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Nixdorf R, Kotera Y, Baillie D, Garber Epstein P, Hall C, Hiltensperger R, Korde P, Moran G, Mpango R, Nakku J, Puschner B, Ramesh M, Repper J, Shamba D, Slade M, Kalha J, Mahlke C. Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries. PLoS One 2024; 19:e0298315. [PMID: 38408108 PMCID: PMC10896522 DOI: 10.1371/journal.pone.0298315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/18/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. METHOD Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. RESULTS 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. DISCUSSION Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.
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Affiliation(s)
- Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Dave Baillie
- East London NHS Foundation Trust, London, United Kingdom
| | - Paula Garber Epstein
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Cerdic Hall
- East London NHS Foundation Trust, London, United Kingdom
| | | | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Richard Mpango
- Butabika National Referral Hospital, Kampala, Uganda
- School of Health Sciences, Soroti University, Soroti, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
- Makerere University, Kampala, Uganda
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Julie Repper
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Donat Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Namsos, Norway
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Haun M, Adler Ben-Dor I, Hall C, Kalha J, Korde P, Moran G, Müller-Stierlin AS, Niwemuhwezi J, Nixdorf R, Puschner B, Ramesh M, Charles A, Krumm S. Perspectives of key informants before and after implementing UPSIDES peer support in mental health services: qualitative findings from an international multi-site study. BMC Health Serv Res 2024; 24:159. [PMID: 38302955 PMCID: PMC10835950 DOI: 10.1186/s12913-024-10543-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Peer support is an essential part of recovery-oriented care worldwide. Contextual factors have an impact on the implementation of peer support work. However, research has paid little attention to similarities and differences of implementation factors in settings varying by income-level and cultural values. The aim of this study is to assess the factors influencing the implementation of a peer support intervention across study sites in low-, middle- and high-income countries in line with the Consolidation Framework for Implementation Research (CFIR). METHOD 6 focus groups with a total of 54 key informants with relevant contextual (organisational) knowledge regarding implementation facilitators and barriers were conducted at six study sites Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Pune (India) before and 1.5 years after the start of UPSIDES peer support. Transcripts were analysed using qualitative content analysis. RESULTS Across study sites key informants reported benefits of peer support for service users and peer support workers as implementation facilitators. At study sites with lower resources, reduced workload for mental health workers and improved access to mental health services through peer support were perceived as implementation facilitators (CFIR Domain 1: Intervention characteristics). The degree of engagement of mental health workers (CFIR Domain 3: Inner Setting/Domain 4: Individuals involved) varied across study sites and was seen either as a barrier (low engagement) or a facilitator (high engagement). Across study sites, adequate training of peer support workers (CFIR Domain 5: Implementation process) was seen as animplementation facilitator, while COVID-19 as well as low resource availability were reported as implementation barriers (CFIR Domain 2: Outer setting). CONCLUSIONS This study highlights the importance of considering contextual factors when implementing peer support, including previous experience and perceived benefits. Particular attention should be given to organisational benefits such as workload reduction and the allocation of sufficient resources as key drivers in LMICs. In HICs, the potential of organisational benefits for successful implementation should be further investigated and promoted.
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Affiliation(s)
- Maria Haun
- Department of Psychiatry II, Ulm University, Ulm, Germany.
| | - Inbar Adler Ben-Dor
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Cerdic Hall
- East London NHS Foundation Trust, London, UK
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | | | | | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Silvia Krumm
- Department of Psychiatry II, Ulm University, Ulm, Germany
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Khanthavudh C, Grealish A, Tzouvara V, Huang J, Leamy M. Implementation and evaluation of recovery-oriented practice interventions for people with mental illness in Asia: An integrative review. Int J Nurs Stud 2023; 147:104591. [PMID: 37708624 DOI: 10.1016/j.ijnurstu.2023.104591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Recovery is a process involving empowering individuals to take control of their lives and develop meaningful and purposeful life, regardless of whether their mental health symptoms persist. Recovery-oriented practice has been widely implemented, particularly in Anglophone countries, during the past two decades. Mental health recovery in Asia is also moving towards recovery-oriented practice. Little is known about how recovery-oriented interventions originating in the West have been implemented and evaluated in Asian contexts. OBJECTIVE This review aimed to identify 1) types of recovery-oriented practice interventions that have been implemented in Asia, 2) how they have been culturally adapted, 3) barriers and facilitators to implementation, and 4) how the interventions have been evaluated. DESIGN This is an integrative review. METHODS This integrative review followed Whittemore and Knafl's five-stage framework. Six electronic databases (e.g., PsycINFO, MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library) were systematically searched from their inception to January 2022 to identify eligible studies published in English language. The key search terms included "mental illness", "recovery-oriented intervention", and "Asia". Studies reporting on implementation and evaluation of recovery-focused interventions in Asian settings were eligible. Quality assessment and narrative synthesis were subsequently undertaken. RESULTS Thirty-eight studies were included. Seven main types of recovery-oriented intervention were identified: (1) peer programmes; (2) illness management and recovery; (3) individual placement and support; (4) strength model case management; (5) clubhouse model; (6) wellness recovery action plan and (7) psychiatric advance directive, alongside several novel recovery programmes. Studies reported cultural adaptations for language, content, cultural norms, religious beliefs, family, and local context. Barriers to implementation included a poor understanding of recovery concepts and inadequate organisational resources. A range of clinical and personal recovery outcome measures were reported. CONCLUSIONS Recovery-oriented interventions are increasing in Asia, with nearly half of reviewed studies featuring cultural adaptations. However, research is geographically skewed, and more rigorously conducted studies are needed across a wider range of Asian countries. REGISTRATION This review was registered with the PROSPERO International prospective register of systematic reviews (CRD42022310049). TWEETABLE ABSTRACT Recovery-oriented practice interventions for people with mental illness are on the rise in Asia @chonmananNN.
