Organizational Climate and Support Among Peer Specialists Working in Peer-Run, Hybrid and Conventional Mental Health Settings

"Do I feel safe here?" Organisational climate and mental health peer worker experience

BACKGROUND

In Australia, lived experience peer support workforces are expanding making it one of the fastest growing emerging disciplines in transdisciplinary mental health settings. This article provides insight for organisations on the contextual realities peer workers face, increases understanding of peer support services to improve service delivery environments and contributes to mental health systems reform. This study aimed to qualitatively explore peer support workers experience integrating into and working within transdisciplinary mental health service teams.

METHOD

Semi-structured interviews were undertaken with 18 peer support workers currently working in mental health services in Australia. The research was a qualitative descriptive study design. All data collected were analysed utilising thematic analysis.

RESULTS

Peer workers found their experience in the workplace was influenced by their colleagues and the organisation's understanding of the peer role. Factors relating to organisational culture and climate were a central theme throughout discussions noting that a negative climate was perceived as harmful to peer workers. Themes established through results include (1) the role of leadership, (2) attitudes and behaviours of colleagues, (3) provision of psychologically safe environments, (4) the organisations messaging and use of language and (5) organisational structures and policy.

CONCLUSION

This study contributes to evidence for the impact of organisational culture on integrating and supporting peer support workers in mental health service delivery. This study provides insights into peer worker experiences integrating into transdisciplinary teams, confirming findings established in previous studies, highlighting a lack of movement or change in workplace culture to support peer worker integration into mental healthcare settings.

Pathways for Strengthening Lived Experience Leadership for Transformative Systems Change: Reflections on Research and Collective Change Strategies

INTRODUCTION

The Activating Lived Experience Leadership (ALEL) project was a South Australian participatory action research project that aimed to improve the ways lived experience is recognised, valued and integrated across mental health and social sector systems. ALEL was completed during 2019-2021, where it engaged 182 participants in generating community action and research knowledge.

OBJECTIVE

Our paper discusses the project's processes of building a collective partnership among lived experience leaders and other leaders from within the sector, so that the actions and strategies identified through research could be implemented by systems-level impact. We describe the collaborative process and key learnings that resulted in eight key action areas for transformative systems change in South Australia.

METHODS

The project invited a diverse range of self-identified lived experience and other leaders to be involved in a PAR process featuring formal qualitative research (focus groups, surveys and interviews) as well as community development activities (leaders' summit meetings, consultations, training and community of practice meetings). These processes were used to help us describe the purpose, achievements and potential of lived experience leadership. Project priorities and systems-level analysis was also undertaken with lived experience sector leaders and project advisors across two leaders' summit meetings, integrating research outcomes with sector planning to define high-level actions and a vision for transformational change.

RESULTS

Participatory action research as informed by systems change and collective impact strategies assisted the project to generate detailed findings about the experiences and complexities of lived experience leadership, and collective responses of how systems could better support, be accountable to and leverage lived experience perspectives, experience and peer-work approaches.

CONCLUSION

Systems change to define, value and embed lived experience leadership benefits from collective efforts in both formal research and sector development activities. These can be used to generate foundational understandings and guidance for working together in genuine ways for transforming mental health and social sector systems, experience and outcomes.

PUBLIC CONTRIBUTION

Members of lived experience communities codesigned the project, and contributed to project governance and the development of all findings and project reports.

Implementing peer support into practice in mental health services: a qualitative comparative case study

BACKGROUND

Peer workers are people with personal experience of mental distress, employed within mental health services to support others with similar experiences. Research has identified a range of factors that might facilitate or hinder the introduction of new peer worker roles into mental health services. While there is mixed evidence for the effectiveness of peer worker delivered interventions, there are no studies exploring how implementation might be associated with effect.

METHODS

This was a qualitative comparative case study using data from interviews with 20 peer workers and their five supervisors. Peer workers delivered peer support for discharge from inpatient to community mental health care as part of a randomised controlled trial. In the trial, level of participant engagement with peer support was associated with better outcome (hospital readmission). Study sites with higher levels of engagement also had higher scores on a measure of fidelity to peer support principles. We compared data from sites with contrasting levels of engagement and fidelity using an analytical framework derived from implementation theory.

