Content uploaded by Evan Hunt
Author content
All content in this area was uploaded by Evan Hunt on Apr 19, 2020
Content may be subject to copyright.
A Report on the Impact of Peer Support Workers
in Mental Health Services.
Hunt, E., & Byrne, M.
Peer Support
Workers in Mental
Health Services
The Impact of Peer
Support Workers
in Mental Health
Services
Hunt, E., & Byrne, M. (2019).
Dublin: Health Service Executive.
Contents
Foreword 6
Acknowledgements 7
Executive Summary 8
Introduction 12
Recovery 12
What is a Peer Support Worker? 13
The Irish Context 15
Present Study 16
Methods 18
Data Processing & Analysis 20
Results 22
The Impact of Peer Support Workers on Service Users 22
The Impact of Peer Support Workers on Services 25
Discussion 49
Benets to Services 49
Benets for Service User Recovery 50
Benets for Service Providers 52
Facilitators & Barriers of Peer Support 52
Conclusion 55
Recommendations 56
References 57
Foreword
Recovery is a key priority for the HSE Mental Health Services, and this is outlined in A Vision for Change
(2006). The development of the National Framework for Recovery in Mental Health (2018) is a further
step in ensuring the provision of recovery oriented services in Ireland. Actions within the framework
include introducing lived experience supports into the workforce and in 2017 the mental health
service committed to employing Peer Support Workers to support service users in their recovery.
There are currently twenty-six Peer Support Workers employed in mental health services across ve
Community Healthcare Organisations. They are employed as equal members of multidisciplinary
teams and work across the continuum of services.
The Health Service Executive (HSE) Mental Health National Oce commissioned this impact study to
assess the impact of Peer Support Workers in Mental Health Services in supporting the development
of more recovery oriented services and in improving recovery outcomes for our service users. The
HSE are happy to take on board the ndings from the developmental stage of this initiative and
progress the recommendation of this report.
I would like to acknowledge the commitment of the Peer Support Workers to date. They have been
pioneers for peer support working within the HSE and have overcome the many inevitable challenges
associated with a new role. They have enhanced the service for our service users and conrmed the
benets and importance of having people with personal lived experience as part of the workforce.
Based on the ndings from this study we endeavour to expand the provision of peer support as it is a
key driver to enhance the recovery capacity of our services.
Jim Ryan
Assistant National Director,
Head of Operations –
Mental Health National Oce
6Peer Support Workers in Mental Health Services
Acknowledgements
The development of this report would not have been possible without the assistance and
participation of a wide variety of stakeholders from across the country. We would like to acknowledge
the contributions of those who assisted in the research design, implementation, and development of
this report.
In particular, we would like to say a sincere thank you to:
| The Peer Support Workers employed across the country in Mental Health Services for their
assistance and participation in this research. We would also like to acknowledge their
commitment and determination to advancing recovery practices in Mental Health Services
and in placing service users at the centre of their own recoveries, as is evidenced in this
report.
|AllHSEMentalHealthServicesstawhogenerouslygaveuptheirtimetoprovideuswith
their valuable insight into the impact of Peer Support Workers in their services.
| Area Mental Health Management Teams, Service Leads, and Peer Support Worker
Supervisors for their assistance in carrying out this research.
|ThestaoftheMentalHealthEngagementandRecoveryOce,withouttheirsupportand
guidancethisreportwouldnothavebeenpossible,inparticular:MichaelRyan,National
HeadofMentalHealthEngagementandRecovery;LauraMolloy,ServiceImprovement
Lead;GerryMaley,BusinessManager;andFrancisWalsh,NationalEngagementand
RecoveryLead.
Finally, and most importantly, we would like to thank all service users who participated in this
research for giving us their time and for their open and honest sharing of their experiences of peer
support and the impact it has had on them.
Evan Hunt Dr Michael Byrne
Research Lead Principal Investigator
7Peer Support Workers in Mental Health Services
Executive Summary
Background
As outlined in A Vision for Change (2006) and A National Framework for Recovery in Mental Health (2018),
the promotion of a recovery-based mental health service model is a key priority in Irish Mental
Health Services. Recovery focuses on living a full and meaningful life whether or not the person
continues to experience mental health diculties; rather than merely focusing on the reduction of
clinical symptoms, it considers a service users’ wellbeing from a holistic point of view. Core processes
identied by service users as necessary for recovery, known as CHIME include having Connections
with others, Hope for the possibility of recovery, having an Identity beyond that of a service user,
living a Meaningful life, and being Empowered through directing one’s own recovery (Leamy et
al., 2011). A recovery orientated service is a service which supports service user recovery through
embracing these recovery principles.
An established method of increasing the recovery orientation of services is through the employment
of Peer Support Workers.
Peer Support Workers
A Peer Support Worker is someone who is employed to utilise their lived experience of mental health
diculties and their support skills to assist service users in their recovery. Peer Support Workers
draw on their lived mental health experience to support others; they oer hope and the possibility of
recovery to service users, provide emotional and practical support, empower service users in self-
management of their recovery and act as a recovery resource to the service and team.
In 2017, Peer Support Workers were employed by Mental Health Services to support service users
in their recovery. There are currently twenty-six Peer Support Workers employed in Mental Health
Services across ve Community Healthcare Organisations, in eleven counties. They are employed as
full and integral members of multidisciplinary teams and work on community mental health teams
(CMHT), rehab and recovery teams, acute wards, and early intervention psychosis services.
Aims and Objectives
The aim of this report was to evaluate the impact of Peer Support Workers on Mental Health Services,
specically the impact of Peer Support Workers on service users and service providers.
Methodology
A mixture of qualitative and quantitative methods were employed, with a focus on open ended
questions on participants’ experience of peer support.
8Peer Support Workers in Mental Health Services
There were three specic cohorts:
|PeerSupportWorkers;
|Serviceusers;
|Service providers.
In order to maximise participation, a multitude of data collection methods were employed including:
|Onlinesurvey;
|Hardcopysurvey;
|Focusgroups
|Interviews.
Ethical approval was granted from research ethics committees in each of the areas Peer Support
Workers are employed. Due to logistical reasons, ethical approval could not be received for service
users in Cork Kerry Community Healthcare and, therefore, service users in that location were excluded
from the survey.
Key Findings
Overall, Peer Support Workers have had a positive impact on service users, service providers and
Mental Health Services. They had a key role in supporting service users with their recovery and in
promoting recovery orientation of services.
Impact on Service Users
Service users were overwhelmingly positive about the impact of peer support on their recovery. Peer
Support Workers acted as recovery role models, inspiring hope in service users, normalising mental
health diculties and reducing self-stigma. They connected service users to their community and
Mental Health Services, encouraging their participation in the community and advocating on their
behalf to services. 76% of service users stated they are more active in their community as a result.
Peer Support Workers’ person centred ways of working placed service users at the centre of their own
recovery, adding a personal connection to their lives and helping them to become more empowered
and independent in their lives. Many service users stated that Peer Support Workers played a vital role
in their recovery and found peer support to be one of the most benecial supports they availed of
from Mental Health Services.
Impact on Services
Peer Support Workers embodied the principles of recovery outlined in National Framework for
Recovery in Mental Health (2018). The majority of service providers were very positive about the
impact of Peer Support Workers and felt that they enhanced the recovery orientation of the service
in which they were employed.
9Peer Support Workers in Mental Health Services
Service users viewed Peer Support Workers as a recovery resource who normalised mental health
diculties to them and provided them insight and understanding into the lived experience of mental
health diculties. Service providers felt that Peer Support Workers helped communicate service
users’ wishes and goals to them, improving their connection to service users and encouraging them to
place service users at the centre of their care. Peer Support Workers strengthened service providers’
recovery orientated thinking and practice.
Facilitators and Barriers of Peer Support
Service readiness is an important factor in the success of peer support. A lack of understanding and
acceptance of Peer Support Workers and the recovery practices they embody was one of the primary
barriers to the positive impact of Peer Support Workers. Training on peer support and recovery
principles is helpful and necessary for teams prior to the implementation of Peer Support Workers
to the team. Additionally, the provision of appropriate support and supervision structures must be
ensured to maximise the impact of peer support.
The services and service users who have had the opportunity to experience peer support have
beneted from it. However, in order to maximise the benet and impact of Peer Support Workers,
there are issues which must rst be addressed. Through continued education, support, and
development of the role, the positive impact of Peer Support Workers on service users’ recovery and
on increasing the recovery orientation of services can be developed further.
““ To bring you through the recovery, to bring you out of
institutionalisation and into life. I felt institutionalised, [my Peer
Support Worker] supported me in that very much so.” Service User
““ Her support has meant a great deal to me, having someone who
understands (from personal experience) what it’s like to have
anxiety and depression. Her role has played a huge part in my
on-going recovery.” Service User
““ If there was more people doing the same thing you’d go a long way
in helping people recover.” Service User
10 Peer Support Workers in Mental Health Services
““ Like a drink of water in the desert.” Service User
““ Maybe if it was available in time gone by people wouldn’t be as sick
as they are. If they had it earlier on in life. A lot of people could have
been saved.” Service User
““ The work of the PrSW has a signicant positive inuence on service
users’ experience of mental health services. The PrSW develops
a therapeutic relationship based on shared experiences, mutual
understanding, respect and empowerment. Service users feel
listened to and understood on a deeper level than that of other
mental health professionals within the MDT. PrSW connect to
service users on a personal level which develops trust in the mental
health services as a support network.” Occupational Therapist
““ The addition of a peer support worker has been a very useful and
helpful addition to our MHS.” Psychiatrist
““
Vital in the role of changing the service for the better.” Nurse
11Peer Support Workers in Mental Health Services
Introduction
The Peer Support Worker project is a HSE national initiative aimed at realising benets for both service
users and Mental Health Services. As part of this initiative, in 2017 thirty people were employed
by the HSE as Peer Support Workers in Mental Health Services across the country. Peer Support
Workers are employed as full and integral members of Community Mental Health Teams. A Peer
Support Worker is someone who has lived experience of mental health diculties and now provides
formalised peer support and practical assistance to service users. Peer Support Workers help service
users to regain control over their lives and their own unique recovery journey. They use their expertise
gained through lived experience to inspire hope and to support recovery. They facilitate and support
information sharing to promote choice, self-determination and opportunities for connection with local
communities. They work alongside service users on a one to one and/or group basis. The Peer Support
Worker has a lead role in embedding recovery values within the service in which they work.
The Peer Support Worker project was envisaged to benet:
Service users through:
–
Improved social functioning;
–
Enhanced treatment planning and
incorporation of key recovery principles;
–
Inspiring an improved quality of life by
demystifying access to Mental Health
Services through appropriate sharing of
their recovery journey; and
–
Engendering hope.
