Benefits and mechanisms of recovery among peer providers with psychiatric illnesses

Exploring the Self-Care Factors for Recovery in Alcohol Use Disorder and the Role of Peer Recovery Coaches: A Qualitative Study

Self-care is important in addiction recovery, and peer recovery coaches (PRCs) play key roles in recovery. This qualitative study explored self-care factors for individuals recovering from alcohol use disorder and the role of PRCs in supporting these individuals' self-care. Individual interviews with five PRCs and five workers in community addiction management centers in South Korea were performed. Data were analyzed using content analysis. Two categories and six subcategories were derived. The two categories were "elements of self-care: preparation and practice for a new way of life" and "the roles of PRCs: recovery facilitators with differentiated competencies." The factors identified as being involved self-care were summarized as "changing one's thought process and attitude" and "practical enactment considering the situation." The effective roles of PRCs were "sharing specific and realistic information," "providing motivation," "building empathy," and "presenting role models as mentors." This study identified self-care factors that should be included in addiction recovery programs with the participation of PRCs and also identified the roles of the PRCs. Developing and applying nursing interventions with PRCs in clinical and community nursing settings is necessary.

Exploring the Experiences of Compassion Fatigue Amongst Peer Support Workers in Homelessness Services

Peer support workers have lived experiences of the challenges their clients face. While research has shown peer work can benefit recovery, the negative consequences have not been clearly addressed. This study aimed to explore the experiences of compassion fatigue amongst peer support workers in homelessness services, and the coping strategies used. An explorative qualitative design was adopted. Six peer support workers, in homelessness services, were recruited via snowball sampling. Data was collected using semi-structured interviews and analysed using thematic analysis. Five themes were identified: relentless nature of working in homelessness services, change, making meaning of past experiences, organisational support, and personal coping strategies. There were two novel findings: (1) multiple clients recounting traumatic experiences, and (2) being unfairly blamed for lack of progress, exacerbating compassion fatigue. The findings of this study furthers limited research on compassion fatigue and can be used to develop protocols and practices for organisations that utilise peer support.

Perspectives of key informants before and after implementing UPSIDES peer support in mental health services: qualitative findings from an international multi-site study

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.

The role of patients' stories in medicine: a systematic scoping review

BACKGROUND

Patients' stories provide Palliative Care physicians with a glimpse into the former's lives and their psycho-emotional, sociocultural, and contextual considerations. Yet, few physicians are trained to interpret and apply patients' stories in their practice. Inherent variability in how stories are transmitted and interpreted raises questions over their potential effects on care. Amidst a dearth of accounts in Palliative Care, we map current use of patient stories to guide the training, assessment, and oversight of this 'care influencing' practice in medicine.

METHODS

This systematic scoping review was guided by the Systematic Evidence-Based Approach (SEBA) to ensure a reproducible and structured approach. The themes and categories identified through the Split Approach's concurrent and independent thematic and directed content analyses provided a comprehensive sketch of the included articles. The Jigsaw Perspective combined the themes and categories identified. The last stage of SEBA compared these results with two recent reviews of storytelling to ensure consistency of the domains created that guided the discussion.

RESULTS

Ten thousand two hundred seven articles were reviewed, 963 full text articles were evaluated, and 199 articles were included. The four domains identified were study characteristics, benefits, approaches, and positive effects and concerns.

CONCLUSION

Stories support patient-centered, personalized, and holistic clinical care. However, variability in the stories, their interpretations and use in care decisions underscore the need for further study on the structuring, teaching, assessing, and delivery of this 'care influencing' practice.

Perspectives of parents of adolescents with repeated non-suicidal self-injury on sharing their caretaking experiences with peers: a qualitative study

Background

The prevalence of non-suicidal self-injury among adolescents has increased over the years. Most parents, however, are poorly informed and confused about this behavior. Sharing caretaking experiences with parents in similar situations seems to be beneficial. Nevertheless, few researchers have explored the views of parents who share their caretaking experiences with peers.

Aim

This study aimed to investigate the perspectives of parents of adolescents with repeated non-suicidal self-injury on sharing their caretaking experiences with peers as well as the motivations for and barriers to this behavior.

Methods

This qualitative study adopted a purposive sampling method. Participants (16 mothers and 2 fathers) were recruited from the mental health center of a tertiary hospital in Chengdu, Sichuan, China. A total of 18 semistructured face-to-face individual interviews were conducted. All interviews were audio-recorded and analyzed thematically using NVivo 11.

Results

Three themes and nine subthemes were identified: (1) sharable caretaking experiences: reflection and transformation, self-emotional management, and diversified support; (2) motivations for sharing: empathy, reciprocity, and meaning; and (3) barriers to sharing: inadequate knowledge, low self-identity, and concerns for children.

Conclusion

Parents accumulate a wealth of experience during their long-term care of adolescents with repeated non-suicidal self-injury. Although most parents are willing to share their caretaking experiences with peers, there are several barriers. Therefore, in order to increase parents' motivation to share, psychological education is necessary.

"Teaching somebody else makes you a better person:" A phenomenological exploration of the importance of informal peer support for individuals with spinal cord injury

BACKGROUND

Peer support is widely recognized as an important aspect of health promotion for individuals with spinal cord injury (SCI). Reports indicate positive effects for the recipients of either informal and formal peer support. The experience can also be meaningful to the person(s) providing support, although the value to providers is not well studied.

OBJECTIVE

This study examines the experience of provision of and receipt of informal peer support for individuals with SCI through semi-structured interviews.

METHODS

Data were analysed using a qualitative phenomenological approach. 16 participants with SCI participated in the study.

RESULTS

Three main themes were developed, each describing different benefits of peer support from the perspective of both members of the peer support dyad. First, participants found personal satisfaction from using their own experiences to help others adjust to their disability. Participants also noted that they learned how to complete activities of daily living as well as how to be autonomous in travel from others with SCI. Finally, participants spoke of the intrinsic benefit in teaching others with SCI.

CONCLUSIONS

This study provides a novel understanding of the importance of informal peer support for individuals with SCI. Practitioners should provide opportunities for individuals with SCI to develop informal peer relationships with others who have sustained SCI.