RESULTS

In high engagement-high fidelity sites, there was regular work with clinical teams preparing for working alongside peer workers, and a positive relationship between staff on inpatient wards and peer workers. The supervisor role was well resourced, and delivery of peer support was highly consistent with the intervention manual. In low engagement-low fidelity sites peer workers were employed in not-for-profit organisations to support people using public mental health services and in rural areas. Supervisors faced constrained resources and experienced barriers to joint working between organisations. In these sites, peer workers could experience challenging relationships with ward staff. Issues of geography and capacity limited opportunities for supervision and team-building, impacting consistency of delivery.

CONCLUSIONS

This study provides clear indication that implementation can impact delivery of peer support, with implications for engagement and, potentially, outcomes of peer worker interventions. Resourcing issues can have knock-on effects on consistency of delivery, alongside challenges of access, authority and relationship with clinical teams, especially where peer workers were employed in not-for-profit organisations. Attention needs to be paid to the impact of geography on implementation.

TRIAL REGISTRATION

ISRCTN registry number ISRCTN10043328, registered 28 November 2016.

Understanding Lived Experience Organizations: A Systematic Scoping Review of Organizational Elements and Characteristics

OBJECTIVE

Mental health lived experience organizations (LEOs) and their lived experience workforce are increasingly recognized as invaluable. However, a deeper understanding of the elements that enhance or inhibit LEOs' efficacy is required to learn how to sustain LEOs and support their workforce. Rapid international expansion has resulted in significant LEO growth and change, challenging many LEOs to adapt. With this rapid expansion, the field is evolving faster than many LEOs can keep pace with. This review, codesigned and coproduced in partnership with a LEO to draw on both lived experience and academic perspectives, aims for a deeper understanding of which elements within a LEO enhance or inhibit its efficacy, growth, and support for its lived experience workforce.

METHODS

A systematic search of peer-reviewed and non-peer-reviewed literature, following the PRISMA-ScR guidelines and JBI methodology, identified 60 records published in English between 2000 and 2022.

RESULTS

The results indicate general agreement regarding which LEO elements are important (e.g., culture, leadership, board composition, organizational structure, financial arrangements, and professionalization). However, considerable disagreements exist regarding the relative influence of several of these elements, especially funding arrangements, in which funder and LEO values often diverge; training for increased lived experience professionalization; and partnerships with medical model-focused mental health services.

CONCLUSIONS

Organizational disagreements relate to managing future LEO growth and advancing the lived experience workforce while preserving LEOs' unique characteristics that make them valued mental health services. Further research should examine community differences among LEOs, including hybrid LEOs within services and non-LEO mental health organizations.

Supporting Peer Support Workers and Their Supervisors: Cluster-Randomized Trial Evaluating a Systems-Level Intervention

OBJECTIVE

Peer support workers are a substantial and growing part of the mental health workforce. Because little research has investigated how to effectively support and supervise peer support workers, the authors evaluated the efficacy of a training program to strengthen the peer support workforce and the supervision of its workers.

METHODS

Mental health services sites with peer support workers and supervisors in Los Angeles County were recruited for this cluster-randomized trial and 10-month follow-up. Of 348 peer support workers and 143 supervisors at 85 sites, 251 (72%) peer support workers and 115 (80%) supervisors completed baseline surveys. SHARE! the Self-Help And Recovery Exchange, a peer-run organization, delivered four training sessions on strategies to reduce stigma and to build an effective peer workforce, cultural competence, and a trauma-informed developmental model of supervision. Primary outcomes were peer-supportive organizational climate, mental health stigma, and peer support worker recovery.

RESULTS

Intention-to-treat analyses indicated that sites receiving the training had significantly higher scores on peer-supportive organizational climate (Cohen's d=0.35, 95% CI=0.02-0.68, p=0.04) relative to sites not receiving the training. No significant differences were found between the two conditions for mental health stigma (Cohen's d=0.04) or peer support worker recovery (Cohen's d=0.14).