Mental Health Services through:
–
Fostering a more recovery-oriented culture
within teams in which service users are seen
as active partners as distinct from passive
recipients of services.
A robust evaluation of the Peer Support Worker initiative is needed to ensure that the positive values
of this initiative translate into benecial outcomes for users, services and the public. This report is
aimed at reviewing the impact of Peer Support Workers in Mental Health Services in the HSE.
Recovery
Recovery focuses on living a full and meaningful life despite experiencing mental health diculties
(Anthony, 1993). Rather than merely focusing on the reduction of symptoms it considers a service
users’ wellbeing from a holistic point of view, including social interaction, community engagement,
general wellbeing and empowerment (Canadian Mental Health Commission, 2009).
Where recovery was once widely viewed as an illusory concept, numerous studies have identied some
of the core elements and processes of recovery (Anthony, 1993). Core values of recovery include self-
determination, empowerment, normative roles, community integration, hope, working to strengths,
self-help, and self-ecacy (Hebert, Rosenheck, Drebing, Young, & Armstrong, 2008). A number of these
recovery processes have been identied as central elements to recovery; they are known as CHIME.
12 Peer Support Workers in Mental Health Services
CHIME
CHIME was developed by Leamy et al. (2011), through an analysis of ninety-seven papers detailing
service user recovery narratives. The CHIME recovery processes are conditions that service users felt
were essential to their recovery. They are:
Recovery Orientated Services
A recovery orientated service is one which does not merely focus on clinical recovery but embraces
recovery principles and recognises the holistic nature of a service user’s recovery. Naturally the
recovery orientation of services plays a signicant role in supporting service users’ recovery, with
more recovery orientated services supporting service users’ recovery to a greater degree, especially
those involving peers (Thomas, Despeaux, Drapalski, & Bennett, 2017).
What is a Peer Support Worker?
As outlined above, a Peer Support Worker is someone who
is employed to use their lived experience of mental health
diculties to assist service users with their recovery (Repper &
Watson, 2012). The peer aspect of the role may not necessarily
be in relation to a directly shared mental health diculty or
diagnosis, but rather to the shared experience of having a mental health diculties in general and the
personal and social cost that this incurs (Sunderland & Mishkin, 2014.). Peer Support is a recognised
method of supporting service user recovery (Slade et al., 2014). Peer Support Workers have been
shown to empower service users, give them hope, reduce self-stigma and increase socialisation and
independence (Davidson, Bellamy, Guy & Miller 2012; McLean, Biggs, Whitehead, Pratt & Maxwell, 2009).
““ It’s not walking in front
leading or from behind
pushing
— it’s walking
alongside”
(Scottish
Recovery Network, 2013)
Having good relationships, being a part of the community, and getting
support from others.
Belief in the possibility of recovery, inspiring relationships, positive
thinking, valuing success, having dreams and aspirations, and having
the motivation to change.
CONNECTEDNESS:
HOPE:
IDENTITY:
MEANING:
EMPOWERMENT:
Having an identity with multiple facets, with a positive sense of
identity, free from stigma.
Living a fullling life, with social roles and goals, with meaning of mental
illness experiences, and quality of life.
Taking personal responsibility, focusing on strengths, and having
control over one’s own life.
13Peer Support Workers in Mental Health Services
A multitude of benets of Peer Support Workers have been identied for services including improving
service providers’ understanding of service users and the lived experience of having mental health
diculties (Repper & Watson, 2012). Peer Support Workers can also help to remove the ‘them and us’
mentality within services (McLean, Biggs, Whitehead, Pratt & Maxwell, 2009) and increase providers’
understanding of recovery (Pollitt et al., 2012). They have been identied as a means of increasing the
recovery orientation of Mental Health Services (Repper et al., 2013).
Peer support can be provided on a one to one basis or in a group setting. It is delivered in a variety of
settings and may take place in Mental Health Services, the community or in the home, depending on
the service users’ wishes.
Elements of a Peer Support Worker’s role (Naughton, Collins, & Ryan, 2015)
The Peer Support Worker’s role includes:
|Drawing on their lived mental health experience to support others.
|Empathising with mental health service users.
|Oeringemotionalandpracticalsupporttoserviceusers.
|Beingpresentwithserviceusersintimesofdistress.
|Oeringhopeandthepossibilityofrecoverytoserviceusers.
|Empoweringserviceusersinself-ecacyandself-managementconcerningtheirown
recovery.
| Supporting the service user in developing their recovery through personal development
and social integration.
|Providing a recovery resource to the service and team.
|Promoting safe recovery.
|Improvingcommunicationbetweenserviceuserandprovider.
|Supporting recovery focused care planning.
|Providing a training resource on recovery to the service.
|Helping reduce stigma.
|Modelling good recovery practice.
|Modelling appropriate disclosure.
14 Peer Support Workers in Mental Health Services
The Irish Context
A Vision for Change (2006) called for an overhaul of Mental Health Services in Ireland, with
recommendations and proposals across many aspects of service provision. In particular, it outlined the
need for increasing the recovery orientation of services. It was recognised that service users wanted and
needed to be viewed as active participants of their own recovery rather than passive recipients. One
of the ways to achieve this goal was the recommendation of a new position of mental health support
worker, who would act as a voice for service users, provide companionship and practical support.
Since then, there has been a growing movement in Mental Health Services in Ireland to shift towards
a more person centred and recovery orientated model of mental health service provision. In the
intervening years, there have been a number of projects aimed at doing just this, most notably, the
Prosper Genio Project, the Refocus Project, and the Advancing Recovery Initiative (ARI). The Prosper
Genio Project was a pilot peer support project set up in 2012 in the west of Ireland. It was funded by
Genio and, although these Peer Support Workers were not directly employed by the HSE, they worked
with service users from rehab and recovery teams. As the Prosper Genio project was deemed a success,
the Refocus Project began in 2013, building on the work of the previous project and expanding further,
laying the groundwork for future peer support in working out the practicalities and intricacies of the role.
In 2012, parallel to the other projects, Advancing Recovery Ireland (ARI) began. The goal of ARI was to
support the development of recovery orientated services. It focused on bringing about the organisational
and cultural changes required to achieve more recovery focused services. It achieved this through the
inclusion service users, family members, and carers in the design delivery and evaluation of services
through a co-production process. It recognised the reality that true partnership between those who use,
those who support, and those who provide our services, deliver better outcomes than care driven by
one party alone (A National Framework for Recovery 2018 – 2020). ARI played a crucial role in developing
the recovery orientation of Mental Health Services necessary for the implementation of peer support in
Mental Health Services. In 2014, ARI became a mainstream HSE project and the promotion of recovery
orientation of services became a national priority.
Developing from and building on the work of these projects, in 2016 it was announced that a number of
Peer Support Workers would be employed within the HSE as a new initiative to provide peer support to
mental health service users. Prior to their employment, they completed a specialised purpose QQI level 8
undergraduate certicate in Dublin City University. The purpose of the course was to equip them with the
skills to utilise their experience to support service users in their recovery and to work as a member of a
multi-disciplinary team (MDT).
The course covered the following topics:
|Recoveryprinciples;
|Theoreticalmodelsofpeersupport;
|Practicalelementsofpeersupport;
|Mentalhealthpolicy;
|ThestructureoftheHSE;
|Reectivepractice.
As part of the course Peer Support Workers also undertook placement in Mental Health Services.
Following this course in 2017, for the rst time, thirty Peer Support Workers were employed by the HSE
and integrated fully to multi-disciplinary teams in Mental Health Services.
15Peer Support Workers in Mental Health Services
Present Study
Health Services across ve Community Healthcare Organisations (CHOs) in eleven counties. They
are employed in a multitude of settings, such as Community Mental Health Teams (CMHT), rehab
and recovery teams, acute wards, and early intervention psychosis services (See the tables below for
the breakdown regarding CHOs and teams). They interact with service users in a variety of settings
including mental health services, recovery colleges, service users’ homes, and in places within the
community such as coee shops. The majority of Peer Support Workers are employed on part-time
contracts.
Peer Support Workers are predominantly supervised by social workers, with nurses and occupational
therapists providing supervision in areas where social work did not have the capacity.
PEER SUPPORT WORKER LOCATIONS
CHO No. of Peer Support Workers
Community Healthcare Organisation Area 1 3 (1 Cavan + 2 Monaghan)
Community Healthcare West 11 (8 Mayo + 2 Galway + 1 Roscommon)
Cork Kerry Community Healthcare 6 (3 Cork + 3 Kerry)
South East Community Healthcare 4 (3 Carlow/Kilkenny + 1 South Tipperary)
Community Healthcare Organisation Dublin North
City & County 2
TOTAL 26
PEER SUPPORT WORKER TEAMS
Team No. of Peer Support Workers
Community Mental Health Team 13
Rehab and Recovery 11
Early Intervention Psychosis 1
Acute 1
16 Peer Support Workers in Mental Health Services
Objectives
This study arose as an attempt to understand the eect of Peer Support Workers on Mental Health
Services and the people who work in them and use them. It aims to determine if peer support is
benecial and, if so, to shed light on what makes it so and how it can be improved on.
The overall objectives of this study are to:
1. Evaluate the impact of Peer Support Workers in Mental Health Services
2. Identify barriers to peer support in services
3. Identify ways to overcome barriers and improve peer support.
This is to be achieved through consulting with all stakeholders involved in peer support: Peer Support
Workers, service providers, and most importantly, service users.
More specic objectives are to determine the following:
1. What have service users experienced as a result of interacting with Peer Support Workers?
2. Have there been improvements for service users through their contact with Peer
Support Workers?
3. What is the impact of Peer Support Worker on their service/team?
4. What has been the mechanism of impact on service users and providers?
5. What has hindered Peer Support in Services?
6. How can the impact of Peer Support Workers be maximised?
These objectives can be summarised in the following research questions:
?
?
?
?
?
?
What is the impact of
Peer Support Workers
on Service Users?
What is the impact of
Peer Support Workers
on Services?
What are the
facilitators and barriers
of Peer Support?
17Peer Support Workers in Mental Health Services
Methods
In order to capture the full impact of Peer Support Workers there were three specic stakeholder
cohorts in this study: Peer Support Workers; service users; and service providers. Each cohort had
their own separate data collection methods.
Ethical approval was granted for this research from ve research ethics committees. Each committee
covered separate areas where Peer Support Workers were employed. Due to logistical reasons,
ethical approval could not be received for service users in Cork Kerry Community Healthcare, so
service users from that location had to be excluded from the study.