'I Will Fight for People to Not Have the Experience I've Had': A Thematic Analysis of the Experiences and Perspectives of Chronic Pain Lived Experience Advocates

Navigating the healthcare system with chronic pain, alongside navigating the experience of the chronic pain itself, is recognised to be highly challenging. Frequently available interventions do not fully meet the needs of people with chronic pain. This study aimed to explore the perspectives of people who have been through these experiences and now support and campaign for improved approaches to chronic pain management. Semi-structured interviews of 10 participants who independently support others through some form of chronic pain advocacy or support were conducted online. Data were digitally recorded, transcribed, and analysed using reflexive thematic analysis, through a critical realist and constructivist lens. Data were interpreted to represent a journey into chronic pain advocacy, represented by three overarching themes. Advocacy as healing incorporates sub-themes of pain trauma, gaining knowledge, and using my experience for good. Unequal partnership includes respect and unmet needs from institutions. The final theme, evolution, relates to two sub-themes of pushing boundaries and personal growth. Participants talked about the dual benefit of their contribution to pain advocacy, both in terms of helping others and also their own personal benefit. Overall findings indicated that pain advocacy can take multiple and various forms. Commonly, our participants who took on the role of pain advocacy were motivated by their own early difficult experiences, both navigating their pain and healthcare systems, and by a wish for others to not have similar difficult experiences. Having taken on the role, despite its challenges, rewards can include recognition and personal growth.

Personal Well-being and Recovery in Peer Support Specialists Working at Psychiatric Hospitals

Objectives: Personal well-being is a major part of recovery for the many people who experience mental illness. Peer support specialists are mental health professionals who have themselves experienced mental illness and use their recovery experiences to facilitate the healing of others. In this study, we explored how peer specialists view their subjective well-being in their work with others and how they perceive their profession. Methods: Seven peer specialists working in a psychiatric hospital participated in individual interviews. We asked them about their personal experiences, their subjective well-being, and their perceptions of the peer specialist profession. We analyzed the interviews thematically. Results: The peer specialists' responses emphasized the link between mental health recovery and subjective well-being. Our findings also indicated the importance of positive relationships and community belonging as fundamental to subjective well-being, and consequently, to recovery. Conclusions: The insights that peer support specialists have acquired and the tools they have mastered in their own recovery process highlight the valuable experience-based knowledge and skills they can provide to others. Future studies may investigate how the experience of their own well-being and recovery directly influences their work with others.

Peer Workers in Co-production and Co-creation in Mental Health and Substance Use Services: A Scoping Review

People with lived experience of mental health challenges are extensively employed as peer workers within mental health and substance use services worldwide. Research shows that peer workers benefit individuals using such services and can have essential roles in developing recovery-oriented services. However, understanding how peer workers' contributions, by their role, functions, and input can be better used remains a critical challenge. Research on public sector innovation has focused on relevant actors collaborating to tackle complex demands. Co-production and co-creation are concepts used to describe this collaboration. Co-production refers to the collaboration between providers and users at the point of service delivery, whereas co-creation refers to collaboration starting in the early service cycle phases (e.g., in commissioning or design), including solution implementation. We overviewed research literature describing peer workers' involvement in mental health and substance use services. The research question is as follows: How are peer workers involved in co-production and co-creation in mental health and substance use services, and what are the described outcomes? A literature search was performed in 10 different databases, and 13,178 articles were screened, of which 172 research articles describing peer workers' roles or activities were included. The findings show that peer workers are involved in co-production and function as providers of pre-determined services or, most often, as providers of peer support. However, they are rarely engaged as partners in co-creation. We conclude that the identified peer worker roles have different potential to generate input and affect service delivery and development.

From Social Network to Peer Support Network: Opportunities to Explore Mechanisms of Online Peer Support for Mental Health

An increasing number of psychological interventions are shifting to online modes of delivery. One such intervention is peer-to-peer support, which in this context may provide internet users living with mental health disorders an opportunity to connect with and support others living with similar conditions. This paper presents a call for further research into how platforms such as Facebook could be used as channels for peer support and the mechanisms that may underlie their effectiveness. We discuss the background of peer support, how it has transitioned online, and consider theories and models that may have relevance. We also consider the importance of moderation within online peer support and the development of specific social network-based online interventions. We conclude that for social network sites to be used as peer-to-peer support interventions, more research is needed to understand their effectiveness, the role of moderation in these communities, and the mechanisms that produce the benefits experienced by users.

Peer Support and Exercise Adherence in Adolescents: The Chain-Mediated Effects of Self-Efficacy and Self-Regulation

In the context of exercise psychology, the mediating relationship between peer support, self-efficacy and self-regulation, and adolescents' exercise adherence was to be explored.

METHODS

A questionnaire was distributed among 2200 teenagers from twelve middle schools in Shanghai. The "process" program in SPSS and the bootstrap method were applied to construct and analyze the direct and indirect effects of peer support on adolescents' exercise adherence.

RESULTS

Peer support directly affected adolescents' exercise adherence (β = 0.135, p < 0.001, effect size of 59%) and self-efficacy (β = 0.493, p < 0.001, effect size accounted for 42%), and self-regulation (β = -0.184, p < 0.001, effect size of 11%) influenced exercise adherence indirectly. In addition, self-efficacy and self-regulation could impose a chain-mediated effect on peer support and exercise adherence (effect size of 6%).

CONCLUSION

Peer support could promote adolescents' exercise adherence. Self-efficacy and self-regulation are mediating factors of peer support on exercise adherence in teenagers, self-regulation as well as self-efficacy-imposed chain-mediating effects on peer support and adolescents' exercise adherence.

How clinicians can support posttraumatic growth following psychosis: a perspective piece

Psychosis is often a traumatic experience that can lead to significant suffering. However, people may also experience posttraumatic growth following psychosis. Posttraumatic growth refers to the positive changes that people experience following a struggle with an adversarial event and has been shown to occur in at least five domains, including a greater appreciation for life; improved relationships with others; greater personal strengths; new life possibilities and spiritual/existential growth. Studies have shown that mental health services can play a key role in facilitating posttraumatic growth. However, there are no recommendations that clinicians can follow to best support posttraumatic growth following psychosis specifically. Without guidance, clinicians risk invalidating people's experiences of, or providing improper support for, posttraumatic growth. To address this knowledge gap, we reflect on current research and clinical guidelines to recommend ways that clinicians can support posttraumatic growth following psychosis.

Peer Recovery Coaches Perceptions of Their Work and Their Implications for Training, Support and Personal Recovery

The peer recovery workforce, including individuals in sustained recovery from substance use, has grown rapidly in the previous decades. Peer recovery coaches represent a scalable, resource-efficient, and acceptable approach to increasing service delivery, specifically among individuals receiving substance use services in low-resource communities. Despite the potential to improve access to care in traditionally underserved settings, there are a number of barriers to successfully integrating peer recovery coaches in existing recovery services. The current study presents results from two focus groups composed of peer recovery coaches. Findings suggest that peer recovery coaches report discordance between their perceived role and their daily responsibilities and experience both inter- and intrapersonal challenges that impact their own recovery processes. These results point to several promising policy and structural changes that may support and enhance this growing workforce.

