mental health peer worker experience

BACKGROUND

In Australia, lived experience peer support workforces are expanding making it one of the fastest growing emerging disciplines in transdisciplinary mental health settings. This article provides insight for organisations on the contextual realities peer workers face, increases understanding of peer support services to improve service delivery environments and contributes to mental health systems reform. This study aimed to qualitatively explore peer support workers experience integrating into and working within transdisciplinary mental health service teams.

METHOD

Semi-structured interviews were undertaken with 18 peer support workers currently working in mental health services in Australia. The research was a qualitative descriptive study design. All data collected were analysed utilising thematic analysis.

RESULTS

Peer workers found their experience in the workplace was influenced by their colleagues and the organisation's understanding of the peer role. Factors relating to organisational culture and climate were a central theme throughout discussions noting that a negative climate was perceived as harmful to peer workers. Themes established through results include (1) the role of leadership, (2) attitudes and behaviours of colleagues, (3) provision of psychologically safe environments, (4) the organisations messaging and use of language and (5) organisational structures and policy.

CONCLUSION

This study contributes to evidence for the impact of organisational culture on integrating and supporting peer support workers in mental health service delivery. This study provides insights into peer worker experiences integrating into transdisciplinary teams, confirming findings established in previous studies, highlighting a lack of movement or change in workplace culture to support peer worker integration into mental healthcare settings.

Organisational Actions for Improving Recognition, Integration and Acceptance of Peer Support as Identified by a Current Peer Workforce

Recovery-orientated practice is crucial to mental health care services-consistently identified in policy, service delivery guidelines and national mental health action plans. An essential component to systems reform and the adoption of recovery-orientated practice is the inclusion of peer support workers as practice leaders to support shifting culture in mental health service delivery. Designated peer support roles operate as healthcare professionals who utilise their lived and living experience of mental health difficulty to support those on their recovery journey through mutual understanding of shared experience. This research sought to explore the experiences of peer support workers integrating into mental health teams and identify organisational actions to facilitate successful recognition, integration and acceptance by colleagues; therefore, promoting sustainability of the peer support role. Qualitative interviews were undertaken with 18 peer support workers employed across four Australian states within 12 different government and non-government organisations. Study findings reveal three key areas for organisational change with seven main themes to assist organisations to better facilitate the successful integration of peer support workers into mental health service teams. These included robust induction, training for existing staff, clear referral pathways into the service, consistent supervision and debriefing, leadership support, professional development pathways and involving peer workers through change processes. These themes were grouped into three key areas for change including preparation, process and structural changes, and cultural change actions for sustainability. This article makes recommendations for organisations to consider when implementing peer support roles into mental health services.

A bridge to recovery: an interpretative phenomenological analysis with peer support specialists in Singapore

Recovery-oriented mental health care approach is gaining acceptance in Asian countries, including Singapore. Following Western countries, Singapore started hiring peer support specialists (PSS) as part of mental healthcare services. The aim of this paper was to explore and understand how individual peer support specialists in Singapore perceive and make sense of their role given their unique perspective as both recipients and providers of mental healthcare treatment. Six PSS in Singapore were interviewed utilizing a semi-structured interview schedule. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. Four superordinate themes were generated illustrating how PSS viewed their role: embracing and embodying recovery, balancing on a bridge, impossible without support, and helping to end stigma. Findings also illustrated participants' awareness of the nature of the job and the role of PSS as still in the infancy stage. They embraced a recovery-oriented mindset despite experiencing stigma from professionals and/or their social support. The need to understand familial attitudes towards the PSS role is discussed. The limitations, contributions to the research, and several areas for future research are also outlined.

Peer supporters' mental health and emotional wellbeing needs: Key factors and opportunities for co-produced training

INTRODUCTION

Peer supporters are a valuable asset to mental health and support services, but their own mental health needs are often overlooked in research and practice. This study explored peer supporters' perceived challenges of maintaining their mental health and emotional wellbeing and co-produced training needs.

METHODS

A qualitative approach was used to explore factors affecting peer supporters' mental health and emotional wellbeing. Semi-structured interviews and focus groups were conducted online with 11 peer supporters across North East England.

RESULTS

A thematic analysis identified: 'Lack of training and support', 'Role ambiguity' and 'Emotional labour' as challenges experienced by peer supporters in relation to maintaining their mental health and emotional wellbeing. Peer supporters' own lived experiences had the potential to act as a barrier towards providing support to others. Conflict with peer 'supportees' sometimes negatively impacted on the peer supporter experience. Participant responses emphasised a need for person-centred, co-produced training.

CONCLUSION

This work highlights the need for targeted training for peer supporters, including both role-specific education and strategies to support their mental health and emotional wellbeing.

PATIENT OR PUBLIC CONTRIBUTION

Participants were contacted and asked to provide feedback on finalised themes to ensure the analysis was congruent with their experiences, further enabling the future development of an emotional wellbeing training programme for peer supporters.

Lessons learned from employing Medicaid-funded peer recovery support specialists in residential substance use treatment settings: An exploratory analysis

INTRODUCTION

This article explores the experiences of peer recovery support specialists (PRSS) and their colleagues working in residential adult services (RAS) facilities in a rural state to better understand how the role has been implemented in this setting. In West Virginia, PRSS and RAS services have been covered by Medicaid since 2018 for the treatment of substance use disorder (SUD). Thus, the aim of this study is to uncover what has and has not worked well in the early years of service implementation from the perspectives of both PRSS and their colleagues working in the SUD field.

METHODS

The study interviewed forty-eight clinical and administrative staff at RAS facilities, including nine PRSS, across fourteen focus groups between 2020 and 2021. The study asked participants about general knowledge of West Virginia's 1115 Medicaid Waiver supporting the funding of PRSS, communication among providers, transitioning patients to other providers, scope of practice, barriers and facilitators to providing services, ethical challenges, and COVID-19. Data analysis utilized a phenomenological approach to describe individuals' unique experiences.

