"Is the Service Ready?": Integrating Peer Support Workers Within Community Mental Health: An Ethnographic Study from Trieste and its Region.

Abstract

Peer support, endorsed by WHO and national guidelines, is increasingly recognised as a key component of mental health care innovation. However, while peer support has gained increasing attention, the effective integration of Peer Support Workers (PSWs) within mental health services-and the systemic challenges it involves-remains a relatively under-investigated area. This study investigates the integration of PSWs in Trieste and its region, a pivotal site of Italy's psychiatric reform, where the deinstitutionalisation movement fostered the transition to a community-based care model. The present study adopted an ethnographic methodology, encompassing a six-month field study involving participant observation and 22 semi-structured interviews with 12 PSWs and 10 mental health professionals. PSWs contribute to enhancing empathy, user engagement, and social inclusion, while also fostering a recovery and community-oriented approach to care. However, challenges have emerged, including role ambiguity, institutional under-recognition, and professional resistance. These tensions often reflect broader issues around power dynamics and the epistemic legitimacy of lived experience. The study also identifies strategies to support PSW integration, including safeguarding practices, interprofessional training, and institutional recognition. In addition to their clinical and relational contributions, PSWs offer an opportunity for mental health services to critically reflect on their practices, assumptions, and power structures. Their meaningful inclusion can catalyse a shift towards more participatory, rights-based, and recovery-oriented care.