Preventing, reducing, and attenuating restraint: A prospective controlled trial of the implementation of peer support in acute psychiatry

INTRODUCTION

The use of restraint as a means of managing patients is considered a critical factor that interferes with recovery. Strategies to create a less restrictive environment within psychiatric facilities are therefore eagerly sought. Peer support workers (PSWs) are increasingly employed in mental health settings. The prevailing theory is that PSWs have the potential to contribute to conflict and restraint prevention efforts in acute psychiatric wards. However, to date, research in support of this claim remains limited.

OBJECTIVE

The present study aimed at assessing the effectiveness of employing peer support workers with regard to reducing the use of restraint.

METHODS

This prospective controlled pre-post study sought to evaluate the implementation of peer support in one locked ward compared to treatment as usual (TAU) with no implementation of peer support in a second locked ward of a psychiatry department in Berlin, Germany. The pre-post comparison was planned to consist of two assessment periods of 3 months each, taking place directly before and after peer support implementation or TAU. Both assessments were extended to a period of 6 months, before and after the initially planned 12-month implementation process, in order to balance the effects of disruptions and of the COVID-19 pandemic. Using routine data, the proportion, frequency, and duration of mechanical restraint, forced medication as well as mechanical restraint in combination with forced medication, were evaluated.

RESULTS

In the control group, an increase in the proportion of patients subjected to measures of restraint was found between pre- and post-assessment, which was accompanied by a further increase in the mean number of events of restraint per patient within this group. In the intervention group, no significant change in the application of restraint was observed during the study period.

DISCUSSION

There is some indication that peer support may be protective with regard to restraint in acute wards. However, our study faced major challenges during the implementation process and the post-assessment period, such as COVID-19 and staff reorganization. This may have led to peer support not reaching its full potential. The relationship between the implementation of peer support and the use of restraint therefore merits further investigation.

Roles and Effects of Peer Recovery Coach Intervention in the Field of Substance Abuse: An Integrative Literature Review

PURPOSE

There are ongoing public initiatives to help substance abusers by involving peer recovery coaches (PRCs) in the field of substance abuse worldwide. This study examines the contents and delivery methods of PRC intervention programs and their effects from the participants' standpoint.

METHODS

An integrative literature search was conducted in seven electronic databases using English and Korean search terms. Two researchers independently reviewed the extracted papers and rated their quality based on predetermined inclusion and exclusion criteria, resulting in the selection of nine papers.

RESULTS

Research on PRC participation in substance abuse treatment were predominantly US-based, and all articles derived were quantitative studies. The main roles of PRCs included liaising between treatment and community resources, assisting with stress management and coping skills, counseling and case management, and recovery and recurrence prevention education. In addition, the PRC-delivered intervention was tested with various outcome variables. It reduced participants' substance use and enhanced their treatment adherence rates, self-efficacy, quality of life, and stress control.

CONCLUSIONS

This study confirmed the need to extend existing studies by testing the effects of PRC-delivered intervention through multidisciplinary efforts in more regions and establishing PRCs' role definition and concretization. The results of this study will serve as significant basic data in developing and applying for nursing intervention programs with PRCs in clinical and community nursing settings in the future.

Employment Outcomes After Certification as a Behavioral Health Peer Specialist in Four U.S. States

OBJECTIVE

A 3-year study explores employment outcomes of certified peer specialists (CPSs). Analyses reported here identified relationships between demographic, clinical, work history, and geographic characteristics and employment status and current employment in peer services jobs versus other jobs.

METHODS

The study recruited adults who recently became a CPS, regardless of current employment status, in four states. Online survey data were collected from March to October 2020 and included demographic information, health status and diagnoses, mental health service use, motivations for becoming certified, employment history, and job characteristics, including job satisfaction. Descriptive statistics and logistic regression models were used to compare groups.

RESULTS

Of 681 respondents, 591 provided data on current employment and were included. Participants who received Social Security Disability Insurance or Supplemental Security Income, veterans, those who used outpatient counseling or therapy, and those who did not disclose their mental health status in the workplace were less likely to report current employment. Lack of disclosure and higher local unemployment rates contributed to a lower likelihood of working in peer services jobs, whereas individuals reporting depressive disorders were more likely to hold such jobs. Compared with those in other jobs, those in peer services jobs reported longer job tenure, and a larger proportion received employee benefits. Job satisfaction was significantly higher among those with peer services jobs.

CONCLUSIONS

Workers with a CPS credential had higher employment rates, compared with adults with psychiatric disabilities, and the quality of peer specialist jobs was equal to or higher than the quality of other jobs held by study participants.

Meaning in life and flow experiences among people with psychiatric disabilities who are engaged in peer-helping vs. non-helping work-roles

BACKGROUND: Finding meaning in life and wellbeing through vocational work-roles are central to recovery of persons with psychiatric disabilities. However, there is a disconnect between positive concepts and vocational rehabilitation, rendering meaning and wellbeing rarely explored in vocational rehabilitation. OBJECTIVE: We assume higher meaning and wellbeing exists among individuals engaged in peer helping work-roles (meaningful role) as compared to non-helping work-roles. We examine this and additional questions to learn about relationships between positive concepts and vocational work-roles illuminating mental health recovery. METHODS: 114 individuals with psychiatric disabilities (ages 20-70) from various vocational-services participated. Sixty-nine worked in peer-helping roles (i.e. consumer-providers/peer-supporters) and 45 engaged in non-helping work-roles (vendors/clerical work, etc.). Participants filled in the Meaning in Life and Work-related Flow (assessing wellbeing at work) scales. Additionally, participants in peer-helping work-roles filled a peer-developed scale estimating their salience of peer-role characteristics. RESULTS: Individuals in peer-helping work-roles had significantly higher meaning in life levels than those in non-helping roles. Having meaning in life also predicted higher work-related flow across the sample. Finally, meaning in life positively mediated relations between salience of peer-role characteristics and work-related flow experiences. CONCLUSION: Researching meaning and wellbeing can broaden theoretical understanding and bear practical implications for enhancing vocational work-role fit and recovery.

