An Exploration of the Factors That Effect the Implementation of Peer Support Services in Mental Health Settings
Certified Peer Specialists (CPS’s) are individuals who have utilized mental health services for a mental illness and, on the heels of their recovery, provide a variety of mental health-related services to others with mental illness. CPS’s routinely rely on the wisdom gained through their personal lived experiences with psychiatric disabilities to engage with other mental health service users on an authentic level. Since 2001, more than 30 states have developed certification programs for peer specialists. Research on the effectiveness of peer-delivered services is growing. However, few studies have explored the experiences and challenges faced by CPS’s working in mental health settings. This project explored the factors that facilitate and hinder integration of CPS’s into community-based mental health settings through qualitative interviews with CPS’s and their social work colleagues.
Methods
This exploratory study used in-depth qualitative interviews with a convenience sample of 20 Certified Peer Specialists and 10 masters level social workers working in community-based mental health settings in a mid-western metropolitan area. CPS’s were recruited electronically from a list of 35 practicing peer specialists. Social workers who worked alongside CPS’s on treatment teams were also recruited electronically at community-based agencies in the same city. Interviews were guided by a semi-structured protocol developed by the lead investigator. Key informants in the peer specialist community provided consultation on the protocol to enhance authenticity and credibility. Thematic analysis was used to develop an in-depth understanding of the experiences of CPS’s and community mental health social workers and then to compare and contrast the views of these two groups. This process involved generating initial codes to be attached to data within and across transcripts and then comparing and contrasting these codes to generate themes grounded in the data. Trustworthiness was established and maintained through peer-debriefing and member checking, the analysis of negative case examples and counter narratives, and continuing interviews until saturation of information and perspectives were achieved.
Results:
The analyses revealed several broad themes. First, peer specialists struggled to feel accepted within their organizations and had to negotiate shifting work roles and expectations. Second, CPS’s struggled to find adequate sources of support, supervision and advancement within their profession. Third, CPS’s utilized extensive amounts of explicit and implicit knowledge and skill sharing their lived experiences. Fourth, CPS’s endured extensive emotional labor as they negotiated a complex array of professional and organizational boundaries, low pay and changing and varied work roles while also working to establish credibility within their organization and grappling with their own mental health issues.
Implications:
It is widely recognized that certified peer-specialists play a vital role in the evolution of mental health service systems. To maximize their effectiveness, future research must now focus on how best to implement peer specialist services into mental health organizations. This study suggests that supportive organizational leadership, professional education and training in CPS services, the development of clear fidelity standards and the establishment of professional development and advancement are all implicated in the effective implementation of peer services into mental health organizations.