Peer Support – THE CARe NETWORK

Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It can take a number of forms such as peer mentoring, listening, or counseling. Peer support is also used to refer to initiatives where colleagues, members of self-help organizations and others meet as equals to give each other support on a reciprocal basis. Peer in this case is taken to imply that each person has no more expertise than the other and the relationship is one of equality (http://en.wikipedia.org/wiki/Peer_support).

Basic elements

The effectiveness of peer support is believed to derive from a variety of psychosocial theories and processes: social support, experiential knowledge, social learning theory, social comparison theory and the helper-therapy principle (Salzer, 2002).

Social support is the existence of positive psychosocial interactions with others with whom there is mutual trust and concern. Positive relationships contribute to positive adjustment and buffer against stressors and adversities by offering emotional support (esteem, attachment, and reassurance), instrumental support (material goods and services), and information support (advice, guidance, and feedback).
Experiential knowledge is specialized information and perspectives that people obtain from living through a particular experience such as substance abuse, a physical disability, chronic physical or mental illness, or a traumatic event such as combat, a natural disaster, domestic violence or a violent crime, sexual abuse, or imprisonment. Experiential knowledge tends to be unique and pragmatic and when shared contributes to solving problems and improving quality of life.
Social learning theory postulates that peers, because they have undergone and survived relevant experiences, are more credible role models for others. Interactions with peers who are successfully coping with their experiences or illness are more likely to result in positive behavior change.
Social comparison means that individuals are more comfortable interacting with others who share common characteristics with themselves, such as a mental illness or addiction, in order to establish a sense of normalcy. By interacting with others who are perceived to be better than them, peers are given a sense of optimism and something to strive toward.
The helper-therapy principle proposes that there are four significant benefits to those who provide peer support: (a) increased sense of interpersonal competence as a result of making an impact on another person’s life; (b) development of a sense of equality in giving and taking between himself or herself and others; (c) helper gains new personally-relevant knowledge while helping; and (d) the helper receives social approval from the person they help, and others.

Peer support exists in many different ways, both on a one-to-one basis as in a group. A common ground for peer support are similar experiences with traumatic life events (such as child abuse, war, forced migration) a certain personal condition (a disability, addiction or mental illness such as psychosis, depression, anxiety) or social conditions (poverty, homelessness). Peer support can be used to help survivors of trauma, such as refugees, cope with stress and deal with difficult living conditions, as well as supporting personal recovery journeys.

Peer support in addiction and mental health

The oldest form of peer support is the AA-groups for people with alcohol addiction. Since the 1930s Alcoholics Anonymous has promoted peer support between new members and their sponsors: “The process of sponsorship is this: an alcoholic who has made some progress in the recovery program shares that experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety through AA”. Many self-help groups are structured according to the twelve-step programme. Twelve-step methods have been adapted to address a wide range of alcoholism, substance abuse, and dependency problems.

Peer support is a key concept in the recovery approach. In mental health care, peer support can occur within, outside or around traditional mental health services and programs, between two people or in groups. Consumers/clients of mental health programs have also formed non-profit self-help organisations and serve to support each other and to challenge associated stigma and discrimination. Organisations that offer peer support services for people with mental health problems include clubhouses like Fountain House, and Recovery Colleges (Whitley, Shepherd and Slade (2019). A key value underlying Recovery Colleges is the meaningful involvement of peers in all aspects of college life. This means that peers are heavily involved in management and governance, helping decide upon course offerings and overall structures and orientations (known as co-production). Likewise, peers are involved as teachers of courses, either alone or in conjunction with other experts (known as co-delivery).

In several countries, such as the Netherlands, peer workers have become a recognized profession in the mental health work force (Shalaby and Agyapong, 2020). For Assertive Community Treatment teams, it is mandatory to have peer specialists on board. However, there is still debate going on about the identity, role and position of peer workers (Vanderwalle et al, 2016). For services developing a peer support service, organisational culture including role support (training, role clarity, resourcing and access to a peer network) and staff attitudes need to be considered (Ibrahim et al, 2020).

Evidence

Research shows that there is some evidence that peer support is associated with positive effects on measures of hope, recovery and empowerment at and beyond the end of the intervention, although this was not consistent within or across different types of peer support (Lloyd-Evans et al. 2014; Simmons et al., 2023).