Course:SOWK551/2021/Peer Support in Mental Health

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Short Summary

Literature review of the benefits and challenges with peer support in mental health settings.

Author: Anonymous

Date: 2022-Dec-11

Introduction

Peer support is growing in popularity and is increasingly utilized in many mental health settings (Tseris, 2020). It may continue to expand as the government of British Columbia recognizes that peer support in health care and social services is of critical importance (2021). Social workers will likely be in a position of power when working with peer support workers and therefore it is important for social workers to understand peer support. This literature review aims to explore within the mental health field the role of peer support workers, peer support values and their overlap with social work, the benefits and challenges of peer support work, and the role of social workers with peer support.

Peer Support Definition

In the mental health field, there is no standard definition of peer support and its role has evolved. Historically, peer support has been in the form of peer groups where mutual support was provided (Chinman et al., 2014). This version of peer support came out of the ex-patient movement in the 1970s due to negative experiences in the mental health system and goes against the medical model (Cusick, 2021). In recent years, peer support has shifted to an emphasis on assisting the consumer instead of it being a mutually beneficial relationship (Fortuna, Solomon, & Rivera, 2022). Additionally, professionalization is becoming increasingly important in peer support (Chinman et al., 2014). In 2019, the government of BC provided one million dollars to support the development of the Provincial Peer Support Worker Training Curriculum and standards of practice (Government of BC, 2021). This training is free and can be accessed at peerconnectbc.ca.

Many studies define who is considered a peer support worker (PSW) differently. Wang, Chen, & Deng define a peer as an individual who has successfully lived with a serious mental illness and is now supporting others with a mental illness (2021). Braiser et al.’s definition includes the additional need for the use of professional skills and training in the direct support of others (2022). Chinman defines PSWs as employees either in traditional mainstream positions who self-identify as having a serious mental illness or in unique positions designed specifically for peers (2014). There is a difference between the two as peer support workers in unique positions fill a gap in the system that peers in traditional mainstream positions are unable to address (Cusick, 2021). Other terms for PSW include peer worker, peer consultant, consumer consultant, service user-run, and service user-led (Tseris, 2020; Chinman et al., 2014)

The role of PSWs within an organization also has no set standard. One form of peer support is peers as employees (Fortuna, Solomon, & Rivera, 2022). This form of peer support work often occurs within traditional mental health care. Chinman et al. found that the most common job task of peer support employees in their meta-analysis was providing mutual aid and sharing personal experiences (2014). However, there are many other expectations of peers in this role. Peers may be expected to be involved in group facilitation or co-facilitation (Moll et al., 2009). Peer support services also typically include education and supporting the development of problem-solving and coping skills to self-manage the consumer’s mental health, supporting the activities of the rest of the healthcare team, and traditional activities such as case management (Chinman et al., 2014).

Another form of peer support is peer-run services (Fortuna, Solomon, & Rivera, 2022). This often occurs in larger non-peer organizations. The services include peer respite, non-clinical support phone lines, and drop-in centers. An additional form of peer support is relationships that voluntarily, informally, and naturally occur between consumers who are using the same service (Bouchard, Montreuil, & Gros, 2010). This form of support could occur in a voluntary group format (Fortuna, Solomon, & Rivera, 2022). Informal peer support has been found to be beneficial as it may include supportive actions such as providing information and advice, sharing material goods, helping with activities, and offering emotional support which has then led to improved mental health and quality of life (Bouchard, Montreuil, & Gros, 2010).

A new form of peer support is digital peer support (Fortuna et al., 2022). This form of support has gained popularity since covid-19 (Fortuna, Solomon, & Rivera, 2022). This is a newly emerging form of peer support and there is a lack of supporting data for its efficacy due to its novelty (Fortuna et al., 2022).