CONCLUSIONS

The training had no impact on mental health stigma or peer support worker recovery. However, the findings suggest that the training increased the value organizations gave to peer support work, which may help improve peer support worker retention and outcomes among those served. Efforts to incorporate principles of the training into practice may strengthen outcomes.

Changing the Game? Increasing the Impact of Peer-Run Organizations

Employment and deployment of peer support specialists in both clinical and non-clinical mental health settings has increased substantially since the 1990's. Peer-run organizations are defined as those led and managed by individuals with self-disclosed lived experience of mental health conditions. Many peer-run organizations promoting advocacy and offering services have been established during the past 30 years. Some adherents assert the effectiveness of peer-run organizations over hybrid mental health service providers in which peer support workers are integrated or partnered with existing community mental health agency multidisciplinary clinical and treatment teams. Although research has indicated the positive contributions of peer-run organizations to service user recovery, the impact of peer-run organizations on system transformation is not well documented. This concept paper explores benefits, accomplishments, and challenges faced by a peer-run organization during its 30-year evolution in offering self-help groups, supported housing, peer support services, peer specialist training, and systems change projects in Los Angeles County, California. Future research topics and policy options are suggested, along with recommendations for the SAMHSA Office of Recovery.

Engaging with peers to integrate community care: Knowledge synthesis and conceptual map

CONTEXT

Engaging with peers is gaining increasing interest from healthcare systems in numerous countries. Peers are people who offer support by drawing on lived experiences of significant challenges or 'insider' knowledge of communities. Growing evidence suggests that peers can serve as a bridge between underserved communities and care providers across sectors, through their ability to build trust and relationships. Peer support is thus seen as an innovative way to address core issues of formal healthcare, particularly fragmentation of care and health inequalities. The wide body of approaches, goals and models of peer support speaks volumes of such interest. Navigating the various labels used to name peers, however, can be daunting. Similar terms often hide critical differences.

OBJECTIVES/BACKGROUND

This article seeks to disentangle the conceptual multiplicity of peer support, presenting a conceptual map based on a 3-year knowledge synthesis project involving peers and programme stakeholders in Canada, and international scientific and grey literature.

SYNTHESIS/MAIN RESULTS

The map introduces six key questions to navigate and situate peer support approaches according to peers' roles, pathways and settings of practice, regardless of the terms used to label them. As a tool, it offers a broad overview of the different ways peers contribute to integrating health and community care.

DISCUSSION

We conclude by discussing the map's potential and limitations to establish a common language and bridge models, in support of knowledge exchange among practitioners, policymakers and researchers.

PATIENT OR PUBLIC CONTRIBUTION

Our team includes one experienced peer support worker. She contributed to the design of the conceptual map and the production of the manuscript. More than 10 peers working across Canada were also involved during research meetings to validate and refine the conceptual map.

Implementing peer support work in mental health care in Germany: The methodological framework of the collaborative, participatory, mixed-methods study (ImpPeer-Psy5)

BACKGROUND

Starting in the 1990s in the United States, individuals with lived experience of mental health crises and recovery have been employed as peer support workers (PSWs) internationally. However, the implementation of PSW in clinical contexts remains challenging.

METHODS

This manuscript presents and discusses the methodological framework of the ImpPeer-Psy5 study on the PSW implementation in the German mental healthcare sector. This study used a mixed-methods and collaborative research approach, as well as participatory research strategies. After describing the study design, populations, teamwork and assessments, the epistemic challenges of its methodological framework will be critically discussed and how it has iteratively shaped the object of study.

DISCUSSION AND PRACTICAL IMPLICATIONS

The healthcare, policy and funding context of PSW implementation as well as the study's methodological framework have differently influenced the ways in which the implementation of PSW has been conceived in this study. The choice of a collaborative or participatory methodological framework is advised to better align research questions and procedures to the specific needs and challenges of PSWs and other stakeholders concerned with PSW implementation.

PATIENT AND PUBLIC CONTRIBUTION

The research team of the ImpPeer-Psy5 study was collaboratively staffed by a portion of researchers who also identify as users or survivors of psychiatric services. A nonprofit organization for the training of PSWs served as a practice partner throughout the research process. Different participatory formats involve a significant number of diverse stakeholders relevant to PSW implementation.

