Peer support is the core principle of Child & Family Connections. At its simplest, peer support is based on mutuality and a shared journey of discovery. Through peer support, people help and support each other as equals, sharing their personal stories, teaching, learning, and growing together with an important goal of finding a new sense of self, meaning, value and purpose in life.
Recognition of the power of peer support to transform lives and revolutionize services is not limited to the mental health arena. From breastfeeding to bullying in schools, from diabetes to dementia, head injury to heart disease, its transformational value is being recognized.
Our story provides a good illustration of the concept:
In 2010, nine-year-old Charlotte asked if she could share her struggles with other kids who have a parent with a mental illness. It was a milestone in a journey that began a decade before with her father’s recovery from near-death, institutionalization, and destitution followed by years of hard work by father and daughter to rebuild their relationship, damaged by the effects of Evan Kaplan’s bipolar disorder.
Inspired by his daughter’s request but unable to find any programs, Evan collaborated with the Mental Health Association of Southeastern Pennsylvania and the City of Philadelphia to assemble a cross-functional, cross-organizational team of behavioral health experts, academics, researchers, and parents with “lived experience” and formed a support group for families living with parental mental illness. CFC trains parents with lived experience to teach other parents and their children real-world skills and strategies that promote individual and family resiliency.
With a curriculum grounded in the latest research from Harvard, UCLA, Dartmouth, and other, facilitators also draw upon their own recovery experiences. Hugs, tears, and compassion empower participants to overcome years of crippling shame, guilt, and stigma. Whether they come to a workshop or call or login into the support group, the people we serve are unified by their love for their families and their willingness to do the difficult work necessary to help them thrive. The sweat equity and passion of a core group of people has enabled CFC to accomplish so much more than we ever envisioned in that cramped conference room with the rattling fan four years ago.
And Charlotte’s request continues to transform lives.
Frequently Asked Questions
Peer Support has a long and honorable history in mental health. Fellow patients and service users have always provided invaluable support to each other, both informally and through self-help and activist groups (Jackson 2010).
At the core of peer support is the need to feel truly understood, to learn that you are not alone with your experiences. Finding others who have had similar experiences can lead to a sense of genuine empathy and shared understanding, reassurance, and hope. Some people who had previously felt alone with their experiences found reassurance and affirmation of their experiences in the company of others. (Faulkner and Layzell 2000)
In related fields, organizations have been constructed entirely around peer support and the ability of people with various problems to use collective expertise to assist each other. Mental health peer support has developed along more formal lines over the years. Networks of groups and organizations (such as Child & Family Connections) have been established to raise awareness about and to promote self-management strategies and mutual support for managing parental mental illness.
Today, there is an acceptance that peer expertise can be an effective part of mental health services. People with lived experience have been increasingly involved as facilitators, educators, and trainers in both national and local mental health efforts. Their status as “experts by experience” is now acknowledged alongside that of the various mental health professions.
- Informal and usually provided on a voluntary unpaid basis
- Formal, or “intentional” – where the peer support worker is usually paid
- Peer-led or Staff/professional-led
- Run by a service user-led group (usually part of the fabric of their work) or within a statutory environment (for example, an NHS Trust)
- An initiative, program, project, service, group or organization
- Provided in various contexts, such as: peer support in acute admissions, in a crisis center, in the community, in a day center, in forensic services, offering peer support training, peer support brokerage, 24-hour peer support service.
Bradstreet (2006) talks about three types of peer support:
- Informal/unintentional and naturally occurring peer support
- Participation in peer-run groups/programs, and
- Use of peers as paid providers of services – formal or intentional peer support.
The essence of peer support may be contained in these 12 principles. Successful peer support contains the following principles.
- Sharing with safety and trust
- Focus on strengths and potential
- Equality and empowerment
- Being yourself
- Reduction of stigma
- Respect and inclusiveness
There is a long-standing tradition of peer support within service user groups and organizations. The authenticity of peer support, rooted in personal experience, is a very powerful and effective way of learning. It can create:
- Shared identity
- Increased self-confidence
- The development and sharing of skills
- Improved mental health and well-being, accompanied by less use of mental health and other services
- An increased role in information sharing and signposting
- A feeling that peer support challenges stigma and discrimination
- For those involved in giving one-to-one and more formal peer support, there was also the benefit gained from helping others
People who received peer support had:
- Increased community integration (Nelson 2007)
- Increased quality of life (Nelson 2007)
- Significantly greater involvement in work or participation in education (Nelson 2007)
- Lower levels of symptom distress (Nelson 2007)
- Enhanced social relations (Forchuk 2005)
- Earlier discharges from hospitals; an average of 116 days earlier (Forchuk 2005)
- A greater focus on recovery in both the culture and practice of mental health services (Lawn 2008)
- A 50% reduction in re-hospitalizations, compared to the general outpatient population (Chinman 2001); 73% of people in a comparison group were re-hospitalized, versus 62% in the peer support group (Min 2007)
- Fewer hospital admissions and fewer emergency room visits (Clarke 2000)
Traces of past attitudes often emerge that block and compromise the progress of peer support. and peer support may jar with conventional service perspectives and models.