Connections to social work values

There are many commonalities between social work and peer support values. Both peer support work and social work value social justice (Penney, 2018). Other values in common are a strength-based approach, respect, empowerment, collaboration, valuing of lived experience, equity, and self-determination (Loumpa, 2012; Cusick, 2021; Tseris, 2020). Peer support work recognizes that trauma has played a central role in many consumers’ experiences in the mental health system (Penney, 2018). Many social workers also use a trauma-informed lens with their clients. Finally, Social Work values align with recovery theory, and recovery theory advocates for PSWs involvement as part of the recovery process (Loumpa, 2012). It is important to recognize the mutual values between social work practice and peer support as they identify a common ground between the professions. Additionally, as previous initiatives involving peer support have caused harm to peers it is important to adopt values that hold social workers accountable (BCcampus, n.d.).

Benefits of Peer Support

There are many identified benefits for consumers to having PSWs working on mental health teams. These benefits include the knowledge they hold, their ability to contribute to change mechanisms, their support of the consumer-health team relationship, and their support in reducing the consumer’s need for mental health services.

The knowledge base that PSWs provide is one that many non-PSWs employees are lacking as PSWs have knowledge of the social context, experiences, and needs of service users (Tseris, 2020). This is a benefit as this knowledge base is a largely underutilized resource and harnessing it may improve service experiences for consumers (Tseris, 2020).

Another benefit that PSWs contribute is their ability to impact the consumer's change mechanisms by building trusting relationships with them through common lived experiences, role-modeling recovery and living well, and engaging service users in both mental health services and the community (Gillard, 2020). Braiser et al. also found that PSWs have skills in relationship-building, empathy, de-escalation, and listening (2022). The findings of multiple studies provide evidence to support that consumers are experiencing positive change as they found that consumers have a decrease in loneliness and stigma and an increase in well-being, hope, and empathy due to PSWs (Repper & Carter, 2011; Wang, Chen, & Deng, 2021). Furthermore, they found that consumers are empowered through their interactions with PSWs (Repper & Carter, 2011; Chinman et al., 2014).

Additionally, PSWs build a bridge between the staff and the clients due to their ability to engage with those highly unlikely to engage in services (Tseris, 2020). Chinman also found that PSWs promote engagement with care and relationships with care providers (2014). This is a benefit as engaging in services and with their care team may aid in the consumer's recovery.

Finally, PSWs may help the consumer decrease their need for mental health services. Studies on PSWs have shown they help with medication adherence, reducing inpatient service use, reducing admissions rates to hospitals, and increasing community tenure (Wang, Chen, & Deng, 2021; Chinman et al., 2014; Repper & Carter, 2011). Looking beyond the benefits to consumers with regard to decreasing service needs, Muschler found that the benefits of PSWs to the healthcare organization outweigh their financial costs (2022).

Challenges to Peer Support

There are many challenges that PSWs face in the mental health field. These range from lack of clarity of their role, lack of respect for their role and expertise, inadequate hours provided by the employer, power differentials, and maintaining boundaries.

The lack of clarity around the role was a challenge raised by multiple articles (Tseris, 2020; Moll et al., 2009). Each organization may have different expectations for PSWs and without clarification from the employer, PSWs may not be aware of the expectations of their position (Cusick, 2021). Moll et al. highlighted how tension between PSW and non-PSW can occur due to this lack of clarity especially if there are overlapping job duties between PSW and non-PSW staff (2009). Additionally, Tseris found that non-PSW staff lacked an understanding of how to effectively utilize PSWs due to this and that in turn, PSWs felt undervalued by non-PSWs (2020). However, Hiller-Venegas et al. found that in their study of PSWs supporting youth aged 16-24 having an unstructured peer support program allowed PSWs to provide a wide range of services to their clients (2022).

Another challenge for PSWs is a lack of respect from non-PSW staff members. Braiser et al. found that PSWs must be recognized as experts and full members of the team (2022). Tseris also found that PSWs need to be supported by the actions and attitudes of non-PSW staff and organizational structures (2020). If PSW are not supported, Repper and Carter suggest that PSWs risk being socialized into the usual ways of an organization, especially if their role is undervalued (2011). This may undermine the potential benefits of peer support (Repper and Carter, 2011). Cusick also acknowledged the risk of PSW adapting to the practices of a clinical model and stated that it is critical that PSWs remain peers and work against the hierarchical nature of the medical model (2021).

