Therapeutic Approaches

Peer Support: Roles, Clients and Settings

The growth of peer support work in Australia has led to a proliferation of roles for diverse populations. This article outlines common roles, which populations they support, and in which settings.

By Mental Health Academy 2023-10-16 01:52:39

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The growth of peer support work in Australia has led to a proliferation of roles for diverse populations. This article outlines common roles, which populations they support, and in which settings.

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In a recent article (read it here), we discussed the notion of peer support: what it is and how it has evolved in Australia and the United States. We also outlined the major research findings about the benefits of it.  In this companion article, we develop the theme more, examining what the common roles are of the peer support/lived experience workforce – along with the settings that employ them – and which populations they serve. First, though, we make a major differentiation between the two main types of peer support work.

Lived experience work: a major distinction

Lived experience work or practice is now regarded as a separate discipline from other mental health fields, and a crucial distinction is made between two major parts of the workforce:

  • Personal or direct experience roles (also referred to as consumer or lived experience roles). These are informed by: personal experience of mental health challenges, service use, and periods of healing/personal recovery
  • Family/carer experience roles (also described as family, support, or carer roles). These are informed by: the experience of supporting someone through mental health challenges, service use, and periods of healing/personal recovery

Allies are people in non-designated roles who actively and vocally advocate for lived experience roles. Support from allies is needed at all levels including colleagues, management, and funders to help the lived experience workforce drive and develop peer support work (Byrne et al, 2021). When we talk about the lived experience/peer support workforce in this article, we are not referring to allies.

Common roles of peer support workers and their settings

We have previously noted the lack of consistency in what we call the lived experience/peer support workforce. That diversity of role titles stems from both the evolution of the roles over the last half-century of their development, and also from the reality that, while different positions have similarities, each is unique to the needs of its clients.

Common titles

The National Mental Health Commission lists these common titles, acknowledging that when roles are advertised, they can be listed generically as most of these below, or the area of “specialisation” (more on that in a moment) can be included:

  • Lived experience/peer support worker – Direct support role from the perspective of personal experience.
  • Carer lived experience/carer peer support worker – Direct support role from the perspective of family/carer experience.
  • Specialist lived experience/peer support worker – Specialist support based on identified lived experience within a specialist setting (e.g. alcohol and other drug, youth, and culturally and linguistically diverse).
  • Senior lived experience/peer support worker – Supervisory, mentoring, team leader, project coordinator role.
  • Lived experience researcher/academic – Research, teaching, policy development.
  • Executive lived experience role – Manager, director, board member.
  • Lived experience consultant – Advisory role, project work, policy development.
  • Lived experience advocate/representative – Direct advocacy role, public speaking, campaign development, lobby work (Byrne et al, 2021).

Specialisations, from two perspectives

Specialisations in lived experience are deemed to occur from either the perspective of a particular type of lived experience or that of a specific demographic/population.

Specialisation according to lived experience: These peer support workers are comprised of people with a history and/or experience of: trauma, family violence, perinatal mental health issues, eating disorders, suicidality, involuntary treatment, the criminal justice system, homelessness, or alcohol and other drug use/dependence.

Specialisation according to demographic/population: Some peer support workers may be drawn to working with specific portions of the population, such as: Aboriginal and Torres Strait Islander peoples, people from culturally and linguistically diverse backgrounds, people from the deaf and hard of hearing community, people identifying as LGBTQIA+, older persons, veterans, youth, people identifying as neurodivergent, or people with disability. Naturally, there is intersectionality, so for example, a peer support person may have a history of trauma and also be a veteran, wanting to work with other veterans. Note that the development of specialist roles must be led by lived experience leaders and workers with relevant experiences. In addition, the undergirding knowledge and values of the wider lived experience workforce and an experience of both mental health challenge or supporting someone with that challenge informs these roles (Byrne et al, 2021).

The types of roles and populations served largely determine the setting, and to some degree, the model for service delivery, in and through which a member of the lived experience workforce serves.

Settings of service and models for delivery

Settings they work in

Peer support workers have long been involved in domains of the general health system such as mental health, suicide prevention, and alcohol and other drug use. In accordance with those and the above areas of specialisation, lived experience workers have been increasingly employed in a widening range of industries and settings, including:

  • General health
  • Family and domestic violence services
  • Gender and LGBTQIA+ services
  • Disability services
  • Community and arts services
  • Housing and homelessness services
  • Construction industries
  • Veterans, emergency, and other first responder services
  • Universities and other post-secondary education and training sectors (Byrne et al, 2021)

Models for service delivery

When we say “model”, we refer to how a peer support service is delivered, and this could include aspects related to both theory and structure. Different models work in different environments, for different individuals and different stages of a person’s recovery process. There is wide agreement in the field of lived experience work that there is no agreement; the models are hard to categorise and different funders and organisations all have their “favourites” (Paton and Sanders, 2011). That said, here are some key ways in which peer support work can be delivered.

Community based models

An example of this way of delivering support in Australia began in 2006 when a federal government initiative was launched called the Personal Helpers and Mentors (PHaMs) program. Running until funding was cut in 2019, it provided funding for paid peer support workers to work in teams alongside general mental health caseworkers. The PHaMs programs operated within established organisations in every Australian state and territory, including mental health and employment services, utilising a strengths-based, recovery-focused approach to provide support to people aged 16 years and over who were living in the community and experiencing mental ill-health. PHaMs workers provided practical assistance to help service recipients achieve personal goals, develop better relationships with family and friends, and manage everyday tasks (Bell et al, 2014).

