Self-stigma, which comes from public stigma that’s been internalized, can have a significant negative impact on those of us living with mental illness. Peer support can help to reduce self-stigma, and I wanted to explore that and some of the other benefits that research has shown.
Peer support can happen in a lot of different ways, including informally (e.g. in online communities), through stand-alone services (e.g. mutual support groups or peer support coaches), or as part of health care services. There seems to be a push towards traditional mental health services incorporating peer support specialists.
Characteristics of peer support programs
Before we look at what some of the benefits are, a good place to start is what kind of peer support models the research has been evaluating. It sounds like a lot of the research has looked at peer support services targeting people with severe mental illness.
The Mental Health Commission of Canada (MHCC) says:
Peer support programs work by offering people support, encouragement, and hope that recovery is possible. Peer support considers the wellness of the whole person and focuses on health and recovery rather than illness and disability, in order to assist people in finding their own path to recovery.
A briefing from the UK-based organization ImROC (Implementing Recovery Through Organizational Change) came up with eight core principles of peer support:
- mutual (shared experience of mental illness)
- reciprocal and non-hierarchical
- emotionally safe
Elements of effective peer support programs
A review of existing research conducted by the Centre for Addiction and Mental Health (CAMH) identified key characteristics of effective peer support programs. These include:
- effective training and supervision (Mental Health America has developed a National Certified Peer Specialist certification program, and the MHCC has developed peer support training guidelines)
- provision of social connection and support in way that promotes empowerment rather than being directive
- creation of a safe, respectful environment where people can feel heard
- ongoing engagement with other peer support workers as well as proactive engagement of program participants
- characteristics of effective peer support workers: good communicators, authentic, motivated, calm, good judgement, compassionate, optimistic, and accepting
- peer support workers should be doing well in their recovery
Benefits of peer support
Research has identified a number of potential benefits of peer support. The CAMH review found that peer support workers (PSWs) are in a better position than health professionals to support improvements in several areas:
- self-efficacy (a sense of being capable of doing things)
- social inclusion
- belief that recovery is possible
Stigma researcher Patrick Corrigan has called empowerment an antidote to self-stigma (source). Accessing peer support can help to reduce self-stigma, and this may be related to how it affects the way we construct our identities in relation to mental illness (source).
Peer support can also help people to stay in treatment and promote self-confidence and ability to function.
ImROC identified other potential benefits, including improved problem-solving skills, improved access to work and education, and greater feelings of being accepted, understood, and liked.
A report from the Centre for Mental Health in the UK noted that PSWs can play a unique role in helping people to make sense of their illness and how it’s affected their lives. They’re able to move away from the focus on symptoms and dysfunction that’s common in the health care system. A couple of studies have shown that frequent contact with PSWs has improved people’s stability in employment, education, and training. Besides benefits to clients, PSWs themselves can also benefit in terms of feeling empowered, more confident, and less stigmatized.
Mental Health America has also weighed in on the value of peer support, concluding that it reduces inpatient days, re-hospitalization rates, and overall cost of health services. They also found evidence that peer support improves quality of life.
Potential benefits in health care services
The ImROC report noted that there’s some indication that incorporating PSWs on inpatient units can improve patient experiences and outcomes. I can see peer input being particularly valuable in initiatives to decrease the use of seclusion and restraint. I also see a lot of value in getting feedback from people with lived experience on whether services that claim to be recovery-oriented and trauma-informed actually look that way from a service user perspective.
The last nursing job I had was at a program that management said was all about recovery, but their policies and actions were completely contradictory to that. They employed PSWs, but those workers didn’t have any input into how the program was actually run. I think that patient voice in higher-up decision-making is a really important thing to have, although that doesn’t happen very often.
The recovery college model
The recovery college model was first implemented in the UK in 2007 (source: ImROC). It involves recovery-focused, strengths-based programming that promotes personal growth. It may involve providing information about mental illness and forms of treatment, teaching life skills, or developing strategies for living with mental illness. Courses are co-designed and co-delivered by health professionals and people with mental illness. They’re accessible to everyone, unlike mental health services that have specific mandates and require referrals. Participants have reported being able to achieve personal recovery goals, having increased hope, and experiencing less self-stigma. Peer leaders have also reported enhancement of their own wellbeing.
Here in Canada, the Canadian Mental Health Association (CMHA) has started implementing recovery colleges. They also use a co-production and co-delivery model. In a white paper on the topic, they say their courses focus on “empowering students and utilizing critical reflection to develop strengths and competencies. Examples of critical reflection include class discussion, reflective journaling, arts-based learning, and physical expressions such as dance or movement.” In a survey of students who had taken courses at the Calgary Recovery College, 96% felt more hopeful and 81% gained a skill or information to support personal wellness.
Examples of courses at the CMHA Calgary Recovery College include A Good Night’s Sleep, Adulting 101, Building Better Boundaries, Challenging Procrastination, Coping with Current Events, and Managing Your Inner Critic. It looks like courses range from 1-4 sessions.
The role of online communities
There’s been some research on peer support in social media communities, but I didn’t find anything that specifically addressed the topic of self-stigma. I think informal peer support in online communities is more accessible and can occur more organically than peer support services, but there are also inherent downsides to the online world, like trolling and fostering comparisons.
I’m sure it would have been harder in the pre-internet days to connect with peers dealing with mental illness, and that sounds very isolating. Having these kinds of online peer communities helps with feeling like part of an in-group, even if it’s not the mainstream in-group. I think my own life would be much more difficult without this supportive peer community.
Thoughts on the role peer support
I’ve never participated in any kind of formal peer support. A couple of places I’ve worked have had PSWs, but in my role, I didn’t work closely with them. I like the recovery college idea; in a way, it offers an in-person version of some of the things you can get out of blogging.
I don’t see peer support as being a replacement for professional treatment, but I can certainly see it placing a positive adjunct role. A key piece is that it shouldn’t just be a matter of tokenism on the part of health care providers; I see it working best if there’s genuine teamwork, and if the people at the top are actually listening.
I can also see why it can help to reduce self-stigma. In real life, a lot of us don’t have many people in our lives (that we know of) who are dealing with mental illness, and I think there’s a lot to be said for being able to share that insider perspective to help normalize mental illness experiences.
What are your thoughts on the potential benefits of peer support?
This video comes from the Health Foundation in the UK.