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Affiliation(s)
- Chonmanan Khanthavudh
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom; Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Annmarie Grealish
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom; Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Vasiliki Tzouvara
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Jing Huang
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Mary Leamy
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
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Chennapragada L, Kandlur R, Pushpanadh S, Shailendra Aragula S, Kilby DJ, Richardson-Vejlgaard R. A study of attitudes and experiences relating to alcohol use in a community of family farmers from Southern India. J Ethn Subst Abuse 2023:1-23. [PMID: 37610764 DOI: 10.1080/15332640.2023.2248032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Problematic drinking is found to be common among Indian farmers. This study aims to improve our understanding of the causes, consequences, and culture surrounding drinking in Indian farming communities. 36 semi-structured interviews with male and female farmers were thematically analyzed. Problematic drinking in male farmers was found to significantly impact farmer's relationships, work, finances, and health, and to be related to spousal abuse and neglect. Drinking to cope with mental and physical pain was common, and stigma around drinking appears to be a barrier to social support. Implications for future research and treatment efforts for Indian farmers are discussed.
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Affiliation(s)
| | - Raksha Kandlur
- Teachers College Columbia University, New York, NY, USA
- Old Dominion University, Norfolk, VA, USA
| | - Sreelakshmi Pushpanadh
- Teachers College Columbia University, New York, NY, USA
- Pennsylvania State University, University Park, PA, USA
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Ramesh M, Charles A, Grayzman A, Hiltensperger R, Kalha J, Kulkarni A, Mahlke C, Moran GS, Mpango R, Mueller-Stierlin AS, Nixdorf R, Ryan GK, Shamba D, Slade M. Societal and organisational influences on implementation of mental health peer support work in low-income and high-income settings: a qualitative focus group study. BMJ Open 2023; 13:e058724. [PMID: 37612104 PMCID: PMC10450133 DOI: 10.1136/bmjopen-2021-058724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/17/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES Despite 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. DESIGN Study 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. SETTING The 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. PARTICIPANTS 12 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. RESULTS Six themes relating to implementation influences were identified: community and staff attitudes, resource availability, organisational culture, role definition, training and support and peer support network. CONCLUSIONS This 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 NUMBER ISRCTN26008944.
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Affiliation(s)
- Mary Ramesh
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Ashleigh Charles
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alina Grayzman
- Department of Social Work, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Southern, Israel
| | | | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Arti Kulkarni
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Candelaria Mahlke
- Department of Psychiatry, University Medical Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Galia S Moran
- Department of Social Work, Ben-Gurion University of the Negev, Southern Israel, Israel
| | - Richard Mpango
- Butabika National Referral Hospital, Kampala, Uganda
- Department of Mental Health, School of Health Sciences, Soroti University, Soroti, Uganda
| | | | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Grace Kathryn Ryan
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Donat Shamba
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mike Slade
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Postbox 474, 7801 Namsos, Norway
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Kafczyk T, Hämel K. Primary mental healthcare for older people in India: between stigmatization and community orientation. DISCOVER MENTAL HEALTH 2023; 3:14. [PMID: 37861873 PMCID: PMC10501019 DOI: 10.1007/s44192-023-00040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Questions of equitable access to primary mental healthcare (PMHC) for older persons in India have been examined mostly in terms of the coverage of services, although perceptions of mental health and old age and social norms at the community level should be considered in the shaping of PMHC approaches. The present qualitative study, therefore, examined how social perceptions and norms of mental health in old age are and should be considered in the design and implementation of primary healthcare approaches in India. METHODS A secondary thematic analysis of semi-structured interviews with key stakeholders (n = 14) of PMHC in India was conducted. RESULTS Four key themes emerged from the analysis, in which social perceptions and norms were discussed: (1) family participation and low threshold access to mental healthcare, (2) the position of community health workers as an important pillar of old age and mental health-sensitive community-based care, (3) the role of social cohesion and traditional values in fostering a positive and supportive community environment for old age mental health, and (4) the empowerment of communities, families and older persons through mental health education. CONCLUSIONS PMHC, with its focus on mental health promotion, could be an important anchor for combatting negative attitudes about mental health and old age. The findings presented in this study can inform age-sensitive policies and programmes for mental health in India and could inform future research on the subject.
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Affiliation(s)
- Tom Kafczyk
- School of Public Health, Department of Health Services Research and Nursing Science, Bielefeld University, Universitaetsstrasse 25, 33651, Bielefeld, Germany.
| | - Kerstin Hämel
- School of Public Health, Department of Health Services Research and Nursing Science, Bielefeld University, Universitaetsstrasse 25, 33651, Bielefeld, Germany
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Tenneti S. LGBT+ People's Approaches to the Psy Disciplines: A Case Study of A Mental Health Collective in Mumbai, India. JOURNAL OF HOMOSEXUALITY 2023; 70:1263-1286. [PMID: 35014945 DOI: 10.1080/00918369.2021.2020541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The paper presents the case study of a mental health collective run by queer people in Mumbai that aims to promote mental health literacy and help-seeking behavior that are anchored in the psy disciplines although the founders are not psy professionals themselves. The study analyses the delicate balance between valorizing personal experience and trusting psy authority that is evident in the functioning of the collective and in the founders' own negotiations of their psychiatric diagnoses with their queer identities and other experiences. The analysis is anchored in a broader pattern in India of privileging the psy disciplines over other medical systems although psy authority remains contested and diffused owing to several factors. The limitations of the informal nature of the collective and their acceptance of psy authority are also explored.