Participants were recruited via the service they worked in or attended. The research was open to
all services across Mental Health Service in Ireland where Peer Support Workers were employed.
All service users (excluding Cork Kerry Community Healthcare), service providers and Peer Support
Workers involved in peer support were oered the chance to take part in the research. Every eort
was made to include anyone who wished to participate, however, due to logistical reasons this was
not always feasible. To allow for maximum participation and inclusion, this study employed a variety
of data collection methods:
Peer Support
Worker
Data Collection Methods
Service
User
Service
Provider
Survey
Survey
Survey
Interview Focus GroupFocus Group
18 Peer Support Workers in Mental Health Services
Service Provider
Survey
The survey was designed to prole
the experience of service providers
working with Peer Support Workers
and to assess the impact of them
on service users and services.
The survey was primarily comprised of open-
ended qualitative questions addressing areas
such as: service users; working alongside Peer
Support Workers; barriers to peer support; and
suggestions for improvements.
Focus Group
The focus groups allowed for sta to
conceptualise their thoughts and discuss the
Peer Support Worker process in their service,
to examine the impact of Peer Support Workers
on service users and service providers, and the
successes and challenges that were
faced.
Peer Support Worker
Survey
The survey was designed to prole
the experience of being a Peer
Support Worker and to assess the
impact of Peer Support Workers
on service users and services. The
survey was primarily comprised of open-ended
qualitative questions addressing areas such as:
Working with service users; working as part of
an MDT; barriers to peer support; and support
structures.
Focus Group
The focus groups provided an opportunity for
Peer Support Workers to share their thoughts
and discuss the impact of peer support. Topics
for discussion included: the quality of their
relationships with service users and other
sta; the way they work with service users; and
challenges they faced.
Service User
Survey
The survey is comprised of a
series of questions on service
users’ experience of receiving peer
support scored on a scale of ‘not at
all’ to ‘very much’ and a selection of
scientic measures. These measures assessed
mental well-being, community engagement,
recovery progress, and the level of support
received from Peer Support Workers.
Interview
The interview gave service users a space to
openly describe their experience of engaging
with peer support. The interview schedule
comprised topics such as: the quality of their
relationships with Peer Support Workers, the
impact of the work of Peer Support Workers on
their individual recovery, aspects
of peer support that they found
most helpful.
19Peer Support Workers in Mental Health Services
Data Processing & Analysis
Following data collection, the data was processed and analysed. Questionnaires were scored and
the data entered into computer software SPSS for quantitative analysis. Audio recordings and
notes from interviews and focus groups were organised and transcribed in preparation for analysis.
All qualitative data was analysed manually following the Braun & Clarke (2013) model of thematic
analysis. The data was studied and generated into codes, which were then organised and developed
into themes.
Survey
128 Participants completed the surveys.
»18 Peer Support Workers
»38 Service User
»72 Service Providers
Data Collection Timeline
Interviews
22 Service Users took part in interviews
Peer
Support
Worker
Survey
Peer
Support
Worker
Focus
Groups
Service
Provider
Survey
Service
Provider
Focus
Groups
Service User
Survey
Service User
Interviews
20 Peer Support Workers in Mental Health Services
Participant Breakdown by
CHO and Group
CHO Peer Support
Workers
Service
Providers
Service
Users Total
Community Healthcare
Organisation Area 1 2 5 20 27
Community Healthcare West 7 19 19 45
Cork Kerry Community
Healthcare 3 8 N/A 11
South East Community
Healthcare 4 22 10 36
Community Healthcare
Organisation Dublin North City &
County
2 18 11 31
TOTAL 18 72 60 150
Focus Groups
4 Service Provider focus groups were held
»Cavan
»Galway
»Dublin
»Carlow
1 Peer Support Worker focus group was held
»17 Peer Support Workers attended
21Peer Support Workers in Mental Health Services
Results
The purpose of this study was to evaluate the impact of Peer Support Workers in Mental
Health Services.
To achieve this, the following were determined:
The Impact of Peer Support Workers on
Service Users
All service user participants felt that Peer Support Workers had a positive impact on their recovery
and experience of services. They were overwhelmingly positive about the role of Peer Support
Workers and its impact on them.
The graph on page 23 illustrates service users’ answers on the INSPIRE Brief measure. Derived from
the CHIME framework, this 5-item Likert-scale questionnaire asked participants about how their Peer
Support Worker supported their recovery. Service users rated the level of recovery support they
received on a scale of ‘0’ (No support at all) to ‘4’ (Very much support).
In addition to the above measure, service users were asked a series of questions on their experience
of receiving peer support. Service users answered on a 5-item Likert-scale ‘0’ ‘Not much’ to ‘4’ ‘Very
much’. All of the service users who were surveyed stated that they liked receiving peer support (32%
quite a lot; 68% very much). They stated that Peer Support Workers had a positive impact on their
What is the impact of
Peer Support Workers
on Service Users?
What is the impact of
Peer Support Workers
on Services?
What are the
facilitators and barriers
of Peer Support?
22 Peer Support Workers in Mental Health Services
experience of mental health service (53% quite a lot; 47% very much). All service users found that
receiving peer support was benecial to their recovery (41% quite a lot; 59% very much), and felt that
peer support workers empowered and supported them on their recovery journey (3% somewhat;
39% quite a lot; 58% very much). In addition, they also stated that peer support workers helped them
become active and involved in their community (21% somewhat; 45% quite a lot; 32% very much).
Service providers also held positive views of Peer Support Workers’ impact on service users.
Similarly, 99% (76% yes; 23% somewhat) of service providers felt that Peer Support Workers are
having a positive impact on service users’ experience of Mental Health Services and 96% (78% yes;
18% somewhat) of service providers felt that Peer Support Workers are making a dierence to
service users.
As developed through thematic analysis of all qualitative data, the following are the ways in which
Peer Support Workers have positively impacted service users:
My worker helps me
to feel supported
by other people
No. of Service Users
Not at all
0
2
4
6
8
10
12
14
16
18
20
My worker helps me
to have hopes and
dreams for the future
My worker helps me
to feel good
about myself
My worker helps me
to do things that mean
something to me
My worker helps me
to feel in control
of my life
Not much Somewhat Quite a lot Very much
INSPIRE RESULTS
23Peer Support Workers in Mental Health Services
Recovery Role Model
Peer Support Workers were found to act as recovery role models to service users and
service providers, illustrating to them what living a full and meaningful life with mental
health challenges can be. In doing so, they act as a source of hope for service users,
channel their lived experience to relate to service users, provide insight to service providers
and normalise mental health diculties for both service users and service providers.
Through acting as a ‘Recovery Role Model’ Peer Support Workers have:
»Increased service users’ hope for recovery
»Normalised mental health diculties to service users
»Reduced service user self-stigma
»Improved service users’ self-esteem
Making Connections
Peer Support Workers were found to connect service users to their communities and
to Mental Health Services. In forging these connections, they enhanced service users’
experience of services and aided them in becoming active members of their communities.
Through ‘Making Connections’ Peer Support Workers have:
»Helped service users to navigate services
»Improved service users’ experience of services
»Increased service users’ voice in services
»Enhanced service users’ communication with services
»Improved service users’ involvement in their community
Person Centred Ways Of Working
Peer Support Workers were found to place service users at the centre of their work and
assist them in directing their own recovery. These ways of working lead to authentic and
meaningful relationships with service users, which fostered independence and enabled
service users to become empowered.
Through their ‘Ways of Working’ Peer Support Workers have:
»Empowered service users to direct their own recovery
»Increased service users’ independence
24 Peer Support Workers in Mental Health Services
The Impact of Peer Support Workers
on Services
Overall, service providers felt that Peer Support Workers had a positive impact on
services. Most said that they increased the recovery orientation of services and helped
service providers think in a more recovery focused manner, putting service users’ wishes
at the centre of their care.
94% (75% yes, 19% somewhat) of service providers felt that Peer Support Workers have a
positive impact on services, while 92% (60% yes, 32% somewhat) of service providers felt
that Peer Support Workers have a positive impact on other service providers.
Through thematic analysis of the survey and focus group data of service providers, the
following are the ways in which Peer Support Workers have positively impacted services:
Recovery Role Model
Through acting as a ‘Recovery Role Model’ Peer Support Workers have:
» Improved service providers’ insight into the lived experience of mental
health diculties
»Developed service providers’ understanding of recovery
»Normalised mental health diculties to service providers
»Reduced service providers’ stigma of mental health diculties
Making Connections
Through ‘Making Connections’ Peer Support Workers have:
»Improved services understanding of service users’ wishes
»Improved communication between services and service users
»Improved the recovery orientation of services
Person Centred Ways Of Working
Through their ‘Person Centred Ways of Working’ Peer Support Workers have:
»Supported service providers in thinking in a recovery-oriented way
»Supported service providers in practicing in a recovery-oriented way
25Peer Support Workers in Mental Health Services
““ [Peer Support Worker] gives me hope as she’s been through what
I’ve been through.” Service User
Service users and service providers alike felt that the presence of someone with lived experience
of mental health diculties working as part of the service with service users, oers them hope that
recovery from such diculties is possible. Peer Support Workers allow service users to believe that
they too can recover and lead a fullling and meaningful life even if symptoms of mental health
challenges persist.
““ She’s the rst person that made me feel I can do it like, you know”
Service User
““ I believe that peer support workers provide invaluable support
to service users as role models with lived experience giving the
message that recovery is possible.” Social Worker
Recovery Role Model
ThisthemereferstothebenetsandpositiveimpactsofPeerSupport
Workersbeingviewedasarolemodelforrecoverybybothstaandservice
users alike. Through their presence and work in Mental Health Services, it
was found that Peer Support Workers illustrate the possibility of living a full
and meaningful life even if symptoms of mental health challenges persist.
Thebenetsofthiscanbeseenthroughthreeprimarymeans:
Acting as a
source of hope
for service users
NORMALISATION
Normalisingmentalhealth
dicultiesbytalkingopenly
about their own
SHARED EXPERIENCE
Sharing their lived experience of
mentalhealthdiculties
HOPE
HOPE
26 Peer Support Workers in Mental Health Services
Service providers recognised that this source of hope for recovery is something that only those with
lived experience can give. Most participants felt that, through their work and employment in Mental
Health Services, Peer Support Workers instil “condence” and “hope” in Service Users, thereby helping
them to progress further in their own recovery
““ I see the value of PrSW and how their experience can oer
something unique re hope for the future that other sta can’t.”