Inadequate hours were another challenge for PSWs (Tseris, 2020). Moll et al. found that inadequate hours provided a challenge to integrate with the full-time staff which was identified by both managers and PSWs (2009). Braiser identified that PSWs need long-term financial support from the organization (Braiser et al., 2022). Limited hours may limit the financial support PSWs are receiving.

An additional identified challenge is power differentials between PSW and non-PSW staff (Tseris, 2020; Repper & Carter, 2011). This may occur as PSWs inhabit a social location between consumers and other staff members (Moll et al., 2009). Due to this social location, consumers may view PSWs as staff which hurts trust and non-PSW staff may see them as consumers which may lead to PSWs being stigmatized and discriminated against (Moll et al., 2009). However, this social location may also be beneficial as Fortuna, Solomon, & Rivera found that PSWs may alter non-PSW staff’s detrimental views of consumers by providing a direct example of someone who is successfully functioning (2022).

PSWs maintaining boundaries with consumers was another identified challenge (Moll et al., 2009; Repper & Carter, 2011). This is because PSWs are expected to share personal experiences and knowing how much and when to share is required to maintain boundaries (Moll et al., 2009). Additionally, a lack of clear role expectations may leave PSWs unable to know where the boundaries of their role lay (Cusick, 2021).

These are only some of the identified challenges that PSWs face in their employment. For example, there is a lack of research on the role of cultural competency in PSWs’ work (Chinman et al., 2014). Therefore, there may be challenges that PSW are facing which do not appear in the current literature on this topic.

Social Work Role

Social workers have a role in promoting peer support practices and workers. Three areas this review will highlight are peer engagement and consultation, promoting informal peer support, and supporting PSWs in their workplace. For additional education, the government of BC has created a resource for facilitators working with PSWs which was made by peers (2021). It can be located at https://peerconnectbc.ca/.

Social workers may be in positions where they utilize peer engagement and consultation. BCcampus has a list of recommendations for when working with peers in this capacity (n.d.). The recommendations include following the provincial peer payment guidelines, challenging power structures as consultation may be tokenizing, accommodating the needs and wants of PSWs, only including PSWs if the project is willing to adapt to peer feedback, seeking diversity in the PSWs included, and prioritizing the process over the outcomes (BCcampus, n.d.). Tseris also highlights that for ethical practice social workers need to be open to listening to PSWs and willing to change their practices based on PSW feedback (2020). As social workers need to be aware of these considerations so that they are engaging with peer support in an ethical manner.

Social workers can also promote informal peer support by creating a supportive environment and facilitating peer relationships in their workplaces (Bouchard, Montreuil, & Gros, 2010). Loumpa suggests that when SWers facilitate groups for peer support they can provide space for group members to hold the position of expert by ensuring conversation and exchange of peer support is happening (2012).

Finally, Social Workers have a role in advocating for PSWs. This is because PSWs may not be able to voice their views due to fears about job security (Tseris, 2020). Social workers can advocate for PSWs to not be taken advantage of by organizational assumptions and for the improvement of PSWs’ job conditions (Tseris, 2020). In partnership with PSWs social workers may consider engaging in macro reform and policy work relating to social justice for people involved in the mental health system (Tseris, 2020).

Conclusion

As social workers in the mental health field are increasingly likely to work with peer support workers it is important that they understand their role, how they benefit consumers, and the challenges they may face. Social work and peer support have many common values and are likely to work simultaneously together with consumers. Social workers have a role in promoting peer support and assisting their PSW colleagues.