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Eiroa-Orosa FJ, Sánchez-Moscona C. Implementing the figure of peer support workers in mental health: an international perspective from the context of its implementation in Catalonia. Salud Colect 2023; 19:e4252. [PMID: 37311138 DOI: 10.18294/sc.2023.4252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/29/2022] [Indexed: 01/24/2023] Open
Abstract
In the context of debates surrounding the training of mental health peer support workers and their incorporation into the Catalan Health System, this article presents a literature review complemented by interviews carried out between 2020 and 2021 with both international and Spanish experts. Based on the information obtained, content analysis of elements of their training and integration within the health system was performed. German-speaking countries offer the most homogeneous training and recruitment programs. In the case of English- and French-speaking countries, non-profit or third sector organizations are usually in charge of training programs and recruitment. Various experiences with training programs exist in the Ibero-American world, although they are not recognized as professional qualifications. Recommendations are offered for the development of this figure in Catalonia, which include advancing towards professional training with recognition as health care providers, as well as contracting options from both socio-health or health care providers or from third sector entities.
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Affiliation(s)
- Francisco José Eiroa-Orosa
- Doctor en Psicología Clínica y Psiquiatría. Investigador Ramón y Cajal, Sección de Personalidad, Evaluación y Tratamiento Psicológico, Departamento de Psicología Clínica y Psicobiología, Universidad de Barcelona. Integrante, Grupo de Investigación en Salud Mental en Primera Persona, Federación Veus, Barcelona, España
| | - Cecilia Sánchez-Moscona
- Magíster en Psicología General Sanitaria. Sección de Personalidad, Evaluación y Tratamiento Psicológico; Departamento de Psicología Clínica y Psicobiología, Universidad de Barcelona. Integrante, Grupo de Investigación en Salud Mental en Primera Persona, Federación Veus, Barcelona, España
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9
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Ong QS, Yang HZ, Kuek JHL, Goh YS. Implementation of peer-support services in Asia: A scoping review. J Psychiatr Ment Health Nurs 2022; 30:309-325. [PMID: 36263517 DOI: 10.1111/jpm.12879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Peer-support services was started in the 1970s psychiatric survivor movement in the United States of America (USA) due to the lack of transitional support for deinstitutionalized psychiatric patients. Delivered by peer-support workers (PSWs) with lived experiences of mental health conditions, peer-support workers use their experiential knowledge to help others with similar conditions. The paradigm shifts in mental health recovery has led to an increase in interest on peer-support services among the Asia countries. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The diversity political and cultural differences in Asia makes it a unique for people to understand the mental health ecosystem that exist within. This review is timely as it provides the insights into the current state of peer-support services for mental health consumers in Asia and the future research on them. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: First, this review provided a broad overview on the current types of peer-support services and their implementation in Asia. Second, emphasized the importance and value of peer-support services for individuals with mental health conditions in their journey towards recovery. Third, important to build a more positive image for peer-support workers by assigning more clarity to their roles and systematizing training to hone their skills in providing peer support. ABSTRACT Introduction The increasing recognition and need for recovery-oriented services led to the heightened interests of peer-support services globally, including Asia. However, little is known about the peer-support services in Asia as compared to the West, where peer-support services primarily originated from and are well established. Aim To examine available evidence on the implementation of peer-support services for such consumers in Asia. Method This scoping review was based on the Arksey & O'Malley's framework. A comprehensive search was performed across seven electronic databases. The grey literature was also searched through Open Grey and ProQuest Dissertation and Theses, alongside hand searching of the reference of the studies. Articles searched was from January 2000 to December 2021. Results Three main themes were identified to provide an overview on peer-support services for mental health consumers in Asia: the delivery of such services in Asia; Asian consumers' perceptions of them; and factors affecting their implementation. Discussion Given their relative novelty in Asia, findings from this review represent useful insights for organizations and policy administrators when formulating such services. Implications for Practice Future research should also focus on evaluating the effectiveness of such services in Asia and comparing their outcomes with other regions.
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Affiliation(s)
- Qin Soo Ong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Hui Zhu Yang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Jonathan Han Loong Kuek
- Susan Wakil School of Nursing, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yong Shian Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Poremski D, Kuek JHL, Yuan Q, Li Z, Yow KL, Eu PW, Chua HC. The impact of peer support work on the mental health of peer support specialists. Int J Ment Health Syst 2022; 16:51. [PMID: 36258206 PMCID: PMC9578199 DOI: 10.1186/s13033-022-00561-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background Peers support specialists have positive impacts on the mental health of their service users. However, less is known about how their mental health changes as a result of their activities. Methods We followed 10 peer support specialists over their first year of employment and interviewed them thrice. We used grounded theory to analyse the way in which the health of participants changed. Results Self-reported mental health of our participants did not change over the course of the study. However, the role did help participants grow and learn about their condition and their strengths. While sharing their past experiences could be taxing, they learned how to harness their recovery journey without risking relapse. Conclusion Entering the role of a peer support specialist does not appear to negatively impact mental health, but might enhance insight and resilience. However, this appears to occur in individuals who already possess an inclination toward introspection. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00561-8.
