Peer support in mental health care
An NHS audit in 2023 found that there are over 1,000 peer workers – staff with lived experience of mental ill health employed in peer support roles – working in NHS-commissioned mental health services. This represents one of the biggest changes to the mental health workforce in England in the last decade. How best to mobilise and support this new mental health workforce remains unclear in practice and research. In this piece, we’ve considered the evidence base and platformed the views of a range of people involved in peer support in England.
“Becoming a peer support worker was transformative. It was the first time I could bring my full, authentic self to work – something I never experienced in previous roles”
The research evidence behind peer support
Ruth Cooper, King’s College London and Natasha Lyons, University College London
The NIHR Policy Research Unit in Mental Health (MHPRU) conducted one of the largest reviews of paid peer support workers in mental health to date, summarising 35 systematic reviews to understand their effectiveness, implementation and experiences. The review team included people with lived experience of peer support. In terms of effectiveness, results were mixed, indicating we still need to understand more about the models and contexts in which peer support can work best. But the evidence suggests that peer support may improve depression (particularly perinatal depression) and self-belief, and could help service users’ personal recovery.
Key factors in the successful implementation of peer support included ensuring peer support workers were adequately trained and paid and working within a culture advocating for a recovery-oriented workplace. The research highlighted a number of barriers to implementation of peer support workers, however, including lack of time, resources and funding, and a lack of recognised certification of the role. Peer support workers themselves felt their work helped recovery and wellbeing for service users and themselves. The research also underscores a number of challenges, including a lack of role clarity and low pay, which could lead to perceptions of tokenism.
To learn more about experiences, MHPRU Lived Experience Researchers interviewed 35 peer support workers based in mental health services across the NHS, voluntary and community sectors. Some of the key learnings included:
- Peer support works well when it’s flexible, while keeping some structure and boundaries. A supportive team, with access to good training, support and supervision, helps
- People in leadership positions need to value peer work, with poor pay and career progression being barriers
- Peer support is individualised, recovery-focused, builds connection through sharing lived experience and can have tensions with clinical approaches; with values of being person-centred, empowering rather than “fixing”, and showing recovery is possible
- The role can have benefits for peer support workers’ recovery, as well as their clients’, but has emotional challenges and isn’t right for everyone using services
- Peer support workers felt it could bring about wider, positive changes, through using lived experience to help teams meet people’s needs.
“Peer support… has to start with being real; meeting people where they are, not where systems expect them to be”
Perspectives from the field
Below are personal reflections from five people involved in planning, delivering or researching mental health peer support, about key challenges or lessons learnt.
Sharif Mussa, Peer Support Worker, North London NHS Foundation Trust
I will always carry the identity of someone who came to this country as an immigrant of the Rwandan genocide from Africa. That journey has deeply shaped who I am today. Becoming a peer support worker was transformative. It was the first time I could bring my full, authentic self to work – something I never experienced in previous roles, including as a security manager. By “authentic self,” I mean not only the strong and joyful parts of my identity, but also the broken and vulnerable parts. The opportunity to work within a broken system, while also trying to heal and improve it, has been one of the greatest privileges of my life.
From the perspective of peer work, this role is more than a job; it is a deeply human, purposeful practice, embedded in how I live and relate to others. I hope that many peer support workers feel that same level of connection and meaning in their work.
Bringing in my subsequent experience through training as a nurse, I have often found myself reflecting on the apparent tension between peer and clinical roles. Why are they so often viewed as incompatible? Why is there a disconnect?
At the core, these are simply roles, titles that can help us make sense of our place in the system. But when we become overly attached to these titles, whether peer worker, support worker, nurse, or commissioner, they can limit us. They can become boxes that give us a sense of worth or belonging but also prevent us from connecting across roles. This attachment can inadvertently lead to rigidity in our thinking and practice, and ultimately to harm.
One area where this plays out is around disclosure. I struggle to understand why personal disclosure is sometimes accepted or expected from peer workers but seen as problematic when it comes from clinicians. From my perspective, as both a nurse and a peer worker, I engage with people at the same human level. The language may differ, but the intent and connection remain the same.
