Peer Support for Mental Health

This project explores the effectiveness of peer support in mental health. Mental health policies in many jurisdictions support the incorporation of peer workers into mental healthcare services. The peer workers are individuals with personal experience in applying mental health services/distress to assist others currently using the services (Heaney & Israel, 2008). Peer support refers to a mutual exchange of practical and emotional support between people who relate as peers due to similar or shared mental distress experiences (Mahlke, Priebe, Heumann, Daubmann, Wegscheider & Bock, 2017).  It can also be defined as “a direct service that is delivered by a person with a serious mental illness to a person with a serious mental disorder…” (Puschner, Repper, Mahlke, Nixdorf, Basangwa, Nakku, & Slade, 2019). Such specialized assistance provides social support pre, during, and post-treatment, and facilitate long-term recovery, in the setting when the recovering individual lives (Huang, & Chengalur-Smith, 2014).

Peer support is a comprehensive recovery plan that emphasizes person-centered patient outcomes, such as empowerment and social inclusion, instead of traditional clinical results, including psychiatric symptomatology (Usta, 2012). The peers are encouraged to support their recovery process and others through positive self-disclosure, emotional and practical support, empowerment, expanding social networks, and promoting hope (Landers & Zhou, 2014). Peers also offers a broad range of services such as disease management, social support, outreach, counseling, advocacy, and coaching, which are formalized in individually-designed peer positions, which cut across peer advocates, peer companions, peer counselors/specialists, peer companions, and consumer case managers/specialists (O’Leary, Bhattacharya, Munson, Wobbrock, & Pratt, 2017).

This project aims to adopt ‘Social Return on Investment’ (SROI) research methodology to explore the social value created and effectiveness of peer support groups in enhancing the recovery process among individuals with mental illness and their care. The central question that the project will address is: “What is the impact of peer support groups in promoting recovery among individuals with mental illness?” The questions that were subsequently asked are:

1. Are peer support interventions effective for mental health?
2. How does peer support affect social value?
3. Is peer support intervention cost-effective?
4. How do the different peer support models compare?

Research Methodology

Data Collection

This study will use three support groups sampled from Georgia, Arizona, and New York, where the methods have been widely embraced in most mental health facilities. The researcher prefers diverse support groups to reflect on the various forms of peer models observed within the community and healthcare settings. The sample peer support groups will be selected based on host health or community care organization, group size and activities, funding source, and staffing. The three groups must be found with the chosen geographies and must be operating for a period not less than one year. This ensures that reliable and quality costing data can be gathered for SROI analysis (Willis, Semple & de Waal, 2018).  The research participants, comprising people with mental illness, caregivers, and group support staff, will be interviewed through phone calls and face-to-face interactions. Follow-ups will be done through phone calls and emails where necessary. 

Data Analysis Using SROI Methodology

The study will adopt a social return on investment (SROI) research methodology to assess the social impact of peer support in enhancing the mental care recovery process’s effectiveness. In the most recent social return on investment (SROI) methodology guideline, SROI is defined as the framework for assessing and accounting for the broader facet of value. The SROI comprises a set of principles intended to ensure that any particular model’s assessment and implementation process is robust, transparent, and engages the stakeholders (Maldonado & Corbey, 2016).

The study will closely adhere to the established SROI methodology, which comprises a mix of qualitative and quantitative research. A qualitative approach will be adopted to evaluate peer support elements and outcomes, having the most significant impact on the patient’s lives and social support value. The quantitative method is adopted to generate a monetary representation of the effects, and the actual value, in the cost-saving analysis (Millar & Hall, 2013).  The researcher will adopt unstructured focus groups and interviews with the selected sample population. Both the focus groups and interviews will adopt open questioning as it encourages research participants to state freely how being involved in the peer support group positively or adversely. Allowing the participants to put forth their opinions and thoughts reduces the risk of interviewer bias and, at the same time, enables them to steer and lead the discussion where necessary (Willis, Semple & de Waal, 2018).

Thematic analysis, characteristic of the SROI framework, will be used to identify outcomes of each participant by detecting the fundamental theme in every interview transcript and charting the number of participants who responded to individual themes. SROI uses economic proxies to determine the value of every theme identified during the research process, allowing a market price to be accredited where there is no linked market (Fujiwara, 2015). The researcher will select proxies relevant to the value of peer support adoption in mental health care facilities. The main goal of an SROI analysis is to develop a ratio indicating the “cost of investment of an intervention” against the expected “total social value” from the implementation of the intervention (Krlev, Münscher, & Mülbert, 2013). The overall impact is obtained by multiplying each theme’s value by the number of participants reporting the benefit. The SROI method prescribes a specific factor applicable to each article to avoid over-claiming (Banke-Thomas, Madaj, Charles & van den Broek, 2015).

Potential Challenges and Ethics

The research is a service evaluation. Hence may not require any form of ethical approval as set university committee. However, any practice that is against the University’s academic policies will be avoided during the study. The consent forms will be obtained from the participants before engagement for ethical purposes. A pilot study will be conducted to expose any potential challenges during the research.

Situating Within Existing Literature

Both quantitative and qualitative research have established the far-reaching impact of peer support, particularly in high-income nations or the developed world, in providing social support. The positive effects include improved empowerment, self-esteem, quality of life, social inclusion, better functioning, and recovery alongside peer support workers’ employment (Repper & Carter, 2011).  Other positive outcomes like peer support in mental health include improved workers’ attitude towards service users, recovery-orientation, skill mix, cost, time, and resource-saving for the mental health service providers. Puschner, Repper, Mahlke, Nixdorf, Basangwa, Nakku, & Slade (2019), conducted a study involving a systematic review of 20 scholarships, comprising of quasi-experimental trails. Their research established that peer support workers were more effective in managing inpatient service, cultivating relationships with mental health care providers, and meeting the peers’ needs, among various other recovery-related outcomes in individuals with acute mental illness (Valenstein & Pfeiffer, 2018). General research evidence affirms that peer support adds immensely to improvement in mental healthcare service effectiveness, responsiveness, efficacy, safety, and ensuring that the service delivery is more person-centered.

