"Being There" Vs "Being Direct:" Perspectives of Persons with Serious Mental Illness on Receiving Support with Physical Health from Peer and Non-Peer Providers

Background. Individuals with serious mental illness (SMI) experience multiple barriers to engaging in health behavior change, including challenges accessing and receiving high quality healthcare, low SES, and a higher likelihood of experiencing adverse life events, such as homelessness. To improve the health of persons with SMI, it is necessary to both increase access to high quality healthcare and expand and enhance the support they receive through the collaboration of multiple types of healthcare providers. This study explores the experiences of individuals with SMI receiving health-related services from both peer and non-peer providers.

Methods. Semi-structured qualitative interviews were conducted with 28 participants of a peer-led healthy lifestyle intervention across three supportive housing agencies. Interviews explored their experiences working with both a healthy lifestyle peer specialist and a non-peer provider who assisted them with health (e.g. primary care provider, nurse). Interviews were audio recorded, transcribed, and analyzed using grounded theory.

Results. Participants generally viewed their relationships with peer and non-peer providers positively, but described differences in approach to practice. Participants described the peer specialists as process-oriented, attuned to and validating of participants’ feelings and life circumstances beyond health, while non-peer staff were seen as task-oriented and focused on participants accomplishing concrete treatment objectives. Participants emphasized that peer specialists individualized health-related content (e.g. providing healthy foods that catered towards special diets) while non-peer staff provided more standardized information (e.g. reviewing objective measures like blood pressure) that enhanced their comprehension of health conditions. Each provider helped build motivation for behavior change, with peers building hope that change is possible and non-peer providers building urgency regarding the need for change. Participants related to peer staff through shared experiences of SMI and health challenges, while identifying the importance of having a shared treatment goal with their non-peer provider.

Conclusions & Implications. Overall, participants appreciated the unique roles of both peer and non-peer staff, highlighting the importance of both provider roles in supporting individuals with SMI with their health. These findings have implications for expanding and integrating the use of peer-based health interventions to improve the health of people with SMI.