'Maybe I Shouldn't Talk': The Role of Power in the Telling of Mental Health Recovery Stories

Mental health 'recovery narratives' are increasingly used within teaching, learning and practice environments. The mainstreaming of their use has been critiqued by scholars and activists as a co-option of lived experience for organisational purposes. But how people report their experiences of telling their stories has not been investigated at scale. We present accounts from 71 people with lived experience of multiple inequalities of telling their stories in formal and informal settings. A reflexive thematic analysis was conducted within a critical constructivist approach. Our overarching finding was that questions of power were central to all accounts. Four themes were identified: (1) Challenging the status quo; (2) Risky consequences; (3) Producing 'acceptable' stories; (4) Untellable stories. We discuss how the concept of narrative power foregrounds inequalities in settings within which recovery stories are invited and co-constructed, and conclude that power imbalances complicate the seemingly benign act of telling stories of lived experience.

The benefits and challenges of established peer support programmes for patients, informal caregivers, and healthcare providers

PURPOSE

Peer support programmes that provide services for various health conditions have been in existence for many years; however, there is little study of their benefits and challenges. Our goal was to explore how existing peer support programmes help patients with a variety of health conditions, the challenges that these programmes meet, and how they are addressed.

METHODS

We partnered with 7 peer support programmes operating in healthcare and community settings and conducted 43 semi-structured interviews with key informants. Audiorecordings were transcribed and qualitative analysis was conducted using grounded theory methods.

RESULTS

Peer support programmes offer informational and psychosocial support, reduce social isolation, and connect patients and caregivers to others with similar health issues. These programmes provide a supportive community of persons who have personal experience with the same health condition and who can provide practical information about self-care and guidance in navigating the health system. Peer support is viewed as different from and complementary to professional healthcare services. Existing programmes experience challenges such as matching of peer supporter and peer recipient and maintaining relationship boundaries. They have gained experience in addressing some of these challenges.

CONCLUSIONS

Peer support programmes can help persons and caregivers manage health conditions but also face challenges that need to be addressed through organizational processes. Peer support programmes have relevance for improving healthcare systems, especially given the increased focus on becoming more patient-centred. Further study of peer programmes and their relevance to improving individuals' well-being is warranted.

From Self-Doubt to Pride: Understanding the Empowering Effects of Delivering School-Based Wellness Programmes for Emerging Adult Facilitators-A Qualitative Study

Ample literature exists on the impact of prevention programmes on their target audience, while much less is known about how delivering such programmes influences their facilitators. Even less literature exists on the emotional and social processes that form this potential impact on facilitators. The current study analysed qualitative in-depth, non-structured interviews, as well as written essays provided by 33 student-facilitators who delivered the "Favoring Myself" programme in Israel during 2019-2021. This school-based wellness programme comprised 10 weekly, 90 min sessions on self-care behaviours, media literacy, self-esteem, and positive body image, which are well-known protective factors against risky behaviours. A thematic analysis was applied to explore the main themes in the collected data. An interesting affective transformation from self-doubt to pride in themselves emerged as a shared experience of these young facilitators. Facilitators related their ability to facilitate the programme, as well as to undergo an individual maturation and empowerment experience, to certain components of the programme itself, such as the preparatory course, individual supervision, and the peer-group experience. This shift from doubt to pride is discussed using two frameworks-a theoretical discourse of emerging adulthood as a developmental stage, and the self-determination theory.

The impact of working as a peer worker in mental health services: a longitudinal mixed methods study

BACKGROUND

Peer workers are increasingly employed in mental health services to use their own experiences of mental distress in supporting others with similar experiences. While evidence is emerging of the benefits of peer support for people using services, the impact on peer workers is less clear. There is a lack of research that takes a longitudinal approach to exploring impact on both employment outcomes for peer workers, and their experiences of working in the peer worker role.

METHODS

In a longitudinal mixed methods study, 32 peer workers providing peer support for discharge from inpatient to community mental health care - as part of a randomised controlled trial - undertook in-depth qualitative interviews conducted by service user researchers, and completed measures of wellbeing, burnout, job satisfaction and multi-disciplinary team working after completing training, and four and 12 months into the role. Questionnaire data were summarised and compared to outcomes for relevant population norms, and changes in outcomes were analysed using paired t-tests. Thematic analysis and interpretive workshops involving service user researchers were used to analysis interview transcripts. A critical interpretive synthesis approach was used to synthesise analyses of both datasets.

RESULTS

For the duration of the study, all questionnaire outcomes were comparable with population norms for health professionals or for the general population. There were small-to-medium decreases in wellbeing and aspects of job satisfaction, and increase in burnout after 4 months, but these changes were largely not maintained at 12 months. Peer workers felt valued, empowered and connected in the role, but could find it challenging to adjust to the demands of the job after initial optimism. Supervision and being part of a standalone peer worker team was supportive, although communication with clinical teams could be improved.

CONCLUSIONS

Peer workers seem no more likely to experience negative impacts of working than other healthcare professionals but should be well supported as they settle into post, provided with in-work training and support around job insecurity. Research is needed to optimise working arrangements for peer workers alongside clinical teams.

Reducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program

Background

Individuals discharged from inpatient psychiatry units have the highest readmission rates of all hospitalized patients. These readmissions are often due to unmet need for mental health care compounded by limited human resources. Reducing the need for hospital admissions by providing alternative effective care will mitigate the strain on the healthcare system and for people with mental illnesses and their relatives. We propose implementation and evaluation of an innovative program which augments Mental Health Peer Support with an evidence-based supportive text messaging program developed using the principles of cognitive behavioral therapy.

Methods

A pragmatic stepped-wedge cluster-randomized trial, where daily supportive text messages (Text4Support) and mental health peer support are the interventions, will be employed. We anticipate recruiting 10,000 participants at the point of their discharge from 9 acute care psychiatry sites and day hospitals across four cities in Alberta. The primary outcome measure will be the number of psychiatric readmissions within 30 days of discharge. We will also evaluate implementation outcomes such as reach, acceptability, fidelity, and sustainability. Our study will be guided by the Consolidated Framework for Implementation Research, and the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Data will be extracted from administrative data, surveys, and qualitative methods. Quantitative data will be analysed using machine learning. Qualitative interviews will be transcribed and analyzed thematically using both inductive and deductive approaches.

Conclusions

To our knowledge, this will be the first large-scale clinical trial to assess the impact of a daily supportive text message program with and without mental health peer support for individuals discharged from acute psychiatric care. We anticipate that the interventions will generate significant cost-savings by reducing readmissions, while improving access to quality community mental healthcare and reducing demand for acute care. It is envisaged that the results will shed light on the effectiveness, as well as contextual barriers and facilitators to implementation of automated supportive text message and mental health peer support interventions to reduce the psychological treatment and support gap for patients who have been discharged from acute psychiatric care.

