Mental health workers’ perspectives on peer support in high-, middle- and low income settings: a focus group study

Abstract

Background Peer support is increasingly acknowledged as an integral part of mental health services around the world. However, most research on peer support comes from high-income countries, with little attention to similarities and differences between different settings and how these affect implementation. Mental health workers have an important role to play in integrating formal peer support into statutory services, and their attitudes toward peer support can represent either a barrier to or facilitator of successful implementation. Thus, this study investigates mental health workers’ attitudes toward peer support across a range of high- (Germany, Israel), middle- (India), and low-income country (Tanzania, Uganda) settings. Methods Six focus groups were conducted in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be’er Sheva (Israel), and Ahmedabad, Gujarat (India) with a total of 35 participants. Transcripts were analyzed using thematic content analysis. Results Participants across the study sites demonstrated overall positive attitudes towards peer support in mental health care, although some concerns were raised on potentially harmful effects of peer support such as negative role modelling and giving inadequate advice to service users. Notably, mental health workers from low- and middle-income countries described peer support workers as bridge-builders and emphasized the mutual benefits of peer support. Mental health workers’ views on peer support workers’ roles and role boundaries differed between sites. In some settings, mental health workers strongly agreed on the need for role clarity, whereas in others, mental health workers expressed mixed views, with some preferring blurred role boundaries. Regarding collaboration, mental health workers described peer support workers as supporters and utilizers, equal partners or emphasized a need for trust and commitment. Conclusions Mental health workers’ attitudes toward peer support workers were positive overall, but they also varied depending on local context, resources and previous experiences with peer support. This affected their conceptions of peer support workers’ roles, role clarity, and collaboration. This study demonstrated that reconciling the need for local adaptations and safeguarding the core values of peer support is necessary and possible, especially when the implementation of recovery-oriented interventions such as peer support is accelerating worldwide.

Explaining job satisfaction among mental health peer support workers.

“…Furthermore, peer support is growing internationally with research implications to explore addressing local contextual and cultural aspects (Charles et al, 2020). Globally, there are many contextual factors that impact peer support implementation (Krumm et al, 2022).…”

Mental health workers’ perspectives on the implementation of a peer support intervention in five countries: qualitative findings from the UPSIDES study

“…Preintervention findings of UPSIDES 24 suggest that MHWs were concerned about possible downsides of peer support, such as negative effects on SUs and PSWs, decreased service quality and reputational damage to mental health services. The results of this postintervention data collection do not support these concerns.…”

“…Participants in study sites with more experience in implementing peer-delivered interventions (Be’er Sheva, Hamburg and Butabika) emphasised that MHWs should be clear about the role of PSWs as colleagues. 24 …”

“… 26 27 Before the start of the UPSIDES intervention, we conducted FGDs with 35 MHWs from the UPSIDES implementation sites in Germany, Uganda, Tanzania, Israel and India on their expectations regarding peer support. 24 MHWs shared an overall positive attitude about peer support but also expressed some concerns, including PSWs possibly giving inadequate advice to SUs. Furthermore, results suggest that the local context, such as prior experience with PSWs and availability of resources, impacts MHWs’ attitudes towards peer support, including their expectations of tasks, roles and role boundaries.…”

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

“…Currently, there are an estimated 30,000 peer-support specialists in the United States working in both clinical (e.g., community mental health centers, inpatient facilities) and non-clinical (e.g., homes, peer-run organizations) settings (Government Accountability Office, 2020). While this article focuses on the United States, comparable peer-support programs exist throughout the world within high-, middle-, and low-income countries at various levels of integration within the provision of mental health services (Krumm et al, 2022; Puschner, 2018).…”