Alan Simpson: 'Peer support in mental health needs a welcome, not wariness'
Recognise that mental health nursing can profit from collaborating with peer support workers who have first-hand experience as service users, says Alan Simpson
Few will be surprised by growing evidence that mental health service users who offer help to fellow service users obtain outcomes that are at least as effective as those achieved by professional care staff. However, many are worried about the effect peer support workers are having on mental health nursing as a profession.
When you’re going through tough times, talking to someone considerate who knows from experience what you’re going through can prove invaluable and the evidence for peer support is persuasive.
A new Cochrane systematic review looked at the results of 11 randomised controlled trials in which services users provided interventions, including peer support, coaching and advocacy.
“At times of threat it is difficult to keep our minds open to the opportunities that these times may bring”
Looking at five trials, they found outcomes across a range of measures were no different from when services had been provided by professionals. Another six studies compared mental health services with or without the addition of service user-providers and found no significant differences in psychosocial outcomes.
Additionally, the results of 14 RCTs found peer support for people with depression was superior to usual care in reducing symptoms, and similar in effectiveness to group cognitive behaviour therapy.
So, results achieved by peer supporters are at least equal to those of professional staff - and they usually cost less. Evidence from UK studies is influencing policy that calls for the roll-out of peer support roles.
Should mental health nurses be worried? While many may welcome the concept of peer support in principle, the introduction of peer workers comes at a time when nursing is being attacked on two fronts.
First are the well-publicised concerns about the quality of nursing care. Second, the NHS is having to make massive efficiency savings. Around 5,000 nursing posts have been cut and healthcare assistants are taking on more nursing responsibilities.
Professional defensiveness is understandable, but not necessarily helpful. The focus should, instead, be on providing a strong argument for mental health nursing and it is in our interests and those of our service users and their families to do so in partnership with peer support workers.
Professional confidence should allow nurses to recognise that our role can profit from collaborating with and listening to peer support workers who have first-hand experience as service users. This could guard against complacency and improve outcomes.
We need to provide evidence of our effectiveness and demonstrate the positive values of mental health nursing. We can discuss with peer workers how we can best collaborate with service users and carers to focus on hopes and strengths, not just symptoms, deficits and illness.
It is essential nurses explore how best to negotiate boundaries in relationships without becoming remote and uncaring. We can explore alternatives to restraint and seclusion, and ensure the safety of service users, peers, staff and the public. Together, we can educate service users, peer workers, staff and students - and conduct research.
At times of threat it is difficult to keep our minds open to the opportunities that these times may bring. We need to highlight where attacks on service users and nurses are designed to undermine our common interests and find ways to collaborate and support those who are keen to redesign and improve how we care for and empower people in mental distress.
Alan Simpson is professor of collaborative mental health nursing, School of Health Sciences, City University London