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

Abstract

People with lived experience of mental health challenges are extensively employed as peer workers within mental health and substance use services worldwide. Research shows that peer workers benefit individuals using such services and can have essential roles in developing recovery-oriented services. However, understanding how peer workers’ contributions, by their role, functions, and input can be better used remains a critical challenge. Research on public sector innovation has focused on relevant actors collaborating to tackle complex demands. Co-production and co-creation are concepts used to describe this collaboration. Co-production refers to the collaboration between providers and users at the point of service delivery, whereas co-creation refers to collaboration starting in the early service cycle phases (e.g., in commissioning or design), including solution implementation. We overviewed research literature describing peer workers’ involvement in mental health and substance use services. The research question is as follows: How are peer workers involved in co-production and co-creation in mental health and substance use services, and what are the described outcomes? A literature search was performed in 10 different databases, and 13,178 articles were screened, of which 172 research articles describing peer workers’ roles or activities were included. The findings show that peer workers are involved in co-production and function as providers of pre-determined services or, most often, as providers of peer support. However, they are rarely engaged as partners in co-creation. We conclude that the identified peer worker roles have different potential to generate input and affect service delivery and development.

The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review

“…However, there was the view that lived experience was not solely sufficient to work in interprofessional teams [62]. Despite this, supervision and support were often not offered to PSWs leading to risks [58,62].…”

“…Perspective of mixed samples: A final theme was the perception that service users should be able to choose among PSWs as service providers [58] PSWs [23,32,59]: PSWs experienced improved wellness and recovery. The role enabled them to reframe and accept their illness and kept them engaged in recovery.…”

“…Peer-support group members [47]: Forming relationships in peer support groups was valuable for recovery, e.g., enabled re-evaluation of self and expectations [of motherhood]. Mixed* [58,62]: PSWs are role models, give service users hope of recovery, are valued and provide guidance and support to service users through the process of engaging with mental health services, e.g., how to…”

“…Working as a PSW in substance abuse could lead to disconnection from their own recovery communities due to ethical concerns when sharing in support groups, putting the PSWs recovery at risk. Mixed* [58,61]: whether PSWs should relate to service users as friends (seen as unprofessional) or service users. Some PSWs would not share service user information with agency staff due to concern about violating friendship.…”

“…PSWs reported their supervision felt superficial, and problems in their relationship with their supervisors, e.g., due to PSWs not feeling that they had enough autonomy. Mixed* [23,58,62]: It was felt that lived experience wasn't solely sufficient to work in interprofessional teams. Some PSWs were positive about certification, others felt that certification could conflict with the grassroots, user-led ethos.…”