Internationally, there are numerous examples of community-based peer support models with a focus on one-to-one supportive relationships. Some of these have been explicitly developed as models for other providers to draw upon. A notable example is Intentional Peer Support (IPS), a model developed in the U.S. by Shery Mead, drawing on her experiences as a service user (Bell et al, 2014).

Group based mutual support

GROW, a community mental health and mutual aid organisation founded in Sydney in 1957 and now operating worldwide, is a good example of this model of delivery. GROW offers a recovery-focused, strengths-based 12-Step Program delivered through weekly structured meetings, developed and facilitated by peers. In a study that examined how GROW impacts on wellbeing, observational data and participant interviews indicated GROW supports an increased sense of personal value and confidence, an enhanced sense of belonging and purpose, social skills development, and increased motivation and hope (Finn, Bishop & Sparrow, 2009).

Peer education

Here we can nominate the notion of “recovery colleges” as an example of peer education. They are an innovative way of supporting recovery and thinking about mental health service more generally. First introduced in the US and now operating internationally, recovery colleges differ from typical mental health education in two ways. First, they are designed and run according to an education model, instead of a therapeutic one. People enrol in a college as students, rather than being referred to the program as consumers. Secondly, recovery college courses are designed and delivered by people with personal experience of mental distress. A central notion is that people can not only learn from their mental health challenges, but can also pass that learning onto others. In partnership with college staff, students take an active role in all aspects of the college, including curriculum choices, course design, and delivery. As such, recovery colleges actively challenge the traditional dichotomy of service provider and service user (Bell, Panther, and Pollock, 2014).

Coaching/mentoring

People with complex mental health issues face many challenges entering or re-entering the workforce and finding employment. Some of these challenges include stigma, discrimination, and lack of appropriate support, education, or training. (SANE, 2023). Thus, they could use a mentor or coach to help prepare them for employment. SANE’s Peer Guide Program is an initiative funded by the Department of Social Services: Strong and Resilient Communities (SARC) and Mental Health Commission of New South Wales. The aim of this program is to support people living with complex mental health concerns to access pathways designed to support their journey towards employment and/or further education. People are able to leverage their experiences with mental illness – one of the very issues that may have compounded their disadvantage – into a pathway to employment, engagement, and participation. Peer Guides are service users who seek help on SANE’s Forums to transition from people accessing mental health services to becoming trained volunteers providing support to others. The Peer Guide Program focuses on:

  • Online training on key competencies for peer support work and transferrable employment skills
  • Providing participants with mentoring by a dedicated peer mentor
  • Practical work experience by volunteering within SANE
  • Supporting education/employment readiness for program participants (SANE, 2023a).

Telephone support

Peer-run ‘warm lines’ typically operate after business hours, when general public health services are not available to provide support. In one qualitative study spanning four years, callers to a warm line in the United States reported a reduction in use of crisis services and in feelings of isolation, and positive impacts in terms of wellbeing, personal empowerment, and use of coping strategies (Dalgin, Maline, & Driscoll, 2011). The warm line used for the study was operated by 2-4 peer support workers, seven nights per week, between 5pm and 8am. Warm line peer workers were provided with introductory training, weekly group and individual supervision, and access to an on-call supervisor during all shifts (Dalgin, Maline & Driscoll, 2011).

Arafmi has a 24-hour carer support line (1300 554 660), staffed by peer and non-peer volunteers, which is open to anyone who is caring for or about a relative or friend with a psychosocial disability (Arafmi, 2023).

Ward-based support

Since 1999, Carers Offering Peers Early Support (COPES), based in St. Vincent’s Hospital in Victoria, has been an example of a ward-based, replicable peer mentoring support service for carers of people with a mental illness. The carer peer support worker is based within an adult clinical mental health setting, providing one to one peer support that is connected to and complements formal clinical, health and support services. Carers and family members referred are initially contacted via telephone by COPES. COPES provides individual peer support on-site, at a time when families/carers have reported high support and information needs. As a partnership model between a clinical and community mental health service provider, additional support is provided in the community to allow access beyond the acute environment. Carers may receive one-off support, or ongoing short-term support; where counselling and advocacy needs are identified, the COPES worker will assist with referral (Mind, 2023; COPES, n.d.).

Peer-led organisations

One of Australia’s largest peer-led and operated organisations is the Brook Recovery, Empowerment and Development (RED) Centre, based in Brisbane, Queensland. Brook RED provides a range of peer support services and activities and is funded by both State and Federal government departments. Brook RED services include:

  • 24-hour peer-supported respite program
  • Out-of-hours community support phone line
  • Centre-based programs across two sites including: activities e.g., music, health and fitness; men’s and women’s groups; excursions; shared meals
  • Group-based and individual peer support (Brook RED, n.d.).

Follow-up article: Working with Peer Support Workers.

Key takeaways

  • The lived experience workforce can be in either a personal/direct experience role or a family carer/support experience role
  • Roles can either be generic or have a “specialisation”, the latter according to type of lived experience and/or population served
  • The type of peer support role and the population served may determine the setting and model for service delivery, with an increasing range of possibilities

References

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