This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Peer support workers use their lived experience of mental health difficulties (such as anxiety, psychosis or substance abuse) to support service users or carers. A review of the best available evidence found that peer support could aid recovery, depression (particularly perinatal depression), and self-belief. It found that service users valued peer support workers, and that peer support workers themselves had improved wellness and recovery. However, peer support workers needed:
- more clarity about their role
- better training, supervision and pay.
Although the included evidence was of low quality, the researchers hope their findings will help commissioners considering implementing this service.
More information about peer support workers can be found on the NHS website.
The issue: how can peer support in mental health work better?
Peer support workers draw on their own experiences to support users of mental health services or their carers. They may be former service users or carers. Peer support has historically been voluntary and unpaid but is now being incorporated into the structure of mental health services. The numbers of peer support workers employed by NHS England increased from 48 in 2016, to 862 in 2019.
Peer support workers share coping strategies with people with mental health problems, and aim to provide hope and an example of recovery. Peer support might be provided in one-to-one or group sessions, online or face-to-face. Group sessions can be informal (crafts, gardening, walking or other activities) or formal (structured support in perinatal mental health, for instance).
The researchers aimed to provide clinicians, policymakers and researchers with an assessment of peer support: its effectiveness, experiences, and what influences its implementation.
What’s new?
The analysis was based on 35 reviews of paid peer support interventions in mental health. Each review included between 95 and 40,927 participants. Most reviews were low or very low quality; only 1 was high quality.
How effective is peer support?
In 23 reviews, the effectiveness of peer support was mixed; many reviews showed no effect. There was some evidence that it may reduce perinatal depression, reduce hospitalisation in severe mental illness, improve confidence and help people live fulfilling lives even if they still have mental health symptoms. The few reviews (4) that reported on cost, suggested that peer support was low cost and potentially cost-saving.
What helps implement peer support?
The 9 reviews on implementation suggested that successful peer support services:
- are co-designed with people with lived experience
- have clear job descriptions and guidelines for peer support workers
- offer appropriate training, supervision and pay for peer support workers
- focus on helping people live fulfilling lives even when they have mental health symptoms (a recovery-oriented approach) rather than tackling symptoms alone
- have receptive leadership, and a supportive and trusting workplace culture, with effective collaboration between peer support workers and non-peer staff.
How do people experience peer support?
In 11 reviews, people described the benefits and challenges of peer support. Peer support workers said their role improved their own wellness, recovery, self-esteem, personal growth and social connections. Some used the role as a route back to employment.
Service users valued peer support workers’ lived experience of mental health problems. They felt that peer support workers had more empathy than other staff, and gave service users hope of recovery.
However, the role lacked clarity, which made peer support workers uncertain about when they could disclose their personal experiences to service users. Pay was often low; some felt undervalued. Some service users lacked trust in peer support workers’ knowledge because of the lack of formal training. While some peer support workers felt accepted within teams, others experienced negative attitudes from non-peer staff.
Why is this important?
This is one of the largest reviews of peer support to date. Many peer support workers found their role enjoyable, and said that it helped their own recovery. They were valued by service-users. This research provides insights on how to implement the role successfully.
This research, which summarised reviews of peer support, was based on the best evidence available, but that evidence is low quality. Control groups varied across studies (usual care, active controls and waiting list controls), and some research was old (from before 1980). More research is needed; but the varied nature of peer support makes it challenging to evaluate the role.
Barriers to successful implementation of peer support workers included a lack of time, resources, training certification and appropriate funding.
What’s next?
ImROC (Implementing Recovery through Organisational Change), an organisation that supports peer support implementation, recommends training and ongoing professional development. The findings of this review are in line with ImROC’s recommendations. The researchers say formal career pathways for peer support workers might address some barriers to implementation of the role, but these pathways are still in early development.
You may be interested to read
This is a summary of: Cooper R, and others. The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review. BMC Medicine 2024; 22.
A webinar Collection from NIHR Evidence about mental health crisis.
A panel discussion about the paper by the authors.
Guidelines for peer support workers for the UK and the US.
Funding: This study was funded by the NIHR Policy Research Programme.
Conflicts of Interest: One of the study authors is the director of a consultancy company that provides peer support training and consultancy. See paper for full details.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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