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This paper aims to provide a summary of where peer support currently sits in the UK mental health services policy and practice. It presents an overview of models of peer support; the UK national policy on peer support; evidence of the benefits of peer support; case studies of recent and continuing peer support in action; challenges facing peer support; and suggestions for developing peer support in the future.

The paper selects and discusses evidence from academic literature and policy and practice on peer support within the UK.

The evidence base demonstrating the benefits of peer support in mental health across the UK is increasing. This has persuaded UK governmental bodies to encourage the development of peer support services, of which there is a number of models and examples, although the current economic climate poses challenges to their development.

Historically, peer support in mental health services across the UK has developed piecemeal. But at a time when policy-makers, health practitioners and people who use mental health services are increasingly recognising the benefits of peer support, this paper draws key evidence together and provides pointers towards the future development of such services.

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.

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 report the findings of a third-sector community review into peer-to-peer best practices in mental health service provision in Sussex. This community initiative was funded by the Big Lottery to explore the benefits of the peer-led approach on individual and public health outcomes and identify avenues for partnership working.

A total of 131 participants who had engaged with peer-to-peer services both as receivers and providers of support were invited to share knowledge and best-practice expertise via a survey, focus groups and a public consultation day.

This case study review suggests peer-to-peer support services as an innovative approach to reducing suicide, self-harm, reliance on public health services (GPs, hospital stays, etc.) and engaging with drugs, alcohol and criminal activity. In addition to offering a holistic and social approach to mental health, it further identifies that engagement in peer-to-peer activities potentially provide long-term benefits by reducing the stigma associated with mental health conditions and treatment. This review highlights the importance of third-sector groups in providing peer-to-peer mental health support services. It recommends a network of Peer-to-Peer services to share best practices and improve partnership working.

Conducted by and for people with personal or family experiences with mental health challenges, this review captures the often inaccessible ideas of a highly marginalised group. It communicates how they would prefer to work in partnership with academic institutions, public and statutory service to improve individual and community health outcomes.

This chapter will provide an overview of the lived experience and peer support context and draws on the origins of peer work in mental health arenas. The recovery movement will be discussed and peer support will be put in context as an alternative/adjunct/complimentary role to the predominant biomedical model. What is the role of peer support in mental health settings? What is it that a peer does on a day-to-day basis? What are the principles and practices that a person with lived experiences engages in to operationalise peer support? What are the outcomes associated with peer support working and what does peer work look like when it works well? What type of settings does the peer work in and what teams are they a part of? This chapter explores some of the challenges peers face when integrating into teams and organisations. The dominance of the biomedical model will be discussed and how this can potentially impact on the peer's role in these settings.

The purpose of this paper is to review current perspectives on peer support in mental health informed by service user perspectives.

The paper is informed by a literature review and consultations with five groups of service users engaged in different forms of peer support.

The findings suggest that there are many benefits to service users from engaging in peer support. These include: shared identity; development and sharing of skills; increased confidence; improved mental health and wellbeing; and the potential for challenging stigma and discrimination. Most difficulties encountered were associated with “intentional peer support”, where service users are employed as peer support workers – these included role conflict, setting boundaries, and ensuring adequate training and support. A key theme that divided opinion was the degree to which peer support should be “professionalised” as part of statutory services.

The findings suggest that it is vital to acknowledge the different views about peer support that arise in different service user and voluntary sector groups: views about such core issues as payment, equality, and professionalisation. Ultimately, peer support arises from people wanting to create their own support networks; any plans to formalise it from within statutory services need to acknowledge that pre‐existing grassroots expertise.

Recent developments mean that peer support, which originated from the grassroots of service user experience, has taken a new direction through becoming incorporated into statutory services. This paper looks at some of the benefits and pitfalls of these developments informed by the views of service users.

The purpose of this paper is to provide an overview of the implementation of a peer support volunteer scheme in a high secure setting and to explore the peer support volunteer’s experiences conducting this role, based predominantly on an assertive rehabilitation ward.