Dual Relationships in Mental Health Peer Support

Mental health peer support is a growing care modality; yet, understanding is limited regarding the ethical complexities that distinguish it from clinical mental health services. In particular, clinicians in mental health care do not navigate boundaries in the same way as peer workers, whose relationships with clients are notably different and may include interactions with clients outside designated support programs ("dual relationships"). Drawing on data from ongoing qualitative research, two researchers with lived experience of serious mental illness highlight the implications of dual relationships for both peer practice and research.

Programmatic Support for Peer Specialists that Serve Transition Age Youth Living with Serious Mental Illness: Perspectives of Program Managers from Two Southern California Counties

Peer Specialists (PS) often work in outpatient mental health programs serving transition age youth (TAY). This study examines program managers' perspectives on efforts to strengthen PS' professional development. In 2019, we interviewed program managers (n = 11) from two Southern California Counties employed by public outpatient mental health programs (n = 8) serving TAY and conducted thematic analyses. We present themes and illustrative quotes. PS' roles are highly flexible; thus, PM support PS to strengthen skills to address organization-facing and client-facing responsibilities. PM addressed time management, documentation, PS integration into the organization, and workplace relationships. Trainings to better support clients included addressing cultural competency to serve LGBTQ TAY and racial/ethnic subgroups. Diverse supervision modalities address PS' diverse needs. Supporting PS' technical and administrative skills (e.g., planning, interpersonal communication skills) may aid their implementation of a complex role. Longitudinal research can examine the impact of organizational supports on PS' job satisfaction, career trajectories, and TAY clients' engagement with services.

Predicting Response to Services for Homeless Adolescents and Transition Age Youth (TAY) with Substance Use And/Or Mental Health Disorders: Implications for Youth Treatment and Recovery

PURPOSE

This paper examines patterns of response to a multi-disciplinary wrap-around program for homeless adolescents and transition-aged youth with substance use and/or mental health disorders.

METHOD

A cluster analysis of outcome data from 148 youth was conducted.

RESULTS

Cluster 1 (n = 67) demonstrated significant decreases in risky behavior (e.g., engaging in unprotected sex, crime, and substance use) and poor interpersonal relationships (e.g. more interaction with family and friends and lower rates of violence) but experienced relatively fewer interactions with family and friends. Cluster 2 (n = 57) demonstrated a significant decrease in poor life functioning (e.g., lower rates of employment/education, better quality of life, and less symptoms of internalizing disorders). Cluster 3 (n = 24) experienced significant increases in risky behavior, poor life functioning, and poor interpersonal relationships.

DISCUSSION

Clusters 1 and 2 improved over six months of care. Cluster 3 deteriorated despite receiving similar services and used more opioids and stimulants.

CONCLUSIONS

Peer engagement in programs for this population are important. Recommendations for cluster 3 include targeted outreach, medication assisted treatment, and additional research-supported treatments. Further research is needed to test these interventions over longer periods of time.

Managers as peer workers' allies: A qualitative study of managers' perceptions and actions to involve peer workers in Norwegian mental health and substance use services

BACKGROUND

Citizens with experience and knowledge about what it is like to use mental health and substance use services are increasingly employed within similar services as peer workers. Peer workers are portrayed as achieving societal obligations and help ensure that the outputs from service provision are more effective. Even though peer workers have worked in mental health and substance use services for a while, few studies have focused on exploring managers' experiences and perspectives about involving peer workers. This knowledge is needed because these managers can enable and hinder equitable involvement and collaboration with peer workers.

METHODS

A qualitative explorative study was chosen to explore the following research question: How do managers in Norwegian mental health and substance use services experience, relate to, and embrace peer workers as assets in these services? A researcher (Ph.D. student) and a coresearcher (peer worker) conducted four online focus groups with a strategic selection of 17 Norwegian mental health and substance use services managers who had some experience with the involvement of peer workers in their organizations.

