Exploring the Unique Contributions of Peer Specialists Delivering Health Interventions for People with Serious Mental Illness

Background and Purpose: People with serious mental illness (SMI) experience excess morbidity and premature mortality compared to the general population. While peer-delivered services have demonstrated effectiveness for this population, a lack of understanding of how these services work has resulted in the underutilization of peer specialists, particularly in delivering health interventions. In this federally-funded study, we examined the unique contributions of peer specialists facilitating a healthy lifestyle intervention for people with SMI.

Methods: In-depth qualitative interviews were conducted with stakeholders (such as peer specialists (n=4), clients (n=25), supervisors (n=6)) involved in the delivery of a peer-led healthy lifestyle intervention at three supportive housing agencies. Interviews explored stakeholders’ perspectives regarding the unique contributions of peer specialists and included a card-sorting exercise in which stakeholders ranked statements describing key interpersonal attributes of peer- and non-peer providers. Interviews were audio recorded, transcribed verbatim, and analyzed using grounded theory. The following strategies were used to ensure the trustworthiness and rigor of our analysis: developing of an audit trail to document analytical decisions, peer-debriefing meetings, and member checking presentations.

Results: Three features were identified as unique to the peer specialist's successful delivery of the intervention including their use of shared experience, collaborative approach, and commitment to physical health. While the peer’s titles had been defined by having an SMI, stakeholders emphasized that the peer specialists’ on-going self-disclosure of personal experiences related to living a healthy lifestyle, and their own struggles and successes, were essential. This type of sharing helped to normalize clients' own struggles with adopting a healthy lifestyle and building hope for change. It also boosted peers’ credibility, providing clients with unique reassurance that the peers were knowledgeable about the intervention. Peers were also perceived as less directive than non-peer staff, giving consumers greater discretion in what health related changes they would make and in fostering empowerment.  Peers’ exclusive focus on health and the time they devoted to supporting clients were also identified as key to building trust and to sustaining clients’ motivation. Card sort results demonstrated that the most important aspects of the peer specialist/consumer relationship were that peer specialists helped participants feel hopeful about change, were knowledgeable about physical health and made participants feel comfortable.

Conclusions and Implications: Stakeholders articulated specific ways in which the role of peer specialists was an integral feature of the health intervention. These findings have implications for training and practice standards that can facilitate the use of peer-based health interventions to improve the health of people with SMI. Additionally, the findings have implications for professional social work practice through providing insights in developing a more empathic, strengths-based approach.