Does Peer Support Work?
Written by Simon Bradstreet
This is the first publication in a new demystifying research series from Imroc.
We are starting with a topic that we know from feedback that many people involved with Imroc are interested in, which is research related to peer support. Our starting point is a deceptively simple question with a less than simple answer.
Does peer support work?
In unpicking this question we introduce and explain various research terms in a way which is understandable and accessible. All technical research terms are underlined and link to our research jargon buster which will grow as we explore more questions and methods.
This paper will also focus on the strengths and limitations of the main research method that is used to answer questions about effectiveness, which are known as Randomised Controlled Trials.
Key Points
Methods related
All research methods have limitations, so it is important to take a critical and informed perspective.
There is a hierarchy of research evidence with certain types of methods more highly prized than others.
Peer support related
Peer support working is at least as effective as non-peer delivered alternatives.
Peer support workers are more likely to support positive outcomes related to recovery and less likely to impact clinical outcomes.
Peer support workers are held to a higher standard of evidence than other professional groups.
There is a need for more high quality Randomised Controlled Trials of peer support working.
The value of peer support extends beyond what can be easily measured in RCTs - we encourage a broad range of fitting research methods.
Summary
This first paper in the demystifying research series explores the question ‘Does peer support work?’ By unpicking this question, we aim introduce and explain various research terms in a way which is accessible.
The paper begins by establishing that peer support, as a system of giving and receiving, is a long-standing human behaviour, predating formal research. However, the focus of much research, particularly in mental health systems, is on the effect of professionalised Peer Support Workers as measured by Randomised Controlled Trials (RCTs).
While RCTs are widely considered a high standard of evidence in mental health research, applying them to complex interventions like peer support presents challenges. These include the lack of a consistent definition of peer support, and variability in control conditions across studies. As a result, systematic reviews, which explore findings across multiple RCTs, have produced mixed results regarding the impact of peer support working.
Reviews suggest peer support is at least as effective as non-peer delivered alternatives and may be particularly beneficial for recovery-oriented outcomes like empowerment. There is less evidence that peer support is effective when focusing on more clinical outcomes, like symptoms or hospital admission. Notably, the quality of the studies included in reviews is often a concern, limiting the confidence in the overall findings.
The article concludes by suggesting ways to improve research on peer support, such as focusing more on peer-delivered interventions and using meaningful control groups. Ultimately, it emphasises that when making decisions about mental health care, this type of research should be one part of a wider evidence picture.
What do we mean by peer support?
It is reasonable to assume that as long as there has been a means of human communication there has been peer support. Have you heard about this new thing called farming? No! Well, you should totally spend time with [insert neolithic name here]. They’ve been doing it for ages and their clan rarely goes hungry these days... You get the picture – peer support is part of our story as a species of big-brained and deeply interconnected animals.
Fast forward millennia and that same principle is being applied in services and systems that are intended to help people experiencing various forms of distress and exclusion, commonly referred to as mental health problems, mental health issues or ‘mental illnesses.’ In this context, peer support has been described as “offering and receiving help, based on shared understanding, respect and mutual empowerment between people in similar situations” (Mead et al., 2001).
Based on learning from self-organising peer support groups and communities, where people shared a common need and unique skills and knowledge derived from personal experiences, the new professional role of peer support worker has emerged. Peer worker roles have grown at pace in many countries over the past few decades, often driven by strong policy commitments as well as demand from people using services.
So, when we ask the question “does peer support work” what we often mean is: “Does peer support working work?”