Managing Peer Support Workers in Swedish Mental Health Services – A Leadership Perspective on Implementation and Sustainability

Abstract

Background: Even though it has been demonstrated that peer support contributes to positive outcomes for service users, organizational implementation issues remain. The aim of the current study was to examine an implementation of peer support from the perspective of managers in order to develop knowledge of factors influencing sustainability of this initiative.Methods: Eighteen managers were interviewed in connection with the introduction of peer support in sixteen mental health settings. The interviews were transcribed and analyzed utilizing inductive as well as deductive approaches where, in the latter, a theoretical framework was applied in order to identify critical implementation components at the levels of organization, team and continuous support. Results: The results suggested that managers were predominantly positive in their evaluation of peer support as a recovery-oriented and user-friendly addition to their services, but noted developmental issues regarding role, professional identity, supervision and financing in relation to other traditional personnel. Managers also reflected on the fact that broader commitment at higher levels of the organizational leadership was largely lacking in relation to implementing user involvement in the organization as a whole. The involvement of the user movement, especially with regard to training and supervision helped prepare staff and support peer workers, yet there was some apprehension attached to the critical scrutiny that this ‘outsider’ perspective might imply. Conclusions: The results confirm previously noted uncertainties regarding peer support as an integrated component of mental health systems. While offering clues as to the factors that would further define and integrate peer support, this study also highlights a number of challenges regarding role, identity and connection to the user movement, that need to be considered by managers before assuming that peer support should be implemented with the same approach as other interventions. The findings suggest that the implementation of peer support requires a comprehensive shift in perspectives, power dynamics and culture. Simultaneously, peer support is highlighted as a catalyst for progress towards increasingly recovery-oriented care-giving cultures.