Challenges Experienced by Paid Peer Providers in Mental Health Recovery: A Qualitative Study

Moran, Galia S.; Russinova, Zlatka; Gidugu, Vasudha; Gagne, Cheryl

doi:10.1007/s10597-012-9541-y

Cited by 170 publications

(202 citation statements)

References 34 publications

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“…Moran et al (2013) connected such pressures to the tension participants experienced in keeping a balance between their desire to help and their need to take care of themselves: A particularly challenging aspect of the role is the dual identity as both service consumer/user and service provider, which impacts on relationships and boundaries with both professional colleagues and clients. This resonated in all but two (5, 9) studies.…”

Section: Sense Of Identitymentioning

confidence: 99%

“…One review paper found that consumer-led mental health services reported client outcomes that were equally positive to those reported by traditional services (Doughty and Tse, 2011). The growth in PSW is of little surprise given it is consistent with both recovery-oriented system transformation processes (Moran et al, 2013) and may also fit with economic agendas due to potential cost-savings (Solomon, 2004). A review of cost-effectiveness found that the financial benefits to services of employing PSWs exceeded the costs (Trachtenberg et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

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Effects of employment as a peer support worker on personal recovery: a review of qualitative evidence

Bailie

Tickle

2015

Mental Health Review Journal

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Purpose -The purpose of this paper is to systematically identify, appraise and synthesise qualitative research into how working as a peer support worker (PSW) affects personal recovery. Design/methodology/approach -Ten articles were identified through a systematic search of seven databases, grey literature, reference lists, citations and contact with authors in the field. Identified articles were critically appraised and their results synthesised using metaethnography. Findings -There is potential to significantly improve the quality of the research in this field. Four categories were constructed to synthesise the findings of the reviewed studies, which demonstrated that being a PSW has the potential to be both facilitative of and detrimental to personal recovery.Research limitations/implications -The quality of existing studies varies widely. Further, high-quality research is required to specifically investigate the effects of employment as a PSW on personal recovery. Practical implications -The findings are tentative in light of the quality of the studies, but should be considered in the employment, training and ongoing support of PSWs and the services they join. Originality/value -Through its systematic methodology and appraisal of the quality of the studies reviewed, this review adds value to the literature about the effect of working as a PSW on personal recovery. It offers an original synthesis and criteria for measuring the quality of research in this field.

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Section: Sense Of Identitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of employment as a peer support worker on personal recovery: a review of qualitative evidence

Bailie

Tickle

2015

Mental Health Review Journal

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“…. VPW At times peer workers had to contend with an element of mistrust from the people they sought to support, and these challenges have also been seen in another recent, qualitative exploration of the peer worker role: 83 I know there's people in here that probably wouldn't appreciate having a talk with [the peer worker] because they just see [the peer worker] as another member of staff. PSU Occasionally, even from a person on the ward, I would get negative, like, 'Oh, you're working for the other side now.'…”

Section: Sameness and Differencementioning

confidence: 99%

New ways of working in mental health services: a qualitative, comparative case study assessing and informing the emergence of new peer worker roles in mental health services in England

