Consumer-providers of care for adult clients of statutory mental health services

Abstract

Involving consumer-providers in mental health teams results in psychosocial, mental health symptom and service use outcomes for clients that were no better or worse than those achieved by professionals employed in similar roles, particularly for case management services.There is low quality evidence that involving consumer-providers in mental health teams results in a small reduction in clients' use of crisis or emergency services. The nature of the consumer-providers' involvement differs compared to professionals, as do the resources required to support their involvement. The overall quality of the evidence is moderate to low. There is no evidence of harm associated with involving consumer-providers in mental health teams.Future randomised controlled trials of consumer-providers in mental health services should minimise bias through the use of adequate randomisation and concealment of allocation, blinding of outcome assessment where possible, the comprehensive reporting of outcome data, and the avoidance of contamination between treatment groups. Researchers should adhere to SPIRIT and CONSORT reporting standards for clinical trials.Future trials should further evaluate standardised measures of clients' mental health, adverse outcomes for clients, the potential benefits and harms to the consumer-providers themselves (including need to return to treatment), and the financial costs of the intervention. They should utilise consistent, validated measurement tools and include a clear description of the consumer-provider role (eg specific tasks, responsibilities and expected deliverables of the role) and relevant training for the role so that it can be readily implemented. The weight of evidence being strongly based in the United States, future research should be located in diverse settings including in low- and middle-income countries.

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

“…Furthermore, a recent Cochrane Review has indicated that the equivocal nature of findings in trials of peer worker intervention to date is at least in part due to poor definition of the intervention and associated mechanisms of change. 16 Coherent future evaluation that usefully informs service provision in England might therefore be prioritised as follows:…”

“…As a result, the overall picture demonstrating the effectiveness of peer worker interventions remains less than convincing. 16 Medical Research Council guidance for the evaluation of complex interventions 21 suggests that sufficient theoretical, modelling and piloting work needs to be done around complex, organisational or service-level interventions before properly informed decisions can be made about what to evaluate and how. The introduction of peer workers into existing teams alongside other mental health professionals within the NHS, or establishing innovative peer-led services in partnership with or outside of statutory mental health service provision, constitute complex approaches to mental health care.…”

Evaluating the Selection, Training, and Support of Peer Support Workers in the United Kingdom.

“…Peer support can be provided informally through mutual support of friends and acquaintances sharing similar experiences; through the provision of userrun services; or through formal peer support. Now, increasingly, mental health service providers are attempting to harness this naturally occurring companionship to provide more formal peer support either alongside or in place of mainstream or 'professional' mental health services (Repper 2013), often with impressive results (Pitt et al 2013).…”

Maximizing Utilization of Peer Specialists in Community Mental Health: The Next Step in Implementation

“…Among participants that worked in close proximity with peer specialists, between 52 and 65 % of their consumers were referred for peer support services. The referral rate on the team with a peer specialist was much higher at 97 % [5].…”

“…Peer supported services have been associated with positive consumer outcomes including reduced symptoms, increased functioning in activities of daily living, enhanced sense of empowerment, and decreased service utilization [2,3]. While other studies have found moderate or little impact of peer support services on consumer outcomes [4,5]. However, the promise of peer provided services supported by the recovery community and research have propelled the implementation of peer support services forward.…”