- Issues about boundaries and disclosure
- Their relatively powerless position within mental health services
- Stress generated as a consequence of their work
- Issues of responsibility, accountability, and governance
- A clear need for strong and relevant support, supervision and training
- Sometimes unclear roles and job descriptions
- Mainstream services may inhibit the effectiveness of the role
- Branfield, F. & Beresford, P. (2006) Making user involvement work – supporting service user networking and knowledge’ York: Joseph Rowntree Foundation.
- Bradstreet, S. (2006) Harnessing the ‘lived experience’. Formalising peer support approaches to promote recovery. The Mental Health Review. Vol 11, 2, 33-37.
- Chamberlin, J. (1988) On Our Own: patient-controlled alternatives to the mental health system. London: Mind Publications.
- Chinman, M. J., Weingarten, R., Stayner, D., Davidson, L. (2001) Chronicity Reconsidered. Improving Person-Environment Fit Through a Consumer-Run Service. Community Mental Health Journal. Vol 37, 3, 215-229.
- Clarke, G., Herinckx, H., Kinney, R., Paulson, R., Cutler, D., & Oxman, E. (2000) ‘Psychiatric hospitalizations, arrests, emergency room visits, and homelessness of clients with serious and persistent mental illness: Findings from a randomised trial of two ACT programs vs. usual care’ Mental Health Services Research, Vol 2, 155-164.
- Daniels, A., Grant, E., Filson, B., Powell, I., Fricks, L., Goodale, L., (eds), (2010) Pillars of Peer Support: Transforming Mental Health Systems of Care, Through Peer Support Services, www.pillarsofpeersupport.org; January, 2010.
- Department of Health (2010a) Equity and Excellence: Liberating the NHS. London: Department of Health.
- Department of Health (2010b) Putting People First: Planning Together – peer support and self-directed support. London: Department of Health.
- Department of Health (1999) The National Service Framework for Mental Health. London: Department of Health.
- Department of Health (2009b) New Horizons: a shared vision for mental health. London: Department of Health.
- Department of Health (2009a) Achieving World Class Productivity in the NHS 2009/10 – 2013/14: Detailing the Size of the Opportunity. London: Department of Health.
- Duffield, A. & Rendell, N. (2009) Working Together; An Evaluation of the introduction of User-Run Peer Support Sessions and development of Person Centred Planning and Bridge Building Support in Bromley Mind. London: Bromley Mind.
- Faulkner, A. & Layzell, S. (2000) Strategies for Living – A report of user-led research into people’s strategies for living with mental distress. London: Mental Health Foundation.
- Faulkner, A. & Basset, T (2010) A Helping Hand: Consultations with Service Users about Peer Support. London: Together/University of Nottingham/NSUN.
- Forchuk, C., Martin, M. L., Chan, Y. C. L., Jensen, E. (2005) Therapeutic Relationships: from psychiatric hospital to community. Journal of Psychiatric and Mental Health Nursing. Vol 12, 556-564.
- Jackson, C. (2010) Critical Friends, Openmind 161, January/February, 14-15.
- Knowledge Institute (2009) Characteristics of Good Peer Support. Wellington (NZ): Wellink Trust.
- Lawn, S., Smith, A, Hunter, K. (2008) Mental health peer support for hospital avoidance and early discharge: an Australian example of consumer driven and operated service. Journal of Mental Health,17(5), 498-508.
- Lindow, V. (1994) Self Help Alternatives to Mental Health Services. London: Mind Publications.
- Malpas, G. & Weekes, J. (2001) An Investigation into Drop-ins. London: Mental Health Foundation.
- McLean, J., Biggs, H., Whitehead, I., Pratt, R., Maxwell, M. (2009) Evaluation of the Delivering for Mental Health Peer Support Worker Pilot Scheme.
- Mead, S Hilton, D., Curtis, L. (2001) Peer Support: A theoretical perspective, Psychiatric Rehabilitation Journal, 25, 2, 134 -141.
- Min, S., Whitecraft, J., Rothband, A. B., Salzer, M. S. (2007). Peer Support for Persons with Co-Occurring Disorders and Community Tenure: A Survival Analysis. Psychiatric Rehabilitation Journal. Vol 30, 3, 207-213.
- Munn-Giddings, C., Boyce, M., Smith, L., Campbell, S. (2009) The Innovative Role of User-Led Organisations. – A Life in The Day, Vol 13,2, 14-20.
- Repper, J. & Perkins, R. (2003) Social Inclusion and Recovery: A Model for Mental Health Practice. London: Balliere Tindall.
- Wallcraft, J., Read, J., Sweeney, A. (2003) On Our Own Terms – Users and survivors of mental health services working together for support and change. London: Sainsbury Centre or Mental Health.