RESULTS

The results identified using systematic text condensation are as follows: [1] Peer workers boost the ongoing shift toward increased service user involvement. [2] Peer workers are highly valued in the service transformation process. [3] Managers involve peer workers as partners in co-creation. The results show that managers connect with peer workers and facilitate their involvement in collaborative activities across the service cycle. Peer workers' proximity to service users and bridging capacity is highlighted as the reasons for their involvement. Thus, peer workers are involved in co-defining challenges, co-designing potential solutions, co-delivering those service solutions, and, sometimes, co-assessing service solutions to rethink and improve services. As such, peer workers are considered partners in co-creation.

CONCLUSION

As managers involve peer workers, they increasingly discover peer workers' value, and because peer workers are involved, they increase their skills and capacity for collaboration. This research strengthens the knowledge base of the perceived value of peer workers' roles, bringing in new perspectives from management about utilizing and evaluating peer worker roles.

Positive Organizational Psychology Factors as Serial Multiple Mediators of the Relationship between Organization Support and Job Satisfaction Among Peer Support Specialists

BACKGROUND

Research has demonstrated the effectiveness of peer support specialists in helping people with severe mental illness increase community tenure, decrease hospitalization, boost treatment satisfaction, improve social functioning, and increase quality of life.

OBJECTIVE

The purpose of the present study was to evaluate positive organizational psychology constructs as serial multiple mediators of the relationships between perceived organizational support and job satisfaction among peer support specialists.

METHODS

One hundred and twenty-one peer support specialists from the Texas statewide peer certification training programs and the National Association of Peer Supporters participated in the present study. These peer support specialists completed an online survey composed of self-report measures related to perceived organizational support, positive organizational psychology factors, and job satisfaction. A serial multiple mediation (SMMA) analysis was conducted to evaluate autonomous motivation to work, work engagement, and organizational commitment as mediators of the relationship between perceived organizational support and job satisfaction.

RESULTS

The SMMA model accounted for 49% of the variation in job satisfaction scores (R2 =. 49, f2 = 0.96 [> 0.35], a large effect size). Autonomous motivation to work, work engagement, and organizational commitment were significantly associated with job satisfaction after controlling for the effect of perceived organizational support.

CONCLUSIONS

Perceived organizational support increased autonomous motivation to work, work engagement, organizational commitment, and job satisfaction. Peer support specialists are integral members of the interdisciplinary mental health treatment team. Leaders of community-based mental health and rehabilitation agencies who are committed to hire and retain peer support specialists must provide strong organizational support and develop interventions to increase peer support specialists' autonomous motivation to work, work engagement, and organizational commitment as a job retention and career development strategy.

"Getting the Staff to Understand It:" Leadership Perspectives on Peer Specialists Before and After the Implementation of a Peer-Delivered Healthy Lifestyle Intervention

Over the past two decades, there has been increased recognition of the effectiveness of peer delivered services, with prior research highlighting the benefits for both recipients of peer services and peer providers. Despite this, peer specialists report challenges to their work such as experiencing stigma associated with their role and difficulty integrating into a non-peer dominated workforce. The study sought to explore the perceptions of agency leadership from three supportive housing agencies regarding peer specialists and peer-delivered services within their organization before and after a peer-led intervention to promote healthy lifestyles for people with SMI. Semi-structured qualitative interviews were conducted with agency leadership and analyzed using a content analysis approach. Findings from this study contribute to the literature on the peer specialist workforce by identifying factors (e.g., agency's prior experience employing peer specialists) and potential strategies (e.g., exposure to peer services) impact the level of workplace integration of peer specialists.

Adaptation of a Hearing Voices Group Facilitation Training for VA Stakeholders

The Hearing Voices (HV) Movement promotes diverse understandings of voice-hearing and seeing visions, which mental health professionals commonly refer to as 'auditory hallucinations,' 'schizophrenia,' or 'psychosis.' Central to this movement are peer support groups through which attendees connect with others who have similar experiences. This paper describes an adaptation of a Hearing Voices group facilitation training at VA Greater Los Angeles (VAGLA) and discusses training modifications, along with trainee perceptions and implementation and intervention outcomes. This is a first step towards adapting HV-inspired groups to VA systems of care. Data collection involved surveys of trainees (n = 18) and field notes throughout the 24 h online training. Findings indicate high acceptability and appropriateness of the training and high feasibility in implementation, suggesting the training was well-adapted to VAGLA. This research contributes to global efforts to integrate the Hearing Voices approach in diverse settings and increase awareness about its benefits among providers.