Peer support interventions have proven to be more cost-effective than other forms of traditional treatments. Study shows that makes peer support workers or specialists even more compelling is the personal connection/touch with the patients who have to refuse other forms of treatments (Fisher, Ayala, Ibarra, Cherrington, Elder, Tang, & Simmons, 2015). The hope and connection that peer support inspires the individual receiving treatment may make recovery faster and help the patient use less costly services, which are more effective. The patient can use less intensive health care services for a shorter period. Studies have also indicated that peer support helps minimize multiple admissions and hospitalization cases for costly inpatient care services (Puschner, Repper, Mahlke, Nixdorf, Basangwa, Nakku, & Slade, 2019). In research conducted in Georgia, 2006, people who incorporated Certified Peer Specialists in their mental health care to reduce symptoms experienced more improvements over individuals not using peer support (Trachtenberg, Parsonage, Shepherd & Boardman, 2013).  Peer support reduces mental health symptoms, increases coping abilities and skills, access to resources, and the patients’ abilities to meet their needs. The improvements translated to an average cost reduction of about $5,498 annually per individual for the state of the agency, particularly for patients using day treatment models (Hope 2012). Another study in New York studied the adoption of “Peer Bridgers.” The research participants had been hospitalized for about 60% of the time during the two-year baseline before the study. However, the hospitalization period was reduced by about 41% when participants in the care program were matched with peer support specialists (Hope 2012).

Peer support workers have proven more effective in promoting the recovery process and other mental health patients’ outcomes than other professionally qualified health staff (Burke, Pyle, Machin, Varese & Morrison, 2019). Areas where peer support workers significantly improve include self-esteem, empowerment, patient hope, social inclusion, engagement, and promoting self-efficacy (Fisher, Ayala, Ibarra, Cherrington, Elder, Tang, & Simmons, 2015). For instance, the “Recovery Innovation” is a mental healthcare approach widely adopted in many of Arizona’s healthcare systems. The model relies significantly on the adoption of peer support specialists in the recovery process. Several peer support experts work in the local psychiatric clinics. Study in some of the hospitals in Arizona that embrace peer support indicated a 35% reduction in the application of seclusion methods, about 48% in the adoption of restraints, and an average of 56% reduction in hospitalization and readmission rates compared to the use of traditional treatment approaches to mental health (Burke, Pyle, Machin & Morrison, 2018). The Center for Medicaid Services, in its 2007 report, also recognize peer support as evidence-based mental health models. The report suggested that peer support specialists’ experiences as consumers of mental health services are paramount in the state’s effort to deliver effective treatment (Bergeson, (2007), further supporting the efficacy of peer support in mental healthcare. 

How does this project further existing knowledge?

The project furthers the existing knowledge in two fundamental ways. First, peer support offers diverse settings as an integral element of professional care and as an alternative to independent service within the health care system. Therefore, the model provides mental health professionals with the mechanisms for incorporating individuals with lived/firsthand experiences of mental health complications to interact, and offer social and moral support for patients who need help seriously but feel alienated from the conventional healthcare services. Secondly, the approach contributes to innovative recovery models and ongoing research within the mental health and other care services to establish the most effective and cost-friendly recovery process away from the traditional models.

Details of Any Previous Work in the Proposed Field

I have completed a discourse analysis at my graduate degree level on peer support and the impact on the overall health care system, scoring a grade of 90%. The knowledge acquired during the study, alongside experience during my placements and present working experience in mental healthcare, will contribute to this project’s successful completion.

Conclusion

This project explores the effectiveness of peer support in mental health. The researcher will adopt the social return on investment (SROI) research method to provide comprehensive insight on the social value created and the effectiveness of peer support groups in enhancing the recovery process among individuals with mental illness and their care. The study looks into the efficacy of the recovery process and the cost-effectiveness as the primary parameters.

References

Banke-Thomas, A. O., Madaj, B., Charles, A., & van den Broek, N. (2015). Social Return on Investment (SROI) methodology to account for value for money of public health interventions: a systematic review. BMC Public Health, 15(1), 582.

Bergeson (2007). Cost-Effectiveness of Using Peers as Providers By Sue Bergeson, Vice President, Consumer Affairs, Optum Health.

Burke, E. M., Pyle, M., Machin, K., & Morrison, A. P. (2018). Providing mental health peer support 1: A Delphi study to develop consensus on the essential components, costs, benefits, barriers, and facilitators. International Journal of Social Psychiatry, 64(8), 799-812.

Burke, E., Pyle, M., Machin, K., Varese, F., & Morrison, A. P. (2019). The effects of peer support on empowerment, self-efficacy, and internalized stigma: A narrative synthesis and meta-analysis. Stigma and health, 4(3), 337.

Fisher, E. B., Ayala, G. X., Ibarra, L., Cherrington, A. L., Elder, J. P., Tang, T. S., … & Simmons, D. (2015). Contributions of peer support to health, health care, and prevention: Papers from peers for progress.

Fujiwara, D. (2015). The seven principle problems of SROI. London: Simetrica Ltd.

Hope (2012). Understanding the Cost-Effectiveness of Using Peer Specialists. Peer Specialist Integration Workbook. Austin, Texas: Via Hope. http://sites.utexas.edu/mental-health-institute/files/2012/10/Understanding_the_Cost_Effectiveness_of_Using_Peer_Specialists.pdf