Actionable Items to Address Challenges Incorporating Peer Support Specialists Within an Integrated Mental Health and Substance Use Disorder System: Co-Designed Qualitative Study

Abstract

Background Peer support specialists offering mental health and substance use support services have been shown to reduce stigma, hospitalizations, and health care costs. However, as peer support specialists are part of a fast-growing mental health and substance use workforce in innovative integrated care settings, they encounter various challenges in their new roles and tasks. Objective The purpose of this study was to explore peer support specialists’ experiences regarding employment challenges in integrated mental health and substance use workplace settings in New Hampshire, USA. Methods Using experience-based co-design, nonpeer academic researchers co-designed this study with peer support specialists. We conducted a series of focus groups with peer support specialists (N=15) from 3 different integrated mental health and substance use agencies. Audio recordings were transcribed. Data analysis included content analysis and thematic analysis. Results We identified 90 final codes relating to 6 themes: (1) work role and boundaries, (2) hiring, (3) work-life balance, (4) work support, (5) challenges, and (6) identified training needs. Conclusions The shared values of experience-based co-design and peer support specialists eased facilitation between peer support specialists and nonpeer academic researchers, and indicated that this methodology is feasible for nonpeer academic researchers and peer support specialists alike. Participants expressed challenges with agency restrictions, achieving work-life balance, stigma, and low compensation. We present actionable items to address these challenges in integrated mental health and substance use systems to potentially offset workforce dissatisfaction and high turnover rates.

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

“…Although we have a small number of studies describing co-creation as a basis, these studies may reveal that when peer workers were involved in processes extending the service delivery phase, they seemed more likely to engage in several phases of the service cycle. In addition, we found one study reported that peer workers participated in the delivery and assessment of services (Almeida et al, 2020 ). Though, as peer worker involvement occurs across the service cycle but not in the early phase, it is not considered co-creation.…”

Assessing Mental Healthcare Worker Experiences of Workplace Fairness and Organizational Value: A National Survey of Peer-Support Specialists

“…Our findings align with previous studies of peer-support specialists’ experiences. For example, they have reported facing discrimination based on both their own mental health diagnoses and their position as non-clinical staff, leading to a perceived lack of workplace value (Almeida et al, 2020; Firmin et al, 2019; Jones et al, 2019). Evidence suggests that this lack of perceived value negatively impacts peer-support specialists’ psychosocial well-being and is detrimental to the functional capacity of healthcare workplaces.…”

“…Despite these benefits to service users, organizational dynamics can lead peer-support specialists to feel stigmatized, undervalued, or excluded, ultimately leading to dissatisfaction and impacting retention (Almeida et al, 2020; Jones et al, 2019). A recent study of peer-support specialists found that they experienced both overt stigmatization (e.g., negative treatment toward people with a mental illness) and microaggressions (e.g., negative messages about peer support) in the workplace related to their role and diagnostic status and did not feel valued by clinical teams (Firmin et al, 2019).…”

Peer Support in Coordination of Physical Health and Mental Health Services for People With Lived Experience of a Serious Mental Illness

“…Research studies report that peer support specialists can experience difficulties with managing their role, low payment, and job insecurity, job stress that influences their wellness, and a lack of support from managers and clinical staff (25,26). Formal and informal support and supervision of peer support specialists, better pay, recovery-focused organizations, and training may help to support individual resilience and sustainability (25,27).…”