Societal and organisational influences on implementation of mental health peer support work in low-income and high-income settings: a qualitative focus group study

Abstract

ObjectivesDespite the established evidence base for mental health peer support work, widespread implementation remains a challenge. This study aimed to explore societal and organisational influences on the implementation of peer support work in low-income and high-income settings.DesignStudy sites conducted two focus groups in local languages at each site, using a topic guide based on a conceptual framework describing eight peer support worker (PSW) principles and five implementation issues. Transcripts were translated into English and an inductive thematic analysis was conducted to characterise implementation influences.SettingThe study took place in two tertiary and three secondary mental healthcare sites as part of the Using Peer Support in Developing Empowering Mental Health Services (UPSIDES) study, comprising three high-income sites (Hamburg and Ulm, Germany; Be’er Sheva, Israel) and two low-income sites (Dar es Salaam, Tanzania; Kampala, Uganda) chosen for diversity both in region and in experience of peer support work.Participants12 focus groups were conducted (including a total of 86 participants), across sites in Ulm (n=2), Hamburg (n=2), Dar es Salaam (n=2), Be’er Sheva (n=2) and Kampala (n=4). Three individual interviews were also done in Kampala. All participants met the inclusion criteria: aged over 18 years; actual or potential PSW or mental health clinician or hospital/community manager or regional/national policy-maker; and able to give informed consent.ResultsSix themes relating to implementation influences were identified: community and staff attitudes, resource availability, organisational culture, role definition, training and support and peer support network.ConclusionsThis is the first multicountry study to explore societal attitudes and organisational culture influences on the implementation of peer support. Addressing community-level discrimination and developing a recovery orientation in mental health systems can contribute to effective implementation of peer support work. The relationship between societal stigma about mental health and resource allocation decisions warrants future investigation.Trial registration numberISRCTN26008944.

Actions targeting the integration of peer workforces in mental health organisations: a mixed-methods systematic review

“…The provision of education was found to emphasise the value of lived experience knowledge, provided boundaries for peer workers, and assisted in managing non-peer employee expectations [ 34 , 37 ]. Byrne, Roennfeldt [ 38 ] highlight the provision of education and whole-of-workplace training on lived experience roles is most beneficial when delivered regularly rather than a one off.…”

“…Twelve studies highlighted the importance of clear and defined role descriptions provided both to peer support workers and their colleagues for the successful uptake of peer support roles and services. Providing clarity to the peer role was found to alleviate uncertainty and ambiguity for all stakeholders, improved peer confidence in their role and enable a smoother transition to acceptance and understanding of peer worker roles [ 34 , 35 , 45 ]. Crucial for this is acknowledging peer services can vary greatly between organisations, highlighting the importance of establishing and clearly communicating organisational needs and expectations of the role [ 34 ].…”

“…Providing clarity to the peer role was found to alleviate uncertainty and ambiguity for all stakeholders, improved peer confidence in their role and enable a smoother transition to acceptance and understanding of peer worker roles [ 34 , 35 , 45 ]. Crucial for this is acknowledging peer services can vary greatly between organisations, highlighting the importance of establishing and clearly communicating organisational needs and expectations of the role [ 34 ]. Further, the provision of a clear role description highlighting the uniqueness of the peer role was found to distinguish peer work from other services and find its appropriate fit within the team and service delivery [ 44 ].…”

“…In addition to organisation’s establishing readiness for the introduction of peer workers to service teams, ensuring adequate structural adjustments have been made to accommodate the peer role, the provision of resources to effectively undertake the role and ongoing support are crucial. This includes ensuring organisations are flexible and able to make reasonable adjustments for the role, recognising that peer workers shape the role based on their skills and expertise [ 34 , 46 ]. Further, organisations introducing systems that provide specific information on peer workers including their areas of expertise and instructions on how to ‘book’ specific peers for service users [ 35 ].…”

“…Commitment to peer practice was demonstrated by providing equal access to opportunities for all staff including fulltime or ongoing work, access to resources (computers, desks, phones, patient records, transport) and staff benefits including annual leave and sick pay [ 34 , 38 , 39 , 44 ]. Gates, Mandiberg [ 47 ] highlight that applying the same policy for all staff reduced segregation between workers and promoted the inclusion and acceptance of the peer support role.…”