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Affiliation(s)
- Daniel Poremski
- Health Intelligence Unit, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Jonathan Han Loong Kuek
- Health Intelligence Unit, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Qi Yuan
- Research Department, Institute of Mental Health, Singapore, Singapore
| | - Ziqiang Li
- Department of Nursing, Institute of Mental Health, Singapore, Singapore
| | - Kah Lai Yow
- Department of Allied Health Services, Institute of Mental Health, Singapore, Singapore
| | - Pui Wai Eu
- Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Hong Choon Chua
- Office of the CEO, Institute of Mental Health, Singapore, Singapore
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Krumm S, Haun M, Hiller S, Charles A, Kalha J, Niwemuhwezi J, Nixdorf R, Puschner B, Ryan G, Shamba D, Epstein PG, Moran G. Mental health workers' perspectives on peer support in high-, middle- and low income settings: a focus group study. BMC Psychiatry 2022; 22:604. [PMID: 36088330 PMCID: PMC9464408 DOI: 10.1186/s12888-022-04206-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peer support is increasingly acknowledged as an integral part of mental health services around the world. However, most research on peer support comes from high-income countries, with little attention to similarities and differences between different settings and how these affect implementation. Mental health workers have an important role to play in integrating formal peer support into statutory services, and their attitudes toward peer support can represent either a barrier to or facilitator of successful implementation. Thus, this study investigates mental health workers' attitudes toward peer support across a range of high- (Germany, Israel), middle- (India), and low-income country (Tanzania, Uganda) settings. METHODS Six focus groups were conducted in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Ahmedabad, Gujarat (India) with a total of 35 participants. Transcripts were analyzed using thematic content analysis. RESULTS Participants across the study sites demonstrated overall positive attitudes towards peer support in mental health care, although some concerns were raised on potentially harmful effects of peer support such as negative role modelling and giving inadequate advice to service users. Notably, mental health workers from low- and middle-income countries described peer support workers as bridge-builders and emphasized the mutual benefits of peer support. Mental health workers' views on peer support workers' roles and role boundaries differed between sites. In some settings, mental health workers strongly agreed on the need for role clarity, whereas in others, mental health workers expressed mixed views, with some preferring blurred role boundaries. Regarding collaboration, mental health workers described peer support workers as supporters and utilizers, equal partners or emphasized a need for trust and commitment. CONCLUSIONS Mental health workers' attitudes toward peer support workers were positive overall, but they also varied depending on local context, resources and previous experiences with peer support. This affected their conceptions of peer support workers' roles, role clarity, and collaboration. This study demonstrated that reconciling the need for local adaptations and safeguarding the core values of peer support is necessary and possible, especially when the implementation of recovery-oriented interventions such as peer support is accelerating worldwide.
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Affiliation(s)
- Silvia Krumm
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany.
| | - Maria Haun
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Selina Hiller
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Ashleigh Charles
- grid.4563.40000 0004 1936 8868School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jasmine Kalha
- grid.32056.320000 0001 2190 9326Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Jackie Niwemuhwezi
- grid.461309.90000 0004 0414 2591Butabika National Referral Hospital, Kampala, Uganda
| | - Rebecca Nixdorf
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Grace Ryan
- grid.8991.90000 0004 0425 469XCentre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Donat Shamba
- grid.414543.30000 0000 9144 642XDepartment of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Paula Garber Epstein
- grid.12136.370000 0004 1937 0546Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Galia Moran
- grid.7489.20000 0004 1937 0511Department of Social Work, Ben Gurion University of the Negev, Be’er Sheva, Israel
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de Wet A, Pretorius C. From darkness to light: Barriers and facilitators to mental health recovery in the South African context. Int J Soc Psychiatry 2022; 68:82-89. [PMID: 33307927 DOI: 10.1177/0020764020981126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND South Africa is a low and middle income country facing many challenges in public mental health care and implementation of recovery. AIMS To contribute to what barriers and facilitators to recovery might be for service users in South Africa, from the perspective of service users, carers and service providers from three psychiatric hospitals in the Western Cape province. METHOD Interviews and focus groups were conducted with service users, carers and service providers. Interviews and focus groups were transcribed and analysed using atlas.ti software and reflexive thematic analysis, from the bottom up. RESULTS The barriers, environment, family, public mental health services, stigma and service users' attitude or behaviour generated, were found to be the most salient. The facilitators to recovery generated were support, family or friends, service providers, structure and empowerment. The need for support was identified as an underlying component to all these themes. CONCLUSION Barriers and facilitators to recovery seemed to have both intrapersonal and external sources that intersect at times. Recovery needs to be supported at an individual level, especially through an under-utilised resource such as peer support work, but in conjunction with the development of recovery-enabling environments in services and communities in South Africa.
