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The emergence of COVID-19 has exacerbated and spurred the growth of mental health issues in ways that have challenged mental health workers tremendously. The complex nature of COVID-19 has made the need of mental health professionals extremely important. Hospital ward overcrowding, social distancing requirements, sequestrations, limits to face-to-face consultations have created barriers to mental health access, especially those in need of Certified Peer Recovery Specialists. Certified Peer Recovery Specialists play a critical role in the treatment of mental illness through their support and engagement of those recovering from substance abuse. Many in this role are hired because they have a strong skillset for help-oriented clinical work but are often challenged, especially in times like this to development and demonstrate leadership skills. This paper explores the nature and need to develop leadership skills and leadership challenges for people in this field through interpretative phenomenological analysis (IPA) and a content analysis of the current and seminal literature.

This paper explores the nature and need to develop leadership skills and leadership challenges for people in mental health through IPA and a content analysis of the current and seminal literature.

The essential necessity to invest in the cultivation of peer recovery specialists and mental health professionals as organizational leaders.

Hospital ward overcrowding, social distancing requirements, sequestrations, limits to face- to- face consultations have created barriers to mental health access, especially those in need of Certified Peer Recovery Specialists. Certified Peer Recovery Specialists play a critical role in the treatment of mental illness through their support and engagement of those recovering from substance abuse.

Peer support and other consumer-provided services have burgeoned within the USA during the past 30 years and are now a central component of mental health services nationally. However, their growth has been uneven and somewhat dependent on state initiatives, policies, and funding. Recent programs have matured along myriad paths, resulting in a variety of program typologies, service structures, and funding streams, but with common values, missions, and principles. The paper aims to discuss these issues.

The landscape of peer specialist services in the USA, as well as innovations afoot, is reviewed. The empirical information that speaks to the efficacy of peer support and the need to better understand the mechanisms by which it is effective is described.

Although peer support has grown exponentially across the USA, its growth has been uneven. Evidence suggests that peer specialists experience role ambiguity within many existing programs and systems. Though the empirical evidence for peer services has grown, research has been most favorable for manualized, group interventions. There is still a need to better understand how individual peer support is beneficial and effective, and how individual peer support can best be utilized to promote the best outcomes for those served.

In order for the workforce of peer support specialists to continue to grow and for services to be responsive and innovative, we need to better understand the mechanisms by which peer support is beneficial and how it can be structured and delivered to promote the best outcomes for those served. The “core conditions” of helping relationships promulgated decades ago by Rogers along with research on self-disclosure may be useful frameworks for understanding and researching the effectiveness of peer support.

More research is needed to better understand the effectiveness of peer support services and how best to insure that they are well-integrated into the mental health programs and systems in which they serve.

There is a need to understand why peer support is effective and how best to sustain peer specialists in their roles within the mental health system.

This paper aims to focus on The Pillars of Peer Support initiative, an ongoing project to examine and develop the principles of peer support services. These services are differentiated from peer support and define the parameters of a certified workforce that promotes recovery and fosters wellbeing. This process is based upon the lived experience of the peer support specialist.

A review of the literature indicates that a range of models and activities for peer support services have been developed, and established outcomes for these services are emerging. Since Medicaid has defined peer support services as reimbursable, the workforce has continued to expand. The Pillars of Peer Support initiative is designed to provide a standard set of principles to guide states in their work with Medicaid, and others in the development of this workforce.

The results of three Pillars of Peer Support summits are presented. This includes the 25 Pillars that have been developed and their role and use in state funded and other services. Additional findings support the process through which states and others can build these resources. A statement of how Peer Support Services fit within an essential health benefits package is also included.

The workforce of certified peer specialists is rapidly expanding. Their role in providing peer support services is identified, and principles to guide their professional roles are presented. This will help guide the field in the development and deployment of this important component of the healthcare delivery system.

The purpose of this paper is to examine the gap between recovery-oriented processes and clinical outcomes in peer support, an exemplar of recovery-oriented services, and offer suggestions for bridging this gap.

This viewpoint is a brief review of literature on peer support services and gaps in outcome measurement towards building an evidence base for recovery-oriented services.

Clinical outcomes like hospitalizations or symptoms remain a focus of research, practice and policy in recovery-oriented services and contribute to a mixed evidence base for peer support services, in which recovery-oriented outcomes like empowerment, self-efficacy and hopefulness have more evidentiary support. One approach is to identify the theoretical underpinnings of peer support services and the corresponding change mechanisms in models that would make these recovery-oriented outcomes mediators or process outcomes. A better starting point is to consider which outcomes are valued by the people who use services and develop an evaluation approach according to those stated goals. User driven measurement approaches and more participatory types of research can improve both the quality and impact of health and mental health services.

This viewpoint provides a brief review of peer support services and the challenges of outcome measurement in establishing an evidence base and recommends user driven measurement as a starting point in evaluation of recovery-oriented services.

The integration of peer support workers with lived experience of mental health problems into existing mental health services has been found beneficial in some ways. However, some peer support workers have experienced unique challenges in terms of role confusion and limited opportunities for networking and support. Qualitative research and evaluation regarding peer support worker integration is limited. This paper aims to address this issue.

The current paper presents a qualitative evaluation of the experiences of two peer support specialist (PSS) workers and their managers within one UK mental health trust. The PSS workers and managers were interviewed individually using a semi‐structured format. Thematic analysis was applied to the interview transcripts.

