Essay: Do peer group specialist improve recovery in adults with mental illness in an outpatient setting?

KEY FINDINGS – Kara
In the article “Introducing peer worker roles into UK mental health service teams: a qualitative analysis of the organizational benefits and challenges,” Gillard, Edwards, Gibson, Owen, and Wright (2013) described five themes that they encountered in their study of the role of peer mentors. The first theme studied who, how, and why people become involved with peer work.  They found that all of the peer workers were recruited from the facilities they attend.  All of the peer workers interviewed stated that they took the position because they wanted to help others using the knowledge they have from their own difficult experiences. One peer worker said “…my ears are there, my shoulder is there, and everything they say is confidential and I would try to help them the best I can” (Gillard et al., 2013). This desire to help others recovering from mental illness is supported by the article “Peer support among persons with severe mental illnesses: a review of evidence and experience.”  Davidson, Bellamy, Guy, and Miller (2012) identified the peer mentor’s burden of disclosing their personal experiences and using them to help other patients. The clients interviewed for Cabral, Strother, Murh, Sefton, and Savageau’s (2013) article felt like their shared experiences with the mentors allowed them to form a deeper bond than with other staff.  They also reported that they were inspired by the peer mentors, and were able to see a positive direction for their recovery to take, and a goal to work towards.  Many reported an interest in becoming a peer mentor further into their recovery (Cabral et al., 2013).
A second theme identified by the managers of the psychiatric facilities is how being a peer worker is beneficial to the individual as well.  Through their training and experience, they obtain group facilitation skills, personal development skills, self-confidence, and self esteem (Gillard et al., 2013).  Peer specialists use these skills to help fellow staff members by conducting training sessions about working with clients, the use of language, and the recovery model.  This provides a greater responsibility for the peer mentors, and challenges providers who have not personally experienced a mental illness to see things from a different perspective (Cabral et al., 2013).
Another theme identified was the switch of the dynamic between the peer mentors and the staff.  There is a shift from client to colleague, even though the peer workers still feel like they are not the staff’s equals.  According to one peer worker, “I wouldn’t say that I feel completely like I’m a member of the team… I guess I still feel somewhat inferior in how I’m seen by the team or members” (Gillard et al., 2013).  This leads into the third identified theme, where the peer workers do not feel like a staff member or a patient, but they do not feel “sick” either. The role places them in a position that is neither wholly a patient, nor wholly a staff member. If the person can perform the tasks required of a peer mentor, the patient’s psychiatric history should not be considered as a factor included in the assessment of their level of functioning.  If practitioners only assess the individual’s current frame of mind, the shift between being seen as someone with a mental illness to a fellow employee (Davidson et al.,  2012).
A fourth theme identified was the need for boundaries within the care team and between peer workers and clients.  One boundary identified was reducing the exposure of the peer worker to situations where professional and social contact might overlap such as giving other clients their phone number.  Other important boundaries relate to confidentiality. Peer mentors are expected to abide by the same confidentiality policies as other employees.  This can be ensured through training and supervision.  According to Davidson’s study, peer mentors are more likely to protect their client’s confidentiality because they have been service user’s themselves.  (Davidson et al.,  2012).
The fifth theme studied came to the conclusion that peer workers as well as staff members identified the inclusion of people who had experienced mental illness first hand was beneficial and helped to engage service users.  They all feel peer workers bring insight to the team that would otherwise be lacking, such as approachability, as well as being able to relate to patients, which is something most psychiatric health care professionals are not able to do (Gillard et al.,  2013).  Peer mentors help to bridge the gap between patient and practitioner as well as promote a sense of trust between the patients and the providers (Davidson et al., 2012).
The patients interviewed who have worked with peer workers have identified this as having a positive impact on their recovery.  They report an increase in self-confidence, an improved support system, and the acquisition of helpful coping mechanisms. A portion of those interviewed report that they have been inspired to become peer specialists themselves.  The only negative comments regarding the peer specialists is that the time they were able to spend one-to-one was very limited (Cabral et al., 2013).
