The Experiences of Peer Support Workers in New

Zealand: Benefits and Challenges

Recovery approach

• The seeds of the recovery vision were sown in the aftermath of the era of deinstitutionalisation in the 1960’s and 1970’s

• The recovery approach is widely promoted as the guiding framework for the provision of mental health services in New Zealand and overseas (Mental Health Commission, 2007)

• The impact of the recovery approach is evident in the development of a variety of service delivery models and initiatives, including peer support

Deinstitutionalisation• Deinstitutionalisation is the process of replacing long stay

psychiatric hospitals with less isolated community health services for those diagnosed with mental disorders

• This can occur by releasing individuals from hospital as well as by removing processes that may create dependency, hopelessness and learned helplessness (Farhourya and Priebs, 2007)

• Due to deinstitutionalisation in mental health care it was recognised that community-based services needed to move beyond psychopathology and focus on restoration of community life and that clients being discharged into the community needed a bridge into supportive social networks and therefore not just the formal care provided by mental health services alone (Borus, 1981; Sharfstein, 1979)

Recovery model• Traditionally a medical model of mental illness focused on

total cure. Under this model recovery was narrowly defined as an outcome occurring at a discrete point in time after an illness, when one’s health was entirely regained

• However consumers regard themselves as being recovered even when they experience on going symptoms which resulted in a shift in the values of mental health services to understand a new meaning of recovery

• The new broader definition which emerged in the 1980’s and 1990’s defines recovery as living a satisfying, hopeful and contributing life even with limitations caused by an illness.

• Rather than focusing on symptom elimination, recovery is concerned with fostering a sense of meaning and personal comfort in one’s life as one grows beyond the catastrophic effects of mental illness

Peer support

• Social emotional support, frequently coupled with instrumental support, that is mutually offered or provided by people having a mental health condition to others sharing a similar mental health condition to bring about a desired social or personal change (Solomon, 2004, p3)

Why peer support works

• The helper therapy principle-increased sense of interpersonal competence as a result of making an impact on another’s life, (Skovholt, 1974)

• Social learning theory-people learn new behaviour through observational learning (Bandura, 1977)

Why peer support works

• Social comparison theory-individuals look to outside images to evaluate their own opinions and abilities (Festinger, 1954)

• Experiential knowledge-knowledge gained through experience rather than gained through information provided by others (Borkman, 1976)

• Social support-physical and emotional support provided to clients by family, co-workers and friends

Peer support• Peer support has been found to benefit

consumers, service providers and the mental health system (Davidson et al, 1999; Solomon and Draine, 2001)

• However most of the studies on peer support were conducted outside of New Zealand and there has been a scarcity of research in New Zealand despite New Zealand’s pioneering contribution to the recovery approach and the development of peer support services since the 1980’s

Current study

• This study aimed to investigate the role of peer support workers in mental health services and how this role impacts on their own recovery. It also examined the views that mental health staff hold towards peer support and explores the benefits and challenges of peer support for the mental health system. The study also aimed to address the cultural responsiveness of peer support services and how peer support services can be improved

Methodology• A qualitative approach was used with semi structured interviews• The study involved two groups of participants. The first group was

the peer support workers involved in mental health settings and the second group comprised mental health professional, peer support co-ordinators and colleagues working with peers support workers

• A total of 14 peer support workers and 9 mental health staff were interviewed

• Of the 14 peer support workers, 8 were male and 6 were female of which 8 were European, 4 were Chinese and 2 were Pacific Islanders. Age range was 29 to 79 years

• All peer support workers had a history of mental illness. Most were still on medication at the time of the interview. Six had a history of major depression (one with psychosis and depression), four had a history of bipolar disorder (one also had drug and alcohol issues), three had a history of schizophrenia. One didn’t want to discuss details of their mental illness

Methodology• All the mental health staff interviewed were female of

which 7 were European and 2 were Chinese• There were 3 team leader, 2 practice advisors, 1

rehabilitation psychiatrist, 1 service manager, 1 community mental health support worker and 1 general manager of learning

• Ages ranged from 26 to 59 years• Most worked on daily basis with peer support workers

except the community mental health worker, rehabilitation psychiatrist and general manager of learning who interacted with peer support workers on a monthly basis

Results: What supports recovery

• Instilling hope• Empowerment• Living a full life even with symptoms present• Enjoying life• Recovery is ongoing

Results: Motivation to become peer support workers

• Ability to relate to clients• Being with people

Results: Services provided by peer support workers

• Ranged from individual support to group work, including WRAP (wellness recovery action plan), community outreach and job net programmes

• Peer support was culturally specific so that Chinese peer support workers worked with Chinese clients and Pacific Island peer support workers worked with clients of Pacific Island descent.

• Ages of clients were 20-60 years• Hours that peer support workers worked ranged from 4

hours every two weeks to full time• Length of time being a peer support worker ranged from

6 weeks to 14 years

Results: Selection of peer support workers

• Selection of peer support workers was conducted by an interview which identified suitable candidates. It was deemed more suitable to employ peer support workers who had had a period of over 5 years since their last episode of mental illness

Results: Retention• Retention of peer support workers was

adequate however some peer support workers left for higher paying positions in other areas

Results: Training

• Training was dependant on the organisation in which the peer support worker worked. 5 had completed the WRAP training, 6 completed mind and body certificate in peer support, 1 completed IPS (Intentional peer support) training. 1 peer support worker completed diploma in mental health support work and 1 had done advanced training in management. 1 had not formal qualifications

Results: Support

• Peer support can be stressful therefore appropriate supports need to be put into place to provide ethical and safe practice. Support for peer support workers was by way of weekly meetings where peer support workers can discuss issues that arise. Support is also provided by other health professionals such as psychologists and nurses.

Results: Benefits to peer support workers

• Reduced isolation• Giving back/helping others• Changing perspectives on their own situation• Learning about oneself and self care• Work (which is flexible to peer support

workers needs, eg mothers)

Results: Benefits to clients

• Instrumental support• Emotional support• Social support• Minimised power differential• Mutual experiences• Confidentiality

Results: Benefits to the mental health system

• Positive attitudes of mental health staff• Breakdown of stigma• Peer support work promotes a recovery focus• Augmentation of care for clients

Results: Challenges• Not connecting with a client• Not enough funding or pay• Stigmatisation of peer support workers• Not being recognised• Risk• Stress• Boundary issues• Peer support workers not having worked before• Not enough research or recording of outcomes

Results: Cultural aspects

• Maori-most peer support workers have training on the treaty of Waitangi and some have had training in Te Reo however this study identified that there seems to be a lack of Maori peer support workers

• Pacific Island-in this study peer support workers commented that Pacific peer support services were adequate

• Chinese-more training in the Chinese language is needed

Recommendations

• Clients and peer support workers need to be better matched possibly by providing specific peer support services for certain groups

• Increased financial renummeration• Increased recognition of peer support by

providing more training, eg to psychiatric registrars

• Risk-all clients deemed to be at risk should be discussed with supervisor

Recommendations

• Stress reduction by appropriate support and feedback

• Boundaries maintained by establishing code of ethics

• Increased research• Peer support workers who hadn’t worked

before could have introductory workplace orientations and courses

• Increased peer support for ethnic minorities