Gillard

Edwards

Gibson

et al. 2014

Health Services and Delivery Research

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BackgroundA variety of peer worker roles are being introduced into the mental health workforce in England, in a range of organisational contexts and service delivery settings. The evidence base demonstrating the effectiveness of peer worker-based interventions is inconclusive and largely from outside England. An emerging qualitative literature points to a range of benefits, as well as challenges to introducing the peer worker role.AimsIn this study we aimed to test the international evidence base, and what is known generally about role adoption in public services, in a range of mental health services in England. We also aimed to develop organisational learning supporting the introduction of peer worker roles, identifying learning that was generic across mental health services and that which was specific to organisational contexts or service delivery settings.TeamThe research was undertaken by a team that comprised researchers from a range of academic and clinical disciplines, service user researchers, a peer worker, and managers and service providers in the NHS and voluntary sector. Service user researchers undertook the majority of the data collection and analysis. We adopted a coproduction approach to research, integrating the range of perspectives in the team to shape the research process and interpret our findings.Study designThe study employed a qualitative, comparative case study design. We developed a framework, based on existing evidence and the experiential insight of the team, which conceptualised the challenges and facilitators of introducing peer worker roles into mental health services. The framework was used to inform data collection and to enable comparisons between different organisational contexts, service delivery settings and the perspectives of different stakeholders.SettingsThe study took place in 10 contrasting cases comprising mental health NHS trusts, voluntary sector service providers and partnerships between the NHS and voluntary sector or social care providers. Peer workers were employed in a variety of roles, paid and unpaid, in psychiatric inpatient settings, community mental health services and black and minority ethnic (BME)-specific services.ParticipantsParticipants were 89 people involved in services employing peer workers, recruited purposively in approximately equal proportion from the following stakeholder groups: service users; peer workers; (non-peer) coworkers; line managers; strategic managers; and commissioners.Data collectionAll participants completed an interview that comprised structured and open-ended questions. Structured questions addressed a number of domains identified in the existing evidence as barriers to, or facilitators of, peer worker role adoption. Open-ended questions elicited detailed data about participants’ views and experiences of peer worker roles.Data analysisStructured data were analysed using basic statistics to explore patterns in implementation across cases. Detailed data were analysed using a framework approach to produce a set of analytical categories. Patterns emerging in the structured analysis informed an in-depth interrogation of the detailed data set, using NVivo 9 qualitative software (QSR International Pty Ltd, Victoria, Australia) to compare data between organisational contexts, service delivery settings and stakeholder groups. Preliminary findings were refined through discussion with a range of stakeholders at feedback workshops.FindingsMany of the facilitators of peer worker role adoption identified in the existing evidence base were also evident in mental health services in England, although there were issues around pay, leadership, shared understanding of the role, training and management where good practice was uneven. A number of examples of good practice were evident in the voluntary sector, where peer worker roles had been established for longer and organisations were more flexible. In the NHS there were a range of challenges around introducing peer worker roles into existing structures and cultures of practice. Peer workers were able to engage people with services by building relationships based on shared lived experience – the language they used was particularly important in BME-specific services – but barriers to engagement could be created where roles were overformalised.ConclusionsKey barriers to, and facilitators of, peer worker role adoption were identified, including valuing the differential knowledge and practice that peer workers brought to the role (especially around maintaining personally, rather than professionally defined boundaries); maintaining peer identity in a role of work; changing organisational structures to support peer workers to remain well in their work; and challenging organisational cultures to empower peer workers to use their lived experience. Recommendations for future research include developing a theoretical framework articulating the change mechanisms underpinning ‘what peer workers do’, piloting and formally evaluating the effectiveness and cost-effectiveness of peer worker interventions, and mixed-method research to better understand the impact of working as a peer worker.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…The potential benefits of introducing peer workers can be undermined where expectations of the role are not shared; for example, where peer workers are not given sufficient autonomy to use their lived experience in their role (Moran 2012). Difference in expectation of whether or not peer workers should work to conventional, clinical practice boundaries has been highlighted (Mead 2006), and resistance among existing staff can also be encountered where there are perceived challenges to professional jurisdiction (Currie 2009).…”

Section: Shared Expectations Of the Peer Worker Rolementioning

confidence: 99%

“…Where the introduction of peer workers is specifically linked to organisational delivery on a recovery or social inclusion agenda, for example, there might be greater clarity of expectation around the function of the role. Conversely, peer workers have reported that their role felt undermined where attitudes to individual recovery were not shared by their managers and co-workers (Moran 2012). It has been suggested that strategic alignment has to be established on a number of levels -organisation, team and individual -for it to be effective (Nadler 1980).…”

Section: Strategic Alignmentmentioning

confidence: 99%

Peer workers in mental health services: literature overview

Gillard¹,

Holley²

2014

Adv. psychiatr. treat

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SummaryPeer worker roles are being introduced in mental health services in the UK and internationally, to support individuals in their recovery. There is substantial qualitative evidence that demonstrates benefits at an individual level and some evidence of impact on service use and costs, although there are currently few high-quality randomised controlled trials supporting these findings, especially from the UK. A growing body of research indicates that careful consideration of organisational issues regarding the introduction of peer worker roles – the distinctiveness and shared expectations of the role, strategic alignment, organisational support – might maximise their impact. Properly supported and valued peer workers are an important resource to the multidisciplinary team, offering experiential knowledge and the ability to engage patients in their treatment through building relationships of trust based on shared lived experience.LEARNING OBJECTIVESAppreciate the origins of the peer worker role and how the role has been introduced into mental health services to date.Understand the evidence for the benefits of peer worker roles, for patients, peer workers and mental health service delivery.Demonstrate awareness of the organisational and team-level barriers to and facilitators of introducing peer workers into, or alongside, existing multidisciplinary mental health teams.

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Challenges Experienced by Paid Peer Providers in Mental Health Recovery: A Qualitative Study

Cited by 170 publications

References 34 publications

Effects of employment as a peer support worker on personal recovery: a review of qualitative evidence

Effects of employment as a peer support worker on personal recovery: a review of qualitative evidence

New ways of working in mental health services: a qualitative, comparative case study assessing and informing the emergence of new peer worker roles in mental health services in England

Peer workers in mental health services: literature overview

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