Peer Support, Alternative and Innovation of Mental Health Services

What is Peer support?

Peer support in mental health is known as the help and support that people with lived experience of mental illness or a learning disability can give to one another (Shalaby & Agyapong, 2020). Peer support is a person-centred approach, a psycho-social intervention and trauma informed practice in which trained mental health professionals use their personal experience in ethical and sensible ways to support others in finding healthier coping mechanisms to manage distress (Peer Support: What Is It and Does It Work? | National Voices, n.d.). This approach focuses more on relationships and community rather than individual change alone.  It also focuses more on what people have experienced in their life rather than labelling their distress as an illness. Psycho-social support combined with trauma-informed practice can be a powerful intervention to enable people to establish and maintain a fulfilling life in the community. Research has shown that peer support is associated with improvements in mental health, including effective coping mechanisms, reductions in depression, loneliness, and anxiety (Suresh et al., 2021). Positive effects are also present for those providing the support (Richard et al., 2022).

Peer support can play an important role in addressing persistent inequity in access to mental health care for marginalised groups (Baxter et al., 2022). Clinical interventions are essential but vulnerability and a sense of belonging is key to reducing distress and loneliness. One intervention alone won’t satisfy a deeper sense of belonging, and individuals might need mutual aided protection (Cacioppo & Patrick, 2008). Some individuals may find that certain clinical mental health services can disrupt people's lives and isolate them and consequently cause them distress. Thus, peer support can be seen as a social intervention that has the potential to maintain a connection to the community and rebuild relationships in moments of vulnerability. The dynamic of this support can be transferred to real world interactions, and vulnerable sharing offers a chance for healing everyday. 

Community driven approaches and social interventions could make a difference when there are gaps in clinical practice and the needs of the people (Mahomed, 2020). A key aspect is government interventions and how budgets are allocated for community-based services. The investment tends to be medical in nature, delivering psychotropic medication in primary health care settings (Mahomed, 2020). Addressing mental health needs based on the medical model perspective does not fully account for well-being's social, political, legal, and economic determinants. Some mental health approaches and psychiatric services might place the disorder inside the individual, however, their distress might be a result of the social power structure affecting many people (Rosales & Davis, 2023). People’s distress might be an indicator that there is a need for change through a collective response. In other words, people’s distress should not be seen as something that is wrong with the individual, but as a sign and symptom of loneliness and lack of connection. Therefore, if used appropriately and empathetically, personal journeys of healing could empower people. This is especially true if that is returned into the community and through social action and collective healing people’s personal distress can be relieved (Rosales & Davis, 2023).


Loneliness as a public health issue

Loneliness is a public health issue with significant physical and mental health impacts (Cacioppo & Patrick, 2008). It is essential for humans to be part of a community, not only to survive but to develop their innate abilities (Cacioppo & Patrick, 2008). Research indicates that community involvement, participation, and the possibility to engage in community decisions positively impact people’s mental health (Masi et al., 2011). However, people with mental health conditions may be at risk of experiencing barriers to community and cultural engagement due to existing social inequalities and social anxiety (Baxter et al., 2022). Although many interventions to reduce loneliness might focus on some form of socialisation, social anxiety plays an important factor in the prospect of engagement and tackling those issues is one way to encourage engagement. 

In this case, peer support can be the complementary intervention that is needed as a person-centred approach focusing on what the person needs and the relationship built between the peer worker and the person needing support  (Gillard, 2019). People’s social skills can be developed through the relationship they form with the professional peer worker since the relationship is one of equal, and can happen outside a clinical setting. For instance, therapeutic support may not be enough because getting out of loneliness takes reciprocal connections. Thus, community based mental health services are more needed considering the issues that people are facing. Therefore reciprocal relationships based on mutual support can be a way to tackle loneliness, build connections, and reduce distress. Psycho-social education and peer support can improve the quality of social interaction and consequently reduce loneliness. Community interventions and peer support could be the complementary services necessary to tackle loneliness and isolation.

What can be done?

In recent years, governments have invested more in community-based mental health services, however there are still persistent issues and lack of services (Mahomed, 2020). It is critical to build communities in which everyone participates to address the social components of discrimination, stigma, and inequality that people face.

Public health is everyone’s job, and people from different roles can play a part in tackling issues which affect everyone’s lives.

Moreover, mental health workers who are supporting people in distress can play a key role in social transformation while providing opportunities for connection and support rooted in shared experiences. A mental health professional can become a participant in the broader struggle for personal and social innovation and change (Rosales & Davis, 2023). 

On a broader scale, government investments and policies can promote or create barriers to interventions and changes (Dowrick et al., 2013). With regards to social innovation, the steps to make the change happen must be done with the people and for the people who live in the community. Many of the social issues are interconnected, and it is important to improve the quality or efficacy of communication between strategic stakeholders, establishing trust, value and a shared vision for developing a local service ecology that meets the needs of the people living in the community (Campbell & Murray, 2004). Through awareness-raising training, communication between clinical, nonclinical services, and allied healthcare professionals can help people from different roles accept, empathise, and support others in distress.

In addition, developing a framework for stakeholders to build partnerships across statutory and third sectors or NGO’s could help in bridging the different words of clinical practice and the third sector. The opportunity to work together on a common project can help develop the degree of trust required between different agencies and public health actors (Campbell & Murray, 2004). Public health is everyone’s issue and mental health is a human right (Rosales & Davis, 2023). In other words, cooperation is key in developing interventions which work for the community.

Social transformation and collaboration:

The argument emphasizes the role of mental health professionals in supporting social transformation and promoting connection and support rooted in shared experiences. Additionally, it stresses the importance of collaboration and partnership among various stakeholders, including government, clinical services, and community organizations. These aspects highlight the potential for broader societal change and the importance of collective efforts in addressing mental health challenges.

Conclusion

Social interaction in which people can relate to each other and ease each other's distress can be powerful and complement clinical services. Clinical practices are essential, but alternative ways of treating mental distress can be part of the innovation that is needed in the mental health sector.

By

Luiza Bocai and Merina Smith

Acknowledgements

We would also like to thank Lauren Fynn and Aphelele Mtwecu for their comments on this paper, and Charli Sitong Zhang and Jelena Brankovic for coordinating the project.

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