Unintended consequences of institutionalizing peer support work in mental healthcare

Adams, Wallis E.

doi:10.1016/j.socscimed.2020.113249

Cited by 50 publications

(37 citation statements)

References 44 publications

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“…In conjunction with this Delphi consultation, a framework is emerging that could underpin the international PSW accreditation process. On the contrary, unintended consequences of institutionalizing the PSW role are emerging, with one qualitative study in the United States concluding that it “has the potential to reduce the very centrality of experiential expertise, reproduce social inequalities, and paradoxically impact stigma” [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Initial Training for Mental Health Peer Support Workers: Systematized Review and International Delphi Consultation

Charles¹,

Nixdorf²,

Ibrahim³

et al. 2021

JMIR Ment Health

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Background Initial training is essential for the mental health peer support worker (PSW) role. Training needs to incorporate recent advances in digital peer support and the increase of peer support work roles internationally. There is a lack of evidence on training topics that are important for initial peer support work training and on which training topics can be provided on the internet. Objective The objective of this study is to establish consensus levels about the content of initial training for mental health PSWs and the extent to which each identified topic can be delivered over the internet. Methods A systematized review was conducted to identify a preliminary list of training topics from existing training manuals. Three rounds of Delphi consultation were then conducted to establish the importance and web-based deliverability of each topic. In round 1, participants were asked to rate the training topics for importance, and the topic list was refined. In rounds 2 and 3, participants were asked to rate each topic for importance and the extent to which they could be delivered over the internet. Results The systematized review identified 32 training manuals from 14 countries: Argentina, Australia, Brazil, Canada, Chile, Germany, Ireland, the Netherlands, Norway, Scotland, Sweden, Uganda, the United Kingdom, and the United States. These were synthesized to develop a preliminary list of 18 topics. The Delphi consultation involved 110 participants (49 PSWs, 36 managers, and 25 researchers) from 21 countries (14 high-income, 5 middle-income, and 2 low-income countries). After the Delphi consultation (round 1: n=110; round 2: n=89; and round 3: n=82), 20 training topics (18 universal and 2 context-specific) were identified. There was a strong consensus about the importance of five topics: lived experience as an asset, ethics, PSW well-being, and PSW role focus on recovery and communication, with a moderate consensus for all other topics apart from the knowledge of mental health. There was no clear pattern of differences among PSW, manager, and researcher ratings of importance or between responses from participants in countries with different resource levels. All training topics were identified with a strong consensus as being deliverable through blended web-based and face-to-face training (rating 1) or fully deliverable on the internet with moderation (rating 2), with none identified as only deliverable through face-to-face teaching (rating 0) or deliverable fully on the web as a stand-alone course without moderation (rating 3). Conclusions The 20 training topics identified can be recommended for inclusion in the curriculum of initial training programs for PSWs. Further research on web-based delivery of initial training is needed to understand the role of web-based moderation and whether web-based training better prepares recipients to deliver web-based peer support.

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Section: Discussionmentioning

confidence: 99%

Initial Training for Mental Health Peer Support Workers: Systematized Review and International Delphi Consultation

Charles¹,

Nixdorf²,

Ibrahim³

et al. 2021

JMIR Ment Health

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“…They are, however, well positioned to provide support for emotional wellbeing and assistance in coping with difficult challenges. In reality, this is not always as clear a distinction as it sounds and through supervision and case discussions peer supporters need specific guidance on decisions related to their role [31,32].…”

Section: Understanding the Remit Of Their Rolementioning

confidence: 99%

It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV

Wogrin¹,

Willis²,

Mutsinze³

et al. 2021

PLoS ONE

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Introduction Adolescents living with HIV have poor treatment outcomes, including lower rates of viral suppression, than other age groups. Emerging evidence suggests a connection between improved mental health and increased adherence. Strengthening the focus on mental health could support increased rates of viral suppression. In sub-Saharan Africa clinical services for mental health care are extremely limited. Additional mechanisms are required to address the unmet mental health needs of this group. We consider the role that community-based peer supporters, a cadre operating at scale with adolescents, could play in the provision of lay-support for mental health. Methods We conducted qualitative research to explore the experiences of peer supporters involved in delivering a peer-led mental health intervention in Zimbabwe as part of a randomized control trial (Zvandiri-Friendship Bench trial). We conducted 2 focus group discussions towards the end of the trial with 20 peer supporters (aged 18–24) from across 10 intervention districts and audio recorded 200 of the peer supporters’ monthly case reviews. These data were thematically analysed to explore how peer supporters reflect on what was required of them given the problems that clients raised and what they themselves needed in delivering mental health support. Results A primary strength of the peer support model, reflected across the datasets, is that it enables adolescents to openly discuss their problems with peer supporters, confident that there is reciprocal trust and understanding derived from the similarity in their lived experiences with HIV. There are potential risks for peer supporters, including being overwhelmed by engaging with and feeling responsible for resolving relationally and structurally complex problems, which warrant considerable supervision. To support this cadre critical elements are needed: a clearly defined scope for the manageable provision of mental health support; a strong triage and referral system for complex cases; mechanisms to support the inclusion of caregivers; and sustained investment in training and ongoing supervision. Conclusion Extending peer support to explicitly include a focus on mental health has enormous potential. From this empirical study we have developed a framework of core considerations and principles (the TRUST Framework) to guide the implementation of adequate supportive infrastructure in place to enhance the opportunities and mitigate risks.

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“…16 The institutionalisation of the peer support role and resulting dilution of essential peer support tasks have led to a lack of role clarity in some cases 12 , and by role restriction in other cases their activities must conform with existing care mandates. 17 18 Other barriers include the lack of professional development and career advancement opportunities, which hinder sustainability and development. 19 20 It is noteworthy that much of the peer support research originated in western General Psychiatry countries as the recovery movement stemmed from them, except for Hong Kong, which adopted peer support roles in the early 2010s.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators of peer support work in a large psychiatric hospital: a thematic analysis

2021

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BackgroundPeer support workers are an important addition to the mental healthcare profession. However, much of the literature and knowledge of the peer support role is derived from western countries. This concept is relatively new in Asian countries.AimsThe study sought to improve the understanding of the barriers and facilitators of peer support work in a large psychiatric hospital in Singapore.MethodsThis study used qualitative data from a larger mixed-methods study. Thematic analysis was conducted based on the five steps recommended by Braun and Clarke (2006): (1) familiarisation of data whereby transcripts were read and reread, (2) generating initial codes, (3) searching for themes by gathering relevant codes, (4) reviewing themes and (5) defining and naming themes.ResultsFour subthemes under the broader notion of facilitators (supportive figures, defined role, opportunities for personal growth and identifying personalised coping strategies) and three subthemes under the concept of barriers (unclear role, hostility from non-peer-support-specialist staff and unsupportive working environments) were identified.ConclusionOur findings echoed those of previous studies conducted in western countries providing some evidences for the cross-cultural nature of these barriers and facilitators. However, the way their impact can be mitigated or enhanced is likely to be different owing to cultural barriers, such as the general consensus and acceptance of larger personal recovery ideologies. Further research is required in community settings to better understand the boundaries and limitations of our findings. This information will allow us to continue improving peer support worker integration in diverse mental healthcare settings.

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Unintended consequences of institutionalizing peer support work in mental healthcare

Cited by 50 publications

References 44 publications

Initial Training for Mental Health Peer Support Workers: Systematized Review and International Delphi Consultation

Initial Training for Mental Health Peer Support Workers: Systematized Review and International Delphi Consultation

It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV

Barriers and facilitators of peer support work in a large psychiatric hospital: a thematic analysis

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