Peer Support: What is the evidence?. Why has peer support emerged? What is it? What forms does it take? What is the evidence? Why does it work?. History. Family. Values & Beliefs. Friends. PERSON. Work. Hopes & Dreams. Education. Spirituality. Sexuality. Politics. 2. Family.
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Values & Beliefs
Hopes & Dreams
Spaniol et al 1999
People are trying to cope with:
Trauma from the illness and loss of sense of personal identity
Being (initially at least) a passive recipient of mental health services
Dealing with stigma/”the helping relationship”
Peter Ryan March 2013
Recovery as a Journey of the Heart (1996)
Recovery; the Lived Experience of Rehabilitation(1998)
By the turn of the 21st century, the push for recovery and the use of peer support services accelerated across the UK, Canada, United States New Zealand and Australia as Peer Support initiatives matured, diversified, and increased in numbers.
In UK: 2008 onwards - Emergence of ‘Recovery Centres’
Same core values?
Peer support builds upon the value system which has evolved in the ‘recovery movement’
Peer support puts this into practice in terms of activities, services and modes of delivery
Recovery/peer support is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems
Represents a movement away from pathology, illness and symptoms to health, strengths and wellness
About discovering - or re-discovering a sense of personal identity, separate from illness or disability - The language used and the stories and meanings that are constructed have great significance as mediators of the recovery process – the power of narrative
Hope is central to recovery and can be enhanced by each person seeing how they can have more active control over their lives (‘agency’) and by seeing how others have found a way forward
Self-management is encouraged and facilitated.
The helping relationship between clinicians and service users moves away from being expert/patient to being ‘coaches’ or ‘partners’ on a journey of discovery
Clinicians are there to be “on tap, not on top”
People do not recover in isolation. Recovery/peer support is closely associated with social inclusion and being able to take on meaningful and satisfying social roles within local communities, rather than in segregated services
Whilst a shared lived experience of mental distress is fundamental to peer support, it also needs to address other shared experiences, identities and backgrounds.
Peer support has to be based on certain values and ethos, including empathy, trust, mutuality and reciprocity, equality, a non-judgemental attitude.
Contexts and support that people describe as ‘peer support’ do not always fit neatly into definitions of ‘intentional’, ‘formal’, ‘informal’ or ‘naturally occurring’ peer support. (Faulkner, 2011)
75%: more than a shared personal experience of mental distress in common with them
76%: shared ideas about what recovery means
73%: shared understandings of specific diagnoses and their effects
58%: shared views about medication and other treatments
55%: shared gender, ethnic background, sexual orientation, age groups, faith etc.
For respondents from BME groups, 66% said shared ethnic/cultural background; understanding of marginalisation and barriers
“ someone who has had their own experience that resonated with mine and so we can support each other in a way that is personally useful… Someone who can help me think through what is happening to me rather than tell me what is happening to me based on their experience.”
Varies widely in the forms it takes. Can include:
Self-help/self management groups
Specialised peer services (ward based/crisis, unemployment, homelessness)
Lifelong Learning groups (eg EMILIA)
Peer phone/facebook/twitter initiatives
While many of the details of peer support models appear to be different, at the heart of them is a common set of peer structures, beliefs, and practices that are intended to recognize and nourish personal strengths and personhood and support a quality life for participating peers.
The systematic identification of cross-cutting elements common to peer programmes produced a list of “common ingredients” and an objective rating system to measure program fidelity and conduct quality improvement (Holter, Mowbray, Bellamy, MacFarlane, & Dukarski, 2004; Johnsen, Teague & McDonel Herr, 2005).
Service user operated
Operate in socially inclusive ‘normative’ settings
But not always – eg peer support on wards
Embrace the principles of choice, hope, empowerment, recovery, diversity, spiritual growth, and self help/self management
Encourage participants to “tell their stories” of illness and recovery – the power of narrative
Engage in formal and informal peer support
Lifelong learning approaches as a key, core process –
Learning opens possibilities of the ‘power of narrative’
Learning doesn’t assume a mental health services context.
Learning together doesn’t assume one of you is an ‘professional expert’
Everyone learns from the basis of their own lived experience
Designed AND delivered by peers
Or to peers and professionals
Until recently, mental health services research has focused primarily on the effectiveness of traditional mental health modalities and programs to treat mental illness.
Mental health services research has neglected to consider peer support as producing positive outcomes that lead to recovery for persons with mental illness.
After a decade of research on eight peer support programmes located across the United States (1998–2008) (Goldstrom, Campbell, Rogers, Lambert, Blacklow, Henderson & Manderscheid, 2005).
4: peer support drop in centres
2: peer support lifelong learning and advocacy programmes
2: peer support approaches to individuals and groups
Analysis of more than 1,800 participants in the randomized, controlled trial revealed that those offered peer support services as an adjunct to their traditional mental health services showed significant gains in well-being—hope, self-efficacy, empowerment, goal attainment, and meaning of life—in comparison to those who were offered traditional mental health services only.
