Peer support works on the road to recovery

People who have recovered from serious mental health issues often find it difficult to get back into work. Yet their experience of illness and recovering is a valuable one that can be harnessed to help other people in a similar situation.

‘The whole notion of having peer workers is having someone with lived experience who can share that in a positive way with current service user’

Cambridgeshire and Peterborough Foundation Trust decided to develop training and roles as peer support workers for former service users after hearing about a scheme run by Recovery Innovations in the US. Senior staff visited the company and were “gobsmacked” by the success of the scheme, says Sharon Gilfoyle, who was appointed project manager to try to develop the programme at the trust.

Lived experience

Experts from Recovery Innovations delivered the first courses to a group of former service users in 2010. Training lasted a month and included work experience and exams. Ms Gilfoyle developed job descriptions and person specifications for the roles – not all former service users are suitable − and also worked to identify potential posts for the trainees.

To date, 38 former service users have been employed as peer support workers – the highest number at any trust in the UK. They have been based in inpatient units, community teams and specialist areas such as eating disorder services and integrated offender management teams.

The whole notion of having peer workers is having someone with lived experience who can share that in a positive way with current service users. It could be as simple as when someone is admitted to a ward having someone who can say: “I know how scary it is, I was admitted too,” says Ms Gilfoyle. The aim is to offer hope and show that problems can be overcome.

Two peer employment educators have also been developed, to ensure the trust could continue to operate the scheme independently, and they have run courses themselves. They are of degree level and have teaching experience.

Encountering challenges

But such a radical approach to recovery is bound to encounter challenges. One has been around identifying appropriate posts for the support workers once they have been through the training. The trust had some money from an innovation fund to set up the programme but it did not have any funding for additional jobs.

This meant it needed to identify vacant posts that could be filled by peer support workers. These have tended to be band three roles − healthcare assistants or similar − although some band four roles have been developed and peer education educators are band six.

However, band three workers would have to be an integral part of the team and take on some of the functions of healthcare assistants on the wards, such as making beds, taking observations and helping with meal services, as well as supporting existing service users.

Their managers and fellow workers needed to see having a peer support worker on the team as positive, rather than “taking away” part of their support. The trust decided no qualified roles could be replaced by peer support roles.

‘Some peer support workers move on to other jobs outside the organisation’

An ongoing issue is finding enough jobs for peer support workers who “graduate” from the training. The trust did no training last year because it already has a large number of trained workers awaiting jobs. This has been partly due to posts being frozen as the trust – like others – looks to control costs.

But some peer support workers do move on to other jobs outside the organisation: the period working in the trust helps them with their CV and gives them an up-to-date reference.

The right dynamics

Getting the dynamics right between existing employees and the peer support workers is also important. Staff reaction has been varied and some have needed to overcome seeing their new colleague as a service user.

Sometimes they simply need a reminder that someone they may have seen receiving treatment is now an employee, but the majority of staff are accepting of them, says Ms Gilfoyle. As former service users, their insight can be helpful in many ways – for example, about how to make ward environments more welcoming and homely.

Criminal record bureau checks can also be a challenge. The trust has had to be pragmatic about employing peer support workers with minor offences (obviously some offences would rule them out entirely). Those working in the offender management team may find themselves based in police stations, which is another interesting dynamic.

Ms Gilfoyle says it has been important for peer support workers to meet together and share experiences. They also have professional development opportunities and support if they feel they need it. But she suggests this could be strengthened. 

‘Their insight can be helpful in many ways – for example, about how to make ward environments more welcoming and homely’

The trust recently commissioned Rand Europe to evaluate the early impact of the programme. It found there were positive affects on the peer workers from the training and later employment, and people receiving services felt they were approachable and flexible.

Cultural change

There were early indications of cultural change in teams and in the wider organisation, with greater emphasis on recovery and awareness of the perspectives of those using services.

‘The trust should look at greater support for people making the transition from service user to employee, and also support for other staff in understanding this’

The evaluation suggested the trust should look at greater support for people making the transition from service user to employee, and also support for other staff in understanding this. Greater clarity around their role and realistic expectations would also help, as would more practical experience and ongoing support for peer workers.

But overall, Rand said there were very few negative effects mentioned.

Spin-off benefits

Ms Gilfoyle identifies huge benefits in terms of developing recovery. Recovery is also seen not just in terms of clinical symptoms but in terms of social functioning. One spin-off is that staff are more open about their own mental health and it has made the trust think more about how it can support employees with mental health issues.

The scheme has only been running for two years but similar projects in the US have shown dramatic reductions in hospital readmissions, seclusion and restraint where peer support workers are used. And Ms Gilfoyle points out their presence is a positive message of hope that mental health problems can be overcome.