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Affiliation(s)
- Anneliese de Wet
- Psychology Department, Stellenbosch University, Matieland, Western Cape, South Africa
| | - Chrisma Pretorius
- Psychology Department, Stellenbosch University, Matieland, Western Cape, South Africa
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Sims S, Hepsipa Omega Juliet S, Joseph J, Gopal S, Raghavan V, Venkatraman L, Padmavati R. Acceptability of Peer Support for People With Schizophrenia in Chennai, India: A Cross Sectional Study Amongst People With Lived Experience, Caregivers, and Mental Health Professionals. Front Psychiatry 2022; 13:797427. [PMID: 35370806 PMCID: PMC8965369 DOI: 10.3389/fpsyt.2022.797427] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Establishing structured peer support in mental health, particularly for people with schizophrenia, as a psychosocial intervention is early in low and middle-income countries like India. Before implementing and understanding the effectiveness of peer support service and which mode of peer support delivery will be suitable for our culture, our study aimed to understand if peer support would be accepted by the different participants like persons with schizophrenia, caregivers and mental health professionals in a tertiary care center in Chennai, India. METHODS The study was conducted at the outpatient department (OPD) of a tertiary psychiatric care facility in Chennai, India. A cross-sectional study method was used. Consecutive persons diagnosed with schizophrenia and caregivers of persons with schizophrenia, who attended the outpatient department, and mental health professionals within and outside the facility who met the inclusion and exclusion criteria participated in the study. A structured questionnaire purposefully developed for the study was administered to the different study participants. Descriptive statistics were used to analyze the data. Categorical variables were expressed as frequency and percentages, while the continuous variables were expressed as mean and standard deviation. RESULTS A total of 155 participants (52 persons with schizophrenia, 50 caregivers and 53 mental health professionals) completed the survey. The majority of the participants (90.4% of persons with schizophrenia, 86% caregivers and all mental health professionals) welcomed peer support interventions. The participants wanted peers to help persons with schizophrenia achieve personal goals to enhance their mental health and day to day living with an emphasis on independent living and interpersonal and social relationships and help them achieve medication and treatment-related goals toward recovery. Understanding the role of a peer support volunteer and transitioning from a "person with schizophrenia" to a "peer support volunteer" by persons with schizophrenia was thought most challenging. CONCLUSION The results highlight the potential acceptability of peer support across several stakeholders in the care of schizophrenia in a low and middle-income country context. The results may guide the implementation of a peer support volunteer programme as an essential mechanism of delivering psychosocial interventions for persons with schizophrenia.
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Affiliation(s)
- Sonia Sims
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - S Hepsipa Omega Juliet
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - Jainey Joseph
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - Subhashini Gopal
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - Vijaya Raghavan
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - Lakshmi Venkatraman
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - Ramachandran Padmavati
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
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Brooks JM, Wu JR, Umucu E, Storm M, Chiu CY, Walker R, Fortuna KL. Key components of recovery predict occupational performance and health in peer support specialists. Psychiatr Rehabil J 2021; 44:212-218. [PMID: 34516154 PMCID: PMC8443126 DOI: 10.1037/prj0000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: The primary purpose of the study was to explore and identify how components of recovery are associated with occupational performance and health among peer support specialists. Methods: One hundred and twenty-one peer support specialists were recruited from statewide peer certification training programs and the International Association of Peer Supporters. Study respondents completed a survey package including demographic questions and psychometrically sound self-report measures. Two hierarchical multivariable linear regression models were conducted to evaluate whether the recovery components of the process of recovery, social support for recovery, and work self-determination (i.e., work autonomy, work competence, and work relatedness) were associated with indicators of occupational performance (i.e., work engagement) and health (i.e., job satisfaction). Results: Work autonomy was associated with the occupational performance indicator, while the process of recovery and social support for recovery were the only recovery components associated with the indicator for occupational health. Conclusions and Implications for Practice: Findings support the importance of work self-determination and social support and recovery for occupational performance and health among peer support specialists. Mental health and rehabilitation professionals should address these key components of recovery when working with and supporting the work well-being of peer support specialists. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jessica M Brooks
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Jia-Rung Wu
- Department of Counselor Education, Northeastern Illinois University
| | - Emre Umucu
- Rehabilitation Counseling Program, University of Texas at El Paso
| | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger
| | - Chung-Yi Chiu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
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The architecture of the primary mental healthcare system for older people in India: what public policies tell us. Int J Ment Health Syst 2021; 15:72. [PMID: 34461949 PMCID: PMC8404305 DOI: 10.1186/s13033-021-00494-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background Old age mental healthcare is an issue that cuts across old age, general health, and mental healthcare policies. While strengthening the primary mental healthcare system in India is a common strategy across policy fields to improve the mental health of older persons, very little is known about the system’s planned architecture. This study explores public policy strategies for and approaches to the mental health of older persons, focusing on the primary healthcare (PHC) level and the role of the family. Methods A document analysis of 39 key public national policy documents (2007 – 2019) from three thematically grouped policy fields (mental health, old age, and general health) was conducted. Results Comprehensive community-based primary mental healthcare – focusing on vulnerable population groups including older persons – has been strengthened significantly since 2007. The promulgated approaches and strategies build on traditional community-based approaches to mental healthcare in India. They focus on (a) integrating community health workers into primary mental healthcare, (b) empowering the community to participate in healthcare planning, implementation, and monitoring, (c) supporting the family through a family-led approach to mental healthcare, and (d) integrating traditional Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy (AYUSH) services into primary mental healthcare. Conclusions While all policy fields address mental PHC, they do so in different ways, and approaches and strategies that promote an integrated perspective across policy fields are lacking. To realize the policies vision, strengthening PHC will be essential. Further research should evaluate strategies and approaches in light of social developments, such as eroding family norms and the poor state of the public health system in India, in order to assess their opportunities, challenges, and overall feasibility, with the benefits older people would experience taking centre stage in these inquiries.
