Peer support bridges a care gap in serious mental illness

From user of psychiatric services to professional mental healthcare provider is not an easy transition. But it is one made by those few but important patients who become peer support workers. Their direct experience of illness and recovery – and of healthcare services -- offers a uniquely valuable mix of perspective, practical guidance and -- potentially -- inspiration.

“F”, who has a complex family history of psychiatric problems, and major life events, and personal experience of major depression, described her experience as a peer support worker in London, UK.

First, she emphasised, this is not about a knitting circle and eating muesli. She has worked for several years in a locked, intensive care psychiatric ward. Peer support can function even in a demanding environment where people are very acutely ill.

Both one of them and one of us

From the patient’s perspective, the peer support worker is not just “one of them” but also “one of us”. We know what it is like to be ill, we know what it is like to be well, and we know what it is like to be a service user.

The key principle is mutual respect. Even though part of the staff, there is reciprocity in the relationship between peer support worker and patient. And both stand to benefit. That is the second crucial point. Working for the recovery of others aids my recovery, F told the EPA Educational Track workshop on family and carers. The relationship with patients is a two-way street.

Peer support workers have lived experience of mental health issues

And peer support workers can contribute to recovery in many ways: by destigmatising mental illness, by contributing to a patient’s sense of agency, and by providing a model of a service user who is functioning dependably in a “normal” employment and social role.

It is a relationship built on empathy and trust, not diagnosis and treatment, but it may also include advice on the need to continue to take medication.

That said, peer support helps some patients but not others. And there are a number of challenging aspects to the role. The status is only quasi- professional and is not well defined; being a member of the healthcare staff but also an advocate for the patient can create conflicts of interest; there are sometimes difficulties in maintaining boundaries; and adequate provisions for supervision are not yet in place.