Trial registration

clinicaltrials.gov, NCT05133726. Registered 24 November 2021

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07510-8.

Doing peer work in mental health services: Unpacking different enactments of lived experiences

Mental health services are increasingly employing peer workers (PWs), individuals who have lived experiences with mental health problems, to support patients and be part of mental health care teams. While the employment of PWs continues to increase, little is known about how the function unfolds in practice. This paper explores the broader context in which the PWs navigate and the concrete outcomes and everyday issues that exist at the individual level. Methodologically, the paper draws on 22 interviews with PWs employed in the mental health services in Denmark. Theoretically, it combines Lipsky's (1980) theory on street-level bureaucrats with sociological discussions concerning the lay-expert divide. The analysis shows that PWs experience both role ambiguity and goal uncertainty and that they use substantial discretion in determining the nature, amount and quality of their peer practices. This - combined with the PWs' diverse lived experiences - calls for a heterogeneous understanding of peer work and therefore the analysis presents three categories of peer workers: PWs as (1) a representative of patients' lifeworld, (2) an interdisciplinary professional and (3) an 'expert by experience'. These categories display PWs different enactments of their lived experiences and reveal ambiguities tied to the lay-expert divide.

Impact of Being a Peer Recovery Specialist on Work and Personal Life: Implications for Training and Supervision

Peer recovery specialists are an important resource in community mental health settings. This study, which was part of a larger statewide assessment, evaluates how the role impacts work and personal lives of peers, with implications for improving the training and supervision of this service. The importance of peer work has been investigated through client outcomes, however less work has investigated outcomes on peers themselves, which impacts the work force and service delivery. Nine focus groups were conducted with peer recovery specialists. A two-stage qualitative analysis led to two overarching themes, work and personal, and six subthemes. Findings suggest being a peer presents unique benefits and challenges in work and personal life. Peers benefit from more training and supervision, consistency within the role, and maintaining boundaries. Additionally, work environment roles may be improved by attention to needs of supervisors in terms of skills for effective supervision and clarification of supervisory roles.

Key components of recovery predict occupational performance and health in peer support specialists

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).

Burnout and Turnover Intention Among Peer Providers and Other Providers of Mental Health Services in a Rural Two-County Area

Peer providers in the mental health field, having their own lived experience with mental illness, use their personal experience to assist the consumers of their services. Given high burnout rates in the mental health field, there have been two prior investigations of burnout among peer providers. The present study extends those prior investigations to a sample of peer providers working in community mental health programs in a rural area of the United States. Consistent with the prior studies, there were no differences in burnout between peer providers and other providers employed by those programs, with particularly strong support for the null hypothesis regarding the emotional exhaustion component of burnout. There were also no differences in strength of turnover intentions. However, among the non-consumer providers emotional exhaustion was correlated with both types of turnover intention assessed in this study (intent to change job setting within the mental health field and intent to leave the mental health workforce), whereas among the peer providers emotional exhaustion was correlated only with intent to leave the mental health field. Workload dissatisfaction was the workplace variable most strongly associated with emotional exhaustion among both types of providers. Other moderately strong inverse predictors of emotional exhaustion among peer providers were workplace community and workplace control, and the correlation between emotional exhaustion and workplace control was significantly stronger among the peer providers than among the other providers.

Discrepancy between experience and importance of recovery components in the symptomatic and recovery perceptions of people with severe mental disorders

BACKGROUND

Personal recovery has become an increasingly important approach in the care of people with severe mental disorders and consequently in the orientation of mental health services. The objective of this study was to assess the personal recovery process in people using mental health services, and to clarify the role of variables such as symptomatology, self-stigma, sociodemographic and treatment.

METHODS

Standardised measures of personal recovery process, clinical recovery, and internalized stigma were completed by a sample of 312 participants in a Severe Mental Disorder program.

RESULTS

Users valued most the recovery elements of: improving general health and wellness; having professionals who care; hope; and sense of meaning in life. Significant discrepancies between perceived experience and relative importance assigned to each of the components of the REE were observed. Regression modeling (χ² = 6.72, p = .394; GFI = .99, SRMR = .03) identified how positive discrepancies were associated with a higher presence of recovery markers (β = .12, p = .05), which in turn were negatively related to the derived symptomatology index (β = -.33, p < .001). Furthermore, the relationship between clinical and personal recovery was mediated by internalized stigma.

CONCLUSIONS

An improvement in psychiatric services should be focused on recovery aspects that have the greatest discrepancy between importance and experience, in particular social roles, basic needs and hope. Personal and clinical recovery are correlated, but the relationship between them is mediated by internalized stigma, indicating the need for clinical interventions to target self-stigma.

Peer support worker training: Results of the evaluation of the Experienced Involvement training programme in Switzerland and Germany

The 'Experienced Involvement' (EX-IN) training programme prepares and certifies individuals who have experienced mental health problems to work as peer support workers and to support others challenged by similar conditions. We aimed to assess the impact of the EX-IN training on hope, self-efficacy, introspection, stigma resistance, personal recovery, health-related quality of life and employment in participants. Data was collected using standardized assessment instruments before the training started (t1) and upon course completion (t2). Data from 103 participants who participated in both measurement times were included into data analysis. Participants significantly improved their recovery, stigma resistance and introspection during the EX-IN training. In addition, a significant higher proportion of participants were employed at t2. Participants whose last inpatient stay was 0-1 year before the start of the EX-IN training showed significantly lower levels of stigma resistance, and self-efficacy at t1 than participants with two or more years since the last inpatient stay. There were no significant changes in mean values over time, or in the mean values at t2 between the two groups. EX-IN training has a positive influence on the handling of stigma, on one's recovery path and introspection. This indicates that EX-IN training has a therapeutic effect on the participants. EX-IN training seems to meet the challenges of peer support work. Therefore, the training can be recommended as preparation for working as a peer support worker as well as an intervention to improve one´s recovery process.

