The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis

Abstract

Background Peer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions. Method We searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data. Results Twenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery. Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support. Conclusions One-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support. Trial registration Prospero identifier: CRD42015025621.

Barriers and facilitators of peer support work in a large psychiatric hospital: a thematic analysis

“…[2][3][4] These newly minted mental health professionals were eventually integrated into a number of services in various mental healthcare settings, such as to support people with mental health conditions 5 , severe mental illnesses 4 6 and substance use issues. 7 Systematic reviews [8][9][10][11][12] supported these individual findings and demonstrated the effectiveness of integrating peer support workers into larger care teams. As a result of the benefit they bring to multidisciplinary care models, they have been integrated into community mental health teams 13 14 and supported employment teams 15 , where their presence is counted towards increased programme fidelity.…”

Relationship between satisfaction with mental health services, personal recovery and quality of life among service users with psychosis: a cross-sectional study

“…Our previous study did show that recovery-oriented treatment (i.e., Illness Management and Recovery), is associated with higher perceived support for personal recovery (article in press), and another study has shown that service users enrolled in Assertive Community Treatment (ACT) programs are highly satisfied with the care they receive, including those being on a CTO [ 40 ]. Other interventions with a significant evidence base to support recovery include 19 randomised controlled trials of peer support work [ 41 ], 27 randomised controlled trials of the Individual Placement and Support approach to employment [ 42 ] and the development of education initiative called Recovery Colleges in 22 countries [ 43 ].…”

Relationship Between Satisfaction With Mental Health Services, Personal Recovery and Quality of Life Among Service Users With Psychosis: A Cross-Sectional Study

“…Our previous study did show that recovery-oriented treatment (i.e., Illness Management and Recovery), is associated with higher perceived support for personal recovery (article in press), and another study has shown that service users enrolled in Assertive Community Treatment (ACT) programs are highly satis ed with the care they receive, including those being on a CTO (39). Other interventions with a signi cant evidence base to support recovery include 19 randomised controlled trials of peer support work (40), 27 randomised controlled trials of the Individual Placement and Support approach to employment (41) and the development of education initiative called Recovery Colleges in 22 countries (42).…”