 
Purpose summary- Dennisse
A peer worker is an individual of the community who shares similar experiences with people in specialized programs such as mental health programs. Such individuals are highly valued by the mental health team. In the article “Introducing peer worker roles into UK mental health service teams: a qualitative analysis of the organizational benefits and challenges,” peer group specialists are a major component of mental health care. In the UK, peer support is strongly advocated as a strategy in health and social care policies (Gillard, Edwards, Gibson, Owen, and Wright 2013). One of the outcomes involving peer support is a reduction in inpatient admission to psychiatric hospitals.  Research done in the United States has also documented a significant improvement in individuals who have worked with peer specialists, finding an enhanced sense of empowerment, better social support and furthering personal recovery (Gillard et al., 2013).  Peer support has proven to be effective for centuries helping and supporting individuals with severe mental illnesses.  According to Davidson, Bellamy, Guy, and Miller (2012), there has been a rise in the hire of peer support workers because they have proven to be effective in engaging people in care, reducing the number of emergency visits, as well as reducing the use of drugs amongst those with coexistent substance abuse disorders. Peer support has also been found to increase the client’s sense of well-being, which is positively influencing their mental status.  Cabral, Strother, Murh, Sefton, and Savageau (2013) emphasize that peer support improves the well being and trust of clients in the mental health setting. Patients have found it easier to work with peer specialists because they are able to relate to them. The patients in turn feel more comfortable sharing their experiences, facilitating conversation between the two and helping to improve their mental health.
~ Brenda ~
Because of their ability to empathize directly and immediately with their clients, those who are in recovery are especially well suited to helping others suffering from a severe mental illness. Peer specialists can be seen as recovery mentors, helping to guide others in their journey to wellness. Using peers to provide support to clients at this stage of their recovery in conjunction with other forms of treatment is highly effective. Peer specialist positions promote a renewed sense of hope for the possibility of recovery while offering unique and valuable competitive employment options for mental health patients. Nursing professionals play an important role in the development of peer support programs in psychiatric facilities.  Because of the hands-on experience with the patients over an extended period of time, nurses are able to gain a good understanding of the patients and their journeys, and give referrals to peer specialist services (Cabral et al.,2013).  As nurses, we need to identify the role of peer specialists on a care team and help integrate the peer specialists into the care team. Many clients have little orientation or explanation of how a peer specialist will work with them prior to receiving services. Nurses educate patients regarding the expectations of a peer-peer specialist relationship, as well as relay the benefits of engaging in peer support.  Most notably, nurses encourage patients to engage with peer specialists and explain that a peer specialist’s lived experience allows the client to engage with them in a way that health professionals may not be able to because of a lack of understanding.
While the Yaphank Center does utilize the role of peer specialists, many clients are not aware of this service.  There is a peer room that clients are able to spend time in to socialize, play music, and relax, but it is often very empty for most of the day.  There are two peer specialists at the center, but they do not participate in any of the staff-run meetings.  They spend their days in the peer room, in an informal setting but have no participation in the discussion based meetings.  For this role to be fully utilized at the center, there needs to be more peer specialists trained, and there also need to be more opportunities for interaction with the peer specialists.  They should be running groups along with the staff, as well as creating their own services that they see as being beneficial to the clients.  The two peer specialists are in a relationship, and tend to isolate themselves from the other patients.  They run the peer room together, and they sit with each other every morning when the clients are arriving and attendance is being taken.  This is a perfect opportunity to interact with the other clients, and explain what a peer worker does in the facility.  The peer workers should come up with activities such as bingo, or name that tune that can be played in the peer room, and should use that time to invite the clients as well as develop a relationship with them.
These suggestions for improvement are dependent on the staff and peer workers getting the word out about the peer workers.  Clients need to be introduced to and educated on how a peer specialist has lived what they are going through, and how that can truly help in the patient’s recovery.  This role can also serve as a motivational influence and truly inspire the patients to find an inner peace with their mental illness like the peer specialists have.  Effective strategies for implementing peer services include identifying and valuing the unique contributions that peer specialists can make to the programs and settings where they will work. Programs should start with at least two peer specialists to prevent one from getting overwhelmed and provide a source of mutual support in the new role.  It is necessary to provide training for peer staff that details the specific skills and tasks required of them, such as using their recovery story to benefit clients, effective listening skills, creating positive relationships, and maintaining boundaries.  Specialists should also be taught goal identification and setting, what to do in an emergent situation, documentation requirements, ethics and confidentiality, and ways of resolving conflict in workplace ( Davidson et al.,2012).  Staff supervision should concentrate on job skills, performance, and support rather than on the person’s clinical status.  This ensures that a peer specialists performance is assessed the same way as the other employees.