Clients' Perspectives Regarding Peer Support Providers' Roles and Support for Client Access to and Use of Publicly Funded Mental Health Programs Serving Transition-Age Youth in Two Southern California Counties

Peer providers are increasingly used by mental health programs to engage transition age youth (TAY, age 16-24) living with serious mental illness. This study elicited TAY clients’ perspectives on peer providers’ roles, responsibilities, and contribution to TAYs’ use of mental health services. In 2019, six focus groups were conducted with TAY clients (n=24) receiving publicly funded mental health services in Southern California. Results from this analysis included four themes that illustrated the role of peers as perceived by TAY clients, including: 1) building client–peer provider relationships, 2) engaging with mental health services, 3) role-modelling recovery and supporting skill acquisition to instill hope and empowerment, and 4) peer roles and experiences specific to racial/ethnic concordance. These findings provide needed perspectives on the evolving role of peer providers in mental health services programming for TAY clients.

Experiences of mental health support workers in mental healthcare practice: Three visual arts narratives

WHAT IS KNOWN ON THE SUBJECT?: Mental health support workers (MHSWs) are frequently employed in mental health services in order to augment and diversify the workforce and to promote recovery centred care Research shows that while MHSWs positively support service user mental health recovery, these roles are often unclear or not well understood by MHSWs and other mental health practitioners WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Through arts-based research methods, three MHSWs communicated their personal vulnerabilities and anxieties in supporting others with mental health issues; these insights are rarely presented in mental health research. MHSW experiences of not having recovery-oriented expertise recognized or valued by healthcare team were powerfully conveyed through arts narrative. These findings promote recognition of the strengths and contributions of MHSWs to mental health practice. Arts-based inquiry is a means of providing additional depth to what is already known and contributes novel insights regarding the occupational experiences and perceptions of MHSWs. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses and healthcare teams need to engage fully with recovery-oriented principles acknowledging the vulnerabilities of all practitioners and establishing adequate supervision and support. There needs to be greater clarity concerning roles/scope of practice for MHSWs to enable productive working partnerships in mental health teams. This can be achieved through open communication, education and planning among the wider mental healthcare team. ABSTRACT: Introduction Mental health support workers (MHSWs) make positive contributions to mental health recovery practice yet their roles and support needs are often unclear. This research explored the occupational lived experiences of three MHSWs working in Irish mental healthcare services. Aim The study examined the experiences and perceptions of MHSWs regarding their mental health recovery work. Method A narrative design was used incorporating participatory art-based inquiry as a collaborative means of engaging participants. This innovative methodology enabled exploration and evocative expression of participants' occupational experiences and stories. Results Participants revealed feelings of vulnerability and anxiety regarding personal mental health and supporting the mental health of others; a finding not commonly explored in previous research. MHSW skills and knowledge were evident; however, this expertise and recovery focus was not valued in mental health services. Discussion The strengths and challenges of MHSW engagement in service provision are discussed. Interdisciplinary team integration is explored in terms of contrasting recovery philosophies, practitioner vulnerability and professional demands and imperatives. Implications for practice Mental health teams need to engage with recovery principles, acknowledging strengths and vulnerabilities of all practitioners and establishing adequate supervision and support. Greater clarity and education is required concerning roles/scope of practice for MHSWs to enable productive interdisciplinary partnerships.

Effective Peer Employment Within Multidisciplinary Organizations: Model for Best Practice

This study sought a clearer understanding of organizational mechanisms reinforcing effective peer employment and organizational change from the perspectives of peer workers, non-peer staff and management in multidisciplinary mental health and substance use recovery services. Findings were used to develop a model for organizational best practice for peer employment and associated organizational change to promote recovery-oriented and person-directed services. Qualitative research was undertaken, involving 132 people participating in 14 focus groups and eight individual interviews. These people were employed across five U.S. multidisciplinary organizations providing mental health and substance use recovery services and deemed by a panel of experts to provide effective employment of peer workers. Study findings include the articulation of an interactive working model of best practice, comprising organizational commitment, organizational culture and effective organizational strategies necessary for a "whole-of-organization" approach to support authentic peer work and enable organizational transformation, to actualize recovery-oriented values and person-driven services. Strategies include Human Resources engagement, peers in positions of senior organizational authority, recurring whole of workforce training, along with peer training and peer-led supervision. Findings suggest whole-of-organization commitment, culture and practice are essential for the organizational transformation needed to support effective employment of peers in multidisciplinary environments.

