What you need to know
The Mental Health Commission of Canada defines peer support workers as those who provide “emotional and social support provided to others who share a common experience (Mental Health Commission of Canada, 2022).” Evidence shows that the integration of peer support workers into mental health services has many benefits, but developing these programs has several challenges. Some challenges include being able to maintain professional boundaries, difficulties with power dynamics among staff, job-related stress, and role clarity. This literature review uses an implementation science lens to identify best practices for putting in place a peer support program in mental health services.
What is this research about?
The Mental Health Commission of Canada defines peer support workers as those who provide “emotional and social support to others who share a common experience (Mental Health Commission of Canada, 2022)”. This type of support is commonly available in a variety of mental health services, including inpatient and outpatient hospital settings and community mental health.
This literature review identifies the challenges and facilitators to implementing peer support in mental health settings and uses an implementation science lens to develop best practices for mental health peer support programs.
Implementation science is the study of how interventions that are based on scientific evidence can be put into wider practice to optimize outcomes for clients (Bauer & Kirchner, 2020). A key to implementation science processes is that they “seek to intervene to change the context in which clinical innovations are used in order to enhance their uptake.”
What did the researchers do?
Researchers conducted a systematic review of articles in peer-reviewed journals, published in English until October 2019. In particular, they were looking for studies that examined factors that helped and hindered the implementation of peer support in mental health organizations. The search used the following key terms: “peer support;” “lived experience;” “peer to peer;” “peer mental health support;” and “implementation”.
What did the researchers find?
The researchers identified 19 articles that had relevant information, published between 2008 and 2019. The studies were conducted in a variety of settings, such as hospitals, community-based services and primary care clinics. They also described various types of peer support (e.g., group or individual) and intervention lengths.
From the findings, the authors claimed there is enough evidence that the benefits of peer support outweigh the costs associated with its implementation. They provided the following best practices for implementing peer support workers into existing services:
- Strong leadership and commitment to the peer-support role are the most important factors for successfully integrating peer support workers into existing services and enhance its perceived value.
- Policy mandates are needed to inform the development of peer support services, hold organizations responsible and ensure there is adequate funding.
- Adequate funding and logistical and administrative supports (e.g., access to equipment, medical records, and training) for these roles is also significant.
- In settings where peer support is perceived as lacking credibility, education and knowledge exchange should be used to increase understanding of the intervention and enhance buy-in.
- Creation of a flexible and accepting workplace environment that allows for positive individual and cultural changes is needed to integrate peer support workers into existing services.
- Organizations need to recognize the professional value of peer expertise and pay peer support workers accordingly.
- One of the first steps in the implementation process is defining the role of the peer support worker to ensure clarity in roles and responsibilities. This should be done in consultation with peer support workers, team leaders and staff.
- Another step prior to implementation is to ensure there is appropriate training for peer support workers as well as for non-peer staff who will be working alongside them. Ongoing training and supervision are also important supports for peer support workers.
Limitations of the research
The papers reviewed did not provide any information about the process of implementation and its evaluation. Most of the studies were done in the United States and Australia, which have government and organizationally-mandated policies to integrate peer support into existing programs. The authors suggest that more research is needed from countries that don’t have peer support or recovery-oriented mandates.
How can you use this research?
The findings from this article offer a detailed overview of best practices for researchers and service providers seeking to implement peer support in mental health services.
About the researchers
Christina Mutschler1, Chyrell Bellamy2, Larry Davidson2, Sidney Lichtenstein3 and Sean Kidd3,4
- Department of Psychology, Ryerson University (Toronto Metropolitan University)
- Program for Recovery and Community Health, School of Medicine, Yale University, New Haven, Connecticut, USA
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
References
Bauer, M. S. and Kirchner, J. (2020). Implementation science: What is it and why should I care? Psychiatry Research. 283, 112376. https://doi.org/10.1016/j.psychres.2019.04.025
Mental Health Commission of Canada. (2022). Peer Support. https://mentalhealthcommission.ca/what-we-do/access/peer-support