References

BCcampus. (n.d.). 10 Recommendations for Peer Engagement & Consultation. https://peerconnectbc.ca/wp-content/uploads/10-Recommendations-Peer-Engagement.pdf

Bouchard, L., Montreuil, M., & Gros, C. (2010). Peer support among inpatients in an adult mental health setting. Issues in mental health nursing, 31(9), 589–598. https://doi.org/10.3109/01612841003793049

Brasier, C., Roennfeldt, H., Hamilton, B., Martel, A., Hill, N., Stratford, A., Buchanan-Hagen, S., Byrne, L., Castle, D., Cocks, N., Davidson, L., & Brophy, L. (2022). Peer support work for people experiencing mental distress attending the emergency department: Exploring the potential. Emergency medicine Australasia : EMA, 34(1), 78–84. https://doi.org/10.1111/1742-6723.13848

Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatric services (Washington, D.C.), 65(4), 429–441. https://doi.org/10.1176/appi.ps.201300244

Cusick, J. (2021). The B.C. Peer Support Training Curriculum Guide. B.C. Ministry of Mental Health and Addictions. https://peerconnectbc.ca/wp-content/uploads/Curriculum-Guide_Final.pdf

Fortuna, K. L., Myers, A. L., Ferron, J., Kadakia, A., Bianco, C., Bruce, M. L., & Bartels, S. J. (2022). Assessing a digital peer support self-management intervention for adults with serious mental illness: feasibility, acceptability, and preliminary effectiveness. Journal of mental health (Abingdon, England), 1–9. Advance online publication. https://doi.org/10.1080/09638237.2021.2022619

Fortuna, K.L., Solomon, P. & Rivera, J. (2022). An Update of Peer Support/Peer Provided Services Underlying Processes, Benefits, and Critical Ingredients. Psychiatr Q 93, 571–586. https://doi.org/10.1007/s11126-022-09971-w

Gillard, S., Gibson, S. L., Holley, J., & Lucock, M. (2015). Developing a change model for peer worker interventions in mental health services: a qualitative research study. Epidemiology and psychiatric sciences, 24(5), 435–445. https://doi.org/10.1017/S2045796014000407

Government of British Columbia. (2021). Training resources to improve the quality of mental health and substance use services. https://news.gov.bc.ca/releases/2021MMHA0037-001380

Hiller-Venegas, S., Gilmer, T. P., Jones, N., Munson, M. R., & Ojeda, V. D. (2022). Clients' Perspectives Regarding Peer Support Providers' Roles and Support for Client Access to and Use of Publicly Funded Mental Health Programs Serving Transition-Age Youth in Two Southern California Counties. The journal of behavioral health services & research, 49(3), 364–384. https://doi.org/10.1007/s11414-022-09792-6

Loumpa V. (2012). Promoting recovery through peer support: possibilities for social work practice. Social work in health care, 51(1), 53–65. https://doi.org/10.1080/00981389.2011.622667

Moll, S., Holmes, J., Geronimo, J., & Sherman, D. (2009). Work transitions for peer support providers in traditional mental health programs: unique challenges and opportunities. Work (Reading, Mass.), 33(4), 449–458. https://doi.org/10.3233/WOR-2009-0893

Mutschler, C., Bellamy, C., Davidson, L., Lichtenstein, S., & Kidd, S. (2022). Implementation of peer support in mental health services: A systematic review of the literature. Psychological Services, 19(2), 360–374. https://doi.org/10.1037/ser0000531

Penney, D. (2018). Defining “ Peer Support ” : Implications for Policy , Practice , and Research.

Repper, J., & Carter, T. (2011). A review of the literature on peer support in mental health services. Journal of mental health (Abingdon, England), 20(4), 392–411. https://doi.org/10.3109/09638237.2011.583947

Tseris E. (2020). The Expansion of the Peer Adviser Workforce: Opportunities and Challenges for Social Work, Australian Social Work, 73(2), 162-174, DOI: 10.1080/0312407X.2019.1675734

Wang, Y., Chen, Y., & Deng, H. (2022). Effectiveness of Family- and Individual-Led Peer Support for People With Serious Mental Illness: A Meta-Analysis. Journal of psychosocial nursing and mental health services, 60(2), 20–26. https://doi.org/10.3928/02793695-20210818-01

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