RESULTS

Three core themes emerged from the analysis: (i) Lived Experience as Added Value, (ii) Inadequate Funding for PRSS Position, and (iii) Role Difficulties. Participants described the lived experience of PRSS as both beneficial to the recovery journey of patients with SUD and unique in that only PRSS can provide the specific skillset that benefits these patients; these characteristics also helped facilities to connect patients to supportive resources. Two funding limitations emerged as barriers to PRSS employment: funding available through Medicaid billing was insufficient to hire staff and the corresponding hourly compensation rate was not competitive against those offered via grants. Finally, participants identified an underdeveloped hiring system and an unclear scope of practice that led to staff feeling unsupported.

CONCLUSION

PRSS's experiential expertise complements clinical expertise by producing effective health care and support for patients. Despite their high value and expertise in SUD treatment, PRSS face major challenges in the workplace, including inadequate pay, underdeveloped support structures, and narrow job eligibility requirements. Future research should further quantify PRSS's levels of expertise and identify "value-added" benefits of this position.

Managers as peer workers' allies: A qualitative study of managers' perceptions and actions to involve peer workers in Norwegian mental health and substance use services

BACKGROUND

Citizens with experience and knowledge about what it is like to use mental health and substance use services are increasingly employed within similar services as peer workers. Peer workers are portrayed as achieving societal obligations and help ensure that the outputs from service provision are more effective. Even though peer workers have worked in mental health and substance use services for a while, few studies have focused on exploring managers' experiences and perspectives about involving peer workers. This knowledge is needed because these managers can enable and hinder equitable involvement and collaboration with peer workers.

METHODS

A qualitative explorative study was chosen to explore the following research question: How do managers in Norwegian mental health and substance use services experience, relate to, and embrace peer workers as assets in these services? A researcher (Ph.D. student) and a coresearcher (peer worker) conducted four online focus groups with a strategic selection of 17 Norwegian mental health and substance use services managers who had some experience with the involvement of peer workers in their organizations.

RESULTS

The results identified using systematic text condensation are as follows: [1] Peer workers boost the ongoing shift toward increased service user involvement. [2] Peer workers are highly valued in the service transformation process. [3] Managers involve peer workers as partners in co-creation. The results show that managers connect with peer workers and facilitate their involvement in collaborative activities across the service cycle. Peer workers' proximity to service users and bridging capacity is highlighted as the reasons for their involvement. Thus, peer workers are involved in co-defining challenges, co-designing potential solutions, co-delivering those service solutions, and, sometimes, co-assessing service solutions to rethink and improve services. As such, peer workers are considered partners in co-creation.

CONCLUSION

As managers involve peer workers, they increasingly discover peer workers' value, and because peer workers are involved, they increase their skills and capacity for collaboration. This research strengthens the knowledge base of the perceived value of peer workers' roles, bringing in new perspectives from management about utilizing and evaluating peer worker roles.

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 20 years, 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.

Peer Workers in Co-production and Co-creation in Mental Health and Substance Use Services: A Scoping Review

People with lived experience of mental health challenges are extensively employed as peer workers within mental health and substance use services worldwide. Research shows that peer workers benefit individuals using such services and can have essential roles in developing recovery-oriented services. However, understanding how peer workers' contributions, by their role, functions, and input can be better used remains a critical challenge. Research on public sector innovation has focused on relevant actors collaborating to tackle complex demands. Co-production and co-creation are concepts used to describe this collaboration. Co-production refers to the collaboration between providers and users at the point of service delivery, whereas co-creation refers to collaboration starting in the early service cycle phases (e.g., in commissioning or design), including solution implementation. We overviewed research literature describing peer workers' involvement in mental health and substance use services. The research question is as follows: How are peer workers involved in co-production and co-creation in mental health and substance use services, and what are the described outcomes? A literature search was performed in 10 different databases, and 13,178 articles were screened, of which 172 research articles describing peer workers' roles or activities were included. The findings show that peer workers are involved in co-production and function as providers of pre-determined services or, most often, as providers of peer support. However, they are rarely engaged as partners in co-creation. We conclude that the identified peer worker roles have different potential to generate input and affect service delivery and development.

Positive Organizational Psychology Factors as Serial Multiple Mediators of the Relationship between Organization Support and Job Satisfaction Among Peer Support Specialists

BACKGROUND

Research has demonstrated the effectiveness of peer support specialists in helping people with severe mental illness increase community tenure, decrease hospitalization, boost treatment satisfaction, improve social functioning, and increase quality of life.

OBJECTIVE

The purpose of the present study was to evaluate positive organizational psychology constructs as serial multiple mediators of the relationships between perceived organizational support and job satisfaction among peer support specialists.

METHODS

One hundred and twenty-one peer support specialists from the Texas statewide peer certification training programs and the National Association of Peer Supporters participated in the present study. These peer support specialists completed an online survey composed of self-report measures related to perceived organizational support, positive organizational psychology factors, and job satisfaction. A serial multiple mediation (SMMA) analysis was conducted to evaluate autonomous motivation to work, work engagement, and organizational commitment as mediators of the relationship between perceived organizational support and job satisfaction.

RESULTS

The SMMA model accounted for 49% of the variation in job satisfaction scores (R2 =. 49, f2 = 0.96 [> 0.35], a large effect size). Autonomous motivation to work, work engagement, and organizational commitment were significantly associated with job satisfaction after controlling for the effect of perceived organizational support.

CONCLUSIONS

Perceived organizational support increased autonomous motivation to work, work engagement, organizational commitment, and job satisfaction. Peer support specialists are integral members of the interdisciplinary mental health treatment team. Leaders of community-based mental health and rehabilitation agencies who are committed to hire and retain peer support specialists must provide strong organizational support and develop interventions to increase peer support specialists' autonomous motivation to work, work engagement, and organizational commitment as a job retention and career development strategy.

