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The National Day Services Modernisation Network was launched in January 2009 and is a collaboration between the Inclusion Institute (taking on the role previously held by the National Social Inclusion Programme), Mind, Rethink and Richmond Fellowship. The Network came about in recognition that many of those involved in modernising mental health day services were struggling with the same issues, often in isolation, and that there was a need for a forum to discuss and develop approaches to these issues.

The modernisation of day services presents many challenges. One key challenge is not to abandon the people that these have traditionally supported. Peter Bates from the National Development Team makes a plea for a modernisation process that clearly recognises the needs of this important group.

Helen Bird and colleagues report on a small‐scale research project completed in west Yorkshire that examined the effects of the closure of a traditional sheltered workshop on those who attended. The closure was contentious, and the report questions the centrality accorded to ‘social exclusion’ as a central feature of current policy and practice. They argue for a more nuanced approach, which reflects both service users' actual preferences and current social realities.

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.

A novel integrated staffing model for community-based residential rehabilitation services is described. The purpose of this paper is to achieve synergistic gains through meaningful integration of peer support and clinical workers within rehabilitation teams. Key features include the majority of roles within the team being held by persons with a lived experience of mental illness, the active collaboration between peer and clinical workers throughout all stages of a consumer’s rehabilitation journey, and an organizational structure that legitimizes and emphasizes the importance of peer work within public mental health service delivery. This staffing model is not anticipated to alter the core rehabilitation function and service models.

The emergence of the integrated staffing model is described with reference to the policy and planning context, the evidence base for peer support, and the organizational setting. A conceptual and contextualized description of the staffing model in practice as compared to a traditional clinical staffing model is provided.

There is a potential for synergistic benefits through the direct collaboration between horizontally integrated peer and clinical specialists within a unified team working toward a common goal. This staffing model is novel and untested, and will be subjected to ongoing evaluation.

The integrated staffing model may provide a pathway to achieving valued and valuable roles for peer workers working alongside clinical staff in providing rehabilitation support to people affected by serious mental illness.

The purpose of this paper is to describe the learning from a historical NHS vocational service development that focused on: mental health, employment and social inclusion – in an inner city area – involving service users, staff and commissioners.

It is a descriptive case study. A range of historical documents was content analysed and described through a first-person narrative: service user consultations, service specifications, audit records, outcome frameworks, internal service evaluations and published literature.

When vocational NHS service developments are grounded in what service users say helps them (person-centred, networked and co-ordinated approaches) the evidence indicates people can achieve their vocational goals.

The range of documents described is factual, although the learning insights from some of the service developments are based on personal judgements. The author was the responsible manager – personal bias is high. There is not enough robust evidence to warrant generalisation.

When employment and social inclusion are prioritised, as core business in NHS, outcomes and health impact can increase. Greater detail is needed from healthcare policy makers – focusing on who exactly should undertake this work and what the key commissioning social inclusion performance indicators are.

The bulk of literature on employment support focuses on promoting evidence from one model: individual placement and support. Evidence here indicates a broader range of activity (education, training and volunteering) can have value and health impact.

Alex Duffield describes a fascinating project at Bromley Mind to train and support people with lived experience of mental health difficulties ‐ peer support volunteers ‐ to run ‘drop‐in’ sessions at their centres.

The purpose of this paper is to explore what helped seven people in contact with secondary mental health services achieve their vocational goals, such as: employment, education, training and volunteering.

The authors used the practice of co-operative inquiry – staff and peer supporters co-designed an evaluation of vocational and peer support work with service users.

Service users experienced invalidating living conditions that caused serious distress. These life struggles included: isolation, trauma events and stigma. The impact involved distressing emotions such as: despair, fear, pain and confusion. In contrast, when service users experienced supportive validating conditions (trusting relationships, engaging in valued activity and peer support) they reported being able to learn, change and grow – finding their own way forward, to improve well-being and quality of life.

Qualitative analysis from in-depth interviews revealed a range of consistent themes that enabled the authors to visually represent these and “begin” developing a model of change – grounded in lived experience. Further research is required to develop this model.

The development of a model of change grounded in an invalidation/validation framework offers a different approach – in terms of how people are perceived and treated. This has relevance for Government policy development, clinical commissioning groups and practitioners.