The Effectiveness of Peer Support in Personal and Clinical Recovery-Systematic Review and Meta-Analysis

The 'Paths to everyday life' (PEER) trial - a qualitative study of mechanisms of change from the perspectives of individuals with mental health difficulties participating in peer support groups led by volunteer peers

BACKGROUND

Worldwide, peers support has been shown to play a crucial role in supporting people with mental illness in their personal recovery process and return to everyday life. Qualitiative studies underpinning the mechanisms of change in peer support has been reviewed. However, the findings are primeraly based on the perspectives of peer support workers employed in mental health services. Thus, qualitiative studies elucidating the mechanisms of change from the recipient perspective in mental health service independent civil society settings are higly needed to further contribute to the evidence of peer support. The 'Paths to every day life' (PEER) is evaluated in a randomized trial and is substantiated by qualitative studies investigating the experiences of PEER from the perspectives of the recipients and the facilitators of peer support. The purpose of this qualitative study underpinned by critical realism was to substantiate the PEER intervention program theory by gaining deeper insight into the change mechanisms and elaborate how, when, and under what circumstances the peer support groups potentially had or did not have an impact on personal recovery from the perspectives of the recipients of peer support.

METHODS

Eleven individuals were interviewed at the end of the ten-week group course. The semi-structured realist-inspired interviews were audio recorded and transcribed verbatim. The analysis was guided by reflective thematic analysis and through an abductive framework based on the program theory. Data were coded and analysed in Nvivo software.

RESULTS

Four overarching themes were identified that informed and nuanced the program theory: 1) Connectedness as a prerequisite for engagement; 2) A sense of hope by working out new paths to recovery; 3) Seeing new sides of oneself; and 4) Sprout for change.

CONCLUSIONS

This study substantiates the program theory and the quantitative results of the PEER trial by elaborating on mechanisms that were felt to be essential for the personal recovery process from the perspectives of the recipients of the group-based peer support. In addition, the study points out that the opportunities to act in everyday life depended on individual context and where the group participants were on their recovery journey.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04639167.

Exploring lived experiences of gunshot wound survivors: A key to ethnographically informed public health interventions for curbing firearm violence

INTRO

The high rates of gun violence in the United States are a recognized public health concern with increased attention since the 1990's. The predominant studies used in gun violence research have been epidemiological approaches and quantitative analyses. This study, instead, examines lived experiences of gunshot wound survivors to better understand their situations. This study also compared the different census categories and their types of gunshot wound injuries. Ethnographic informed analyses may inform public health interventions to decrease firearm injuries.

METHODS

Data was collected through a series of semi-structured interviews at the emergency department of an urban, Level-1, academic trauma center. 96 patients with gunshot wounds (GSWs) from 2018-2022 were included in the study. Thematic analysis was conducted after coding interview responses.

RESULTS

There was a significant difference found between the 2 census categories (White and Minority populations). Those who self-identified as white had more self-inflicted GSWs (6) than other groups. Those who self-identified in the minority population had more GSWs as a result of an altercation (36) or as an innocent bystander (20). Interview data also demonstrated a trend in changing opinions about firearms in a group of participants with remote previous gunshot wounds (pGSW). When compared to the acute gunshot wound group (aGSW) the previous gunshot wound group (pGSW) responses showed support for increased gun safety and policies that limit firearm access.

CONCLUSION

Different injury patterns between census groups demonstrates that multiple public health approaches will be needed to decrease firearm violence. Ethnographically informed approaches, including the support of people with previous GSW injuries, may help craft those interventions to reduce injury. Matched peer support programs represent one potential intervention to decrease secondary injury and firearm violence.

Employment of Certified Peer Specialists in Mental Health Professional Shortage Areas

The current demand for mental health services is exacerbated by an ongoing shortage of behavioral health care providers in the United States. The Health Resources and Services Administration has identified 5,833 Mental Health Professional Shortage Areas (MHPSAs), many of which are rural, and could be served by Certified Peer Specialists (CPSs). This paper examines the relationship between CPS employment and MHPSA residency. Data are from a 2020 survey of 572 CPS certified in one of four states. Random effects logistic regression models were used to test the relationship between MHPSA residence and employment outcomes. Of 166 unique counties identified by participant zip codes, 47 were characterized as being MHPSAs with 14% of participants residing in one of these counties. A higher proportion of those living in MHPSAs were employed in peer support jobs (rather than other job types or unemployed) compared to those living in non-MHPSAs (68% vs. 54%, p = .020). MHPSA residential status was not a significant predictor of employment status (OR = 1.14, p = .728) but was significantly associated with greater likelihood of employment in peer support compared to other jobs, both for the entire sample (OR = 2.13, p = .026), and among those currently employed (OR = 2.90, p = .032). The greater likelihood of working in peer support among those residing in MHPSAs suggests that CPSs may leverage their credential to address shortages. As a result, peer support may become a more necessary part of the traditional service array. Policies that enable CPS to practice in MHPSAs should be encouraged.