Employment Outcomes After Certification as a Behavioral Health Peer Specialist in Four U.S. States

OBJECTIVE

A 3-year study explores employment outcomes of certified peer specialists (CPSs). Analyses reported here identified relationships between demographic, clinical, work history, and geographic characteristics and employment status and current employment in peer services jobs versus other jobs.

METHODS

The study recruited adults who recently became a CPS, regardless of current employment status, in four states. Online survey data were collected from March to October 2020 and included demographic information, health status and diagnoses, mental health service use, motivations for becoming certified, employment history, and job characteristics, including job satisfaction. Descriptive statistics and logistic regression models were used to compare groups.

RESULTS

Of 681 respondents, 591 provided data on current employment and were included. Participants who received Social Security Disability Insurance or Supplemental Security Income, veterans, those who used outpatient counseling or therapy, and those who did not disclose their mental health status in the workplace were less likely to report current employment. Lack of disclosure and higher local unemployment rates contributed to a lower likelihood of working in peer services jobs, whereas individuals reporting depressive disorders were more likely to hold such jobs. Compared with those in other jobs, those in peer services jobs reported longer job tenure, and a larger proportion received employee benefits. Job satisfaction was significantly higher among those with peer services jobs.

CONCLUSIONS

Workers with a CPS credential had higher employment rates, compared with adults with psychiatric disabilities, and the quality of peer specialist jobs was equal to or higher than the quality of other jobs held by study participants.

Qualitative Study of Certified Peer Specialists' Experiences Delivering Peer Support Services During the COVID-19 Pandemic

OBJECTIVE

The purpose of this qualitative study was to examine the experiences of certified peer specialists (CPSs) in delivering telehealth services during the COVID-19 pandemic.

METHODS

Fourteen semistructured interviews with CPSs were conducted from August to November 2020. Data were analyzed by using thematic analysis.

RESULTS

Helpful support from employers during the transition to telehealth included clear communication and access to training on telehealth technologies. Main barriers and facilitators were related to interpersonal relationships and logistical factors. CPSs reported that telehealth allowed them to continue to support the peers they serve but that the quality of interactions was not as good as with in-person services. Logistical challenges included inadequate equipment and Internet access.

CONCLUSIONS

To support CPSs in delivering telehealth, employers can engage them in open and transparent communication about guidelines for service delivery, provide training and equipment, and allow them the flexibility to tailor service delivery modalities to the peers they serve.

Experiences of peer support workers supporting individuals with substance use disorders in Egypt: phenomenological analysis

Background

Peer support work for substance use disorders is widely implemented in high-income countries. More research is still needed to understand its applicability in settings which have proportionately low budgets allocated to mental health. Peer Support Workers are individuals who managed to achieve recovery from substance use disorders and help people remain engaged in their recovery and prevent relapse through shared understanding.

Aim

To investigate the experience of peer support workers providing recovery support to people with substance use disorders in Egypt.

Methods

A qualitative phenomenological design was used in which 17 adults working as peer support workers for substance use disorders were recruited by means of purposive and snowball sampling. A semi-structured interview with participants was conducted by phone or video-call. Interviews were transcribed and thematically analysed based on descriptive phenomenology.

Results

Three superordinate themes were identified: role responsibility, Peer Support Workers’ need for organizational and stakeholders’ support, and challenges to the role integrity.

Conclusion and recommendations

The findings indicate the need for national and governmental support to peer support workers engaged with people with substance use disorders in Egypt and educating families and the public about the role of peer support workers in substance use disorders.

The impact of working as a peer worker in mental health services: a longitudinal mixed methods study

BACKGROUND

Peer workers are increasingly employed in mental health services to use their own experiences of mental distress in supporting others with similar experiences. While evidence is emerging of the benefits of peer support for people using services, the impact on peer workers is less clear. There is a lack of research that takes a longitudinal approach to exploring impact on both employment outcomes for peer workers, and their experiences of working in the peer worker role.

METHODS

In a longitudinal mixed methods study, 32 peer workers providing peer support for discharge from inpatient to community mental health care - as part of a randomised controlled trial - undertook in-depth qualitative interviews conducted by service user researchers, and completed measures of wellbeing, burnout, job satisfaction and multi-disciplinary team working after completing training, and four and 12 months into the role. Questionnaire data were summarised and compared to outcomes for relevant population norms, and changes in outcomes were analysed using paired t-tests. Thematic analysis and interpretive workshops involving service user researchers were used to analysis interview transcripts. A critical interpretive synthesis approach was used to synthesise analyses of both datasets.

RESULTS

For the duration of the study, all questionnaire outcomes were comparable with population norms for health professionals or for the general population. There were small-to-medium decreases in wellbeing and aspects of job satisfaction, and increase in burnout after 4 months, but these changes were largely not maintained at 12 months. Peer workers felt valued, empowered and connected in the role, but could find it challenging to adjust to the demands of the job after initial optimism. Supervision and being part of a standalone peer worker team was supportive, although communication with clinical teams could be improved.

CONCLUSIONS

Peer workers seem no more likely to experience negative impacts of working than other healthcare professionals but should be well supported as they settle into post, provided with in-work training and support around job insecurity. Research is needed to optimise working arrangements for peer workers alongside clinical teams.

Implementation Challenges and Recommendations for Employing Peer Support Workers in Emergency Departments to Support Patients Presenting after an Opioid-Related Overdose

The placement of a peer support workers (PSWs) in emergency departments (ED) is a promising practice for supporting persons with opioid use disorder who are presenting with an overdose or related medical condition. However, this practice is underutilized. The objective of this study was to identify the challenges of employing PSWs in the ED and provide a checklist to increase the likelihood of their successful integration and retention in this environment. Qualitative methods were used to collect data from nineteen key stakeholders who worked in hospital settings. Using a social-ecological model, themes were identified at the system, hospital, and individual levels. To support integration of PSWs and buy in for the ED team, our findings indicate a need for a planning phase that includes collaboration between leadership, ED staff, and PSWs. Specifically, planning should address four areas: (1) hiring a PSW that is a good fit for the fast-paced ED setting, (2) education of ED staff on the value and role of PSWs, (3) establishing workflow protocols, and (4) providing PSWs with training and appropriate supervision.