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A Longitudinal Qualitative Analysis of the Way Peer Support Specialist Roles Change Over Time in a Psychiatric Hospital Setting in Asia. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:226-236. [PMID: 34390425 PMCID: PMC8850219 DOI: 10.1007/s10488-021-01158-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 12/03/2022]
Abstract
The current study seeks to determine how peer support roles change as peer support specialists’ positions within organizations and departments mature. We followed ten peer support specialists over the course of a year, interviewing them at three points, starting approximately three months after they began working as peer support specialists. We used an inductive process to analyze our data and followed guidelines on the structuring of longitudinal qualitative trajectories to divide the data into watershed moments. Our participants worked in a variety of departments in the hospital, and their service use experiences generally echo those of their service users. Participants appear to pass through four phases over the course of their employment as peers: early beginnings, establishing the role, role narrowing, and role sustainability. Services wishing to integrate new peers must be aware of the time required for integration. Having general job descriptions limited to specifying that peers are expected to use their lived experience to support current service users may lead to uncertainty amongst new and existing staff. Without role clarity, peers may struggle to find their place. Pairing new staff with mentors may limit this burden. As roles consolidate, boundaries may emerge. If these boundaries narrow the role of the PSS, they may no longer find the role appealing. They may then choose other caregiver roles with wider or different spheres of influence. Organizations may benefit by clearly indicating if they expect peer support positions to be static or transitionary.
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Charles A, Nixdorf R, Ibrahim N, Meir LG, Mpango RS, Ngakongwa F, Nudds H, Pathare S, Ryan G, Repper J, Wharrad H, Wolf P, Slade M, Mahlke C. Initial Training for Mental Health Peer Support Workers: Systematized Review and International Delphi Consultation. JMIR Ment Health 2021; 8:e25528. [PMID: 34042603 PMCID: PMC8193486 DOI: 10.2196/25528] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/15/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
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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Affiliation(s)
- Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nashwa Ibrahim
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Masoura, Egypt
| | - Lion Gai Meir
- Department of Social Work, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Richard S Mpango
- Butabika National Referral Hospital, Butabika, Uganda
- School of Health Sciences, Soroti University, Soroti, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Fileuka Ngakongwa
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Hannah Nudds
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Julie Repper
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Heather Wharrad
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Philip Wolf
- Department of Psychiatry II, Ulm University II, Ulm, Germany
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Candelaria Mahlke
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Barbui C, Purgato M, Abdulmalik J, Caldas-de-Almeida JM, Eaton J, Gureje O, Hanlon C, Nosè M, Ostuzzi G, Saraceno B, Saxena S, Tedeschi F, Thornicroft G. Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence. Br J Psychiatry 2021; 218:185-195. [PMID: 32847633 DOI: 10.1192/bjp.2020.144] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Coercive treatment comprises a broad range of practices, ranging from implicit or explicit pressure to accept certain treatment to the use of forced practices such as involuntary admission, seclusion and restraint. Coercion is common in mental health services. AIMS To evaluate the strength and credibility of evidence on the efficacy of interventions to reduce coercive treatment in mental health services. Protocol registration: https://doi.org/10.17605/OSF.IO/S76T3. METHOD Systematic literature searches were conducted in MEDLINE, Cochrane Central, PsycINFO, CINAHL, Campbell Collaboration, and Epistemonikos from January 2010 to January 2020 for meta-analyses of randomised studies. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was classified using quantitative umbrella review criteria, and credibility of evidence was assessed using the GRADE approach. RESULTS A total of 23 primary studies (19 conducted in European countries and 4 in the USA) enrolling 8554 participants were included. The evidence on the efficacy of staff training to reduce use of restraint was supported by the most robust evidence (relative risk RR = 0.74, 95% CI 0.62-0.87; suggestive association, GRADE: moderate), followed by evidence on the efficacy of shared decision-making interventions to reduce involuntary admissions of adults with severe mental illness (RR = 0.75, 95% CI 0.60-0.92; weak association, GRADE: moderate) and by the evidence on integrated care interventions (RR = 0.66, 95% CI 0.46-0.95; weak association, GRADE: low). By contrast, community treatment orders and adherence therapy had no effect on involuntary admission rates. CONCLUSIONS Different levels of evidence indicate the benefit of staff training, shared decision-making interventions and integrated care interventions to reduce coercive treatment in mental health services. These different levels of evidence should be considered in the development of policy, clinical and implementation initiatives to reduce coercive practices in mental healthcare, and should lead to further studies in both high- and low-income countries to improve the strength and credibility of the evidence base.