Social Worker
““ Yeah, she’s excellent, it was a completely dierent kind of thing, I’ve
been to psychologists and psychiatrists, and counsellors and stu
like that over the years but there was something about that kind of
like ‘I’ve been there’ that really helped.” Service User
Participants recognised the positive impact that Peer Support Workers had on service users by
sharing their experience of mental health diculties. Their mutual experiences allowed both parties
to relate to each other, with the Peer Support Workers then using this experience alongside their
training to oer advice and guidance to both service users and providers. This use of experiential
expertise resonated with service users:
““ Her support has meant a great deal to me, having someone who
understands (from personal experience) what it’s like to have
anxiety and depression. Her role has played a huge part in my on-
going recovery.” Service User
““ I think what benets the service user the most is the therapeutic
use of experiential knowledge as this is what truly makes us as
Peer Support Workers unique to other professionals on the Multi-
Disciplinary Team.” Peer Support Worker
Service providers felt that Peer Support Workers have improved services by oering “insight” into
living with mental health diculties to sta, with 98.5% of service providers saying the Peer Support
Workers were seen as a recovery resource in their service. This improved understanding has
impacted the way in which service providers view service users and the way they work with them.
SHARED EXPERIENCE
27Peer Support Workers in Mental Health Services
““ Hearing PrSWs talk about their experience of services has helped
me think about how I work and how my clients might view … the
power services can hold.” Social Worker
““ [Peer Support Workers] share lived experience with team members
to help them understand service users’ perspective of being in the
mental health services.” Nurse
““ I was very institutionalised, the system marked me, peer support
deed that.” – Service User
Service users felt that Peer Support Workers removed the shame and secrecy that can surround
having mental health challenges through their presence in mental health service and through their
candid and honest conversations about it. Peer Support Workers’ normalisation of mental health
diculties played an important role in service users’ recovery. In being open and condent in talking
about their own diculties, they remove the stigma attached to mental health challenges and
improve their self-esteem. This was echoed by 95% of service providers, who felt that Peer Support
Workers helped reduce self-stigma amongst service users.
““ Yeah, like, I grew up in a house where my dad was bipolar and it
was just a secret, so like, to openly talk about mental health is, like,
a massive weight has been lifted, and peer support in particular
you, you get very vulnerable with people you talk to, and that hits a
nerve with people in a good way.” Service User
NORMALISATION
28 Peer Support Workers in Mental Health Services
““ It can only be a good thing for service users to see that a peer
support worker is such a valuable member of the team providing
care and as such, people who may have a history of mental health
diculty are not precluded from contributing to service provision
or any other goals a person may have.” Psychiatrist
To service providers, the presence and employment of Peer Support Workers in Mental Health
Services served as an example of what living a full and meaningful life with mental health challenges
can be. Most service providers view them simply as “another member of the team”, this impacted on
how they viewed service users as individuals rather than “a collection of symptoms”. For some cases,
this reduced their own stigma towards mental health, while 78% felt that Peer Support Workers are
helping to reduce stigma amongst their team. It is worth noting that 18% felt that stigma amongst
service providers was not an issue.
““ I think it certainly reduces stigma among service providers as the
peer support worker will share a lot of perspective during MDT
meetings etc. and this will reduce and remove biases.” Psychiatrist
““ It encourages us to think about service users not just as service
users but as individuals within their own context.” Psychologist
29Peer Support Workers in Mental Health Services
““ Practically, we can contribute to cultural change by asking
questions, oering a missing perspective, forging connections
amongst service users and providers. We are a bridge between
the helper and the helpee because we are both - and believe that
everyone could be both.” Peer Support Worker
““ When you have a Mental Health disorder you lose your voice a little
so to have somebody on your side helping you to nd your voice, it’s
vital.” Service User
Peer Support Workers help service users connect with the services they attend. All service users
agreed that Peer Support Workers had a positive impact on their experience of Mental Health
Services. In doing so, Peer Support Workers improved their perception of services, allowing them to
better engage and progress their recovery. They achieved this by enhancing the voice of the service
user, advocating for them and making their wishes known.
Making Connections
Peer Support Workers were viewed as acting as a connector between service
usersandsociety.Theyencourageserviceuserstondtheirvoiceandspeak
up for themselves and connect with those around them. They act as the voice
for service users when they cannot speak for themselves.
The two primary places they did this in were Mental Health Services and
the community.
COMMUNITY
Connecting services to
service users
SERVICES
Connecting service
users to the community
SERVICES
30 Peer Support Workers in Mental Health Services
““ I feel that the raising of issues on behalf of service users at MDT
level has put their aspirations and wishes back into focus and
results in a more determined eort by the MDT to address these
issues.” Peer Support Worker
Due to their shared experience, it was common for service users to open up more to peer support
workers than to other members of the MDT. This allowed them to conde in peer support workers
about important issues that the Peer Support Workers could then work on with them and inform
the MDT about. As this capacity was built, they also encouraged service users to communicate their
wishes directly to service providers themselves in an eort to improve their communication with the
service. As a result of this, 83% of service providers and 87% of Peer Support Workers felt that the
presence of Peer Support Workers had improved communication between services and service users.
““ It’s not just benecial its vital. At times you can’t talk to Doctors and
Nurses, those days you feel you can talk to the person who’s been
through it, that helps to break down the barriers.” Service User
Similarly, service providers felt that one of the main benets of Peer Support Workers was in acting
as advocates for service users during MDT meetings, in conveying their wishes and making service
providers think in a more recovery focused manner.
““ ...link between “team” and “service user” in order to foster a better
working relationship. That the PrSW will advocate on behalf of the
SU and explain why/how the SU wishes for certain things to happen”
Service Provider
““ I enjoy the Peer support worker asking questions at MDTMs of all
professionals, I nd this makes people stop and think and nd it very
interesting the interactions at these meetings” Nurse
31Peer Support Workers in Mental Health Services
““ I don’t spend as much time sitting around the house moping, peer
support workers take me out of myself. It really brings another
dimension to my life.” Service User
People with mental health diculties can become very isolated and withdrawn from society. Peer
Support Workers have played an important role in bringing them back to engage with society, with
76% of service users stating they are more active in their community as a result. This takes many
forms, from accompanying them to do their shopping, to sitting in a cafe for a coee, to setting up
“cinema club” and “ve a side soccer” teams.
““ Helped me to no end. I suer from social anxiety and I’d have great
diculty to go to the shops, when the Peer Support Workers is there
I don’t feel as anxious, he gives me moral support.” Service User
““ I nd they helped because being social anxious I nd they help me to
socialise more and get to know people (new) more and helped me to
overcome being lonely.” Service User
Rather than merely “getting them out of the house”, they encourage and support service users to
engage in society in a way that they are comfortable with, building their capacity for this over time.
This can range from being able to leave their house, to doing their shopping by themselves, to
returning to work. While some of these goals may seem small, they are all essential steps on the path
to reengaging as an active member of the community.
““ I found it very hard to do things in the community, you know, the
men’s shed and things like that. But since seeing [Peer Support
Worker], since coming to her, I’m getting back to these things.”
Service User
COMMUNITY
32 Peer Support Workers in Mental Health Services
““ I was out of work nearly a year, and through talking to [Peer
Support Worker], it lifted me again to get back to work”
Service User
““ [On their Peer Support Worker assisting them in overcoming
agoraphobia] Sure that was the beginning of everything, that was
the beginning of a new phase for me” Service User
““ When I have seen them attend social events with socially anxious
clients, I see them as a real support and real agents for promoting
recovery” Nurse
33Peer Support Workers in Mental Health Services
Peer Relationship
““ It has been my experience that [it’s] the peer support worker’s new
and sometimes more meaningful way of working with clients that
can bring about some lasting change with the services users we
work to support.” Social Worker
““ My role is the support of the person, this is very dierent from
other sta. My work is individualised, and I believe the relationship
I have with service users is very dierent from any other team
member.” Peer Support Worker
““ Support is the rst thing, people need to make connections. We are
social beings, and if we build a strong relationship with clients, we
are providing good service.” Peer Support Worker
The relationship that Peer Support Workers formed with service users was seen as the foundation on
which all other work is built. It is a non-judgmental, informal, and “mutual relationship”, founded on
the idea of “trust”, “openness” and “shared experience”. In this relationship, the service user is an equal.
Person Centred Ways Of Working
Throughout all discussions, participants frequently referred to the
importanceandbenetoftheworkthatPeerSupportWorkersdo.However,
PeerSupportWorkersthemselvesstressedthatthemainbenetsdidnot
stem from what they did, but instead how they did it.
Empowerment
Supporting service users in
directing their own recovery
Peer Relationship
The informal nature of the relationship
that developed with service users
34 Peer Support Workers in Mental Health Services
““ I feel that PrSW provide the most recovery-oriented service of all
mental health disciplines within the MDT. They support service users
to explore their experiences and diculties in an environment that
is non-judgemental and not focused on giving labels and diagnoses.
I feel that PrSW connect to service users on a personal level as the
basis for a strong therapeutic relationship.” Service Provider
““ Honestly I believe it’s the informal conversations where the
relationship grows and evolve, where trust develops and the space
to set recovery orientated goals opens.” Peer Support Worker
Many service users would refer to their Peer Support Workers as a “friend”. Some service providers
raised concerns that, for certain service users who are not in a place to receive peer support, there
is a risk of peer support being “solely a befriending service”. Peer Support Workers stated they were
always careful to explain to service users the nature of their relationship and of their role. However,
participants noted that it can “take time to bed down to [a] therapeutic relationship”. Overall this form
of peer relationship and way of working is eective for service users and often referred to by service
users as “casual but professional”.
““ We talk normally, its chit chat, but very eective at the same time.
It’s dierent to other sta, a more positive, more casual approach.
They speak to you and relate to you. So casual, but so professional.”
Service User
For many service users, the relationship they had with their Peer Support Worker was in contrast to the
relationship they have with other service providers. While other service providers are not necessarily
precluded from working in this way, they can often be restricted by their position. This fact was not lost
on participants, who acknowledged that Peer Support Workers are aorded certain freedoms in their
means and time when working with service users that other service providers are not.
““ No matter how well intentioned, a doctor or nurse etc. is not going
to be able remove themselves from their professional background
when interacting with service users. There will always be that bias.