A Qualitative Study of the Experience of Peer Workers in the Czech Republic

The study deals with the employment of people diagnosed with mental illness in the position of peer worker. The aim is to demonstrate through semi-structured interviews the involvement of peer workers in the social services for people diagnosed with mental illness and to identify the influences that affect the success of peer workers involvement in services. The results of the interviews were divided into two categories (Position Specifics, Ethical Aspects) and four subcategories (Professionalism, Risk Moments, Stigmatization, Shared Values) using the Coding Method. The individual subcategories were further subdivided in detail. The results show that the most negative influence on the successful involvement of peer workers is the unclear definition of the job role and responsibilities and further, from an ethical point of view, it is the fear of subsequent labelling (stigmatization) in the search for a new job. A positive ethical influence is the sharing of social values (hope, recovery, friendship, sharing, etc.), which supports the peer worker. The study could help anchor the role in practice and could be the basis for further research in human resources management, social work and management.

Former Inpatient Psychiatric Patients' Past Experiences With Traditional Frontline Staff and Their Thoughts on the Benefits of Peers as Part of Frontline Staff

Little is known about how integrating peers into frontline staff might improve the quality of inpatient psychiatric care. In the current study, we interviewed 18 former adult patients of inpatient psychiatric facilities using semi-structured interviews. We first asked about positive and negative past experiences with traditional staff. We then asked participants to share their opinions on the potential benefits of peers as part of frontline staff. We identified themes through a joint inductive and deductive approach. Participants reported past positive experiences with traditional staff as being (a) personable and caring, (b) validating feelings and experiences, (c) de-escalating, and (d) providing agency. Past negative experiences included (a) not sharing information, (b) being inattentive, (c) not providing agency, (d) being dehumanizing/disrespectful, (e) incompetency, (f) escalating situations, and (g) being apathetic. Participants believed that peers as part of frontline staff could champion emotional needs in humanizing and nonjudgmental ways, help navigate the system, and disrupt power imbalances between staff and patients. Further research is needed to understand financial, organizational, and cultural barriers to integrating peers into frontline staff. [Journal of Psychosocial Nursing and Mental Health Services, 60(3), 15-22.].

Engaging peer consultants in mental health services: Narrative research

AIMS

The text deals with the specifics of the new job position of peer consultant in mental health services. The aim is to describe, through a literature search, the involvement of people with mental illness in the position of peer consultant in social services and to identify possible ethical aspects associated with this position.

THEORETICAL BACKGROUND

The problem is viewed from the perspective of the service provider. The involvement of people with experience of mental illness (so-called peer consultants) in mental health services is still a little-known issue. These individuals use their experience of the disease to work with service users and can also act as intermediaries between users and professionals. The way a peer consultant works and his involvement in a team of experts can cause various ethical contradictions.

METHODS

To clarify the issue, a literature search was used, which was conducted for the period 2012 to 2020. Selected studies were analysed on the basis of focus and presented a connection with the practice, the results were compared. Findings were synthesized according to ethical attributes into categories and conclusions were drawn by subsequent logical deduction.

RESULTS

The results indicate a positive benefit of introducing the position to social services focused on mental health care. The positive impact is manifested in working with service user, in the functioning of the organization and also in the impact on the community. Successful implementation of the peer consultant position requires managers to prepare well and become familiar with the possible ethical aspects associated with the position.

Impact of COVID-19 on Peer Support Specialists in the United States: Findings From a Cross-Sectional Online Survey

OBJECTIVE

Peer support specialists (PSS) are an integral part of the mental health workforce. The purpose of this study was to better understand how the COVID-19 pandemic affected their employment status and day-to-day work.

METHODS

A cross-sectional, online survey was conducted (May-June 2020). Recruitment occurred through the National Association of Peer Specialists and additional snowball sampling. Closed- and open-ended questions sought information about employment status, work tasks, challenges faced by PSS and by individuals they supported, and positive impacts they experienced.

RESULTS

A total of 1,280 surveys were analyzed. Nine percent of respondents reported having lost their job as a result of COVID-19. Of these, 65% reported a length of employment of 2 or more years, and 61% reported working 35 hours or less per week. Job tasks changed dramatically, with 73% reporting engagement in new tasks, including increased reliance on technology (N=717), increased coordination of resources (N=123), and COVID-19-related tasks (N=142). Engagement in some support tasks decreased significantly from prepandemic levels, including individual support provision (p<0.001) and group facilitation (p<0.001). Respondents reported significant challenges among individuals they supported, including increased isolation (92%), substance use (67%), housing instability (38%), and food insecurity (64%). Although respondents also reported challenges, satisfaction with organizational and supervisory support was high. Most respondents (73%) reported positive impacts or benefits from the pandemic.

CONCLUSIONS

The changing roles and tasks identified in this study have implications for hiring, training, supervising, and supporting peer staff. The peer workforce demonstrated flexibility and commitment to meeting increasing needs.

Impact of Being a Peer Recovery Specialist on Work and Personal Life: Implications for Training and Supervision

Peer recovery specialists are an important resource in community mental health settings. This study, which was part of a larger statewide assessment, evaluates how the role impacts work and personal lives of peers, with implications for improving the training and supervision of this service. The importance of peer work has been investigated through client outcomes, however less work has investigated outcomes on peers themselves, which impacts the work force and service delivery. Nine focus groups were conducted with peer recovery specialists. A two-stage qualitative analysis led to two overarching themes, work and personal, and six subthemes. Findings suggest being a peer presents unique benefits and challenges in work and personal life. Peers benefit from more training and supervision, consistency within the role, and maintaining boundaries. Additionally, work environment roles may be improved by attention to needs of supervisors in terms of skills for effective supervision and clarification of supervisory roles.