Service User Participation Within the Mental Health System: Deepening Engagement

Over the past decade, there has been a marked uptick in interest in increasing service user participation in the U.S. mental health care system, including clinical practice, research, and policy. Too often, however, these efforts remain superficial and unlikely to bring about the deeper transformation of systems long called for by grassroots activists. This Open Forum-addressed to mental health administrators, researchers, and clinicians-highlights the importance of considering diverse, critical perspectives and engaging in ways that move beyond purely intellectual rapprochement.

Roles of peer specialists and use of mental health services among youth with serious mental illness

AIM

To examine whether roles of peer specialists affect service use among Black, Latinx and White youth ages 16-24 with serious mental illness (SMI) in Los Angeles and San Diego Counties.

METHODS

Administrative data from 2015 to 2018 was used to summarize service use among 6329 transition age youth age 16-24 with SMI who received services from 76 outpatient public mental health programs with peer specialists on staff. Roles of peer specialists were assessed via a program survey. Generalized linear models were used to assess the relationship between peer specialist characteristics and service use outcomes (ie, outpatient and inpatient).

RESULTS

Having a transition age youth peer specialist on staff (vs older peer specialists) and having peer specialists that provide four or more services (vs fewer services) was associated with an increase in annual outpatient visits in both counties (P = <.001 each). In Los Angeles County, having three or more peer specialist trainings (vs fewer trainings) was associated with lower use of inpatient services (P < .001). In San Diego County, having a transition age youth peer specialist and peer specialists that provide four or more services was associated with lower use of inpatient services (P < .001 each).

CONCLUSIONS

Types of peer support and number of types of peer services were associated with mental health service utilization. Detailed examination of the roles of peer specialists is merited to identify the specific pathways that improve outcomes.

Work Climate Scale in Emergency Services: Abridged Version

This study is based on a 40-item work climate scale in hospital emergency services (WCSHES). Teams working in these emergency services experience a heavy workload and have a limited amount of time with each patient. COVID-19 has further complicated these existing issues. Therefore, we believed it would be helpful to draft an abridged version of the 40-item WCSHES, considering both validity and reliability criteria, but giving greater weight to validity. One hundred and twenty-six workers between the ages of 20 to 64 (M = 32.45; standard deviation (SD = 9.73)) years old participated voluntarily in the study. The validity, reliability, and fit model were evaluated in an iterative process. The confirmatory factor analysis yielded appropriate global fit indices in the abridged 24-item version (Χ²(248) = 367.84; p < 0.01, RMSEA = 0.06 with an interval of 90% from 0.05 to 0.07, SRMR = 0.08, GFI = 0.9, AGFI = 0.96, CFI = 0.98, NFI = 0.95, and NNFI = 0.98), along with test criteria validity (ρ_XY = 0.68, p < 0.001) and excellent reliability (α = 0.94 and ω = 0.94), maintaining the same conceptualization and usefulness of the original scale. The abridged 24-item version was used to measure four work climate factors (work satisfaction, productivity/achievement of aims, interpersonal relations, and performance at work). Evidence of the usefulness of the new abridged scale is provided along with a description of our study limitations and future areas for development.