Peer support workers can take the clinical perspective but are not
bound only by it when working with service users.” Psychiatrist
35Peer Support Workers in Mental Health Services
““ The system doesn’t have the time resources, there’s no time for
helping. They’re just not there. It’s not the nurses’ fault, it’s the
system. There’s not enough time, and the time is less and less each
year.” Service User
““ Doctors in the clinic only see you every 6 months maybe so I feel
really they do not know how you have really been in between
appointments and only go on the day they see you where as the
support worker knows you better good and bad days and it is a
comfort to know in a crisis he is on the other end of the phone more
so than the doctors.” Service User
““ I do not proclaim to have the answers to their problems, instead I
encourage them to nd their own. I see people in the clinic, at home
or out in the community, and this is always at the choice of the
person I am supporting” Peer Support Worker
A vital component of the ways in which Peer Support Workers work is their ability to encourage
and empower service users, with 97% of service users stating they felt empowered by their Peer
Support Worker, and 76% stating that they help them to feel in control of their own lives. Participants
frequently referred to the importance of the Peer Support Worker “meeting them where they’re at”
and allowing them to “set the pace”, when discussing the service user’s recovery process.
““ To bring you through the recovery, to bring you out of
institutionalisation and into life. I felt institutionalised, [my Peer
Support Worker] supported me in that very much so.” Service User
Empowerment
36 Peer Support Workers in Mental Health Services
““ Providing tailored support to the needs of individual service users
which may be variable. I think that the exible approach is helpful,
and the non-clinical perspective allows service users relate to the
peer support worker.” Psychiatrist
Peer Support Workers ensured that service users led and directed the work they did: to focus on and
pursue the goals that service users themselves want to achieve, to work at a pace and at a level that
each service user was comfortable with, in essence, to put the control back into the service users’
hands. These are the aspects of Peer Support that service users feel have empowered them, fostering
a sense of control and autonomy in their own recovery. For some this came in stark contrast to the
way in which services had operated in the past.
““ She will make suggestions, it’s up to me to take it up. I never get
from other Doctors and Nurses.” Service User
““ Having a peer support worker has helped me a lot he doesn’t judge
or push me to get out and about again by being with him I feel I can
push myself and have been out more in the last couple of weeks
than I have in years and years” Service User
““ Yeah it would be like trying to get on a bus, stu like that, very
ground level stu… [My PrSW] helped me to integrate back into
society a lot better… Its huge, I still have the bus ticket… Each
goal is as important as the last even if it doesn’t seem that way to
everyone outside.” Service User
It was noted that Peer Support Workers’ method of placing service users’ wishes at the centre of
their work is not an exclusive approach to Peer Support Workers, and that this type of practice is
used by other service providers. However, the presence of Peer Support Workers within the service
encourages service providers to include this perspective more regularly within their practice.
37Peer Support Workers in Mental Health Services
““ These interactions are benecial. They challenge the traditional
concept of boundaries and encourage me to question why certain
things are the way they are and whether they need to change.”
Psychologist
““ They ‘force’ us to think in a more service user and recovery focused
manner. Having a peer support worker present would always make
me check my biases and refocus to one that is more recovery
oriented as opposed to clinically oriented.” Psychiatrist
““ I have supervised PrSW but also co-facilitated groups and co-
worked cases with them. It has been really helpful in challenging me
to work towards clients’ goals and not mine or services goal.”
Social Worker
38 Peer Support Workers in Mental Health Services
Facilitators & Barriers of
Peer Support
InadditiontoexaminingtheeectofPeerSupportWorkersonserviceusersand
services it was also hoped to identify barriers to peer support and to identify ways of
maximising the impact of Peer Support Workers.
72% of Peer Support Workers felt that they had encountered barriers to fullling their role, while 78%
(56% yes, 22% somewhat) of Peer Support Workers said that they had adequate supports in place to
aid them in their role.
There were a variety of factors that inuenced the impact of Peer Support Workers on services and
service users, many of which related to the novel and unique nature of the role. Service users and
service providers’ understanding, and acceptance of the peer support role was found to act as a
barrier or facilitator to the impact of peer support, with the level of support Peer Support Workers
themselves received also acting as a moderator for the role’s impact.
““ Yesterday I was with a person I support and out of the blue she said
that she was sorry because she said to me, at the start she thought
my job was to take her out for coee, now she sees that there is
more to what I do.” Peer Support Worker
As it is new role within Mental Health Services, it has taken time for sta and service users to
understand the role of a Peer Support Worker and the recovery concept that it promotes.
Acceptance
Participants
attitudes towards
the role
Support
The supports in
place for Peer
Support Workers
Understanding
The understanding of
the role and what it
entails
Understanding
39Peer Support Workers in Mental Health Services
““ …it is new, there still are questions which are being answered with
time. It is natural that this development will take time.”
Social Worker
While many service users now understand the role, there are some, in particular those using rehab
and recovery teams, that do not fully understand the role and refer to Peer Support Workers as
“nurses” or simply as “someone to go places with”. Overall, however, the understanding of the role is
improving as service users are experiencing peer support.
““ Some service users don’t recognise the unique position of peer
support and see them as “just” another team member. Role is being
understood more as more service users use the assistance of a
PrSW and have 1st hand experience.” Nurse
““ I think this is a new role and will need more work in relation to
understanding the role by all SU. But with those SU working with
PrSW there is an understanding and certainly a high value placed
on their intervention.” Nurse
Similarly, many service providers did not have a clear understanding of what Peer Support Workers
do and of where they t within the service. When asked if services understood the role of Peer
Support Workers only 35% answered a denitive ‘yes’, 51% answered ‘somewhat’ and 14% said ‘no’.
This corresponded with Peer Support Workers views on services understanding of their role, 20%
answered ‘yes’, 60% said ‘somewhat’ and 20% said ‘no’. This lack of understanding of the role led to
inappropriate referrals or a reluctance of service providers to refer service users to the service at all.
““ Communication with MDTs is essential pre their arrival …They
are an invaluable asset and can hugely contribute to the MDT
work however there needs to be communication about their role”
Psychologist
““ In some instances the initial referrals for Peer Support are being
suggested by MDT members who are unsure as to what exactly Peer
Support workers do. This in turn leads to a misrepresentation of the
role when it is initially proposed to service users.”
Peer Support Worker
40 Peer Support Workers in Mental Health Services
As with any new profession, Peer Support Workers had to develop their own ways of working and
their own understanding of what being a Peer Support Worker means in practice. An initial lack of
clarity arose around the type of work in which they could participate, the clients with which they could
work, their position within the MDT and the responsibilities and roles that came with it.
““ There were no clear guidelines of what a peer support worker
should be or how we would work within an MDT.”
Peer Support Worker
Peer Support Workers spoke of how some sta initially viewed them as “MTAs” (Multi Task Attendant)
or someone whose role it was to simply get service users “out of the house”. Additionally, not all sta
were aware that Peer Support Workers are full members of the MDT which can prevent their full
involvement in the MDT meetings, and can lead to reluctance or reticence in sharing service user
information for fears of breaching condentiality.
However, as they interacted with peer support workers more regularly, service providers began to
get a better understanding of the role and their way of working. This allowed greater cooperation
between the two groups, which ultimately was of great benet to service users.
““ [on the benets of working with PrSW] This has been benecial in
helping me to identify another area of support that may benet
future clients who come to me for assessment/intervention and who
may also benet from engaging with peer support and what they
have to oer.” Psychologist
““ I really think peer support workers do an invaluable service to the
mental health system! Medication, doctors do a lot of work on the
medical side. They do it to the best of their ability. Having peer
support workers really helps to you regain your life back. Always
there if you need them.” Service User
Acceptance
41Peer Support Workers in Mental Health Services
Perhaps the most accepting of the role were service users, who were immensely positive about
the impact Peer Support Workers had on their own recovery and experience of services. All service
users said they liked receiving peer support, with 41% stating they found it quite benecial to
their recovery and 59% that it was very benecial to their recovery. Many described it as a “vital”
component of their recovery, and some went as far to say that it was the most important role that
the service oered to them.
““ I’d be lost without [Peer Support Worker], great inuence on me
altogether.” Service User
““ I wouldn’t say it’s benecial, I’d say it’s vital.” – Service User
““ It’s the only posiwtive thing I’ve had out of Mental Health Services”
– Service User
““ Like a drink of water in the desert.” – Service User
““ Maybe if it was available in time gone by people wouldn’t be as sick
as they are. If they had it earlier on in life. A lot of people could have
been saved. – Service User
As with any new role, acceptance takes time. This is even more so for a role that for some promotes
a new way of working to the service. Amongst some service providers there is still reluctance and
aversion to certain recovery practices:
““ A few had shared with me that they had been sceptical of the role in
the beginning but have changed their minds completely and would
happily welcome more into the team.” – Peer Support Worker
42 Peer Support Workers in Mental Health Services
““ The Team are still struggling with what real recovery is. They
struggle with issues of autonomy, the right to make bad decisions,
positive risk taking, meeting people where they are at - and
steering away from ‘over minding’, ‘over medicating’, ‘being risk
adverse’. But things have improved. Building relationships and trust
are a key factor in this change - and providing leadership.”
Social Worker
For some, Peer Support Workers are seen as “us vs them” by service providers; that theirs is a
separate way of working from the team and that they are “separate from the team”. This sense of
otherness was present for both service providers and Peer Support Workers. Some service providers
felt that Peer Support Workers kept themselves separate from the team; while Peer Support Workers
felt that they were not being included with only 40% felt they were fully valued members of the MDT.
““ Some team members are very cautious about the role and feel the
Peer Support Workers should be excluded from some parts of the
CMHT [Community Mental Health Team] e.g. I have issues raised
around condentiality, access to clinical notes attending meetings
raised by some members…” Nurse
““ The concept of needing a PrSW almost suggests that the rest of the
MDT would not understand something without their presence. Many
of the sta have family members who are or were users of the MH
service and some had MH issues themselves.” – Service Provider
Although this sentiment was present amongst the minority of participants, it raises an important
issue that Peer Support Workers themselves discussed in relation to them being perceived as “the
recovery person” on the team. While they may be seen as “recovery champions”, “experts by experience”
and the only employee where this is the sole focus of their role, Peer Support Workers do not feel that
this should preclude others from working in this way. This view was also supported by other service
providers who, rather than viewing Peer Support Workers as a “threat” or slight on their own ways of
practice, viewed them instead as an “additional resource” and asset for the team to draw on.
““ It is benecial to have another recovery ordinated voice on the
team. Working towards developing a more recovery orientated
model is very challenging and the perspective of the PrSW is
valuable.” – Occupational Therapist
43Peer Support Workers in Mental Health Services
However, as service providers are exposed more to Peer Support Workers’ ways of working and see
the value of it, there has been an increase in the acceptance of Peer Support Workers and in the
recovery focus of services.
““ With work colleagues I nd it is slow. It is sometimes very hard to
get people referred to you because for some, you are seen as a
lesser professional. However, I have noticed that as my work has
started producing positive results I am getting more and more
referrals, however it is still a slow process and will need more time
before we are seen as equals in the health system.”