They are a different breed aren't they? Exploring how experts by experience influence students through mental health education

Experts by Experience (EBE) in mental health are increasingly becoming involved in the education of health professionals. In response, research findings suggest positive attitudinal change towards people who experience mental distress and enhanced appreciation of recovery and person-centred approaches to practice. However, this growing body of evidence has not resulted in the broad adoption of these roles in academia. The perspectives of academics instrumental in implementing academic positions for EBE (referred to as allies) have not yet been articulated. Acknowledging this gap, the aim of this research was to explore experiences of allies involved in implementing EBE positions in academia regarding the impact of EBE led education on students. Qualitative exploratory methods were used involving in-depth interviews with allies. Data were analysed thematically. Participants observed significant positive impacts on students, as evidenced through four themes: contextualized learning, enhancing reflection, feedback from the clinical field, and students' own lived experience. The fifth sub-theme, Challenging experiences were observed to potentially detract from the student experience in some instances. Overall, participants were very supportive of EBE involvement and were confident this approach produced more person-centred and recovery-oriented clinicians, with the skills, knowledge and attitudes needed to work as practitioners. These findings support previous research and suggest positive implications for clinical practice and for students with their own mental health challenges.

Effective Peer Employment Within Multidisciplinary Organizations: Model for Best Practice

This study sought a clearer understanding of organizational mechanisms reinforcing effective peer employment and organizational change from the perspectives of peer workers, non-peer staff and management in multidisciplinary mental health and substance use recovery services. Findings were used to develop a model for organizational best practice for peer employment and associated organizational change to promote recovery-oriented and person-directed services. Qualitative research was undertaken, involving 132 people participating in 14 focus groups and eight individual interviews. These people were employed across five U.S. multidisciplinary organizations providing mental health and substance use recovery services and deemed by a panel of experts to provide effective employment of peer workers. Study findings include the articulation of an interactive working model of best practice, comprising organizational commitment, organizational culture and effective organizational strategies necessary for a "whole-of-organization" approach to support authentic peer work and enable organizational transformation, to actualize recovery-oriented values and person-driven services. Strategies include Human Resources engagement, peers in positions of senior organizational authority, recurring whole of workforce training, along with peer training and peer-led supervision. Findings suggest whole-of-organization commitment, culture and practice are essential for the organizational transformation needed to support effective employment of peers in multidisciplinary environments.

Key components of recovery predict occupational performance and health in peer support specialists

Objective: The primary purpose of the study was to explore and identify how components of recovery are associated with occupational performance and health among peer support specialists. Methods: One hundred and twenty-one peer support specialists were recruited from statewide peer certification training programs and the International Association of Peer Supporters. Study respondents completed a survey package including demographic questions and psychometrically sound self-report measures. Two hierarchical multivariable linear regression models were conducted to evaluate whether the recovery components of the process of recovery, social support for recovery, and work self-determination (i.e., work autonomy, work competence, and work relatedness) were associated with indicators of occupational performance (i.e., work engagement) and health (i.e., job satisfaction). Results: Work autonomy was associated with the occupational performance indicator, while the process of recovery and social support for recovery were the only recovery components associated with the indicator for occupational health. Conclusions and Implications for Practice: Findings support the importance of work self-determination and social support and recovery for occupational performance and health among peer support specialists. Mental health and rehabilitation professionals should address these key components of recovery when working with and supporting the work well-being of peer support specialists. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach

This meta-analytic study synthesized findings from 108 independent data sets across 22 cultures to investigate whether the stigma internalization model (the internalization of experienced stigma and perceived stigma to self-stigma) is associated with well-being and recovery of people with mental illness. We also examined the moderating role of collectivism in the internalization process. Results of the meta-analytic structural equation modeling suggested that self-stigma is a significant mediator in the relationships between experienced stigma and perceived stigma with well-being and recovery variables (indirect effects = 0.02 to -0.16). Experienced and perceived stigma had significant direct effects on well-being and recovery variables (Bs = 0.07 to -0.21, p < 0.05), suggesting that both external (e.g., public stigma) and internal (i.e., self-stigma) influences of stigma work concurrently to affect recovery and well-being of people with mental illness. The results of the mixed effect three-level meta-analytic models showed that collectivism significantly moderated the relationship between experienced and perceived stigma with self-stigma (Bs = 0.06 to 0.11, p < 0.05). This implied that the more collectivistic a culture is, the stronger the correlation between experienced and perceived stigma with self-stigma. Implications to stigma reduction approaches were discussed.

Evolvement of Peer Support Workers' Roles in Psychiatric Hospitals: A Longitudinal Qualitative Observation Study

Peer support workers (PSWs) use their experiential knowledge and specific skills to support patients in their recovery process. The aim of our study was to examine the integration and role-finding process of PSWs in adult psychiatric hospitals in Germany. We conducted open nonparticipant observations of 25 multiprofessional team meetings and 5 transregional peer support worker meetings over a period of six months. The data were analyzed using qualitative content analysis. Regarding the integration of PSWs into multiprofessional teams, we identified three subcategories: "Features of success," "challenges" and "positioning between team and patients." Concerning the PSWs' roles, we developed two subcategories: "Offers" and "self-perception." The PSWs' specific roles within a multiprofessional mental healthcare team evolve in a process over a longer period of time. This role-finding process should be supported by a framework role description which leaves sufficient freedom for individual development. Regular opportunities for mutual exchange among PSWs can help to address specific support needs at different points in time.

Psychometric validation of the Job Satisfaction of Persons with Disabilities Scale in a sample of peer support specialists

OBJECTIVE

The primary purpose of the study was to evaluate the psychometric properties of the Job Satisfaction of Persons with Disabilities Scale in a sample of peer support specialists.

