Stories from the Frontlines: The Who and the How of Peer Support Work

Background & Purpose

Since the early 1990’s, health care systems throughout Canada, the United States, and elsewhere have seen an increase in the creation of mental health and addiction peer support worker (PSW) positions.  Little research, however, has explored the nature and experience of peer support relationships.  This paper addresses this gap by asking: what components of and moments, interactions, or exchanges in peer support relationships are meaningful and why?

By creating spaces for PSWs and persons receiving peer support to share their stories and experiences regarding their unique relationships, this paper also addresses challenges related to a lack of role clarity and knowledge about the nature of peer support. 

Methodology

Three PSWs and three persons who had received formal peer support services in the fields of addictions or mental health within the past year each completed two in-depth semi-structured interviews.  The age range of the participants, comprised of five females and one male, all Caucasian, was 30 to 65 years old. Participants were recruited through flyers posted at several mental health and addictions service providers throughout Southwestern Ontario. 

Narrative inquiry, supplemented with arts-based elicitation techniques, was used to prompt stories of meaningful moments, interactions, or exchanges in peer support relationships.  Interviews were transcribed verbatim and inductively analyzed, with each author thematically coding transcripts individually and then comparatively.

As the authors comprise one academic with professional experience and one academic with professional and lived experience with addictions and mental health, reflexivity is emphasized.  The authors explored multiple subjectivities and interpersonal dynamics, which added a descriptive and analytic layer to understandings of insider/outsider knowledge and peer/non-peer relationships. 

Findings

Data analysis reveals two primary themes of the nature and experience of peer support relationships: the “who” and the “how” of PSWs.  The “who”, the identity or personhood of a PSW, emerges in participants’ stories about relatedness, normalization, stigma, and trust.  The “how”, the actions, engagements, and responses of PSWs, emerges in participants’ stories of difference making, role modeling, and “getting it”.  Distinction is also made between the identity and behavior of peers and “professionals”.  

Rich themes emerge when co-constructing participants’ stories as a collective, overarching story, rather than separate, individual stories.  The third space in which peer support relationships becomes prevalent and the embedded challenge of variation in individual and organizational perceptions of the identity and role of a peer surfaces 

Conclusion and Implications 

Themes emerging from this paper suggest that peer support relationships are impacted primarily by the “who” and the “how” of PSWs.  The nature of peer support work, therefore, appears interwoven with both the identity and role of PSWs.  This finding can increase role clarity and knowledge of the nature of peer support and aid in the creation of organizational and system-level policy recommendations aimed at increasing the efficacy of peer support work.