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A major review commissioned by the Department of Health and Social Care and led by the National Institute for Health and Care Research (NIHR) Policy Research Unit in Mental Health (MHPRU) has explored evidence for peer support in mental health.

A major review commissioned by the Department of Health and Social Care and led by the National Institute for Health and Care Research (NIHR) Policy Research Unit in Mental Health (MHPRU) has explored evidence for peer support in mental health.

Peer support is delivered by individuals who have lived experience of mental health difficulties. These peer support workers draw on their own experiences to support people with mental health conditions, making them uniquely positioned to facilitate recovery through empathy.

Researchers at the NIHR Policy Research Unit in Mental Health (MHPRU) collated and summarised the available evidence from published reviews to understand the effectiveness, implementation, and experiences of paid peer support approaches for mental health. The NIHR MHPRU was established at UCL and King's College London in 2017, and works closely with clinicians and service users at South London and Maudsley NHS Foundation Trust.

The systematic umbrella review, published in BMC Medicine, is one of the largest reviews of peer support to date. Collaborating with people with lived experience of mental health and peer support delivery, the researchers analysed 35 existing reviews, which included a total of 426 individual studies and between 95 to nearly 41,000 participants.

Although results on the effectiveness of peer support were mixed, researchers found evidence that peer support can aid mental health recovery, depression (particularly perinatal depression), and self-belief. Experiences of peer support included improved wellbeing for peer support workers and service users, but the role could feel unsupported and subject to some stigmatising views from non-peer staff.

The researchers identified key barriers to successful implementation and guidance to overcome these.

Dr Ruth Cooper, joint first author and Research Associate at King’s IoPPN said:

Despite peer support interventions being recommended internationally, research into its effectiveness has produced mixed results. Our review, which is one of the largest to date, found that peer support can help mental health recovery, but there are structural and cultural barriers to successful implementation that must be overcome. Understanding how best to implement these interventions is essential to building effective mental health care systems that deliver the best possible care for people.

When exploring the experiences of service-users, peer support workers, and non-peer staff, researchers discovered that numerous reviews highlighted the advantages of peer support. The findings showed it was mutually beneficial for peer support workers and service users, with both experiencing improved wellbeing and recovery from delivering or receiving peer support. Service users also reported that peer support normalised and de-medicalised their experiences, reducing feelings of self-stigma.

However, the researchers also identified challenges to the role. Some peer support workers reported the ‘sick’ label stayed with them in the role, with non-peer staff at times concerned that their mental health would impact their work. A lack of clarity about the job description and low pay could lead peer support workers to feel the role was undervalued and tokenistic. This could affect their own recovery and led to uncertainty in their responsibilities with service users.

Good implementation of peer support was found to include co-design with people with lived experience, clear job descriptions, a recovery-oriented, supportive, and trusting workplace culture, and appropriate training for peer support workers and non-peer staff. However, barriers to peer support being implemented, included a lack of time, resources, and appropriate funding, and a lack of recognised peer support worker certification.

Extract from the Lived experience commentary written by Lizzie Mitchell and Karen Machin states:

A crucial area of future research is exploring what type of peer support works best for whom and in what circumstances, and how we can deliver this. Furthermore, we need to better understand how NHS cultures can be supported to value the expertise that originates in our lived experience, including the marginalised experiences which have been disproportionately represented in mental health services.

Professor Sonia Johnson, senior author and Professor of Social and Community Psychiatry at UCL, said:

It’s widely acknowledged that paid peer support is an important approach to mental health care, now and in the future. However, there is still a lot of uncertainty about the best way to do it right. Our review offers valuable pointers to help service providers deliver peer support that is beneficial to both service users and the staff providing it. Moving forward, we hope to see more research that is co-produced with service users so we can better understand which types of peer support work for who, and in what settings.

The study is funded by the NIHR Policy Research Programme. The NIHR Policy Research Unit in Mental Health, established at King’s and UCL, conducts rapid research to inform mental health policy at DHSC, NHS England, OHID and other government bodies