METHOD

A total of 121 employed peer support specialists with lived experience of a serious mental health condition were recruited for this study from statewide peer certification training programs and the International Association of Peer Supporters. Respondents completed an online survey on job satisfaction and related constructs. A principal components analysis was used to explore and identify the instrument subscales.

RESULTS

The findings identified 2 factors: (a) the 9-item job satisfaction with intangible benefits factor and (b) the 5-item job satisfaction with tangible benefits factor.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The Job Satisfaction of Persons with Disabilities Scale demonstrates good-to-excellent psychometrics. The use of this scale among peer support specialists within training and supervision practices in psychiatric rehabilitation settings is warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Organizational Climate and Support Among Peer Specialists Working in Peer-Run, Hybrid and Conventional Mental Health Settings

As the peer specialist workforce continues to expand, it is critical to better understand peer providers' working conditions and workplace experiences. The current study utilized a targeted non-probability sample of 801 peer specialists to explore whether key organizational climate and support variables would yield distinct multivariate groups, and to investigate the correlates of these groups. Analyses yielded a seven-group solution, with peer run organizations comprising a substantially greater proportion of the groups with high organizational climate and support scores. In direct comparisons, peer-run programs outranked all other groups in the areas of perceived organizational climate, supports for career development and perceived service quality.

Peer Support in Mental Health: Literature Review

BACKGROUND

A growing gap has emerged between people with mental illness and health care professionals, which in recent years has been successfully closed through the adoption of peer support services (PSSs). Peer support in mental health has been variously defined in the literature and is simply known as the help and support that people with lived experience of mental illness or a learning disability can give to one another. Although PSSs date back to several centuries, it is only in the last few decades that these services have formally evolved, grown, and become an integral part of the health care system. Debates around peer support in mental health have been raised frequently in the literature. Although many authors have emphasized the utmost importance of incorporating peer support into the health care system to instill hope; to improve engagement, quality of life, self-confidence, and integrity; and to reduce the burden on the health care system, other studies suggest that there are neutral effects from integrating PSSs into health care systems, with a probable waste of resources.

OBJECTIVE

In this general review, we aimed to examine the literature, exploring the evolution, growth, types, function, generating tools, evaluation, challenges, and the effect of PSSs in the field of mental health and addiction. In addition, we aimed to describe PSSs in different, nonexhaustive contexts, as shown in the literature, that aims to draw attention to the proposed values of PSSs in such fields.

METHODS

The review was conducted through a general search of the literature on MEDLINE, Google Scholar, EMBASE, Scopus, Chemical Abstracts, and PsycINFO. Search terms included peer support, peer support in mental health, social support, peer, family support, and integrated care.

RESULTS

There is abundant literature defining and describing PSSs in different contexts as well as tracking their origins. Two main transformational concepts have been described, namely, intentional peer support and transformation from patients to peer support providers. The effects of PSSs are extensive and integrated into different fields, such as forensic PSSs, addiction, and mental health, and in different age groups and mental health condition severity. Satisfaction of and challenges to PSS integration have been clearly dependent on a number of factors and consequently impact the future prospect of this workforce.

CONCLUSIONS

There is an internationally growing trend to adopt PSSs within addiction and mental health services, and despite the ongoing challenges, large sections of the current literature support the inclusion of peer support workers in the mental health care workforce. The feasibility and maintenance of a robust PSS in health care would only be possible through collaborative efforts and ongoing support and engagement from all health care practitioners, managers, and other stakeholders.

Mental Health Recovery: The Effectiveness of Peer Services in the Community

Peer recovery services are a community-based treatment option for people suffering from mental illness and/or substance use problems. Peer services provide an alternative to inpatient care and can help decrease costs associated with hospitalization or incarceration of the mentally ill. Yet, scant research has explored the effect of these services, particularly in rural communities. The current study assesses the impact of peer services on peer mentees' and mentors' recovery capital, quality of life, and general wellness. Consumers of peer services completed three surveys every three months for approximately 18 months. Quantitative analyses demonstrated that subjects had a marginal change in their recovery capital, but quality of life and general wellness were unaffected. Peer providers' experiences were also explored through interviews. Qualitative analyses revealed that providers have a positive outlook regarding peer services but would benefit from greater resources and additional training. Policy and community implications are also discussed.

Peer Support in Coordination of Physical Health and Mental Health Services for People With Lived Experience of a Serious Mental Illness

BACKGROUND

Engaging peer support to augment and enhance traditional mental health services presents novel opportunities to improve service engagement and delivery. However, there has not been an in-depth analysis of the processes and methods behind the coordination of physical health and mental health care by peer support specialists.

STUDY AIM

To explore the potential of peer support specialists in community mental health centers and as a means to improve coordination of physical health and mental health services for people with a serious mental illness.

METHODS

We conducted 28 semi-structured qualitative interviews with peer support specialists and mental healthcare professionals in community mental health centers in two states (blinded for review) in the United States. Data were triangulated to explore peer support specialists and mental health professionals' perspectives.

RESULTS

We found five themes characterizing the role of peer support services in the coordination of physical health and mental health services for individuals with serious mental illness: (1) Advocacy in interprofessional meetings, clinical teams, and advisory councils; (2) Sharing lived experiences and connecting with available resources and services; (3) Preparing for mental health and physical health care visits; (4) Mutuality; and (5) Affiliations, funding, and sustainability of peer support services.

CONCLUSION

This study suggests that peer support specialists can uniquely contribute to the coordination of physical health and mental health services for individuals with serious mental illness.

