From experience to expertise: A vision for the future of Peer Support Work #VolunteersWeek

Since it's Volunteers' Week I thought I'd share a few posts about my experiences as a Peer Support Worker with South London and Maudsley Trust. You can also read Part One: What even is Peer Support Work here, What does a Peer Support Worker do? and Does Peer Support Work work? here. Today I wanted to share a vision for the future of Peer Support Work and how we can start to recognise lived experience as it deserves.

As outlined in previous posts, Peer Support has many advantages for Peer Support Workers, service-users, services and the wider community, with both empirical and anecdotal evidence supporting the integration of the role into mainstream healthcare services. I now suggest that this role could benefit from enhanced training and skills-development, with PSW afforded the same status, opportunities and protections as other staff, including remuneration. I outline how this would further benefit all parties, with some suggestions on how this could be achieved, while considering how to retain the grassroots ethos and interpersonal qualities that are particular to the role.

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The need for training and development

The provision of peer support has grown as services move towards a more person-centred recovery-focussed model of support. Recovery-based focus insists that service-users are central to the planning and delivery of support (Faulkner & Basset, 2012), and peer support is one of the ways to promote these principles. Recruiting and training lived-experience practitioners can enable services to move towards this more participatory model of provision (Hutchinson et al., 2006). Paid employment, investment and training opportunities is a method by which services can demonstrate their values and dedication to service-users.?

Due to the flexible and individual nature of PSW, as well as limited understanding of the mechanisms by which it works, there is subsequently a lack of consensus about what competencies the role requires, and thus a lack of training or certification in the field (Myrick & Del Vecchio, 2016). Few peer support programmes currently offer standardised or evidenced training to their PSW (Hutchinson et al., 2006). Research and training could there assist in developing understanding of the scope of this role, begin to provide a shared agenda and solidarity (Basset et al., 2010).

A lack of training opportunities may reflect the original understanding of PSW as a values-based, rather than skills-based role. As previously mentioned, a key feature of PSW is in relational and interpersonal, transferable skills of the PSW. While current implementation of PSW suggests that experience is qualification enough (Repper & Carter, 2011) others argue that accredited training programmes need to be developed and established, in order for the role to safely, ethically and successfully meet the needs of services, service-users and Peer Support Workers (Basset et al., 2010). A model of peer support that is more structured and more organised subsequently becomes more focussed and more helpful (Bassett et al., 2010). Accreditation is described by Repper and Carter (2011) as a way of appreciating and acknowledging skills and experience of those with lived-experience.?

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Benefits

Lived-experience is essential to the role of PSW, working as a Peer Support Worker accommodates a shift in identity for the individual, from that of a service-user to an employee. This conceptualisation of the self as moving away from someone who is disempowered and unwell to someone who is valued and empowered is a fundamental mechanism by which the role contributes to the individual’s wellbeing. Working in a PSW role potentially improves confidence and contributes to self-concept, which are important in the individual’s recovery and wellbeing (Cook et al., 2010; Deegan, 2003; Hutchinson et al., 2006).

As individuals with lived-experience some PSW experience unemployment due to their ill-health or hospitalisation. PSW can act as employment, or provide valuable experience leading to improved employment prospects. Some PSW use the role as a stepping-stone in their return to work after their own mental-ill-health, or to initiate a change of careers. In an intervention study Hutchinson et al., (2006) found that PSW who had received sixty hours of training were all in employment by the end of their training, with 89% of participants still employed after 12 months

This suggests that training and employing PSW would benefit them vocationally, economically, socially and psychologically (Hutchinson et al., 2006), contributing to their wellbeing and recovery journeys, improving employment prospects and allowing individuals to utilise and make sense of their experiences while helping others.

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How this could be implemented

Standardised training and clarity around the role of PSW and expectations would enable services to be explicit in what they can offer service-users. The nature of PSW as mutual and reciprocal blurs boundaries of a traditional service/ service-user interaction, with PSW sometimes considered more as friends to the service-user. Clarity around expectations and boundaries protects both the service-user and the PSW, as well as mitigating potential issues for the service.

As lived-experience is fundamental to this role, recruitment, training and line-managing PSW may require more consideration, sensitivity and adjustments than a mainstream member of staff. An extended induction period, reasonable adjustments at interview and throughout the role, and more frequent supervision could be considered, in order to support the PSW in transitioning to the role. Stress, uncertainty, lack of clarity around expectations can be detrimental to all three parties (PSW, service and service-user) so a joined-up approach with standardisation across the role would be beneficial. PSW in turn would be bound by the usual trust protocols, expectations and fitness to practice as any other employee would be.?

Research into future prospects of PSW suggests training is needed in definitions and distinctions of PSW, active listening, recovery planning (of self and service-users), problem-solving, conduct (including maintaining boundaries), working with disclosure, inclusivity and diversity, safeguarding and ethics (Repper & Carter, 2010; Repper & Watson, 2012). As PSW was in part created to address the failures of NHS and mental-health services in meeting the needs of marginalised groups, a focus on working with diversity and difference is imperative. Training can also include psychoeducation, awareness raising and reducing stigma towards one’s own recovery, self-worth and empowerment.?

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Retaining the key aspects of Peer Support Work

Professionalisation and formalisation of PSW might be considered antithetical to the original aims of the role. Care and deliberation must be given to ensure that the ethos and principles of Peer Support Work, grounded in a history of the service-user movement, are not lost as the model transitions to a more formal and professional standpoint. If the key aspect of PSW is as a bridge between services and service-users, with interpersonal relating fundamental to it’s success, then integrating PSW as another part of the system potentially loses those unique benefits. The question of who is equipped to provide training, particularly while retaining the non-hierarchical values of PSW, can be raised; but perhaps indicates the need for a collaborative service-user and PSW-led agreement on the basic elements of the role, identifying training needs and at what point experience can be considered expertise.

There is also the potential that training and accreditation may be discouraging or inaccessible for some, perhaps due to their mental ill-health, experiences within services or entitlement to state-benefits. Mandatory training or employment, therefore would not suit everyone who undertakes this kind of work. I suggest that this should be an opportunity for all, with no expectation to take it up, but additional support in identifying and addressing barriers for uptake, if required.?

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Conclusion

Employing individuals with lived-experience creates a culture that recognises the value and expertise of service-users. Peer Support Work can be an observable demonstration of an organisation’s commitment to growth and inclusivity, as well as challenging hierarchies in care and a lack of accessibility or willingness to engage for service-users. Training and or remunerating former service-users as I suggest here would require a paradigm shift, with services, recruiters and individual staff reflecting on what constitutes professionality as well as quantifying what experience brings to the role and service. Hutchinson et al., (2006) suggests that in order for Peer Support to be integrated and implemented successfully, then organisations and NHS Trusts would need to consider how they are structured, impacting decisions on service-planning and reviewing policies, recruitment and ethics. In presenting some of the arguments for improved training and employment prospects, I hope to have outlined why this work is necessary and should be welcomed.?

You can read other posts in this series here: