Providing formal mental health peer support: what does that mean for peer supporters?

Abstract

The aim of this thesis was to understand the effects of formal mental health peer support interventions. It is presented as four papers: (i) a narrative synthesis and meta-analysis of peer support intervention studies that have published data on outcomes of empowerment, self-efficacy and internalised stigma for peer support recipients; (ii) a study to develop consensus on the essential components, personal costs, personal benefits, barriers and facilitators involved in providing peer support; (iii) a study exploring relationships between experiences of providing peer support and empowerment, hope, recovery, quality of life and internalised stigma for peer supporters; and (iv) a paper presenting a critical appraisal and personal reflections on the research process. In the review paper, 23 studies were identified that met inclusion criteria. Interventions were categorised as: peer-led group interventions; individual peer support; and peer-run services. Most studies were moderate to weak in quality. Meta-analyses were conducted for peer-led group interventions; results suggested these can result in small but significant improvements in empowerment and self-efficacy compared to treatment-as-usual. Evidence was inconclusive for individual peer support, peer-run services, and for internalised stigma as an outcome; more high quality research is needed in these areas. The second and third papers are presented as linked papers; they report analyses from a cross-sectional online and postal survey with a sample of 147 peer supporters in the UK. In the second study, a list of statements was initially generated through literature review and consultation with experienced peer supporters, and then rated by participants in two further rounds. Consensus was reached on statements pertaining to essential components (n=67), personal benefits (n=21), barriers (n=1) and facilitators (n=35). Results indicated that providing peer support involves many skills and that a wide range of personal benefits come with the role. There were differences between peers providing support in statutory versus non-statutory settings. Recommendations are made for role development and career progression, and future research to better-understand personal costs and benefits. In the third study, relationships were examined between participants’ levels of empowerment, hope, recovery, quality of life and internalised stigma, peer support experiences, and total number of personal costs and benefits endorsed. Differences were examined between those who provided support in different settings and with different role-experiences. Experiences did not significantly relate to constructs measured, apart from quality of life. More personal costs was significantly negatively related to empowerment and quality of life; however, many personal costs were related to structural issues which organisations can minimise . Peer supporters endorsed almost twice as many personal benefits than costs including improved wellbeing, reduced service-use, increased social functioning and skill-development. There were no significant group differences. Both papers discuss how peer support may be best facilitated by organisations. The fourth paper provides further explanations for research decisions made and a critical appraisal of the work undertaken, considering the wider context of clinical practice, theory and empirical evidence. Personal reflections on the research process are presented.

Date of Award	31 Dec 2017
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Anthony Morrison (Supervisor)