"I felt some prejudice in the back of my head": Nursing students' perspectives on learning about mental health from "Experts by Experience"

WHAT IS KNOWN ON THE SUBJECT?: Consumer participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal Involving mental health "Experts by Experience" in the education of nursing students demonstrates positive attitudinal change WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: More detailed understanding of nursing students' experiences and perspectives about being taught mental health nursing by "Experts by Experience" An international focus, extending understandings about how Experts by Experience might be perceived in a broader range of countries WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Positive attitudes towards people labelled with mental illness are essential for quality nursing practice Nurses have an important leadership role in facilitating consumer participation within health services. It is critical that their attitudes are professional and optimistic. ABSTRACT: Introduction Consumer participation is central to mental health policy. Negative attitudes of health professionals are barriers to realizing policy goals. Evidence suggests consumers (Experts by Experience) can influence positive attitudes in nursing students. Research in this area to date is limited and primarily from Australia and New Zealand. Aim To enhance understanding of nursing students' perspectives and experiences of being taught mental health by an Expert by Experience. Method A qualitative exploratory approach was used. Focus groups were conducted with nursing students from seven universities in Australia and Europe. Data were analysed thematically. Results Student participants described how exposure to Experts by Experience challenged their views and attitudes and provided a mechanism for reflection, critique and change. The main theme "changing mindset" includes two subthemes: exposing stereotypes and reflection. Discussion This unique international study demonstrates the capacity for Experts by Experience to contribute to positive attitudinal change towards mental illness in nursing students. This changed mindset must occur for policy goals to be realized. Implications for practice Nurses in all areas of practice will work with people labelled with mental illness and experiencing mental distress. Overcoming stereotypes and adopting more positive attitudes is essential to deliver quality mental health care.

International insights into peer support in a neonatal context: A mixed-methods study

Peer support is a widely used intervention that offers information and emotional support to parents during their infant's admission to the neonatal unit and/or post-discharge. Despite its widespread use, there are no comprehensive insights into the nature and types of neonatal-related peer support, or the training and support offered to peer supporters. We aimed to bridge these knowledge gaps via an international study into neonatal peer support provision. A mixed-methods study comprising an online survey was issued to peer support services/organisations, and follow-up interviews held with a purposive sample of survey respondents. Survey/interview questions explored the funding, types of peer support and the recruitment, training and support for peer supporters. Descriptive and thematic analysis was undertaken. Thirty-one managers/coordinators/trainers and 77 peer supporters completed the survey from 48 peer support organisations/services in 16 different countries; with 26 interviews undertaken with 27 survey respondents. We integrated survey and interview findings into five themes: 'background and infrastructure of peer support services', 'timing, location and nature of peer support', 'recruitment and suitability of peer supporters', 'training provision' and 'professional and emotional support'. Findings highlight variations in the types of peer support provided, training and development opportunities, supervisory and mentoring arrangements and the methods of recruitment and support for peer supporters; with these differences largely related to the size, funding, multidisciplinary involvement, and level of integration of peer support within healthcare pathways and contexts. Despite challenges, promising strategies were reported across the different services to inform macro (e.g. to facilitate management and leadership support), meso (e.g. to help embed peer support in practice) and micro (e.g. to improve training, supervision and support of peer supporters) recommendations to underpin the operationalisation and delivery of PS provision.

Strategic Storytelling: An Exploration of the Professional Practices of Mental Health Peer Providers

Peer providers of mental health services use their personal illness and recovery narratives to help other mental health service users. Despite a substantial body of evidence supporting the effectiveness of these providers, little is known about the underlying strategies they employ in their professional practice. In this study, I used in-depth interviews with 23 peers to explore the most important practices they used in their day-to-day work with others. Results indicated that peers engaged in a reflexive process to strategically use their personal illness and recovery stories to help others re-story their life narratives. Peers also used communication strategies from motivational and cognitive-behavioral treatment approaches to engage, inspire, and mentor other service users. Findings suggest the need for research that further explores the rhetorical strategies used by peers using narrative methods. The development and testing of professional development opportunities to assist peers in maximizing their therapeutic potential are also warranted.

'You don't know what you don't know': The essential role of management exposure, understanding and commitment in peer workforce development

The peer workforce has increased significantly in recent years; however, structured development and support for the roles are lacking. This paper explores the role of executive and senior management understanding in the employment of peer roles. In-depth, semi-structured interviews and one focus group were conducted with 29 participants from a range of nongovernment and public mental health services within Queensland, Australia. Findings of this study suggest management exposure to and understanding of peer work are essential to the development of an effective peer workforce. Exposure and understanding of peer roles reportedly led to greater acceptance and commitment from management. This commitment inspired action in the form of; enhanced support including advocacy/championing, increased development of roles and influenced culture within the organization to be more accepting of peer work. There was a perception that developing an 'accepting' organizational culture supported the integrity and expansion of peer roles including designated 'peer management' positions. Development of peer management positions is suggested as an effective means of improving the impact of peer perspectives, advocating for peer work and providing ongoing and timely supervision. Recommendations include the need for training and information for management on the unique function, purpose and value of peer roles; and the development of networks, including mentoring opportunities, for organizations with limited experience to gain support and advice from those with greater experience developing peer roles.

Implementation of a mental health consumer academic position: Benefits and challenges

PURPOSE

Academic positions for consumers of mental health services remain rare despite positive evaluation. This paper considers the benefits and challenges of a consumer academician position, from perspectives of stakeholders involved in the implementation.

DESIGN AND METHODS

Qualitative, exploratory involving in-depth interviews with academicians. Thematic analysis identified the main benefits and challenges.

FINDINGS

Benefits identified included lived experience perspective and facilitates interaction and reflection; demonstrating recovery and promoting person centered care. Challenges identified included process, too close to home, and too little too late.

PRACTICE IMPLICATIONS

Enhanced understanding of consumer academician positions could increase effectiveness and maximize educational opportunity.

Providing mental health peer support 2: Relationships with empowerment, hope, recovery, quality of life and internalised stigma

OBJECTIVE

Qualitative research has identified personal costs and benefits for peer supporters associated with their role; however, quantitative evidence is sparse. This study used quantitative methods to explore relationships in experiences of providing peer support with constructs of empowerment, hope, recovery, quality of life and internalised stigma. Differences were examined for those in statutory versus non-statutory services; who had themselves received peer support versus those who had not and who identified having had negative experiences in clinical teams versus those without such experiences.

METHODS

A cross-sectional online and postal survey was undertaken in tandem with a linked consensus study. In all, 147 peer supporters were recruited from a variety of organisations across the United Kingdom. Validated questionnaires were used to examine constructs. Instruments created for the study measured peer support experiences, and personal costs and benefits involved. Correlations were calculated and results informed further regression analysis. Chi-square tests and independent samples t-tests tested group differences.

RESULTS

Peer supporters indicated they experienced almost twice as many role-related personal benefits than personal costs. Benefits included improvements to mental health and well-being, reduced use of services, increased social functioning and development of skills. Total number of personal costs experienced was significantly negatively related to peer supporters' empowerment and quality of life. There were no significant differences between the groups examined.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

An accumulation of personal costs may result in reduced quality of life; however, costs can be minimised by organisations. Limitations of the research are discussed and recommendations for future research are made including the need for longitudinal research.

Emerging Roles for Peer Providers in Mental Health and Substance Use Disorders

INTRODUCTION

The purpose of this study was to identify and assess states with best practices in peer provider workforce development and employment. A growing body of research demonstrates that peer providers with lived experience contribute positively to the treatment and recovery of individuals with behavioral health needs. Increased employment opportunities have led to policy concerns about training, certification, roles, and reimbursement for peer provider services.

METHODS

A case study approach included a national panel of subject matter experts who suggested best practice states. Researchers conducted 3- to 5-day site visits in four states: Arizona, Georgia, Texas, and Pennsylvania. Data collection included document review and interviews with state policymakers, directors of training and certification bodies, peer providers, and other staff in mental health and substance use treatment and recovery organizations. Data collection and analysis were performed in 2015.

RESULTS

Peer providers work in a variety of settings, including psychiatric hospitals, clinics, jails and prisons, and supportive housing. A favorable policy environment along with individual champions and consumer advocacy organizations were positively associated with robust programs. Medicaid billing for peer services was an essential source of revenue in both Medicaid expansion and non-expansion states. States' peer provider training and certification requirements varied. Issues of stigma remain. Peer providers are low-wage workers with limited opportunity for career growth and may require workplace accommodations to maintain their recovery.

CONCLUSIONS

Peer providers are a rapidly growing workforce with considerable promise to help alleviate behavioral health workforce shortages by supporting consumers in attaining and maintaining long-term recovery.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

An Exploration of Factors that Effect the Implementation of Peer Support Services in Community Mental Health Settings

This study explored the integration of peer services into community mental health settings through qualitative interviews with peer-providers and non-peer mental health workers. Results show peer job satisfaction was contingent upon role clarity, autonomy, and acceptance by non-peer coworkers. Mental health workers reported the need for organizational support for peer services and guidance about how to utilize peers, negotiate their professional boundaries and accommodate their mental health needs. Effective peer integration requires organizational readiness, staff preparation and clear policies and procedures. Consultation from consumer-based organizations, enhanced professional competencies, and professional development and career advancement opportunities for peers represent important resources.

Factors Supporting the Employment of Young Adult Peer Providers: Perspectives of Peers and Supervisors

Peer providers are a promising practice for transition-age youth community mental health treatment engagement and support, yet little is known about the experience of being a young adult peer provider or what helps to make an individual in this role successful. Utilizing a capital theory lens, this study uses data from focus groups (two with young adult peer providers and two with their supervisors) to examine facilitators of young adult peer provider success in community mental health treatment settings. Eight factors were identified as critical to young adult peer provider on-the-job success: persistence, job confidence, resilience, job training, skilled communications with colleagues, regular and individualized supervision, support from colleagues, and family support. Findings suggest that young adult peer providers may benefit immensely from an agency level focus on fostering social organizational capital as well as more individualized efforts to increase cultural, social, and psychological capital through training and supervision.

A one-year longitudinal qualitative study of peer support services in a non-Western context: The perspectives of peer support workers, service users, and co-workers

This study explored the changing views of key stakeholders (peer support workers, their co-workers, and service users) about peer support services in a non-Western community, using a longitudinal qualitative approach. Five trainee peer support workers (PSWs), 15 service users, and 14 co-workers were interviewed over a 12-month period, under the auspices of the Peer Support Workers Project (also known as the Mindset project) in Hong Kong. A total of 77 interviews were transcribed and thematic analyses were conducted across the participant groups at three different time points (training, work placements, and employment). During the initial implementation of the services, uncertainty about the role of the PSWs were reported. However, trusting and beneficial relationships with service users were gradually built, showing growing resilience and confidence over time. The participants realized that PSWs' experiences of mental illnesses were a unique asset that could help service users to alleviate their own somatic symptoms and improve their connections with others. Our findings highlight that the perceptions of peer support services changed from confusion to viewing PSWs as an asset, to an awareness of the importance of family support, and to the belief that implementing such a program will benefit both service users and PSWs.

Risky business: Lived experience mental health practice, nurses as potential allies

Mental health policy includes a clear expectation that consumers will participate in all aspects of the design and delivery of mental health services. This edict has led to employment roles for people with lived experience of significant mental health challenges and service use. Despite the proliferation of these roles, research into factors impacting their success or otherwise is limited. This paper presents findings from a grounded theory study investigating the experiences of Lived Experience Practitioners in the context of their employment. In-depth interviews were conducted with 13 Lived Experience Practitioners. Risk was identified as a core category, and included sub-categories: vulnerability, 'out and proud', fear to disclose, and self-care. Essentially participants described the unique vulnerabilities of their mental health challenges being known, and while there were many positives about disclosing there was also apprehension about personal information being so publically known. Self-care techniques were important mediators against these identified risks. The success of lived experience roles requires support and nurses can play an important role, given the size of the nursing workforce in mental health, the close relationships nurses enjoy with consumers and the contribution they have made to the development of lived experience roles within academia.