Peer Support in Mental Health

Have you ever felt as if no one in the world could possibly understand how you’re feeling or what you are living through? Have you ever felt so alone that even to be in the presence of other people is a painful reminder of the uniqueness of your own internal world? Maybe you have found yourself opposite a person who is trying to help you, maybe even paid to help you, and wondered how they could possibly understand. Worse still, have you ever sat opposite somebody who is telling you they know how you feel when they clearly don’t?

In mental health, ‘peer support’ is the support provided and received by people who have their own experiences of distress and recovery. It is considered to be a ‘mutual’ approach, in that it doesn’t invite the overt power hierarchies that are involved in professional helping relationships, where one person has expertise over the other. This chapter provides an introduction to the concept of peer support in mental health services by reviewing its complex historical roots. We will see that peer support has grown from self-help and activism to become an evidence-based, formalised approach. The chapter includes a variety of definitions of peer support which provide the opportunity to consider the different language that is used to describe the approach. There is also growing interest in what processes are involved in peer support and what benefits it brings. A growing body of evidence has focused on these questions, providing us with an emerging understanding of the multiple benefits of peer support and the reasons why these benefits come about.

In this chapter, we examine the ‘politics’ of peer support, that is, the current tensions and debates surrounding peer support, particularly relating to power and status. We begin by exploring the sources of knowledge and power that underpin peer support, as well as those underpinning mental health services in the western world. This provides a backdrop to consider the debates relating to the economic case for peer support and how research into peer support may serve (and do a disservice to) different groups.

While peer support has been offered informally and in user-led organisations throughout history, recent years have seen a huge increase in the amount of formal peer support that is available across the globe. While the evidence base for peer support and its presence in mental health policy and commissioning guidance continue to grow, the nuts and bolts of peer support working remain undefined. Definitions of peer support are generally broad, emphasising components such as mutuality and reciprocity, but leaving room for the practicalities of the peer support role/approach to be defined in different ways depending on the context it is offered within.

Recovery Colleges are one way of learning about self-management and gaining peer support both formally from peer trainers and informally from students. They share many of the values of peer support and are based on an understanding that: ‘Recovery 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’ (Shepherd et al., 2008, p. 1). Although they are a relatively new development within UK mental health systems, Recovery Colleges have become central to many people’s recovery.

Peer support by many other names has long existed in community-led, self-help, grassroots projects, often with little or no funding, taking the form of supporting people by listening to each other over a cup of tea. This type of support continues to the present day in communities across the UK and a similar, more formalised, model is being used in mental health services. Socially excluded communities are over-represented in mental health services and under-represented within formalised peer support. This suggests that a deeper understanding of inclusion is necessary within peer support. In this chapter we explore some of these inherent inequalities within the recovery and peer support approach and their impact on socially excluded communities. We reflect on the need for a recovery and peer support approach that benefits socially excluded communities, communities that have long benefited from self-help models.

Although ‘carer’ is the official term used in UK services and policies for people who support their family and friends, the term itself can lead to confusion. Colloquially, in the media, and in some official documents, ‘carer’ is also used to describe the paid care workers who provide vital support in the community for people who need additional help with daily tasks, including personal care. Carers’ organisations, such as Carers UK and the Carers Trust, emphasise the difference between these paid workers and the family and friends who provide informal and unpaid support for their relative or friend. The government fact sheet for the Care Act (2014) defines a ‘carer’ as:

This chapter discusses the development of training for peer supporters. After considering the background, it provides an overview of topics for current training, including training before and after a peer support course. There is an emphasis on the core values of training provisions and how these relate to the core values of peer support itself.

Society has a long history of seeing people with mental health challenges as ‘other’ which has led to a culture of separation in mental health services too. This established view of ‘us’ and ‘them’ has been associated with an inhibition or even prohibition of practitioners sharing their personal lives with those they support, particularly their own mental health difficulties.

In its purest form peer support in mental health has existed for as long as people living with such issues have met with each other. At this informal level peer support has generally been a popular and therapeutic means of seeking support. However, in recent years peer support has been formalised. This raises a number of issues for organisations of all kinds, including

This chapter adopts the term ‘peer-led’ to refer to services, organisations and structures where those with lived experience of mental health challenges have control over the design, development, delivery and evaluation of the service. Those with lived experience have historically provided services and support to one another independently and in partnership with statutory services (Mowbray et al., 2005; Wilson, 2015). Recently a wave of global research has investigated services run specifically by and for those with experiences of mental health challenges (e.g. in the UK: Parmenter et al., 2015; in Canada: O’Hagan et al., 2010; in New Zealand: Doughty & Tse, 2005 in the USA: Jones, 2015). Across contexts, peer-led provisions improve patient outcomes, provide increased employment and social integration opportunities, challenge stigma surrounding mental health, and improve statutory services. Peer-led provisions may be hard to identify and categorise due to various ways these approaches are considered. This poses challenges when identifying how they can be supported.