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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

Readers' comments (20)

  • tinkerbell

    working in a collaborative way with MH nurses is a good principle and not one that I feel threatened by if we are all working together towards helping another regain well being.

    It is important that like any other problem that the person with that problem feel they can relate better to someone who has walked in their shoes and come out the other side and still standing.

    Anyone that empowers another in a positive way is right.

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  • So were these peer mentors working with Severe and enduring mental health service users with no other input? Do we really need careplans then? Do we really need any evidence based practice at all, except for having had the diagnosis at some point in our lives ourselves and be willing to work with others? Do we need psychologists too?

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  • tinkerbell

    Anonymous | 4-Jul-2013 4:44 pm

    it is about working in 'partnership', as it states in the article.

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  • "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"

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  • michael stone

    I must see if I can track down an e-mail address for this chap, to ask him about something related to:

    '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.'

    If I can find his e-mail address, I'll be asking him for his opinion about whether fellow professionals can learn a lot from the insights gained by any of their peers who have also been 'on the user end' (here, that would be can professional mental health care staff who have themself experienced a mental problem, usefully impart insights to professionals who have never actually suffered from that mental health problem personally ?). This 'professionals who have been on the other side as well' issue, is one of my 'interests'.

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  • michael stone | 5-Jul-2013 3:06 pm

    Or perhaps we could stop trying to pigeon hole everyone?

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  • Dr Why ?

    Anonymous | 5-Jul-2013 10:19 pm

    If you are suggesting that attaching labels to everyone (patient, professional, informal carer, etc) and then facilely and simplistically treating (behaving towards, or valuing) individuals on the basis of their labels, instead of on a more deeply thought-out consideration of their ability to contribute, then I agree with you.

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  • tinkerbell

    having trained as a psyche nurse in a total institution, where sometimes the staff were more crazy than the patients, having seen some patients who had been locked away for no more than being an unwed mother, having seen patients tranquillized to a stupor day in day out and any tiny bit of spirit or individuality squashed out of them, I very much believe in joint therapeutic process where the ego can sustain such intervention.

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  • michael stone

    Anonymous | 5-Jul-2013 10:19 pm

    If you mean do I agree with the subsequent post by Dr Why, then yes I do. I HATE pointless, inappropriate and unhelpful 'distinctions between professionals and laymen', etc.

    And I've found Alan's e-mail address and sent him my question.

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  • Anonymous | 5-Jul-2013 10:19 pm

    pop 'em in pidgin 'ole. shove package of care closest to their perceived needs in with 'em and they will sink or swim - take it or leave it.

    Isn't this sort of black/white thinking the concept of modern business managed care?

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  • Dr Why ? | 6-Jul-2013 9:51 am
    from
    Anonymous | 5-Jul-2013 10:19 pm

    I couldn't have put it better myself. And I didn't.

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  • tinkerbell

    michael stone | 5-Jul-2013 3:06 pm

    we'd all be a bit pooped if we all had to experience everything that everyone else has experienced in order to help someone - Gordon Bennet. I have been seen by a psychiatrist and told I fall well below any psychiatric disorder by the way, although sometimes I am inclined to disagree with that.

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  • michael stone

    tinkerbell | 6-Jul-2013 3:14 pm

    I'm not suggesting that you need to experience everything in order to help people - what I'm claiming, is that 'observation' can lead to an unwarranted assumption that 'that because I've seen a lot of this, I properly understand it' on the part of professionals. When they move to the 'patient's position' sometimes, what they had previously believed to be true, turns out to be much more questionable (or 'simplistic') because of insight from this altered perspective.

    I'm sure lots of people understand that - I also suspect, that the more expert and experienced people are, the more they tend to understand it.

    I do my own mental diagnosis, and my conclusion that is that I'm at least a bit weird, but I'm still working on exactly where on the scale of comparative weirdness I fit: the problem is that I fairly frequently come across other people are very obviously even weirder than I am.

    I'm beginning to suspect that the surprising thing, is that society manages to function as well as it seems to, considering the number of people whose mental states look 'rather odd'.

    My own mental state, as measured on the 'cheerfulness' scale, is pretty good today as the rapid response I sent to the BMJ yesterday has gone up and already has got 6 likes (probably one person clicking 6 times !), and I'm hoping that Murray wins to keep this (unusual) good mood intact !

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  • tinkerbell

    michael stone | 7-Jul-2013 1:07 pm

    As Elisabeth Kubler Ross reframed the book title to

    'you're not Ok, I'm not OK, but it's OK',

    otherwise we would never be able to tolerate anyone who didn't fit our box.

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  • tinkerbell

    http://www.poetryfoundation.org/poem/178055

    which translates into the sins of the parents are inherited (sometimes) in the children.

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  • Thanks for those who have read and responded to this piece. Re some of the queries, there is evidence that peer workers working alone (with the required training, support etc) can achieve effective outcomes. There is also evidence that peer workers working alongside professional staff can be effective too. There is room for different models and approaches but we also need more research to see what helps who best.

    On Michael's point, I do agree that when we experience something ourselves first hand, it does tend to change our perception of things we previously thought we 'knew'. I favour all attempts to encourage dialogue between people with a range of experiences.

    Best wishes,

    Alan Simpson

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  • michael stone

    Alan Simpson | 8-Jul-2013 11:53 am

    Thanks for the comment, Alan - does 'I favour all attempts to encourage dialogue between people with a range of experiences' indicate I might get an answer to the e-mail I sent to you ?

    Regards, Mike

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  • "...when people are explaining themselves to others they are explaining themselves to themselves, and that is a therapeutic thing to do."

    Colin Murray Parkes, Holly G. Prigerson (2009)
    Bereavement Studies of Grief in Adult Life. Fourth Edition. Penguin.

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  • michael stone

    Anonymous | 9-Jul-2013 10:51 am

    Slightly related to that observation: when you write up something you 'already understand' to explain it clearly to others, you will often discover 'a clearer and more coherent way of describing the point'.

    You also realise how difficult it is to write clearly about anything vaguely complicated !

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  • michael stone

    I am pleased to report that Alan e-mailed me back.

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