Peer Support: A Call for a National Strategy Executive Summary

Foreword – Sean Duggan OBE – Chief Executive of the Mental Health Network, NHS Confederation

The Peer Support Worker role is one of the most exciting new roles that are being deployed across England as part of the Long Term Plan. Both employed and voluntary Peer Support Workers are now found in most adult mental health teams across the country and Health Education England continues to fund an accessible and effective training programme that ImROC along with others is delivering.

In these times of acute pressure on services, it can be difficult for staff to find time to develop safe, supportive and empowering relationships with people who use services. This is exactly what peer support workers are trained and employed to do. Because they know what it feels like to be on the receiving end of services, they constantly remind us about how to make our routine language, practices and processes more recovery focused. I have seen the inspiration and hope that peer support workers bring to others; to staff as well as people using services. I am continually impressed by the courage and resilience that peer support workers have shown in achieving their own recovery goals.

I am pleased to add my personal endorsement of the peer support worker role and the call for a national workforce peer support strategy.

Celebrating 10 Years of Peer Support

Within ten years the role of peer support has evolved in UK health services in a dramatic way. From being an informal, peripheral role, peer support workers are now employed within most mental health trusts, and there are plans to expand these numbers further and at scale. Peer support workers are employed to use their lived experience of having a mental health or long-term condition in order to support others. The approach is underpinned by a specific values base, which pays attention to equality and emotional safety within relationships.

For decades, people who use services and survivors have campaigned for the inclusion of people who explicitly use their lived experience into the health workforce, and for many, the expansion of peer support is a huge achievement. It is hoped that their inclusion into the workforce will contribute to a culture change away from an expert-patient, illness based paradigm, and toward a strengths based, trauma informed approach, where the individual is truly seen as the expert in their own life.

The key milestones in the development of peer support in the last decade include:

● The values that underpin peer support have been well- defined, are becoming increasingly well-articulated, with different iterations for different cultural/geographical and service groups

● The evidence base for peer support is well established, with findings showing that it brings about the same or better outcomes as traditional approaches. Qualitative and user- led research demonstrates a clear need for peer support, and highlights the most effective methods for researching peer support

● Peer support workers are included in local and national workforce plans, with numbers set to grow up until 2024

● The peer support worker Competency Framework has been developed by Health Education England, with ImROC and other organisations to support the commissioning, development and training of peer support workers/peer worker roles

● There is growing clarity and acceptance of peer support within inpatient and community mental health services

● The development of a peer worker apprenticeship is a further step in formalising the peer worker role and offering a different route for progression and development for some peer workers

The Challenges that Peer Support Continues to Face

While for many, these milestones reflect a true acceptance and investment in peer support on a national level, for others they are signs of something more troubling. As peer support becomes more formalised, and peer workers are increasingly described in the same way as other professional groups, challenges to the original vision of peer support are presented. The ImROC evaluation of peer support in 2022 is that…

● There is risk that peer support will be homogenised with specific competencies that are expected to work within all settings when peer support needs room to evolve and be tailored to different service and geographical contexts

● Peer support may be co-opted by professionally led institutions, even while they are attempting to invest in its success. There has been disagreement with the methods used to develop the national competency framework, and subsequently with the competencies themselves

● As peer support is introduced into challenging, illness based, expert led services, peer workers struggle to maintain a connection to their own values base and unique way of working and risk emulating being consumed by the cultures that they work in

● Peer support workers continue to report that they have negative experiences within their working contexts due to stigma and lack of understanding about their role

● There is a noticeable lack of leadership and progression opportunities for peer workers

● There is a need to focus on cultural competency within peer support, which can define lived experience narrowly as relating to mental health, rather than acknowledging how broad experience intersects with other experiences of oppression or privilege

Planning the Peer Workforce for the Next 10 Years

With the endurance of the peer support role and increasing numbers of peer support workers it is time for a clear overarching vision for peer support in England and across the United Kingdom.

For peer support to truly develop ImROC is recommending that the current focus on training peer support workers (in terms of numbers) should now lead to strategic thinking and planning, taking into account the bigger issues of culture and systemic contexts that peer support workers find themselves in.

● Strategy both at an organisational and national level to enable infrastructures that support the introduction of peer support into the workforce as part of current transformations

● Peer Leadership, also at an organisational and national level, with meaningful and supported peer leadership roles at every level of services. This should include the development opportunities to enable progression into peer leadership roles within mental health services. Peer leaders need to recognise the roots of peer support and be enabled to speak from these roots to support wider cultural change

● Reuniting with the roots of peer support

● Critical focus on diversity and inclusion in the development,
delivery and reach of peer support

● Peer support co-ordinated at a locality level with all services that offer peer support

Peer Support – A Vision for the Longer Term

We believe in a future where every person using health and social care services is able to be met and benefit from working with a person with
shared lived experience. These services will welcome peer support as a new occupation and there will be clear strategies in place that support peer workers in their training and ongoing development.

Peer workers will be supported by senior peers, offered co-reflection from within their organisation and feel connected to the bigger picture of peer support through national networks developed for this purpose. We seek to support the cultures of services in the future that will:

● Welcome peer support as new occupation

● Recognise the complementary values of peer support across all sectors

● Adjust the values and principle-based peer support role across different groups

● Recognise the evidence for peer support

● Welcome and support peer leaders

● Be led by a national strategic vision for peer support working