How Adults With Serious Mental Illness Learn and Use Wellness Recovery Action Plan's Recovery Framework

This study was conducted to investigate how adults with serious mental illness learn and utilize an illness self-management framework for pursuing recovery through a program called Wellness Recovery Action Plan (WRAP). The researchers employed an interpretive descriptive methodology with thematic analysis. Data were collected from three focus groups (n = 26) and in-depth interviews with follow-up member checks with 10 participants (n = 20 interviews). Findings aligned with main constructs of self-determination theory (SDT) to explain how an autonomy-supportive environment created opportunities for participants to build competency, implementing personalized recovery strategies that are socially endorsed by peers, resulting in internalized motivation for continued application of WRAP's framework. SDT appears to explain mechanisms of change for WRAP. Recommendations for mental health organizations include broadly ensuring autonomy-supportive environments and services that maximize opportunities to build competence in recovery strategies in collaboration with peers. Future research may utilize SDT as the theoretical basis for investigating self-management programs.

Positive Side Effects: The Perceived Health and Psychosocial Benefits of Delivering an HIV Self-Management Program for Peer Educators Living With HIV

Although there is evidence that peer-led HIV treatment interventions are effective in improving health outcomes of people living with HIV (PLWH), few studies have assessed the health and psychosocial benefits of being a peer living with HIV. Qualitative interviews were conducted with nine PLWH who were peers of an HIV self-management intervention, to examine how this experience was perceived to impact their health behaviors, social support, and professional development. Peers reported improved HIV self-management and reduced health risk behaviors, which were attributed to increased self-efficacy and the desire to be a role model for participants. Peers described the experience as an opportunity to expand social networks and develop professional skills that could be leveraged for future employment. Our findings suggested that the benefits of being a peer could be enhanced in trainings and supervision by linking the importance of health-promoting behaviors to being a role model for other PLWH.

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

As the peer specialist workforce continues to expand, it is critical to better understand peer providers' working conditions and workplace experiences. The current study utilized a targeted non-probability sample of 801 peer specialists to explore whether key organizational climate and support variables would yield distinct multivariate groups, and to investigate the correlates of these groups. Analyses yielded a seven-group solution, with peer run organizations comprising a substantially greater proportion of the groups with high organizational climate and support scores. In direct comparisons, peer-run programs outranked all other groups in the areas of perceived organizational climate, supports for career development and perceived service quality.

[Roles and Work Content of Peer Workers and Experts by Experience in Mental Health Practice, Education, Research and Development - Results of a Survey in Switzerland]

AIM OF THE STUDY

To identify work contents, roles and tasks of peer workers in mental health services in the German-speaking part of Switzerland.

METHODS

A survey was conducted among peers in the German-speaking part of Switzerland.

RESULTS

Most respondents stated that they work mainly in specialized services in the treatment of people with psychoses and affective disorders and in direct contact with service users. "Building bridges" between service users and professionals, conveying hope and confidence, empowerment as well as support in symptom management was most frequently indicated as a work activity. The majority of respondents have job descriptions that correspond to their activities.

CONCLUSIONS

For mental health services, the challenge is to integrate the new professional group of peers workers as well as possible without undermining their proximity to the service users or their possibly critical perspective with regard to the existing practice.

Vocational Peer Support: Results of a Qualitative Study

Peer-delivered services for individuals with psychiatric conditions are becoming an established part of the mental health workforce. Given the growing focus on evidence-based supported employment, peer specialists are often assisting individuals who are choosing, getting, or keeping employment. As part of a larger randomized clinical trial examining the effectiveness of an innovative intervention called vocational peer support, 13 semi-structured qualitative interviews were conducted to examine how recipients perceived peer support, and whether or how it was useful for pursuing vocational goals. A thematic analysis approach was utilized for identifying major themes and sub-themes. Results suggest that a key factor in the effectiveness of vocational peer support is the identification with another individual's "lived experience," which then promotes engagement and a sense of normalcy. Vocational peer support may be particularly useful for individuals with psychiatric disabilities wishing to pursue a vocational goal.

Peer mentoring for individuals with an eating disorder: a qualitative evaluation of a pilot program

BACKGROUND

After receiving intensive medical treatment; individuals with eating disorders often require ongoing care to maintain their recovery, build social networks, and reduce risk of relapse.

METHODS

To address this important transition period, a six-month peer mentoring program was developed and piloted in Melbourne, Australia. Twelve adults with a past history of an eating disorder (mentors) were paired with 14 individuals with a current eating disorder (mentees). Pairs met for thirteen mentoring sessions in community settings. Throughout the program mentees and mentors completed reflective questions online. Upon completion of the program, qualitative interviews were conducted. Both online reflections and interviews explored themes relating to perceived benefits and challenges of participation in the peer mentoring program, and the differences between mentoring and traditional treatment.

RESULTS

Thematic analysis identified several benefits for mentees; including hope, reconnection with others, and re-engaging with the world. The majority of mentees described their mentor as uniquely supportive due to their past experience of an eating disorder. Mentors reported experiencing benefits such as increased connection with self and others, and indicated that the experience helped them positively reframe their past experience of an eating disorder. Ending the relationship at the completion of the program was a significant challenge for both groups, and managing boundaries was deemed a main challenge by mentors.

CONCLUSIONS

Overall, results indicated that this mode of informal support may be worthy of further investigation as an adjunct to clinical treatment programs for this population.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials registration number - ACTRN12617001412325 - Date of registration - 05/10/2017 (Retrospectively registered).

Peer Support in Mental Health: Literature Review

BACKGROUND

A growing gap has emerged between people with mental illness and health care professionals, which in recent years has been successfully closed through the adoption of peer support services (PSSs). Peer support in mental health has been variously defined in the literature and is simply known as the help and support that people with lived experience of mental illness or a learning disability can give to one another. Although PSSs date back to several centuries, it is only in the last few decades that these services have formally evolved, grown, and become an integral part of the health care system. Debates around peer support in mental health have been raised frequently in the literature. Although many authors have emphasized the utmost importance of incorporating peer support into the health care system to instill hope; to improve engagement, quality of life, self-confidence, and integrity; and to reduce the burden on the health care system, other studies suggest that there are neutral effects from integrating PSSs into health care systems, with a probable waste of resources.

OBJECTIVE

In this general review, we aimed to examine the literature, exploring the evolution, growth, types, function, generating tools, evaluation, challenges, and the effect of PSSs in the field of mental health and addiction. In addition, we aimed to describe PSSs in different, nonexhaustive contexts, as shown in the literature, that aims to draw attention to the proposed values of PSSs in such fields.

METHODS

The review was conducted through a general search of the literature on MEDLINE, Google Scholar, EMBASE, Scopus, Chemical Abstracts, and PsycINFO. Search terms included peer support, peer support in mental health, social support, peer, family support, and integrated care.