In agreement with prior research and evaluation, positive experiences and challenges were identified in relation to PSS employment, both for PSS workers and their teams. Overarching themes concern the PSS worker as “other”, the PSS worker as a “change agent”, and “readiness for PSS worker employment”.

The evaluation is limited by the small sample size but the findings could be used to inform the integration of PSS workers into other existing services. This evaluation begins to untangle some of the tensions around the integration process. Strategies to support PSS integration based on the recommendations of participants and the findings of the current evaluation are presented.

There has been a significant growth in the employment of peer workers over the past decade in youth and adult mental health settings. Peer work in mental health services for older people is less developed, and there are no existing peer work models for specialist mental health services for older people in Australia. The authors developed and implemented a peer work model for older consumers and carers of a specialist mental health service. The purpose of this paper is to describe the model, outline the implementation barriers experienced and lesson learned and comment on the acceptability of the model from the perspective of stakeholders.

To ensure the development of the peer work model met the needs of key stakeholders, the authors adopted an evaluation process that occurred alongside the development of the model, informed by action research principles. To identify stakeholder preferences, implementation barriers and potential solutions, and gain insight into the acceptability and perceived effectiveness of the model, a range of methods were used, including focus groups with the peer workers, clinicians and steering committee, consumer and carer surveys, field notes and examination of project documentation.

While the model was overall well received by stakeholders, the authors experienced a range of challenges and implementation barriers, in particular around governance, integrating the model into existing systems, and initial resistance to peer work from clinical staff.

Older peer workers provide a valuable contribution to the mental health sector through the unique combination of lived experience and ageing. The authors recommend that models of care are developed prior to implementation so that there is clarity around governance, management, reporting lines and management of confidentiality issues.

People living with opioid use disorder (OUD) disproportionately encounter the criminal justice system. Although incarcerated individuals with OUD face higher risk for withdrawals, relapses and overdoses, most jails fail to offer comprehensive medications for OUD (MOUD), including recovery support services and transition of care to a community provider. The purpose of this paper is to describe the development and implementation of a comprehensive MOUD program at a large county jail system in Maricopa County, Arizona.

The authors used the Sequential Intercept Model (SIM) to develop a community-based, multi-organizational program for incarcerated individuals with OUD. The SIM is a mapping process of the criminal justice system and was applied in Maricopa County, Arizona to identify gaps in services and strengthen resources at each key intercept. The program applies an integrated care framework that is person-centered and incorporates medical, behavioral and social services to improve population health.

Stakeholders worked collaboratively to develop a multi-point program for incarcerated individuals with OUD that includes an integrated care service with brief screening, MOUD and treatment; a residential treatment program; peer support; community provider referrals; and a court diversion program. Recovery support specialists provide education, support and care coordination between correctional and community health services.

OUD is a common problem in many correctional health centers. However, many jails do not provide a comprehensive approach to connect incarcerated individuals with OUD treatment. The Maricopa County, Arizona jail system opioid treatment program is unique because of the ongoing support from recovery support specialists during and after incarceration.

Recovery is a key organising principle underlying mental health services, but remains under-researched in primary care. The purpose of this paper is to explore what recovery from psychosis means from multiple perspectives, the role of primary care in fostering recovery, and interventions that might enhance its promotion in primary care.

A total of 20 patients who had experienced psychosis and 24 General Practitioners (GPs) with varying expressed interest in mental health participated in semi-structured interviews, and were invited to two subsequent mixed focus groups. Data were analysed using Framework Analysis.

Recovery was conceptualised by GPs without a specialist clinical interest in mental health as improvements in symptomatic outcomes, by GPs with a special interest as improvements in social or functional outcomes, and by patients as a process involving a “whole person” approach. Both GPs and patients highlighted benefits of primary care including continuity, accessibility, and the role primary care professionals can play in supporting patients’ families, and helping patients expand social support networks. Despite feeling “fobbed off” at times, patients desired a shift in responsibility for psychosis from secondary to primary care.

Reflective peer supervision meetings for GPs and patient-led training might improve primary care's ability to provide a more recovery-focused environment.

This study provided original and valuable findings regarding how GPs viewed their own role in promoting recovery from psychosis. This study also provided original findings regarding how patients viewed the role of primary care in promoting recovery from psychosis.

The purpose of this paper is to gain understanding about the effectiveness of a forensic peer support program’s impact on reducing criminal recidivism. People with histories of mental illness returning to the community following incarceration face tremendous challenges in jails and prisons and in successful reentry to community. Transitioning from jails and prisons is fraught with additional challenges such as reconnecting or connecting with mental health and substance abuse treatment, finding adequate housing, finding employment, reuniting with family and friends, etc. Unfortunately, recidivism remains high, principally because of these challenges. Many state and local authorities have supported the development of the forensic peer specialist.

Kaplan–Meier survival analyses were conducted to examine time to re-incarceration.

The population served was determined to be a particularly high risk of re-incarceration population, when released from prison. All had a mental illness diagnosis, with 80 percent diagnosed with at least one serious mental illness, and more than 50 percent had three or more anterior incarcerations. Utilizing Kaplan–Meyer survival analysis, the chance of re-incarceration for participants after one year was of 21.7 percent. Surprisingly, in the first year after release from prison, participants did much better than those in the general US prison population when in terms of re-incarceration rates (21.7 percent vs 43.4 percent).

While preliminary findings of this approach, this study reaffirms the idea that forensic peer support programs are beneficial in reducing recidivism rates for people diagnosed with a mental illness coming out of prison, offering individuals supports to maintain their lives in the community.