Formal ‘peer support’, in which former or current service users take on a professional role in services, are associated with numerous improvements on numerous issues that can impact the lives of persons with mental health conditions and psychosocial disabilities (Repper & Carter, 2011). There does not appear to be research that explicitly seeks to identify a causal relationship between the increase in number of people with lived experience in professional roles at a particular service, and a reduction in coercion. However, there does seem to be an implicit belief in much of the literature that the improvements associated with a larger peer workforce will improve service provision such that, indirectly, coercion will be reduced.

The active involvement of people with lived experience of using mental health services or being subject to involuntary psychiatric intervention in the practice and policies that affect them is also a directive of the CRPD (Article 4(3)). The active involvement of people with this lived experience is by no means limited to the coalface of service provision. Examples from around the world, highlight the variety of roles people with psychosocial disabilities can play concerning mental health, including in research, policymaking, legal advocacy, and so on. However, this sub-section is concerned with direct peer support in mental health services (including in hospitals and community services).

A meta-analyses of studies on peer support workers in mental health services, by Julie Repper and Tim Carter (2011, p.392), indicated that such workers 'can lead to a reduction in admissions among those with whom they work', and hence, are likely to indirectly drive down the use of coercive practices. With sufficient training, supervision and management, according to Repper and Carter, this cohort has the 'potential to drive through recovery-focused changes in services' (Repper and Carter, 2011, p.392).

 Hearing Voices Network – International

Hearing Voices Network groups are based on the idea that members – that is, those who experience hearing, seeing or sensing things that others do not – can share successful strategies with each other in a safe and mutually supportive space. Hearing Voices Network groups appear worldwide, in countries as diverse as Greece, Denmark, the UK, Uganda, Japan, Australia and the US (Submission 27). In the UK alone, there are reportedly over 180 groups, including groups for young people, people in prison, women and people from ‘Black and Minority Ethnic’ communities (Submission 27).

In one systematic assessment of the impact and effectiveness of Hearing Voices Network self-help groups involving 62 groups affiliated with the English Hearing Voices Network, researchers concluded that attendance ‘was credited with a range of positive emotional, social and clinical outcomes’ (Longden et al., 2018, p.184). Aspects that were particularly valued included: opportunities to meet other voice hearers, provision of support that was unavailable elsewhere, and the group being a safe and confidential place to discuss difficult issues (Longden et al., 2018, p.184). Participants perceived Hearing Voices Network groups to facilitate ‘recovery processes and to be an important resource for helping them cope with their experiences’ (Longden et al., 2018, p.184). Successful groups supply a safe context for participants to share experiences, and enable dissemination of strategies for coping with voices as well as considering alternative beliefs about voices.They aim to offer a safe haven where people with shared experiences feel accepted, valued and understood.

There are several differences among Hearing Voices Network groups, even as they share basic values. The differences include, but are not limited to:

Membership

The membership of most groups is purely made up of people with lived experience of voices, visions and other unusual sensory perceptions. Some groups have open sessions that welcome family members and/or supporters too. Some groups focus on a particular group (people from specific cultural groups, genders or ages, for example). Others are open to all.

Setting

The Hearing Voices network includes groups in a range of settings, including: independent community groups; voluntary sector organisations; mental health teams; inpatient units; secure mental health units; prisons. They are also aiming to provide support groups that are also available online.

Facilitation

Some groups are 100% user-led, with all facilitators having personal experience of voice-hearing. Some others are facilitated by people with a combination of personal and professional experience. In some settings, groups may be facilitated completely by people with professional, but not personal, experience. While these groups are no less valuable than any other, the broader network encourage these groups to find ways of more actively involving people with personal experience in their running and facilitation.

For more information, see: Intervoice website, Hearing Voices Network website.

 Intentional Peer Support – the United Kingdom and Internationally

'Intentional Peer Support' (IPS) is a practice that is designed to improve informal relationships of support for people in distress (Submission 27). Darby Penney and colleagues (2021) refer to IPS as ‘a peer-developed, theoretically based, manualized approach that is used in multiple countries’. It is designed to help informal support persons, though it can also be a technique employed by paid staff (Stone et al., 2010), to support a person in a way that helps them to focus on the relationship, and to mutually determine helpful ways to respond to crisis.

Intentional peer support often involves talking very overtly about power—who has it, who does not and how it can be shared through negotiation. The aim is to challenge some of the traditional dynamics that come up in informal care and support for people in crises, and instead create relationships that are more mutual, and in which power is shared rather than taken by those providing care. There is currently no peer-reviewed empirical research into Intentional Peer Support. However, Penney and colleagues (2021) have developed and tested a measure that can be administered to service users to provide quantitative data for assessing ‘IPS core competencies’ in outcomes research, which provides a foundation for future process-oriented research on IPS to systematically document and appraise participant experiences. At present, IPS may be useful in operationalising elements of rights-based support for people in psychological distress and mental health crises which help prevent coercive interventions (see Gooding, 2018, p.202).

For more information, see: Intentional peer support

Médiateur de santé pairs (‘peer to peer mediator’) – France

An example of peer support workforce creation and development is the médiateur de santé pairs (‘peer to peer mediator’), which was developed in France by the Centre Collaborateur de l'Organisation Mondiale de la Santé pour la recherche et la formation en santé mentale (French World Health Organization Collaborating Centre for Research and Training in Mental Health).

The program draws on international trends, particularly in high income countries, to integrate former or current service users into mental health care teams but does so by providing graduates of the trainee program with a tertiary qualification. The program began in 2012, in 3 pilot regions, with 30 peer health mediators who divided their time between university-based training and professional activity in a psychiatry department. In December 2017, a more formalised arrangement was made in which health-peer mediator training formed part of an existing Bachelor of Health and Social Sciences degree from the Bobigny Paris University 13 and CCOMS. 35 peer health mediator positions were filled in 6 regions ‘in areas of psychiatry, hospitals and medico-social structures’ (Submission 15). The training comprised of both theory and practice. The theoretical component was organised in partnership with the University of Paris 8 and the training sessions took place in the 3 regions. The practical training involved 15 adult psychiatry institutions (5 sites per region).

As training registration was conditional on recruitment at one of the 15 sites, participants in this program were hired under a professional contract. This contract covered the year of training and internship as well as the year of service placement. The programme has been the subject of qualitative evaluation, which reported positive results, as well as quantitative study, which is underway at the time of writing.

For more information, see Centre Collaborateur de l'Organisation Mondiale de la Santé pour la recherche et la formation en santé mentale.