Implementing Peer Supports in Mental Health Services: A Perspective from the Field

Blog
Emma Opthof, Center for Health Care Strategies

Peer support is an approach to helping individuals in mental health or addiction recovery that is led by people with similar lived experiences who have had to navigate the challenges of the health care system.

The Better Care Playbook asked Benjamin F. Miller, PsyD, past president at Well Being Trust and Playbook Advisory Group member, to share his perspectives on the recent article, Implementation of Peer Support in Mental Health Services: A Systematic Review of the Literature. The article, published in Psychological Services in spring 2022, summarizes best practices for implementing peer support interventions and advancing recovery-oriented care in mental health provider organizations.

What are key takeaways from this article for the complex care field?

Peer supports have been used for mental health for centuries, with evidence around its effectiveness only increasing the last three decades. But despite the evidence, implementation and scaling up these interventions remains limited.

So, this article does something interesting. It uses the Consolidated Framework for Implementation Research (CFIR) to better understand how and why peer support interventions are implemented successfully. The goal of the review is to use that framework to help us understand ways that we can look at the barriers and facilitators, and there's several key takeaways for the field.

First, peer support interventions are effective, and they're an effective way to augment and complement additional services for mental health and addiction. We should be including them in any and all discussions we have on mental health care delivery.

Second, it's important that any leader or organization looking to onboard or integrate peer support services does so by clearly explaining what they are and what they are not. The lack of clarity around peer support works against system-wide adoption.

And finally, for peer supports to be most successful, it requires strong organizational leadership that commits to peer support and serves as an active vocal advocate for these services.

There are other key takeaways, such as the importance of training and maintenance, et cetera. But the bottom line is, like any new service implementation, it can be challenging for frontline practices, and this article offers suggestions as to how best to implement, according to the best available evidence.

What are the biggest barriers to implementing peer support services?

With any new program, there are significant barriers to adoption. Peer supports are not that different from any other program or service line that a practice or organization may choose to integrate. It requires careful planning, so that the peer supports are connected to existing care pathways and workflows. As the article highlights, it's critical that the organization is ready for change or ready for these new services and new people.  For example, without leadership buy-in and support, peer supports may largely fail, or at least be challenging for the staff attempting to implement the work.

You don't want the peer to be discounted or not given the same weight in their role as other staff, simply because they don't have a degree.

In addition, the article is pretty clear that anything that makes the peer feel as if they are not a part of the care team is a major barrier. From not allowing them into clinical team meetings to not providing them access to certain information, these issues can be a major impediment for implementation.

Without changing the practice culture to one where peers are actively valued, it's likely to lead to failure, and thus a major barrier. You don't want the peer to be discounted or not given the same weight in their role as other staff, simply because they don't have a degree.

What can service providers and program implementers apply from this resource to address those barriers?

A key theme is education. It's so important to make sure that all stakeholders are aware of what peer support services are, and the evidence that supports them. It makes the job of the peer a lot easier. In the same vein, it's vital that implementers create an inclusive culture that's welcoming of peer support.

It's so important to make sure that all stakeholders are aware of what peer support services are, and the evidence that supports them.

Throughout the article, the authors give multiple examples from the literature on what practices should consider when implementing peer supports. The CFIR domains, which include items like inner and outer settings and the process for implementation, can actually be really useful variables for folks to see what might enable success.

Each of the 19 articles that met the inclusion criteria for this study are broken down in tables, so that the reader can see specific examples of implementation using the CFIR criteria. I think this is tremendously useful and could be a nice guide for those looking to implement and better address the barriers around peer support.

What is the relevance of this article for policymakers who want to increase access to recovery-oriented mental health care?

This article holds up several important lessons for policymakers. First and perhaps the most obvious peer support interventions begin to address our significant mental health and addiction workforce crisis. Without embracing this aspect of the workforce, we run the risk of never having enough of the people we need when our communities actually need them.

Without embracing [peer support], we run the risk of never having enough of the people we need when our communities actually need them.

Second, policymakers may wish to consider these best practices when making funding decisions for mental health. Specifically, they may want to make sure that key implementation factors are laid out in any contract procurement so they can actively and proactively avoid any pitfalls.

Also, finding the right people to do this work will largely depend on laying out these clear expectations of what policymakers hope to see with their funding or contracting,

Finally, while not explicitly mentioned in the article, but always underneath the surface, and something near and dear to my heart, is financing. We need to make sure that there are very clear ways to pay for peer support services and pay the peers a livable wage. While many Medicaid agencies already pay for peer support work, Medicare remains absent from this policy party. Although there's federal legislation out there to address this, so far it has not moved forward.