A systematic review and meta-analysis of group peer support interventions for people experiencing mental health conditions

Lyons, Natasha; Cooper, Chris; Lloyd‐Evans, Brynmor

doi:10.1186/s12888-021-03321-z

Cited by 78 publications

(90 citation statements)

References 85 publications

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“…This model has been introduced into acute inpatient environments in the UK 146 , and smallscale qualitative studies show that patients can find it helpful in providing per soncentred emotional and practical sup port and in modelling hope 147 . Research into the implementation and effectiveness of peer support in crisis and acute services is ongoing globally 148 and, while some study findings on discharge and readmis sion to acute care seem promising 128 , a ro bust evidence base is still needed 149,150 .…”

Section: The Contribution Of Service User-led and Co-produced Initiat...mentioning

confidence: 99%

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

et al. 2022

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Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best approaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision‐making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low‐ and middle‐income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low‐resource settings may lead to wider learning from locally embedded strategies.

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Section: The Contribution Of Service User-led and Co-produced Initiat...mentioning

confidence: 99%

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

et al. 2022

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show abstract

“…The value ascribed by participants to incorporating patient perspectives in the post-event analysis of restraint and seclusion events might emphasise the need to include ‘peer professionals’ in debriefing processes, perhaps, especially, where the involved patient is too unwell to engage in this process. Recent systematic reviews and meta-analyses indicate that peer support interventions in mental health settings have more impact on psychosocial outcomes than they do on clinical outcomes [ 38 , 39 ]. This might underscore the importance of peer support, especially, in psychosocial interventions such as those aiming to enhance de-escalation and reduce conflict and containment.…”

Section: Discussionmentioning

confidence: 99%

De-escalation of conflict in forensic mental health inpatient settings: a Theoretical Domains Framework-informed qualitative investigation of staff and patient perspectives

et al. 2022

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Background Violence and other harms that result from conflict in forensic inpatient mental health settings are an international problem. De-escalation approaches for reducing conflict are recommended, yet the evidence-base for their use is limited. For the first time, the present study uses implementation science and behaviour change approaches to identify the specific organisational and individual behaviour change targets for enhanced de-escalation in low and medium secure forensic inpatient settings. The primary objective of this study was to identify and describe individual professional, cultural and system-level barriers and enablers to the implementation of de-escalation in forensic mental health inpatient settings. The secondary objective was to identify the changes in capabilities, opportunities and motivations required to enhance de-escalation behaviours in these settings. Methods Qualitative design with data collection and analysis informed by the Theoretical Domains Framework (TDF). Two medium secure forensic mental health inpatient wards and one low secure mental health inpatient ward participated. 12 inpatients and 18 staff participated across five focus groups and one individual interview (at participant preference) guided by a semi-structured interview schedule informed by the TDF domains. Data were analysed via Framework Analysis, organised into the 14 TDF domains then coded inductively within each domain. Results The capabilities required to enhance de-escalation comprised relationship-building, emotional regulation and improved understanding of patients. Staff opportunities for de-escalation are limited by shared beliefs within nursing teams stigmatising therapeutic intimacy in nurse-patient relationships and emotional vulnerability in staff. These beliefs may be modified by ward manager role-modelling. Increased opportunity for de-escalation may be created by increasing service user involvement in antipsychotic prescribing and modifications to the physical environment (sensory rooms and limiting restrictions on patient access to ward spaces). Staff motivation to engage in de-escalation may be increased through reducing perceptions of patient dangerousness via post-incident debriefing and advanced de-escalation planning. Conclusions Interventions to enhance de-escalation in forensic mental health settings should enhance ward staff’s understanding of patients and modify beliefs about therapeutic boundaries which limit the quality of staff-patient relationships. The complex interactions within the capabilities-opportunities-motivation configuration our novel analysis generated, indicates that de-escalation behaviour is unlikely to be changed through knowledge and skills-based training alone. De-escalation training should be implemented with adjunct interventions targeting: collaborative antipsychotic prescribing; debriefing and de-escalation planning; modifications to the physical environment; and ward manager role-modelling of emotional vulnerability and therapeutic intimacy in nurse-patient relationships.

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“…Researchers have found that support groups that use peer support can be a negative experience ( Galinsky and Schopler, 1994 ). A systematic review and meta-analysis conducted by Lyons et al (2021) found there to be insufficient evidence available on the effectiveness of peer support for mental health issues. Overall, there is a need for more research into the effectiveness of peer support as an intervention before firm conclusions can be drawn ( Ali et al, 2015 ; Lyons et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Commenting and connecting: A thematic analysis of responses to YouTube vlogs about borderline personality disorder

King

McCashin

2022

Internet Interventions

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A systematic review and meta-analysis of group peer support interventions for people experiencing mental health conditions

Cited by 78 publications

References 85 publications

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

De-escalation of conflict in forensic mental health inpatient settings: a Theoretical Domains Framework-informed qualitative investigation of staff and patient perspectives

Commenting and connecting: A thematic analysis of responses to YouTube vlogs about borderline personality disorder

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