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Affiliation(s)
- Corrado Barbui
- Professor of Psychiatry, World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Marianna Purgato
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Jibril Abdulmalik
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - José Miguel Caldas-de-Almeida
- Professor of Psychiatry, Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, Portugal
| | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, UK; and CBM Global, Laudenbach, Germany
| | - Oye Gureje
- Professor of Psychiatry, World Health Organization Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Charlotte Hanlon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, UK; and WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University; and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia
| | - Michela Nosè
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Giovanni Ostuzzi
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Benedetto Saraceno
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, Portugal
| | - Shekhar Saxena
- Professor of the Practice of Global Mental Health, Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA
| | - Federico Tedeschi
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Graham Thornicroft
- Professor of Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Bunn M, Gonzalez N, Falek I, Weine S, Acri M. Supporting and Sustaining Nonspecialists to Deliver Mental Health Interventions in Low- and Middle-Income Countries: An Umbrella Review. INTERVENTION 2021. [DOI: 10.4103/intv.intv_47_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moran GS, Kalha J, Mueller-Stierlin AS, Kilian R, Krumm S, Slade M, Charles A, Mahlke C, Nixdorf R, Basangwa D, Nakku J, Mpango R, Ryan G, Shamba D, Ramesh M, Ngakongwa F, Grayzman A, Pathare S, Mayer B, Puschner B. Peer support for people with severe mental illness versus usual care in high-, middle- and low-income countries: study protocol for a pragmatic, multicentre, randomised controlled trial (UPSIDES-RCT). Trials 2020; 21:371. [PMID: 32357903 PMCID: PMC7195705 DOI: 10.1186/s13063-020-4177-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/17/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Peer support is an established intervention involving a person recovering from mental illness supporting others with mental illness. Peer support is an under-used resource in global mental health. Building upon comprehensive formative research, this study will rigorously evaluate the impact of peer support at multiple levels, including service user outcomes (psychosocial and clinical), peer support worker outcomes (work role and empowerment), service outcomes (cost-effectiveness and return on investment), and implementation outcomes (adoption, sustainability and organisational change). METHODS UPSIDES-RCT is a pragmatic, parallel-group, multicentre, randomised controlled trial assessing the effectiveness of using peer support in developing empowering mental health services (UPSIDES) at four measurement points over 1 year (baseline, 4-, 8- and 12-month follow-up), with embedded process evaluation and cost-effectiveness analysis. Research will take place in a range of high-, middle- and low-income countries (Germany, UK, Israel, India, Uganda and Tanzania). The primary outcome is social inclusion of service users with severe mental illness (N = 558; N = 93 per site) at 8-month follow-up, measured with the Social Inclusion Scale. Secondary outcomes include empowerment (using the Empowerment Scale), hope (using the HOPE scale), recovery (using Stages of Recovery) and health and social functioning (using the Health of the Nations Outcome Scales). Mixed-methods process evaluation will investigate mediators and moderators of effect and the implementation experiences of four UPSIDES stakeholder groups (service users, peer support workers, mental health workers and policy makers). A cost-effectiveness analysis examining cost-utility and health budget impact will estimate the value for money of UPSIDES peer support. DISCUSSION The UPSIDES-RCT will explore the essential components necessary to create a peer support model in mental health care, while providing the evidence required to sustain and eventually scale-up the intervention in different cultural, organisational and resource settings. By actively involving and empowering service users, UPSIDES will move mental health systems toward a recovery orientation, emphasising user-centredness, community participation and the realisation of mental health as a human right. TRIAL REGISTRATION ISRCTN, ISRCTN26008944. Registered on 30 October 2019.
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Affiliation(s)
- Galia S. Moran
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | | | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Silvia Krumm
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Candelaria Mahlke
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
| | | | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Donat Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mary Ramesh
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Alina Grayzman
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Benjamin Mayer
- Institute for Medical Biometry and Epidemiology, Ulm University, Ulm, Germany
| | - Bernd Puschner
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
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21
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Ibrahim N, Thompson D, Nixdorf R, Kalha J, Mpango R, Moran G, Mueller-Stierlin A, Ryan G, Mahlke C, Shamba D, Puschner B, Repper J, Slade M. A systematic review of influences on implementation of peer support work for adults with mental health problems. Soc Psychiatry Psychiatr Epidemiol 2020; 55:285-293. [PMID: 31177310 DOI: 10.1007/s00127-019-01739-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/03/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The evidence base for peer support work in mental health is established, yet implementation remains a challenge. The aim of this systematic review was to identify influences which facilitate or are barriers to implementation of mental health peer support work. METHODS Data sources comprised online databases (n = 11), journal table of contents (n = 2), conference proceedings (n = 18), peer support websites (n = 2), expert consultation (n = 38) and forward and backward citation tracking. Publications were included if they reported on implementation facilitators or barriers for formal face-to-face peer support work with adults with a mental health problem, and were available in English, French, German, Hebrew, Luganda, Spanish or Swahili. Data were analysed using narrative synthesis. A six-site international survey [Germany (2 sites), India, Israel, Tanzania, Uganda] using a measure based on the strongest influences was conducted. The review protocol was pre-registered (Prospero: CRD42018094838). RESULTS The search strategy identified 5813 publications, of which 53 were included. Fourteen implementation influences were identified, notably organisational culture (reported by 53% of papers), training (42%) and role definition (40%). Ratings on a measure using these influences demonstrated preliminary evidence for the convergent and discriminant validity of the identified influences. CONCLUSION The identified influences provide a guide to implementation of peer support. For services developing a peer support service, organisational culture including role support (training, role clarity, resourcing and access to a peer network) and staff attitudes need to be considered. The identified influences provide a theory base to prepare research sites for implementing peer support worker interventions.
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Affiliation(s)
- Nashwa Ibrahim
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.,Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Dean Thompson
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Rebecca Nixdorf
- Department of Psychiatry, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | | | - Galia Moran
- Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | - Grace Ryan
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Julie Repper
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.
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Ryan GK, Kamuhiirwa M, Mugisha J, Baillie D, Hall C, Newman C, Nkurunungi E, Rathod SD, Devries KM, De Silva MJ, Mpango R. Peer support for frequent users of inpatient mental health care in Uganda: protocol of a quasi-experimental study. BMC Psychiatry 2019; 19:374. [PMID: 31783827 PMCID: PMC6883561 DOI: 10.1186/s12888-019-2360-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/15/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Reducing readmissions among frequent users of psychiatric inpatient care could result in substantial cost savings to under-resourced mental health systems. Studies from high-income countries indicate that formal peer support can be an effective intervention for the reduction of readmissions among frequent users. Although in recent years formal peer support programmes have been established in mental health services in a few low- and middle-income countries (LMICs), they have not been rigorously evaluated. METHODS This protocol describes a quasi-experimental difference-in-differences study conducted as part of a broader evaluation of the Brain Gain II peer support programme based at Butabika National Referral Hospital in Kampala, Uganda. The primary objective is to investigate whether frequent users of psychiatric inpatient care who have access to a peer support worker (PSW+) experience a greater reduction in rehospitalisation rates and number of days spent in hospital compared to those who do not have access to a peer support worker (PSW-). Frequent users, defined as adults diagnosed with either a mental disorder or epilepsy who have had three or more inpatient stays at Butabika over the previous 24 months, are referred to Brain Gain II by hospital staff on five inpatient wards. Frequent users who normally reside in a district where peer support workers currently operate (Kampala, Jinja, Wakiso and Mukono) are eligible for formal peer support and enter the PSW+ group. Participants in the PSW+ group are expected to receive at least one inpatient visit by a trained peer support worker before hospital discharge and three to six additional visits after discharge. Frequent users from other districts enter the PSW- group and receive standard care. Participants' admissions data are extracted from hospital records at point of referral and six months following referral. DISCUSSION To the best of our knowledge, this will be the first quasi-experimental study of formal peer support in a LMIC and the first to assess change in readmissions, an outcome of particular relevance to policy-makers seeking cost-effective alternatives to institutionalised mental health care.
