Guest editorial: re-balancing the discourse, inviting critique and welcoming marginalised voices in research about peer support in mental health services

Abstract

Important arguments have been made about peer support in mental health services; where people with personal experiences of mental distress and of using mental health services are employed and trained to provide support for others currently receiving care from statefunded, regulated or partnered mental health service providers. It has been suggested that peer support struggles to survive within the highly procedural and risk-adverse environment of mental health services (Faulkner & Kalathil, 2012); that mutuality in the peer-to-peer relationship is undermined where one person is trained and paid to provide support to another (Mead, Hilton, & Curtis, 2001) or where the peer worker can be required to write notes and share information with clinical colleagues about the person they are supporting (Scott & Doughty, 2012); that people employed as peer workers face the impossible challenge of having to simultaneously prove that they are both ‘well enough’ to be trusted and ‘sufficiently unwell’ to retain a perceived requisite authenticity (Voronka, 2019). As such, we might query whether peer support as it is increasingly being introduced into mental health services is peer support at all, at least as was understood in the context of the mutual aid movement (Borkman, 1999), long before ‘peer support’ as terminology became lingua franca. There are other important points to be made here. First, the contemporary reality is that people are increasingly likely to be offered a peer worker by their mental health service provider. In England, as of the end of 2019, around 750 peer workers were employed in mental health services in the National Health Service (Watkins, Morris, & Fox, 2020) with plans to increase this number to nearly 5000 in the years to come (NHSE, 2019). Similar policy-led initiatives are increasing the volume of peer support on offer within health systems around the world. As such, those critiques advanced above become reason to pay attention to this institutionally provided peer support. If, as other research to date has claimed, peer support offers something distinctive from other forms of mental health support (Mead & Filson, 2017; Oborn, Barrett, Gibson, & Gillard, 2019), then there is a role for research to ensure that that added value is realised in practice, rather than diluted by organisational constraints (Gillard, Edwards, Gibson, Owen, &Wright, 2013). Systematic reviews have begun to explore how the outcomes of peer support might be associated with the way in which peer workers are supported in their role (King & Simmons, 2018; White et al., 2020), and this literature needs more explicit development. Second, it is of course vital that that peer support is experienced as safe for those involved. In particular, the research literature is replete with studies that have indicated how, where appropriate organisational support is not in place (Mirbahaeddin & Chreim, 2022), peer workers can find themselves facing difficulties with workplace and emotional stress, maintaining personal wellness and avoiding relapse (Ahmed, Hunter, Mabe, Tucker, & Buckley, 2015). The peer worker role demands that people give of themselves to support others in a way that we do not explicitly ask of other mental health workers, and this needs to be acknowledged, valued, and properly responded to.