A systematic review of the barriers and facilitators to lived experience involvement in mental health services

INTRODUCTION: Individuals with lived experience of mental health conditions provide a unique perspective to mental health services. In this systematic review, a broad definition of 'involvement in mental health services' was used, which included peer support, peer mentors, and peer specialists. This review aimed to explore the barriers and facilitators reported to peer involvement in mental health services, to develop an understanding of the impact on the 'peer' and mental health care.

METHOD: Five bibliographic databases were systematically searched (inception to May 2024) for qualitative studies, to identify the barriers and facilitators of peer involvement in mental health services. Data were analysed using the COM-B (capabilities, opportunities, motivation, and behaviour) model and Theoretical Domains Framework (TDF) to provide a theoretical framework for understanding the behaviour of being involved in mental health services.

RESULTS: The thirty-three studies included in this review provided data across all components of the COM-B model and eleven of the TDF domains. Barriers included the wider staff teams' lack of knowledge about the peer role, which impacted the peers' capability to be involved. The conflict between the professional peer role and identity impacted peers' motivation, positively and negatively, to remain involved. A lack of social support led to peers feeling stigmatised and excluded from the wider team. When peers felt supported, they could use their skills and lived experience knowledge to drive change in the system.

DISCUSSION/CONCLUSION: This review provides insight into the barriers and facilitating factors experienced by individuals in peer involvement roles within mental health services. The wider implications challenge the notion that peer involvement reduces stigma and discrimination. This review highlights that peer involvement can sometimes increase peers' experience of stigmatisation, specifically when involved in mental health services.