A Narrative Review of Factors Influencing Peer Support Role Implementation in Mental Health Systems: Implications for Research, Policy and Practice

Abstract

With increasing calls to incorporate recovery principles into conventional mental health care, the importance of peer support worker (PSW) services has gained attention. However, studies consistently show that PSWs remain underutilized. Although research addresses several factors that influence formal implementation of their role, there is lack of a comprehensive framework that synthesizes the factors and addresses their interlevel interactions. This paper provides a narrative review and synthesis of literature on multilevel factors that influence formal PSW role implementation in mental health systems. We conducted a search of literature and reviewed 38 articles that met inclusion criteria. Our thematic analysis involved identifying first and second order categories that applied across studies, and developing third order interpretations through iterations. We synthesized the findings in a multilevel framework consisting of macro, meso and micro level influences. Influencing factors at the macro level include broader socio-cultural factors (medical model, recovery values, professional power dynamics, training and certification), regulatory and political factors (policy mandates, political commitment), and economic and financial factors (funding, affordability of services). Factors at the meso level include organizational culture, organizational leadership, change management, and human resource management policies. Micro level influences pertain to relationships between PSWs and team members, and PSW wellbeing. Interlevel interactions are also outlined. Limitations and implications for research, policy and practice are addressed.

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

“…Despite evidence of peer workers’ benefits and the increasing need for mental health support and care, studies consistently show that peer workers remain underutilized (Mirbahaeddin & Chreim, 2022 ). The current wave of research has begun to identify whether and how peer support workers perform unique roles and functions (Kent, 2019 ).…”

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

“…Qualitative data supported that explanation, with peer workers reporting at 4 months having had to adjust to the responsibility they had taken on and needing to better manage their workload, finding ways to cope with the intensity of connecting with people as peers with the support of their supervisor. A recent systematic review of literature exploring factors shaping the implementation of peer support in mental health services identified the importance of appropriate supervision as highlighted across multiple studies [ 10 ]. The implication of these findings for practice is that organisations employing peer workers need to be aware of this potentially challenging time for peer workers in the first few months after coming in to post, ensuring that support and supervision, both practical and emotional, is in place to enable peer workers to successfully adjust to the demands of the role [ 18 ].…”

“…A wider literature explores the impact of implementation issues and organisational environment on peer support in mental health services [ 10 ], suggesting that the potential benefits – for people offered peer support - can become diluted where key aspects of how peer support is put into practice are poorly defined [ 11 ]. Notably, it has been identified that a clear peer worker role description [ 12 ], role specific training and support [ 13 , 14 ], preparation for clinical teams working alongside peer workers [ 15 ], and shared expectations of the peer worker role across peer workers and their clinical colleagues [ 11 ] all facilitate successful delivery of peer support.…”

What are the effects of peer support interventions for parents and carers of children with complex needs? A Cochrane Review summary with commentary

“…Rehabilitation centers in many countries are increasingly concerned with the role of peer support interventions to improve the quality of health care and improve both the physical and mental health of patients with complex needs and disabling conditions, and the mental and emotional well‐being of their families or caregivers 8, 9 . To parents, peers are an important source of information and they are the preferred source of experience‐based knowledge and support 10 .…”