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The purpose of this paper is to provide a perspective on peer work and insights from Flourish Australia’s journey in growing a thriving peer workforce. Flourish Australia is a large not-for-profit organisation that has been supporting people with their recovery journeys for over 60 years. The organisation provides, predominantly, non-clinical community-based support to enable people who live with a mental health issue and/or psychosocial disabilities to lead contributing lives in their community.

Flourish Australia developed and implemented a number of strategic directives in order to support the growth of a peer workforce. Central to these directives were policy positions that encouraged a shared understanding of the value and contribution that people with a lived experience of a mental health issue add to an organisation. From this policy foundation, the Why Not a Peer Worker? strategy and Transformation Peer Worker strategy were implemented and embraced by hiring managers across the organisation.

The “Why Not a Peer Worker?” campaign, coupled with the Transformation Peer Worker strategy, resulted in an increase in Flourish Australia’s peer workforce of almost 600 per cent over an 18-month period to now number 145 positions.

This paper provides organisations who are seeking to develop or grow their peer workforce with practical ideas that have been successfully implemented by Flourish Australia that can be discussed and debated when developing a peer workforce.

This paper provides unique insights into Flourish Australia’s peer workforce journey.

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 study was to identify and understand the barriers and enablers to the implementation of youth peer support in a clinical mental health service. The development of a lived experience workforce in mental health is a key component of policy at both the state and the federal level in Australia. Implementing a peer workforce within existing clinical services, however, can be a challenging task. Furthermore, implementing peer support in a youth mental health setting involves a further degree of complexity, involving a degree of care for young people being invited to provide peer support when they may be still early in their own recovery journey.

This paper reports on a formative evaluation of the beginning stages of implementation of a youth peer workforce within an existing clinical mental health service in Melbourne.

The project found that it was feasible and beneficial to implement youth peer support; however, significant challenges remain, including lack of appropriate training for young people, uncertainty amongst clinical staff about the boundaries of the peer role and the potential for “tokenism” in the face of slow cultural change across the whole service.

Very little evaluation has yet been undertaken into the effectiveness of implementing peer support in youth mental health services. This paper offers an opportunity to investigate where services may need to identify strengths and address difficulties when undertaking future implementation efforts.

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.

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.

Recently, the importance of a lived experience workforce in the delivery of mental health services has been demonstrated. The roll-out of the National Disability Insurance Scheme (NDIS) in Australia has generated the need for a significant increase in the disability workforce, including psychosocial disability. The purpose of this paper is to describe the strategies outlined in the One Door Mental Health Lived Experience Framework (LEF), which is the culmination of over 30 years of experience in providing mental health services and the employment of a lived experience workforce.

One Door developed and implemented the LEF, a thorough guide to the employment and support of a workforce of people with lived experience of mental illness, through consultation with consumers, carers, stakeholders, practice advisors, management, human resources and employee focus groups.

Extensive support structures in the LEF are key to achieving the benefits of a lived experience workforce. The LEF has positioned One Door successfully for the achievement of key organisational goals in mental health support and advocacy.

Mental health policies and support are critical for productivity outcomes in any workplace regardless of the level of lived experience of the employees. This paper provides organisations, particularly those within the mental health sector, an example to build on in their own employment and support strategies.

This paper is of particular value in the context of organisations in the mental health sector transitioning to the NDIS.

This paper aims to explore the use of lived experience research in peer work.

A suite of user-friendly and engaging lived experience research resources was introduced to consumers by peer workers. In-depth interviews were conducted with 33 consumer participants and five peer workers about their experiences. The data were analysed using qualitative content analysis.

The role of the peer workers appeared critical in ensuring that participants, despite their varied needs, preferences and backgrounds, derived optimum benefit from each resource. Features in resource delivery that promoted a positive experience included presenting the resources in the context of an existing relationship, providing clear explanations, going through resources together, encouraging reflection, taking enough time; and flexible delivery. Peer workers viewed the resources as potentially useful in their everyday peer work and as a valuable addition to their peer work toolkit.

The benefit of lived experience research to consumers is likely to be optimised by supportive and thoughtful delivery of the resources. Peer workers have the skills and are in an ideal position to do this. Bringing lived experience research to consumers provides peer workers with a potentially unique and helpful approach for supporting and promoting recovery and is congruent with their overall practice.

Lived experience research has the potential to benefit consumers directly but is rarely brought to their attention. This paper is the first to examine the potential role of peer workers in introducing learnings from lived experience research to consumers.

Peer support workers are becoming more involved in mental health services in Australia. Peer support workers have had to overcome challenges and dilemmas whilst embedding their role within mental health settings. This includes coping with scrutiny from fellow colleagues, supporting consumers and managing their own mental health. The paper aims to discuss these issues.

This paper will explore the author’s perspective and experience of working as a peer support worker in a psychiatric hospital and how the skills, knowledge and values she has developed during her recovery from mental illness have been essential in undertaking the daily activities with consumers and clinicians, overcoming the challenges and dilemmas, and managing her own wellness.

The paper provides insight into the experience of a peer support worker at a psychiatric hospital for adults.

The author’s personal experience of being a peer support worker in a mental health facility.

Peer support work is increasingly becoming part of the delivery of health and social care services. However, in an Irish context, there is a paucity of research in this area. This study aims to investigate the experiences of peers and other key stakeholders across four sectors in Ireland.

Qualitative interviews (N = 35) were conducted with key respondents in mental health, substance use, migrant health and homelessness sectors. Data were analysed using thematic analysis and reported using an ecological framework.

Peer work is a slowly emerging area of practice, although mental health is further ahead in this journey. Findings suggest that peers are important additions to service delivery but also have various support and development needs. Organisations can encourage and support peers into employment through enacting human resource policy and practices, effective supervision, management and maintaining a positive working culture. Helping other professionals to understand the peer role and how it can function within the wider team is highlighted. National policy and governance structures can also support the emergence of the peer role, which exists in a highly complex arena.

Peers can play a meaningful role in supporting service users in four sectors of health and social care in Ireland. Structures and processes to help embed these roles into systems are encouraged across micro, meso and macro levels. Implications and limitations are discussed for moving forward with peer work.

To the best of the authors’ knowledge, this is the first study to include these four areas of practice simultaneously.