This paper has outlined the implementation of the peer support volunteer scheme in a high secure setting and has explored the peer support volunteer’s experiences conducting this role and has explored the views of newly transferred patients who have accessed this scheme. The peer support scheme is based predominantly on an assertive rehabilitation ward. The data have been collected through the completion of detailed questionnaires that have been disseminated to participants through the clinical team.

This paper has outlined the implementation of a peer support scheme on an assertive rehabilitation ward within a high secure forensic mental health setting. This paper has explored the role and experiences of a peer support volunteer on an assertive rehabilitation ward and has explored the experience from a service recipient’s perspective also through the completion of questionnaires. This paper has explored the overall benefits of peer support within mental health services to both the volunteer, staff members and to a patient newly admitted to the ward, and has identified the skills that the volunteer is able to develop following contribution in to the peer support scheme.

This paper has acknowledged that there have been challenges introducing this particular scheme into mental health service teams. Challenges have included establishing appropriate boundaries and dilution of the role due to power imbalances, both between the peer support volunteer and the service recipient, but also between the clinical team that supervises the overall peer support scheme (Christie, 2016). The clinical team within this particular ward have been mindful with regards to the approach that has been utilised and has therefore, included the service users within the overall development of the scheme to encompass the recovery principles, but have continued to review the progression as a team and have taken into consideration all aspects of relational security.

The paper relating to the implementation of the peer support volunteer scheme in a high secure setting has not been published before and is not under consideration for publication with another journal.

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.

The purpose of this paper is to outline what peer support is, covering its history, variations and benefits, then goes on to discuss what the challenges have been to authenticity and what the future holds for peer support.

The authors argue for the necessity of service user leadership in peer support based on both the Service User Involvement Directorate’s (SUID’s) experience and UK-wide learning.

Peer support brings wellbeing and confidence benefits both to the supporter and the supported. However, the lack of understanding of what peer support is, the current climate of austerity and over-professionalisation can threaten the transformational power of genuine peer support.

Peer support is always evolving, and there are areas like the criminal justice service and secure services where more work needs to be done.

Commissioners/funders of mental health services should recognise the value of peer support and its potential for better wellbeing outcomes, while understanding the necessity of service user leadership to maximise its beneficial potential.

The paper looks at peer support at the point in time a decade after the formation of the SUID at Together and four years since the UK mental health strategy No Health Without Mental Health (Department of Health, 2011) and explores the challenges faced at a time when the value of peer support is generally accepted in legislation.

The purpose of this paper is to describe the development, implementation, delivery and evolution of a community-led, comprehensive, peer support service, including co-production approaches, peer support worker role development, outcomes, acceptability and lessons learnt over a five-year timeframe.

This case study presents a reflection on a charity’s peer support service development along with outcomes to highlight client progress.

Improvement in well-being as measured through the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) was evidenced along with demonstrating that the peer support service offers complementary support to Improving Access to Psychological Therapies (IAPT) services.

There was limited quantitative data, and that which existed was analysed on a service-wide basis as opposed to looking at individual components of the service.

This paper demonstrates the value of peer support provision as part of an overall primary care, community-based mental health service, including findings that suggest that for some individuals, where IAPT services did not help them as much, a peer-based service appeared to be more suitable.

The peer support service provided a complementary and alternative service to conventional primary care mental health services whilst offering individuals with lived experience to gain volunteering, employment and development opportunities.

Whilst peer support services have been well documented in the literature for clients experiencing serious mental illness, research on the use of such approaches in the management of common mental health difficulties including anxiety and depression is not as well established. The aim of this paper is to detail the experiences of a user-led charity in developing and delivering peer support services, including challenges encountered. Furthermore, this paper describes a peer support service that has been integrated with a co-existing low intensity IAPT service, reporting recovery rates for clients that have accessed both peer support and IAPT services.