RESULTS

There is abundant literature defining and describing PSSs in different contexts as well as tracking their origins. Two main transformational concepts have been described, namely, intentional peer support and transformation from patients to peer support providers. The effects of PSSs are extensive and integrated into different fields, such as forensic PSSs, addiction, and mental health, and in different age groups and mental health condition severity. Satisfaction of and challenges to PSS integration have been clearly dependent on a number of factors and consequently impact the future prospect of this workforce.

CONCLUSIONS

There is an internationally growing trend to adopt PSSs within addiction and mental health services, and despite the ongoing challenges, large sections of the current literature support the inclusion of peer support workers in the mental health care workforce. The feasibility and maintenance of a robust PSS in health care would only be possible through collaborative efforts and ongoing support and engagement from all health care practitioners, managers, and other stakeholders.

Combining technical and expert-by-experience knowledge in the quest for personal recovery from bipolar disorder: a qualitative study

BACKGROUND

Knowledge construction is a form of communication in which people can work individually or collaboratively. Peer support services have been adopted by the public psychiatric and social welfare service as a regular form of intervention since 2015 in Hong Kong. Peer-based services can help people with bipolar disorder (BD) deal with the implications of the diagnosis, the way in which individuals with BD receive treatment, and the lifestyle changes that take place as a result of the diagnosis. Through a qualitative paradigm, this study aims to examine how individuals with BD use technical and expert-by-experience knowledge.

METHODS

A total of 32 clients of mental health services were recruited from hospitals, Integrated Community Centers for Mental Wellness, and non-governmental organizations. They participated in semi-structured individual interviews. All interviews were recorded, transcribed verbatim, and analyzed using thematic analysis with the aid of NVivo. The findings were verified by peer researchers.

RESULTS

Three main themes are presented in this article, including how clients made sense of the knowledge provided by mental health professionals and peer support workers (PSWs), critical perspectives about peer support services, and the way in which the services are more than knowledge transfer alone. Participants generally indicated that knowledge sharing revolved around three experiences: mood changes, medications, and sense of hope. Nevertheless, an empathic understanding of the clients' experience was more important than the sharing of knowledge. Some clients perceived medication as the chief means to recovery, so PSWs were not useful for them. However, PSW role models had an effect beyond mere knowledge transmission, as they could promote clients' pursuit of functional recovery goals.

CONCLUSIONS

The present study has improved our understanding of knowledge sharing between clients with BD and health professionals or PSWs, which should take place in an empathic and hope-instilling manner. It has also emphasized the value of the presence of a role model who can speak convincingly with clients to facilitate recovery. The present findings can be used to improve the care of people with BD by generating important guidance with regard to enhancing the knowledge exchange between clients and health practitioners.

International insights into peer support in a neonatal context: A mixed-methods study

Peer support is a widely used intervention that offers information and emotional support to parents during their infant's admission to the neonatal unit and/or post-discharge. Despite its widespread use, there are no comprehensive insights into the nature and types of neonatal-related peer support, or the training and support offered to peer supporters. We aimed to bridge these knowledge gaps via an international study into neonatal peer support provision. A mixed-methods study comprising an online survey was issued to peer support services/organisations, and follow-up interviews held with a purposive sample of survey respondents. Survey/interview questions explored the funding, types of peer support and the recruitment, training and support for peer supporters. Descriptive and thematic analysis was undertaken. Thirty-one managers/coordinators/trainers and 77 peer supporters completed the survey from 48 peer support organisations/services in 16 different countries; with 26 interviews undertaken with 27 survey respondents. We integrated survey and interview findings into five themes: 'background and infrastructure of peer support services', 'timing, location and nature of peer support', 'recruitment and suitability of peer supporters', 'training provision' and 'professional and emotional support'. Findings highlight variations in the types of peer support provided, training and development opportunities, supervisory and mentoring arrangements and the methods of recruitment and support for peer supporters; with these differences largely related to the size, funding, multidisciplinary involvement, and level of integration of peer support within healthcare pathways and contexts. Despite challenges, promising strategies were reported across the different services to inform macro (e.g. to facilitate management and leadership support), meso (e.g. to help embed peer support in practice) and micro (e.g. to improve training, supervision and support of peer supporters) recommendations to underpin the operationalisation and delivery of PS provision.

Strategic Storytelling: An Exploration of the Professional Practices of Mental Health Peer Providers

Peer providers of mental health services use their personal illness and recovery narratives to help other mental health service users. Despite a substantial body of evidence supporting the effectiveness of these providers, little is known about the underlying strategies they employ in their professional practice. In this study, I used in-depth interviews with 23 peers to explore the most important practices they used in their day-to-day work with others. Results indicated that peers engaged in a reflexive process to strategically use their personal illness and recovery stories to help others re-story their life narratives. Peers also used communication strategies from motivational and cognitive-behavioral treatment approaches to engage, inspire, and mentor other service users. Findings suggest the need for research that further explores the rhetorical strategies used by peers using narrative methods. The development and testing of professional development opportunities to assist peers in maximizing their therapeutic potential are also warranted.

Development of a peer-led, network mapping intervention to improve the health of individuals with severe mental illnesses: protocol for a pilot study

INTRODUCTION

Adults with severe mental illness (SMI) have reduced life expectancy and many have comorbid physical health conditions. Primary care providers are experiencing increased demands for care for people with SMI. Barriers to accessing physical healthcare have been identified which negatively affect quality of care. We propose that peer support workers (PSWs) could deliver an intervention to service users to promote their physical health by drawing on existing social support. The aim of this research was to pilot a novel PSW-led intervention, including personal well-being network mapping, to improve access to primary care for physical health needs.

METHODS AND ANALYSIS

Twenty-four participants will be recruited from community-based mental health teams in two boroughs of London. Each participant will be offered a six-session intervention. Quantitative data will be collected before and after intervention (at 4-month follow-up). Qualitative interviews will be conducted with PSWs after completion of the intervention and with participants at a 4-month follow-up. Some intervention sessions will be observed by a member of the research team. This is a pilot study with a small sample aiming to assess acceptability and feasibility of an intervention. We aim to use the results to refine the existing theory of change and to optimise the intervention and its evaluation in a future randomised controlled trial. This study is strengthened by its potential clinical importance and origin in previous research where service users engaged with well-being network mapping.

ETHICS AND DISSEMINATION

This study has been approved by the London-Chelsea Regional Ethics Committee (ref: 17/LO/0585). The findings will be disseminated to participants, the National Health Service trusts that we recruited from, primary care mental health leads, commissioners and in peer-reviewed journals and academic conferences.

