Peer support is delivered by individuals who have lived experience of mental health difficulties. These peer support workers draw on their own experiences to support people with mental health conditions, making them uniquely positioned to facilitate recovery through empathy.

Researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London and University College London (UCL) collated and summarised the available evidence from published reviews to understand the effectiveness, implementation, and experiences of paid peer support approaches for mental health.

The systematic umbrella review, published in BMC Medicine, is one of the largest reviews of peer support to date. Collaborating with people with lived experience of mental health and peer support delivery, the researchers analysed 35 existing reviews, which included a total of 426 individual studies and between 95 to nearly 41,000 participants.

Although results on the effectiveness of peer support were mixed, researchers found evidence that peer support can aid mental health recovery, depression (particularly perinatal depression), and self-belief. Experiences of peer support included improved wellbeing for peer support workers and service users, but the role could feel unsupported and subject to some stigmatising views from non-peer staff.

The researchers identified key barriers to successful implementation and guidance to overcome these.

When exploring the experiences of service-users, peer support workers, and non-peer staff, researchers discovered that numerous reviews highlighted the advantages of peer support. The findings showed it was mutually beneficial for peer support workers and service users, with both experiencing improved wellbeing and recovery from delivering or receiving peer support. Service users also reported that peer support normalised and de-medicalised their experiences, reducing feelings of self-stigma.

However, the researchers also identified challenges to the role. Some peer support workers reported the ‘sick’ label stayed with them in the role, with non-peer staff at times concerned that their mental health would impact their work. A lack of clarity about the job description and low pay could lead peer support workers to feel the role was undervalued and tokenistic. This could affect their own recovery and led to uncertainty in their responsibilities with service users.

Good implementation of peer support was found to include co-design with people with lived experience, clear job descriptions, a recovery-oriented, supportive, and trusting workplace culture, and appropriate training for peer support workers and non-peer staff. However, barriers to peer support being implemented, included a lack of time, resources, and appropriate funding, and a lack of recognised peer support worker certification.

Professor Sonia Johnson, senior author and Professor of Social and Community Psychiatry at UCL, said:

"It’s widely acknowledged that paid peer support is an important approach to mental health care, now and in the future. However, there is still a lot of uncertainty about the best way to do it right. Our review offers valuable pointers to help service providers deliver peer support that is beneficial to both service users and the staff providing it. Moving forward, we hope to see more research that is co-produced with service users so we can better understand which types of peer support work for who, and in what settings."

The study is funded by the NIHR Policy Research Programme. The NIHR Policy Research Unit in Mental Health, established at King’s and UCL, conducts rapid research to inform mental health policy at DHSC, NHS England, OHID and other government bodies.

‘The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review’ (Ruth Cooper, Katherine Saunders, Anna Greenburgh, Prisha Shah, Rebecca Appleton, Karen Machin, Tamar Jeynes, Phoebe Barnett, Sophie Allan, Jessica Griffiths, Ruth Stuart, Lizzie Mitchell, Beverley Chipp, Stephen Jeffreys, Brynmor Lloyd-Evans, Alan Simpson, Sonia Johnson) was published in BMC Medicine (DOI: 10.1186/s12916-024-03260-y).

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