Peer Support Worker
The majority of service providers who participated in the research accept peer support workers and
see of the benet of having them on the MDT.
““ A fantastic resource in any service, their training combined with
their lived experience can provide a great support to both peers
and to service users.” Psychologist
““ The peer support worker is considered and treated the same as any
other member of the team with their own role and responsibility
and autonomy. I wouldn’t dierentiate between members of the
MDT including the peer support worker in that regard - everybody
brings their own expertise to the table.” Psychiatrist
““ The addition of a peer support worker has been a very useful and
helpful addition to our MHS.” Psychiatrist
““ Vital in the role of changing the service for the better.” Nurse
The greatest sign of acceptance and endorsement of the impact of Peer Support Workers came from
the call that more should be hired. Peer Support Workers, service providers, and service users all said
that more Peer Support Workers are needed.
44 Peer Support Workers in Mental Health Services
““ If there was more people doing the same thing you’d go a long way
in helping people recover.” Service User
““ employ more people, train more people, put the money into it.”
Service User
““ Wider availability of it across all mental health sectors” Nurse
““ We need more!!! I feel that every area of mental health should be
provided with a peer support worker” Service Provider
““ The job satisfaction is based on knowing that you can make a
dierence in the lives of the people you support. We have a good
supervision structure within our service that promotes wellbeing
and self-care. We also have a separate support structure within
our own group of peer support workers and we see this as the most
benecial contributor to our self-care and wellbeing.”
– Peer Support Worker
Naturally, in teams that had well-established recovery orientated practices, Peer Support Workers
were more readily understood and accepted and thus supported in their work. This is also true of
teams that had received training on the role of Peer Support Workers prior to their implementation.
““ This team is extremely recovery focused and has been instrumental
in supporting me in my role”. Peer Support Worker
Support
45Peer Support Workers in Mental Health Services
““ Our Team was prepared in advance through presentations by Line
Manager of PrSW. We were well informed of the role and specic
work of PrSW. Hence, our Team was ready for a PrSW.”
Social Worker
In areas that did not receive training on recovery principles or Peer Support Workers prior to their
implementation, they felt that there was an “assumption” that sta would know the Peer Support
Workers’ ways of working and scope of practice. However, this was not the case. Participants agreed
that in order to provide support for Peer Support Workers, service providers themselves needed
guidance to understand, and therefore better accept, the new role and ways of working.
““ The value to the SU and the MDT is great but a greater
understanding with clearer role responsibilities and role boundaries
would improve the working relationships within the MDT.”
Service Provider
Service providers felt that they would benet from information and training on Peer Support Workers
and recovery orientated practices. This training was suggested to be delivered in multiple forms, such
as information sessions on recovery and recovery orientated practice, and presentations to teams
on the role of Peer Support Workers prior to their implementation to services. It was suggested that
these presentations could be delivered by Peer Support Workers and service providers who are
working in teams where peer support is already established.
““ working with su/peer is a very new way of working...we should be
supporting sta through quality training and supervision to talk
about the challenges rather than just assuming everyone agrees
and everyone [is] comfortable and knows what to do” Social Work
““ Training from the top down is necessary i.e. mandatory training in
recovery orientated work for all.” Nurse
When Peer Support Workers discussed their own training, they recognised that many aspects
were greatly benecial, such as theoretical models of peer support and personal development.
However, they felt that, in some ways, it did not adequately prepare them for the practicalities of the
role, in particular, working as part of an MDT and some of the practicalities of working with service
users. In this way, Peer Support Workers said that much of their learning took place “on the job”.
46 Peer Support Workers in Mental Health Services
They also believed that, as they have now been in the role for two years, they should have input into
any future training courses.
““ I understood that the training was the rst of its kind and that it be
easier now to improve that as time goes on when the role gets more
recognition as we design it in more structure and detail”
Peer Support Worker
In addition, those who have had access to CPD have beneted greatly from it, in particular courses
that covered the practical elements of the role. However, it is clear that not all Peer Support Workers
have had adequate access to these CPD trainings and courses with only 50% of Peer Support Worker
stating they had access.
““ I would like to see continuing education and employment of PrSW in
the HSE and more education opportunities for PrSW when employed
to continue professional development.” Occupational Therapy
““ I would welcome the opportunity to avail of further training and
education in recovery and contemporary mental health practices.”
Peer Support Worker
Peer Support Workers frequently spoke about their own colleagues as a source of support, nding
great value in their own shared experiences during the process.
““ I have been fortunate in so far as I work with a number of other
peer workers so there is an informal support system at hand. We
also have a monthly Peer Group supervision meeting with all peer
workers within the CHO attending and this is important in relation
to wellbeing and self-care.” Peer Support Worker
For many Peer Support Workers, there were practical issues that added to the diculty of doing their
job. These ranged from low wages, issues with part-time hours, not getting funded for additional
responsibilities and teams that they took on, and access to facilities such as desk space, computers,
and printers. Participants were disheartened by this and felt that it devalued and impeded the work
that they do.
47Peer Support Workers in Mental Health Services
““ Having no computer access printing or internet access is a huge
problem and impacts on my work. The only physical resource i have
is thus phone, i cant ll in forms or write report’s it is disabling and
humiliating at times. Even lling in this survey is dicukt on this
smalk phone” Peer Support Worker
““ I think the Peer Support worker is valued by the team but her salary
does not reect that. The good work she does should warrant a
higher wage. She is a respected member of the MDT and all of her
opinions are valued. She oers a dierent perspective and one that
comes from the service user. This is very unique.” Nurse
Peer Support Workers viewed their supervisors and line managers as an essential source of support.
Overall, they were very satised with their supervision, but both service providers and Peer Support
Workers felt that Peer Support Workers should be supervised by someone in their own profession.
““ I think that Peer support workers should be line managed and
supervised by peer support workers. This gives them full equality
to carry out the role as it should be just like every other worker. In
the beginning we did not know much about the role and we thought
the peer support worker should work similar to us when in actual
fact they work well because they are really dierent from all the
other workers. I think it took a few members of the team time to
understand that and be ok with that.” Nurse
““ I feel that this is extremely dicult because we are completely
dierent roles and this is to no fault of anyone involved because it is
a new role and there are no Peer Support Managers yet. I feel that
sometimes I am being directed to decisions that are not truly Peer
Support, more social work. These issues are seen from a social work
perspective and this has caused some distress, especially in the
beginning …my fear is that the true development of the role can be
inuenced by a dierent discipline and that there is a risk that this
will happen in the future.” Peer Support Worker
This highlighted the need for the further development of the Peer Support Worker role. Primarily, the
need for career progression opportunities, such as “Senior Peer Support Worker” or management roles,
in order to “further demonstrate the value of this service as an equally important perspective to medical,
nursing and other AHP disciplines.”
48 Peer Support Workers in Mental Health Services
Discussion
From this report is it clear that Peer Support Workers are having a positive impact on services and
service users. Peer Support Workers are successfully supporting service users on their recovery
journeys and increasing the recovery orientation of services. In achieving these goals, it is clear that
they add great value to Mental Health Services. Nowhere is this more evident than when looking at Peer
Support Workers in relation to the HSE’s ‘A National Framework for Recovery in Mental Health’.
Benets to Services
When these ndings are examined in relation to the principles of recovery set out in ‘A National
Framework for Recovery in Mental Health’ (HSE, 2018), the true value of Peer Support Workers to Mental
Health Services is revealed. As outlined in ‘A National Framework for Recovery in Mental Health’ the
development of these principles is a vital part of the recovery journey of Mental Health Services. Peer
Support Workers strongly align with these principles and therefore play a crucial role in supporting the
development of recovery-orientated services.
Centrality of Lived Experience
In the way they work Peer Support Workers support service users in directing their own recovery,
placing them at the centre of their own recovery. Furthermore, through their own lived experience they
oer services and service providers a wealth of knowledge and expertise on living with and recovering
from mental health diculties.
Co-Production
Peer Support Workers act as a voice for service users and encourage them to use their own. They
improve communication between the community, service users, and services and put the wishes of
service users at the forefront of their care, while encouraging others to do the same.
Organisational Commitment
The employment of Peer Support Workers illustrates a commitment to the development of recovery
orientated Mental Health Services. In services where they are employed, Peer Support Workers embody
recovery values and communicate them through the ways in which they work. They act as exemplars of
recovery, and through this they play a crucial role in furthering the recovery orientation of services.
Recovery Learning & Practice
Many service providers see Peer Support Workers as recovery resources; they use Peer Support
Workers as a source of knowledge to draw on to enhance their own practices. In addition, through their
own practice Peer Support Workers act as an example to other sta by illustrating recovery orientated
practices and aid in the creation of a recovery culture alongside their fellow service providers.
49Peer Support Workers in Mental Health Services
From the ndings of this report, it would not be hyperbolic to say that not only do Peer Support Workers
align with the recovery principles set out in ‘A National Framework for Recovery in Mental Health’ - they are
the embodiment of these principles. It is clear that they are an asset in promoting recovery in mental
health and therefore should be valued as such.
Benets for Service User Recovery
It is evident that Peer Support Workers play an important role in supporting service users on their
recovery journey. In relation to their direct inuence on service users, Peer Support Workers have
enhanced their experience of services, given them a voice, assisted them in reconnecting with their
communities, provided them with personal connection and supported them to empower themselves,
and develop their ability to direct their own recovery.
The concept of Peer Support Workers oering service users hope was very prominent amongst all
participant groups. When referring to their Peer Support Worker, service users would talk about how
they found them inspirational, the fact that they have “been through it and look where [Peer Support
Worker] is now” “if she can do it so can I”. Peer Support Workers inspiring hope for service users is a
well-documented nding within the literature (Davidson, Bellamy, Guy, & Miller 2012). The importance
of the hope that Peer Support Workers inspire in service users is further highlighted within CHIME.
It is one of the primary recovery processes identied within it and is therefore considered to be a vital
component in service users’ recovery (Leamy et al., 2011).
Service users took great value from having someone with lived experience of mental health diculties
to relate to and to guide them on their recovery. They felt understood by their Peer Support Workers
and could relate to them better than other service providers saying that they are “easier to talk to”
and that they “get it”. For some service users this stemmed from the fact that service providers
“haven’t been through it” and that their knowledge and understanding of mental health diculties was
grounded in “textbooks” or a “theoretical point of view” rather than the personal experience that Peer
Support Workers oered. Although the majority of service users valued the work of other service
providers greatly, they felt that the form of peer relationship with Peer Support Workers oered
them something dierent. This nding is mirrored in other research on Peer Support (Brown &
Kandirikirira, 2007), where the benet of shared experience between service users and Peer Support
Workers is a recurring nding (Davidson, Chinman, Sells, & Rowe, 2006; Repper & Watson, 2012;
Thomas, Despeaux, Drapalski, & Bennett, 2017).