'From my point of view, my wife has recovered': A qualitative investigation of caregivers' perceptions of recovery and peer support services for people with bipolar disorder in a Chinese community

BACKGROUND

Bipolar disorder (BD) is a chronic mental disorder, and family members play a key role in taking care of the affected individuals. The recovery movement has gradually transformed mental health services, for example, through the introduction of peer support services (sharing of expert-by-experience knowledge), and it has challenged the prevailing view that people with mental illness cannot recover.

AIMS

Through this study, the researchers explored how family caregivers in a Chinese context conceptualise recovery, how caregivers interact with peer support workers (PSWs) and how they perceive peer support services.

METHODS

Fourteen family caregivers from community settings participated in individual semi-structured interviews. The data were analysed through thematic analysis.

RESULTS

Family caregivers had multifaceted definitions of recovery and had various degrees of contact with PSWs. The views and experiences shared by PSWs were hope-instilling for caregivers and changed their perception of BD and their loved ones. Some limitations of PSWs were also identified.

CONCLUSION

Social connectedness and functional outcomes were important indicators of recovery among Chinese family caregivers. Caregivers began to understand the benefits of PSWs after experiencing their services. Peer-led services could be a helpful support for both service users and family caregivers.

Using Peer Support in Developing Empowering Mental Health Services (UPSIDES): Background, Rationale and Methodology

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.

Characteristics of mental health recovery narratives: Systematic review and narrative synthesis

BACKGROUND

Narratives of recovery from mental health distress have played a central role in the establishment of the recovery paradigm within mental health policy and practice. As use of recovery narratives increases within services, it is critical to understand how they have been characterised, and what may be missing from their characterisation thus far. The aim of this review was to synthesise published typologies in order to develop a conceptual framework characterising mental health recovery narratives.

METHOD

A systematic review was conducted of published literature on the characteristics of mental health recovery narratives. Narrative synthesis involved identifying characteristics and organising them into dimensions and types; and subgroup analysis based on study quality, narrator involvement in analysis, diagnosis of psychosis and experience of trauma. The synthesis was informed by consultation with a Lived Experience Advisory Panel and an academic panel. The review protocol was pre-registered (Prospero CRD42018090188).

RESULTS

8951 titles, 366 abstracts and 121 full-text articles published January 2000-July 2018 were screened, of which 45 studies analysing 629 recovery narratives were included. A conceptual framework of mental health recovery narratives was developed, comprising nine dimensions (Genre; Positioning; Emotional Tone; Relationship with Recovery; Trajectory; Use of Turning Points; Narrative Sequence; Protagonists; and Use of Metaphors), each containing between two and six types. Subgroup analysis indicated all dimensions were present across most subgroups, with Turning Points particularly evident in trauma-related studies.

CONCLUSIONS

Recovery narratives are diverse and multidimensional. They may be non-linear and reject coherence. To a greater extent than illness narratives, they incorporate social, political and rights aspects. Approaches to supporting development of recovery narratives should expand rather than reduce available choices. Research into the narratives of more diverse populations is needed. The review supports trauma-informed approaches, and highlights the need to understand and support post-traumatic growth for people experiencing mental health issues.

Reported benefits of peer support group involvement by adults with hearing loss

OBJECTIVE

The purpose of this study was to better understand the benefits of self-help group involvement by adults with hearing loss.

DESIGN

A secondary content analysis of interview transcripts of participants from a previous study on the impact of stigma on help-seeking was carried out.

STUDY SAMPLE

Ten members (aged 55-76 years) of self-help groups for persons with hearing loss in the United States of America and Canada participated in the interviews.

RESULTS

Three themes describing the benefits of self-help group participation emerged: (1) Practical and accessible information about hearing loss; (2) Social belonging leading to personal transformation; and (3) A new and mutually beneficial direction.

CONCLUSIONS

The findings are discussed in relation to the "helper therapy principle", as well as group audiological rehabilitation.

Providing mental health peer support 2: Relationships with empowerment, hope, recovery, quality of life and internalised stigma

OBJECTIVE

Qualitative research has identified personal costs and benefits for peer supporters associated with their role; however, quantitative evidence is sparse. This study used quantitative methods to explore relationships in experiences of providing peer support with constructs of empowerment, hope, recovery, quality of life and internalised stigma. Differences were examined for those in statutory versus non-statutory services; who had themselves received peer support versus those who had not and who identified having had negative experiences in clinical teams versus those without such experiences.

METHODS

A cross-sectional online and postal survey was undertaken in tandem with a linked consensus study. In all, 147 peer supporters were recruited from a variety of organisations across the United Kingdom. Validated questionnaires were used to examine constructs. Instruments created for the study measured peer support experiences, and personal costs and benefits involved. Correlations were calculated and results informed further regression analysis. Chi-square tests and independent samples t-tests tested group differences.

RESULTS

Peer supporters indicated they experienced almost twice as many role-related personal benefits than personal costs. Benefits included improvements to mental health and well-being, reduced use of services, increased social functioning and development of skills. Total number of personal costs experienced was significantly negatively related to peer supporters' empowerment and quality of life. There were no significant differences between the groups examined.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

An accumulation of personal costs may result in reduced quality of life; however, costs can be minimised by organisations. Limitations of the research are discussed and recommendations for future research are made including the need for longitudinal research.

The mental health consumer movement and peer providers in Israel

Self-help peer-support groups in Israel emerged in the 1980s and, over time, dynamically interacted and co-developed with the statutory mental health (MH) system. In this editorial, I outline historical milestones of how the evolution of the Israeli mental health system was influenced by the consumer movement. A brief depiction of the consumer movement history. At first, consumers operated outside of the mainstream MH system. Gradually, consumer groups and institutional personnel joined efforts towards community integration and enhancement of quality of life, pushing forward a person-centered recovery orientation. In turn, some administrators and key stakeholders in rehabilitation community services grew to value the impact of knowledge-by-experience in contemporary mental health care. In this context, over the past decade, peer roles were developed in the mental health system, including consumer-providers in community services and peer specialists in inpatient psychiatric hospitals. The insertion of peer roles into the mainstream MH system is far-reaching, including the placement of a peer-project coordinator within the ministry of health. I describe the unique contribution of peers, as experts-by-experience, to mainstream professional knowledge and practice. I also highlight the potential challenges involved when peer models of care are added to traditional medical models of care. The Israeli case demonstrates how the consumer movement can play an active role in MH systems and be acknowledged and recognised as a partner for changing policy, practice and reshaping formal institutions. In addition, they play a vital role in the development of peer-support services.