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Affiliation(s)
- Grace K. Ryan
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | | | - James Mugisha
- Butabika National Referral Hospital, Kampala, Uganda
| | - Dave Baillie
- East London National Health Service Foundation Trust, London, UK
| | - Cerdic Hall
- Camden and Islington National Health Service Foundation Trust, London, UK
| | - Carter Newman
- Harvard T.H. Chan School of Public Health, Boston, MA USA
| | | | - Sujit D. Rathod
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Karen M. Devries
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Sugiura K, Mahomed F, Saxena S, Patel V. An end to coercion: rights and decision-making in mental health care. Bull World Health Organ 2019; 98:52-58. [PMID: 31902962 PMCID: PMC6933425 DOI: 10.2471/blt.19.234906] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 01/04/2023] Open
Abstract
The United Nations Convention on the Rights of Persons with Disabilities requires a paradigm shift from a medical model of disability to a social model that emphasizes overcoming the barriers to equality created by attitudes, laws, government policies and the social, economic and political environment. The approach adopted by the social model recognizes that people with psychosocial disabilities have the same right to take decisions and make choices as other people, particularly regarding treatment, and have the right to equal recognition before the law. Consequently, direct or supported decision-making should be the norm and there should be no substitute decision-making. Although recent mental health laws in some countries have attempted to realize a rights-based approach to decision-making by reducing coercion, implementing the Convention on the Rights of Persons with Disabilities can be challenging because it requires continuous refinement and the development of alternatives to coercion. This article reviews the impact historical trends and current mental health frameworks have had on the rights affected by the practice of involuntary treatment and describes some legal and organizational initiatives that have been undertaken to promote noncoercive services and supported decision-making. The evidence and examples presented could provide the foundation for developing a context-appropriate approach to implementing supported decision-making in mental health care.
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Affiliation(s)
- Kanna Sugiura
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Faraaz Mahomed
- Harvard Law School Project on Disability, Harvard University, Cambridge, United States of America (USA)
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts, MA02115, USA
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Duffy RM, Kelly BD. Authors' reply. Br J Psychiatry 2019; 215:504. [PMID: 31288886 DOI: 10.1192/bjp.2019.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Richard M Duffy
- Consultant Psychiatrist,PhD Researcher,Trinity College Dublin,Ireland.
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Puschner B, Repper J, Mahlke C, Nixdorf R, Basangwa D, Nakku J, Ryan G, Baillie D, Shamba D, Ramesh M, Moran G, Lachmann M, Kalha J, Pathare S, Müller-Stierlin A, Slade M. Using Peer Support in Developing Empowering Mental Health Services (UPSIDES): Background, Rationale and Methodology. Ann Glob Health 2019; 85:53. [PMID: 30951270 PMCID: PMC6634474 DOI: 10.5334/aogh.2435] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with detrimental effects on individuals and societies. The global shortage of human resources for mental health is an important driver of the care gap. Peers are an under-used resource in global mental health. OBJECTIVES To describe rationale and methodology of an international multicentre study which will scale-up peer support for people with severe mental illness in high-, middle-, and low-income countries through mixed-methods implementation research. METHODS UPSIDES is an international community of research and practice for peer support, including peer support workers, mental health researchers, and other relevant stakeholders in eight study sites across six countries in Europe, Africa, and Asia. During the first two years of UPSIDES, a series of qualitative studies and systematic reviews will explore stakeholders' perceptions and the current state of peer support at each site. Findings will be incorporated into a conceptual framework to guide the development of a culturally appropriate peer support intervention to be piloted across all study sites. All intervention and study materials will be translated according to internationally recognised guidelines.Expected Impact: UPSIDES: will leverage the unique expertise of people with lived experience of mental illness to strengthen mental health systems in high-, middle- and low-income countries. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services. The focus on capacity-building of peers may prove particularly valuable in low-resource settings in which shortages of human capital are most severe.
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Affiliation(s)
- Bernd Puschner
- Department of Psychiatry and Psychotherapy II, Ulm University, DE
| | - Julie Repper
- ImROC (Implementing Recovery through Organisational Change), Department of Learning and Organisational Development, Nottinghamshire Healthcare Foundation NHS Trust, Nottingham, UK
| | - Candelaria Mahlke
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, DE
| | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, DE
| | | | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, UG
| | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, UK
| | | | | | | | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Beer Sheva, IL
| | - Max Lachmann
- Department of Social Work, Ben Gurion University of the Negev, Beer Sheva, IL
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, IN
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, IN
| | | | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, UK
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