Peer support has been shown to reduce self-stigma in service users who receive it (Repper & Carter,
2011; Repper & Watson, 2012). For service users, the normalisation of mental health diculties and
reduction in self-stigma was through their interactions with Peer Support Workers and their honest
and condent self-disclosure of their own mental health diculties. This was a signicant factor in
supporting service users’ recoveries. For service users, they stood as an example of what can be
achieved while living with mental health diculties and that they need not be dened by their own.
Once again, the CHIME framework reinforces the important role of Peer Support Workers in service
users’ recovery, through their normalisation and de-stigmatisation of mental health diculties which
form a key part of service users having a positive identity that is not simply grounded in life as a
service user (Leamy et al., 2011).
50 Peer Support Workers in Mental Health Services
A key benet of peer support is that it improves service users’ experience of mental health services
(Pollitt et al., 2012). Through their interactions with Peer Support Workers, service users became more
connected to Mental Health Services. Peer Support Workers helped service users to navigate services
and informed them of their rights. Their presence and support have also improved many service
users’ experience and perception of Mental Health Services. Service users saw them as “advocates”
that put their voices at the forefront of their care.
Peer Support Workers can play an important role in increasing service users’ involvement and sense
of belonging in their community (Davidson, Bellamy, Guy, & Miller, 2012; Repper & Carter, 2011;
Repper & Watson, 2012). Service users were encouraged and assisted by Peer Support Workers in
engaging in their communities. Peer Support Workers gave them comfort and moral support giving
them the condence to leave their homes, removing the isolation and loneliness they previously felt.
In doing so, Peer Support Workers added new meaning to their lives, a core recovery process and a
crucial element to a service user’s recovery (Leamy et al., 2011).
Peer Support Workers provided service users with personal connection and felt that it was this
relationship that formed the foundation for the work they do. They spent time with service users,
getting to know them and forming a relationship built on “openness” and “trust”. Building on this,
service users felt that Peer Support Workers were present for them, “always a call away”, and that
their interactions were free from the “pressure” or “expectations” they felt when interacting with other
service providers. This relationship meant a great deal to service users, who at times felt like “a
number” to other service providers, as they did not have the time to interact with them in a similar
fashion or on such a personal level. It was recognised by all participant groups that, due to the “time
rich” nature of their role, Peer Support Workers were enabled to spend longer and more frequent
periods with individuals and that this was a key factor in building the relationship that they have with
service users. Service users responded well to this form of casual and informal relationship and a
natural response to this form of relationship was to view their peer Workers as “a friend” or “like a
friend”, while still recognising that they were professionals with a role to full, and valuing them as
such. This issue is not a new one in Peer Support (Davidson, Chinman, Sells, & Rowe, 2006; Mowbray,
Moxley, & Collins, 1998) but from the accounts of service users this view of the relationship did not act
as a barrier to the benets of peer support.
As service users viewed Peer Support Workers as such a positive resource Peer Support Workers
must remain mindful of making them dependent on the support they provide. Peer Support
Workers felt that, by encouraging service users to direct the work they did with them, they
prevented this from happening. This person-centred way of working provided service users with
a sense of agency and self-determination. Service users found this empowering and it gave them
an increased sense of control over their lives, both of which are crucial aspects of the recovery
process as identied by the CHIME framework (Leamy et al. 2011). This nding is supported in the
literature on peer support where a multitude of studies have found recipients of peer support to
have an increased sense of independence and empowerment (Austin, Ramakrishnan, & Hopper,
2014; Davidson, Bellamy, Guy & Miller 2012; Ochocka, Nelson, Janzen and Trainer, 2006; Thomas,
Despeaux, Drapalski, & Bennett, 2017).
51Peer Support Workers in Mental Health Services
Benets for Service Providers
It is evident that Peer Support Workers have had a positive impact on service providers and through
the presence of Peer Support Workers there has been an improvement in their recovery orientation.
Peer Support Workers provided insight and understanding to service providers into the lived
experience of someone with mental health diculties. Service providers also beneted from seeking
advice from Peer Support Workers on practical issues. These benets to service providers are a
common nding in research on the impact of Peer Support Workers on service providers (Davis &
Pilgrim 2015; Dark, Patton & Newton, 2017; McLean, Biggs, Whitehead, Pratt & Maxwell, 2009).
Peer Support Workers have been found to improve service providers’ view of those with mental
health diculties and decrease stigma (Asad, & Chreim, 2016; Dixon, Hackman, & Lehman, 1997).
Peer Support Workers acted as recovery role models to service providers; in doing so they normalised
mental health diculties to service providers and illustrated what recovery from mental health
challenges can truly mean: that recovery is something real and tangible, not just an abstract
idealistic concept.
Peer Support Workers improved the connection between service users and service providers.
Through Peer Support Workers advocating on service users’ behalf, through consulting with them
on individual service users and through witnessing the way they work with service users, service
providers gained a better understanding of service users’ wishes and were encouraged to work
towards them. This refocused service providers to work with service users on what they want and
not what the service wants, in a recovery-oriented manner as opposed to a clinical one. Overall these
changes have helped to improve the recovery orientation of service providers.
Facilitators & Barriers of Peer Support
The services and service users who have had the opportunity to experience peer support have
beneted from it. However, in order to maximise the benet and impact of Peer Support Workers,
there are issues which must rst be addressed.
Understanding & Acceptance
The lack of understanding and acceptance of Peer Support Workers and the recovery practices
they embody was one of the primary barriers to the positive impact of Peer Support Workers.
Understanding and acceptance of the role is of vital importance in maximising the impact of peer
support (Biggs, Whitehead, Pratt & Maxwell, 2009). Naturally, as a new role, service users, service
providers, and even Peer Support Workers themselves required exposure to it in order to understand
and accept it (Asad, & Chreim, 2016). However, it is clear that, in addition to exposure to the role,
there are a number of factors that can contribute to an increased understanding and acceptance of
Peer Support Workers.
The job description for Peer Support Workers outlined the general concept of what Peer Support
Workers were meant to achieve and how they would achieve it. However, some service providers and
Peer Support Workers felt that the job description failed to oer guidance on how these goals would
52 Peer Support Workers in Mental Health Services
be achieved in a practical sense. Some service providers felt it used “aspirational” words that were
dicult to translate into practice. As a result, service providers, Peer Support Workers and service
users were left unclear as to how a Peer Support Worker fulls their role. Dening and understanding
peer support in practice is a common issue in service where it is utilised (Gillard et al., 2015).
Peer Support Workers, their supervisors and other MDT members highlighted the need and
importance of possessing a good understanding of the role and of recovery practices, with similar
ndings in the research (Gates & Akabas 2007). This is especially relevant in relation to areas like risk,
where recovery orientated practices are in contrast to the traditional model of care (Scott, Dughty
& Kahi, 2011). A report on the implementation of Peer Support Workers into Scottish Mental Health
Services indicates that the recovery orientation of services played a crucial role in the successful
integration of Peer Support Workers onto MDTs (McLean, Biggs, Whitehead, Pratt & Maxwell, 2009).
While this was acknowledged and advised by the project leads during the implementation of the
role, it was not always adhered to on the ground. As a result, some Peer Support Workers found
themselves in services where there was little knowledge of their role and application of recovery
principles.
Even now two years later, in the areas where there was little education on recovery practices and
the role of Peer Support Workers prior to their joining the MDT, service providers are requesting
education on peer support and recovery principles. The call for recovery orientated training such as
Recovery Principles and Practice workshops, by both sta and Peer Support Workers, is supported
as training programmes like this have been shown to improve service providers’ recovery practices
(Young et al., 2005). Service providers and Peer Support Workers also felt that endorsement of
recovery practices and Peer Support Workers from senior management and clinical leads was an
essential element in their acceptance on the MDT. In their own review of Peer Support Workers
in Scotland, McLean et al. (2009) highlighted the benet of the endorsement and support of
management and psychiatry (McLean, Biggs, Whitehead, Pratt & Maxwell, 2009).
There are numerous negative consequences to a poor understanding and acceptance of the role.
Primarily it prevented service providers from engaging with the role and referring service users for
peer support. While this lack of understanding of the role can frustrate and discourage Peer Support
Workers, its most pronounced eect is on the service users who are not referred for peer support
as a result. This prevents service users from accessing the benets of peer support, which for many
played a central role in their recovery (Dixon, Hackman, & Lehman, 1997; Mancini, 2018; Vandewalle
et al., 2016).
In the two years since the appointment of Peer Support Workers there has been much development
of the role and what it means to be a Peer Support Worker in practice. For Peer Support Workers
this meant learning on the job and sharing ideas and practices with colleagues. Across the country
Peer Support Workers, their supervisors, and their services have all branched out and lled their own
niches, with each Peer Support Worker working to their strengths and the range of the services and
service users’ needs. As this is a new role, this was to be expected; however, these developments
must be taken stock of and shared between Peer Support Workers, supervisors and services, so they
can learn from each other and progress together.
53Peer Support Workers in Mental Health Services
Supervision
The importance of appropriate supervision is recognised as an integral factor in the impact and
success of peer support (McLean, Biggs, Whitehead, Pratt & Maxwell, 2009; Salzer, Katz, Kidwell,
Federici, & Ward-Colasante, 2009). Overall, Peer Support Workers were satised with the level and
quality of supervision they received. However, some service providers, including current supervisors,
raised the issue of protected time and resourcing of supervision and felt that it is needed to ensure
the adequate provision of supervision for Peer Support Workers.
Although Peer Support Workers and service providers were happy with the current supervision, there
was much support for the creation of senior Peer Support Worker roles and Peer Support Workers
supervision of their own role. The primary reason for this relates to the potential for Peer Support
Workers to be compromised by other professions’ ways of working. Both Peer Support Workers
and their supervisors felt that at times supervisors’ own professional background and practice had
the potential to inuence and impinge on Peer Support Workers’ ways of working. Similar studies
such as Kuhn et al. (2015) have previously highlighted the conict between Peer Support Workers’
understanding of their role and practice and their supervisors’ understanding as a potential barrier to
their impact and future development of the role.
