Peer Support Work

Lived experience has increasingly been incorporated into service delivery across health and social care settings. One of the methods used to do this is through the provision of peer support work. While many people will have lived experience of an issue, condition and may even work in services, peers are markedly different insofar as they are employed specifically because they are using this lived experience to explicitly inform their way of providing an intervention. As we will see throughout this book, peers are not a homogenous group; however, they do use some of the same processes to engage and offer support to people with a variety of health and social vulnerabilities. This chapter contextualises these issues before delving into further chapters authored and co-authored by those with lived experience across multiple areas of peer support work.

This chapter will provide an overview of the lived experience and peer support context and draws on the origins of peer work in mental health arenas. The recovery movement will be discussed and peer support will be put in context as an alternative/adjunct/complimentary role to the predominant biomedical model. What is the role of peer support in mental health settings? What is it that a peer does on a day-to-day basis? What are the principles and practices that a person with lived experiences engages in to operationalise peer support? What are the outcomes associated with peer support working and what does peer work look like when it works well? What type of settings does the peer work in and what teams are they a part of? This chapter explores some of the challenges peers face when integrating into teams and organisations. The dominance of the biomedical model will be discussed and how this can potentially impact on the peer's role in these settings.

Peer support in the substance use arena has a long and interesting history. Many of the ideas for substance use treatment can be traced back to the fellowship of Alcoholics Anonymous and its mutual aid/self-help programme. However, as interest in providing care and support progressed, and research began to develop, other equally helpful methods of providing peer supports emerged. In this chapter, we discuss this emergence of peer support, and describe how and where this support is provided. The processes and relationships involved in peer support work and the operationalising of lived experience are outlined.

Those involved in the criminal justice system are very often some of the most marginalised in society and can have some of the most complex needs. Likewise, there is little in the literature on the use of peer support in prison. We begin the chapter by drawing on the literature to examine some of the outcomes associated with peer work in the criminal justice system. The change in identity that marks the desistence process is articulated throughout this chapter. Drawing on his experience of working as a peer in the prison setting, David brings some of these abstract concepts to life.

Housing is a fundamental need for all humans. A roof over our heads can provide safety, warmth and stability. Once we have this stability, our physical and mental health is more likely to be managed effectively. However, housing, or indeed a roof, is not something everyone has the privilege of experiencing. Housing policy across the globe is dominated by capitalistic thinking: the profit becomes the priority. Those marginalised, traumatised and stigmatised suffer the most, many having to access inadequate homeless shelters, still more sleeping on our cold streets. Current service provision favours the middle class. In these circumstances ill-health manifests, responses are often inadequate, yet some innovations develop. Housing First seeks to reach into the homeless population and provide housing to those most entrenched, while Safetynet seeks to provide health-related services to those homeless and experiencing other related problems. Both interventions understand the role peers can play in providing these services.

This chapter introduces the reader to the process that may be involved in supporting those living in Direct Provision (DP) as refugees and asylum seekers. In the first part of this chapter, I will provide a brief history of DP in Ireland, and introduce the role of International Protection Accommodation Service (IPAS) in the DP system. An overview of DP, how it is structured and some of the legislation and national policy governing its delivery will also be highlighted. Moving on from this, I will explore my personal experience of DP as an International Protection Applicant in Ireland. This will be followed by a description of how my experience was used in providing peer support in the DP Centre. The process of becoming a peer advocate will be considered, as this involved a range of activities, which helped me to support others, within the setting.

Peer work would previously have been associated with having a lived experience of mental health conditions and working with people in a relatable way to model that context. However, peer support work has since embraced a wider composition from the generic context, seeing that ethnic minorities face many health, social and psychological challenges, especially those deemed Refugees/Asylum Seekers (International Protection Applicants) on their journey to resettlement in host countries. The Health Service Executive's Social Inclusion office plays a crucial role in responding to the health needs of service users from underserved communities. The health and care needs of people from diverse ethnic, cultural and religious communities fall within the remit of the Health Service Executive Social Inclusion office nationally. The context for peer work in ethnic minority communities is that it is a pilot programme evaluated and endorsed as a national programme by the National Intercultural Health Group. It is evidence-based and aligned with national strategy/policy, with training options available to peer support workers. In the Southeast region of Ireland, communities vulnerable to health inequality targeted by the Social Inclusion team would range from Roma to Refugees and International Protection Applicants – formally known as Asylum Seekers. This chapter will focus on these ethnic populations and how peer support work is delivered in these contexts.

The experiences and challenges encountered by Travellers especially in education is something that I am truly passionate about and want to give others a better insight into. Irish Travellers are defined by the Irish Traveller Movement as a historically recognised minority within Irish society. The group is distinct because of a strong history of sharing an identity, a language and a set of values (Irish Traveller Movement, 2019). In Ireland, there are approximately 31,000 Travellers (Central Statistics Office, 2023). Irish Travellers are a minority ethnic group that experiences discrimination and marginalisation in society (Boyle et al., 2020). According to a large body of evidence, Travellers stand out as a population that is disproportionately disadvantaged in terms of work, housing, health and education (Baker, 2021). One aspect of Irish Travellers' inequality is their educational disadvantage. The hope is for this chapter to make others more knowledgeable on these types of areas so that it can lead to more positive outcomes for Travellers.

Peer support work is increasingly recognised as an adjunct support across various systems of health and social care, and is a core principle in trauma-informed care. Those accessing a wide range of human and social services may have experienced prior trauma. As such, trauma-informed care is a universal organisational model that seeks to realise, recognise and respond to trauma, while limiting possible re-traumatisation when individuals are engaging with systems of care. Peer support can play an integral role in supporting those who have experienced prior traumas. However, trauma does not exist in isolation and the wider environment influences, moderates and contributes to how an individual experiences and heals from trauma. Peers can play an important role helping to alleviate some of the environmental influences by helping to build the capacity of those that use health and social care services.

Supervision is an essential component of the helping professions. It provides a gatekeeping role into the quality and effectiveness of care, while also having a safeguarding and reporting function. Moreover, practitioners' use of effective supervision is associated with various personal and organisational outcomes. Supervision is generally provided by a more senior member of the same or very similar profession. However, peer support is still a developing profession and does not, generally speaking, have peer supervisors. Although other professions can and do supervise peer workers effectively, there are various concerns that for many, the peer role gets diluted when those without lived experience are supervising peers.

The training and education of peers represents an important milestone in the peer's journey to work within organisational settings. Historically, peer support occurred based on a mutual relationship whereby one peer often with more experience provided support and guidance to another. However, as peers began to move into organisations staffed by professionals, a standard of training and education became needed if peers were to be accepted. This chapter outlines these issues, as well as discussing the training standards, the academics and soft skills needed. Some of the challenges peers face during their education and their continued development will be discussed. This chapter will focus on the training of peers for mental health and substance use settings in addition to other emerging areas in social inclusion.

Implementing any evidence-based practice into complex systems is hugely difficult. Implementing peer support is very much at an early stage in most systems around the world. This chapter examines the implementation of peer work into health and social care systems by drawing on an ecological perspective. The wider sociocultural context is considered, while the organisational context and how this shapes both the peer and service delivered is further explored. Some tips are provided across the ecology of factors that the research describes as being important to implementation.