* COSP = Consumer-Operated Service Programs
TMHS = Traditional Mental Health Services
The greatest gains in well-being were found for the participants who used the peer support services the most.
Variations in well-being effects across sites were unrelated to formal COSP models of peer support service delivery.
Most important, analyses of COSP common ingredients and outcome results established evidence of a strong relationship between key peer practices that support inclusion, peer beliefs, self-expression, and an increase in well-being outcomes.
Intervention lasted for 8 weeks
Met for 2 and ½ hours every week
Followed a highly standardized curriculum designed by Mary Ellen Copeland
Facilitator curricular innovations discouraged
Used a detailed Facilitators Manual and Overhead Slides
Daily Maintenance Plan
Triggers and an action plan
Early warning signs and an action plan
When things are breaking down and an action plan
Post Crisis Planning
Session 1: Key concepts of WRAP & recovery
Session 2-3: Identify personalized wellness strategies. Engage in exercises to enhance self-esteem, build competence, & explore benefits of peer support.
Session 4: Create daily maintenance plan (simple, inexpensive strategies) to stay emotionally and physically healthy. Create plan for recognizing & responding to symptom triggers.
Session 5: Identify early warning signs and how these signal a need for additional support
Session 6-7: Create crisis plan specifying signs of impending crisis, names of individuals willing to help, & types of assistance preferred.
Session 8: Create plan for post-crisis support & learn how to retool WRAP plan after a crisis to avoid relapse. Graduation ceremony
Recruited at CMHC & peer support programmes
Subjects were randomised to receive WRAP right away or 9 months later
Telephone interviews at study entry (baseline), 2 months post-baseline, & 8 months post-baseline by (blinded) interviewers
Recovery – Recovery Assessment Scale
Empowerment – Empowerment Scale
Self-Advocacy – Pt. Self-Advocacy Scale
Social Support – Medical Outcomes Study
Hopefulness – Hope Scale
Quality of Life – WHO QOL
Symptoms – Brief Symptom Inventory
Coping – Brief Cope Scale
Stigma – Mental Illness Stigma Scale
Physical Health Perceptions – MOS
No sig. differences by study condition
In a multivariable longitudinal random-effects regression analysis, WRAP recipients improved more than controls from T1 to T3 on multiple outcomes:
Reduced psychiatric symptom severity
Decreased coping through self-blame
Increased quality of life
The greater the % of WRAP classes attended, the greater WRAP participants’…
Reduction in overall symptom severity
Reduction in depressive symptoms
Reduction in symptoms of anxiety
Increased quality of life
Increased sense of recovery
Working with post traumatic stress (PTSD)
Social Network Support
Social and community Competences
Employers and Colleagues
Working with Families
Personal Development Planning online
Training the Trainers
Peer support study results suggest a promising
Peer support approaches promote well-being, and a reduced use of mental health services
When offered as an adjunct to the treatment of mental illness, they promise mental health service users a more stable, meaningful and coherent (connected) life in the community.
are shaped and formed.
experiences may play a pivotal role in resilience and
narrative characteristics, such as coherence and emotionality,
as a shift in focus to thoughts and feelings rather than
concentrating on the facts, is associated with less
distress and anxiety and also better physical health
(Foa, Molnar & Cashman, 1995; Pennebaker, 1997).
coherence in life story narratives are associated with lower
levels of depression, higher life satisfaction, and more
Life event(s) Multi-site
Life Long Learning
Sense of Coherence
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Anthony W A (1993) Recovery from mental illness; the guiding vision of the mental health service system in the 1900s. Psychosocial Rehabilitation Journal, 16, 11-23.
Craddock N. et al (2008) A wake up call for British psychiatry. The British Journal of Psychiatry, 193, 6-9.
College of Occupational Therapists (2006) Recovering ordinary lives the strategy for occupational therapy in mental health services 2007 – 2017. London: COT.
Davidson L, McGlashan TH (1997) The varied outcomes of schizophrenia. Psychiatric Services, 57, 642 – 645.
Deegan P (1996) Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19 (3), 91-97.
Deegan P (1998) Recovery; the lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11, 11-19.
Hope R (2004) The 10 essential shared capabilities: a framework for the whole of the mental health workforce. London: DH.
Gould A, DeSouza S, Rebeiro-Gruhl KL (2005) And then I lost that life: a shared narrative of four young men with schizophrenia. British Journal of Occupational Therapy, 68 (10), 467-473.
National Institute for Mental Health in England (2005) NIMHE Guiding statement on recovery. Available at www.nimhe.org.uk
Shepherd G, Boardman J, Slade M (2008) Making recovery a reality. London: Sainsbury Centre for Mental Health.