Role Development
Related to this, Peer Support Workers and service providers felt that in order to retain current Peer
Support Workers in the role and their valuable expertise, career progression opportunities and salary
increases should be considered. Peer Support Workers are currently aligned to the family support
worker pay scale. Peer Support Workers and some service providers feel the level of salary for
Peer Support Workers does not reect the “unique value” of the role and the level of responsibilities
they take on. Poor career progression opportunities and salary are recognised factors in retaining
Peer Support Workers (Mancini, 2018; Mowbray, Moxley, & Collins, 1998; Repper & Watson, 2012;
Vandewalle et al., 2016). Peer Support Workers raised this issue and felt there was danger that
Peer Support Workers may leave the role due to a lack of progression opportunities and low salary,
denying the services their expertise and experience. Service providers and Peer Support Workers
also highlighted the need for an option to increase hours, as with most working part-time there can
be issues which negatively impact the work they do, such as one to one work with service users,
especially those in distressed states, and in acting as and being accepted as a full member of the MDT.
All of these issues are reported within the literature as acting as challenges to Peer Support Workers
in fullling their role. These include poor work conditions, lack of recovery orientation of the service
they work in, a lack of autonomy from supervisors, being the sole Peer Support Worker in a service,
and lack of clarity in their job description (Moran, Russinova, Gidugu, & Gagne, 2013). From the
ndings of this report there is a clear need to address these issues in order to progress the role.
Research by Campbell and Leaver (2003) has suggested that the development of manuals or guidance
documents could potentially alleviate some of these issues.
54 Peer Support Workers in Mental Health Services
Conclusion
This report set out to determine the impact of Peer Support Workers on Mental Health Services and
on service users. It aimed to investigate whether the Peer Support Workers were achieving the goals
of supporting service users in their recovery and increasing the recovery orientation of services. It
is clear that their impact on Mental Health Service and on service users is a positive one and that
they are achieving the goals of supporting service users in their recovery and increasing the recovery
orientation of services.
Additionally, the report has also helped identify the means through which these goals have been
achieved and how Peer Support Workers and their services have worked towards them in practice.
These goals have been achieved in three main ways: in acting as recovery models to services and
service users; in making connections between service users their community and services; and in
working in a person-centred manner.
However, there have been barriers to achieving these goals. Issues of service readiness have acted
as a barrier to the impact of peer support and it is clear from participants that it has taken time and
exposure to Peer Support Workers since the initial implementation for understanding and acceptance
of the role to grow. There are still sta who do not fully embrace the role, and this can reduce the
impact of Peer Support Workers. Through continued education, support, and development of the role,
the positive impact of Peer Support Workers on service users’ recovery and on increasing the recovery
orientation of services can be developed further.
55Peer Support Workers in Mental Health Services
Recommendations
The following recommendations support ways to overcome barriers and improve
the provision of peer support in Mental Health Services:
1. Increase and expand Peer Support Workers within the current mental health service provision
across all CHOs.
2. Develop a suite of guidance documents on:
|Supervision of Peer Support Workers.
|Service readiness for MDTs working with Peer Support Workers.
|TheroleandpracticeofaPeerSupportWorker,withreferencetoworkingwithdierent
service populations.
All documents should be created with input from Peer Support Workers and other relevant
stakeholders.
3. Develop the Peer Support Worker role through:
|ExploringtheestablishmentofseniorPeerSupportWorkerrolessuchaspeersupervisors;
optionsforincreasinghours;andincreaseinsalarytoreectthelevelofresponsibilitythey
hold and unique value of their work.
| Developing local, regional, and national forums in which Peer Support Workers can support
one another, share ideas, learning, and experiences to promote best practice in the
profession.
4. Ensure MDT, clinical leadership, and local management have undergone brieng and educational
sessions on the role of a Peer Support Worker and training in recovery principles prior to
implementation of Peer Support Worker to the MDT.
5. Ensure the job description of a Peer Support Worker accurately reects the role as it has
developed over the last two years. Develop a version of this that is accessible for service users
and service providers.
6. Liaise with Higher Education Institutes to ensure that the training provided meets the requirements
for the HSE Peer Support Worker role.
56 Peer Support Workers in Mental Health Services
References
Anthony, W. A. (1993). Recoveryfrommentalillness:theguidingvisionofthementalhealthservice
system in the 1990s.Psychosocial rehabilitation journal,16(4), 11.
Asad, S., & Chreim, S. (2016). Peer support providers’ role experiences on interprofessional mental
health care teams: A qualitative study.Community mental health journal,52(7), 767-774.
Austin, E., Ramakrishnan, A., & Hopper, K. (2014). Embodying recovery: a qualitative study of peer
work in a consumer-run service setting.Community mental health journal,50(8), 879-885.
Brown, W., & Kandirikirira, N. (2007). Reportonnarrativeinvestigationofmentalhealth
recovery.Glasgow: Scottish Recovery Network.
Dark, F., Patton, M., & Newton, R. (2017). A substantial peer workforce in a psychiatric service will
improvepatientoutcomes:thecasefor.Australasian Psychiatry,25(5), 441-444.
Davidson, L., Chinman, M., Sells, D., & Rowe, M. (2006). Peer support among adults with serious mental
illness:areportfromtheeld.Schizophrenia bulletin,32(3), 443-450.
Davidson, L., Bellamy, C., Guy, K., & Miller, R. (2012). Peer support among persons with severe mental
illnesses:areviewofevidenceandexperience.World psychiatry,11(2), 123-128.
Davis, J. K., & Pilgrim, S. I. (2015). Maximizing utilization of peer specialists in community mental
health:TheNextstepinimplementation.Journal of Psychosocial Rehabilitation and Mental Health,2(1),
67-74.
Dixon, L., Hackman, A., & Lehman, A. (1997). Consumersasstainassertivecommunitytreatment
programs.Administration and Policy in Mental Health and Mental Health Services Research,25(2), 199-208.
Gates, L. B., & Akabas, S. H. (2007). Developingstrategiestointegratepeerprovidersintothesta
of mental health agencies.Administration and Policy in Mental Health and Mental Health Services
Research,34(3), 293-306.
Gillard, S., Holley, J., Gibson, S., Larsen, J., Lucock, M., Oborn, E., ... & Stamou, E. (2015). Introducingnew
peer worker roles into mental health services in England: comparative case study research across a
rangeoforganisationalcontexts.Administration and Policy in Mental Health and Mental Health Services
Research,42(6), 682-694.
Hebert, M., Rosenheck, R., Drebing, C., Young, A. S., & Armstrong, M. (2008). Integratingpeersupport
initiativesinalargehealthcareorganization.Psychological Services,5(3), 216.
Health Service Executive (2018). A National Framework for Recovery in Mental Health. Mental Health Service.
Kuhn, W., Bellinger, J., Stevens-Manser, S., & Kaufman, L. (2015). Integrationofpeerspecialistsworking
inmentalhealthservicesettings.Community mental health journal,51(4), 453-458.
Mancini, M. A. (2018).Anexplorationoffactorsthateecttheimplementationofpeersupport
services in community mental health settings.Community mental health journal,54(2), 127-137.
McLean, J., Biggs, H., Whitehead, I., Pratt, R., & Maxwell, M. (2009). Evaluation of the delivering for mental
health peer support worker pilot scheme, Scottish Government Social Research, Edinburgh.
57Peer Support Workers in Mental Health Services
Mental Health Commission. (2009). Toward recovery and wellbeing: A framework for a mental health
strategy for Canada.Mental Health Commission for Canada.
Moran, G. S., Russinova, Z., Gidugu, V., & Gagne, C. (2013). Challenges experienced by paid peer
providersinmentalhealthrecovery:aqualitativestudy.Community Mental Health Journal,49(3),
281-291.
Mowbray, C. T., Moxley, D. P., & Collins, M. E. (1998). Consumersasmentalhealthproviders:First-
personaccountsofbenetsandlimitations.The journal of behavioral health services & research,25(4),
397-411.
Naughton, L., Collins, P. & Ryan, M. (2015) Peer Support Workers: A Guidance Paper. National Oce for
Advancing Recovery in Ireland. HSE: Mental Health Division. Dublin.
Pollitt, A., Winpenny, E., Newbould, J., Celia, C., Ling, T., & Scraggs, E. (2012). Evaluation of the peer
workerprogrammeatCambridgeshireandPeterboroughNHSFoundationTrust.
Repper J., Aldridge B., Gilfoyle S., Gillard S., Perkins R., & Rennison J. (2013). Peer support workers:
Theory and practice. ImROC brieng, Centre for Mental Health and Mental Health Network: NHS
Confederation.
Repper, J., & Carter, T. (2011). A review of the literature on peer support in mental health
services.Journal of mental health,20(4), 392-411.
Repper, J., & Watson, E. (2012). AyearofpeersupportinNottingham:lessonslearned.The Journal of
Mental Health Training, Education and Practice,7(2), 70-78.
Salzer, M. S., Katz, J., Kidwell, B., Federici, M., & Ward-Colasante, C. (2009). PennsylvaniaCertiedPeer
Specialist initiative: Training, employment and work satisfaction outcomes.Psychiatric Rehabilitation
Journal,32(4), 301.
Scottish Recovery Network (2013) Reviewing peer working: A new way of working in mental health. Glasgow:
Scottish Recovery Network.
Scott, A., Doughty, C., & Kahi, H. (2011). ‘Having those conversations’: The politics of risk in peer
supportpractice.Health Sociology Review,20(2), 187-201.
Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., ... & Whitley, R. (2014). Uses
and abuses of recovery: implementing recovery‐oriented practices in mental health systems.World
Psychiatry,13(1), 12-20.
Sunderland, K., & Mishkin, W. (2014).Guidelines for the practice and training of peer support. Mental
Health Commission of Canada.
Thomas, E. C., Despeaux, K. E., Drapalski, A. L., & Bennett, M. (2017). Person-oriented recovery
of individuals with serious mental illnesses: A review and meta-analysis of longitudinal
ndings.Psychiatric services,69(3), 259-267.
Vandewalle, J., Debyser, B., Beeckman, D., Vandecasteele, T., Van Hecke, A., & Verhaeghe, S. (2016). Peer
workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental
healthservices:Aliteraturereview.International Journal of Nursing Studies,60, 234-250
Young, A. S., Chinman, M., Forquer, S. L., Knight, E. L., Vogel, H., Miller, A., ... & Mintz, J. (2005). Use of a
consumer-led intervention to improve provider competencies.Psychiatric Services,56(8), 967-975.
58 Peer Support Workers in Mental Health Services
Mental Health
Engagement Oce
(Working with People who use
Mental Health Services, their Family
Members, Carers and Supporters)
HSE, St Loman’s Hospital,
Palmerstown, Dublin 20.
D20 HK69
Tel: +353 (0)1 620 7339
Email: mhengage@hse.ie
Web: www.hse.ie/mentalhealthengagement