Strategies Used to Support Peer Provision in Mental Health: A Scoping Review

The employment of peer providers (people who draw on their lived experience of mental health challenges) has grown in conjunction with the increased acceptance of recovery as a key principle in mental health policy and practice. Barriers to the integration of peer providers in mental health services have been well documented. This review addresses an under-explored area by consolidating strategies undertaken by mental health organizations for the successful implementation of peer provision. A scoping review was chosen to facilitate the rapid summary and dissemination of research findings that are relevant to policymakers and practitioners. Peer-reviewed articles and grey literature were sourced from three databases, key peer support websites and a hand search of the included studies. Following screening, data were extracted from 28 studies: 25 qualitative and three mixed methods studies. The data were analyzed using thematic analysis and organized into themes. Four themes emerged from the data. Championing of peer provision initiatives by organizational leadership is central to the success and sustainability of peer provision. Leadership undergirds three strategies that were discussed: organizational preparation, recruitment, training and induction, and support and development. When peer provision is championed by organizational leadership, measures can be undertaken to prepare the organization for peer provision; recruit, train and induce peer providers successfully into the organization; and support peer providers on the job.

The Availability of Peer Support and Disparities in Outpatient Mental Health Service Use Among Minority Youth with Serious Mental Illness

We examine whether the availability of peer support reduces disparities in service use among minority youth ages 16-24 with serious mental illness in Los Angeles and San Diego Counties. Administrative data from 2015-2018 was used to summarize service use among 13,363 transition age youth age 16-24 with serious mental illness who received services from 183 outpatient public mental health programs; 17.2% were Black, 67.4% were Latinx, and 15.4% were non-Latinx white. The availability of peer support was assessed via a program survey. Generalized linear models were used to assess the relationship between availability of peer support, defined as having a peer specialist on staff, and the annual number of outpatient mental health visits. We also examined the relationship between racial/ethnic concordance of youth and peer specialists and use of outpatient services. Forty-six percent of youth received services from programs that employed peer specialists. Among youth in both counties, the availability of peer support was associated with an increase in annual outpatient visits (P ≤ .05 each). Peer support was associated with reductions in service use disparities among Black and Latinx youth in Los Angeles County (P < .001 each). Peer concordance was associated with an increase in outpatient service use among Latinx youth in both counties (P < .05 each). Peer support was associated with increases in use of outpatient mental health services. Detailed examination of the context for youth peer support implementation is merited to identify the specific pathways that improve outcomes.

[Mutual Support by People with Lived Experience of Mental Distress in Crisis Respites - A Scoping Review]

OBJECTIVE

In various places around the world, crises respites (CR) are being implemented as an alternative to psychiatric treatment, and to offer mutual, short-term residential support by people with lived experience. In this paper, it is examined, how CR are structured, and how - using which approaches and leading to which results - they have been evaluated.

METHODS

A systematic scoping review of the international literature was carried out. Studies were included, also from the "grey" literature, if they were based on empirical material.

RESULTS

12 articles, relating to 10 CR, were selected. The organisational structures of the included CR were found to be quite heterogeneous. Further, different approaches were used for evaluation (RCT, qualitative, mixed methods).

CONCLUSION

CR are no substitute for psychiatric care, but a distinct, effective form of support. The influence of people with lived experience is crucial to the implementation and evaluation of CR to preserve their distinctiveness.

Unintended consequences of institutionalizing peer support work in mental healthcare

The widespread shift towards recovery-oriented mental healthcare has led to the extensive growth of peer-delivered services. Peer support workers draw on lived experience of mental health challenges and service use to provide non-clinical support services. As peer support services have grown, they have also formalized. This mixed-methods study of peer support work in Pennsylvania (USA) explores how peer support has been institutionalized, and identifies the intended impacts and unintended consequences associated with that process. In Pennsylvania, the inclusion of peer support services as a Medicaid reimbursable service, in addition to county level mandates regarding peer support service availability, have served to institutionalize the field. Data include 49 semi-structured interviews conducted with peer support workers (n = 35) and stakeholders (n = 14) in 2016. Qualitative analyses reveal changes to the scope and nature of peer support work, the peer workforce, peer client relationships, and to stigma in the workplace. Despite these changes, peer workers frequently remain underpaid and unable to advance professionally. The institutionalization of peer support serves as a barrier to worker entry and retention and highlights tensions between the consumer-driven origin of the recovery field and the current mental healthcare system. The institutionalization of roles defined by experiential expertise, such as peer support, has the potential to reduce the very centrality of experiential expertise, reproduce social inequalities, and paradoxically impact stigma.