Julie Repper, CEO, IMROC
Imroc first developed and delivered peer support training in 2007 as just one way of driving forward recovery-focused changes in the culture and practice of mental health services. We have been delivering, refining and developing it ever since. However, training alone does not solve the challenges facing peer support workers across the system. We believe that at least as much attention needs to be paid to the context in which peers work as to the preparation of the peers themselves. We are concerned that peer trainees are repeatedly employed in teams that are not clear about the distinct role of peer support workers and do not have confidence in peer support skills or in peers’ wellbeing. In addition, peer support workers are frequently employed in voluntary and temporary employment with little provision for supervision or development. Inevitably this limits continuity of relationships for those receiving peer support, and both devalues the contribution of peer support and reduces opportunities for career development. Within NHS services, peer support workers who are not supported and supervised to provide effective and well-defined peer support either replicate the role of other staff, or burn out through the emotional effort of remaining true to their own values and experience.
Imroc continues to work with teams, organisations and systems to demonstrate the potential and power of peer support, and there are impressive examples of peer-led innovation, success and transformed experience across all parts of the mental health system. Yet, while the numbers of support workers and care assistants increase, overall numbers of peer support workers remain relatively low, with no NHS trusts employing more than 200 peer support workers and most employing less than 50. This is frustrating when there is more evidence supporting their positive impact on the experience of people using services than there is for any other profession.
Big questions must be asked and addressed about why there is so much resistance to employing peer support workers – particularly at a time when vacancies and turnover among mental health staff are so high.
Mel Ball, Director for Lived Experience, Midlands Partnership University NHS Foundation Trust
I’m passionate about the integration of peer support within health and care systems and across communities because peer support has saved my life multiple times; and I have witnessed the potential it has to save others. Living in a therapeutic community, I learned that those who had been where I was could transmit life-saving hope in the darkest moments. If we’re serious about suicide prevention and reducing health inequalities for people most disadvantaged by current structures, we need to bottle that magic.
I’ve been privileged to work in NHS peer support for some time and I’ve stayed engaged in unpaid grassroots peer support throughout my career. These different versions of peer support have been lifelines to me at different times and are crucially, brilliantly distinct. It’s important we respect and support both the similarities and differences across the vast spectrum of peer support; many of the most difficult health experiences for me and people I know might have been different if peer support had been woven throughout all that we do, within and beyond health and social care. By embedding different versions of peer support, we can strengthen communities and transform systems to become genuinely informed by the people they serve.
Isaac Samuels, Lived Experience Peer Supporter, Coproduction Collective UCL, & Camerados
When we talk about peer support, it has to start with being real; meeting people where they are, not where systems expect them to be. That means creating spaces that are genuinely safe, accessible and shaped by the people who actually use them. Anti-oppressive practice means recognising power dynamics, breaking down barriers and refusing to copy the same systems that marginalised people in the first place. It’s not just about ticking a box for inclusion, it’s about making sure people truly feel seen, heard and valued.
Different communities carry different histories of racism, ableism, classism, transphobia and more. So trying to force a one-size-fits-all model doesn’t just miss the mark, it can actually do damage. If we want peer support to be real and accessible we have to centre lived experience, listen properly, build trust and create space for people to show up exactly as they are, not how the system wants them to be.
Now when it comes to the voluntary sector and spaces that are led by and for communities, that’s often where the radical stuff happens. These are groups rooted in community, shaped by people who’ve been through it and who really get the hidden struggles and quiet resilience. A truly led by and for space can challenge oppressive systems, push back against gatekeeping and offer something more human and responsive. But to do that well they need real support with proper structures, funding, and emotional backing – not just a pile of expectations and no resources.
At the heart of all of this is connection. Peer support only works when people feel genuinely understood, when there’s room for honesty instead of judgement. That’s what this is all about; staying human, staying accountable and building something better together through honest and liberating conversations.
Take-home message: Peer support isn’t about fixing people; it’s about creating the kind of space where people can just be. When we lead with lived experience, compassion and trust, we build something real, something powerful, and something that lasts.
Karen Machin, Lived Experience Researcher
Peer support has changed so much over the last 20 years that, like many people, I’m concerned about where it’s heading. Peer support is about lived or living experience. But it’s not just that. It’s about skills and knowledge and empathy and hope, with values of self-determination, equity and justice. It’s fundamentally about building mutual and reciprocal relationships. And yes, it’s also about challenge and advocacy and finding a way through struggles. But with the growing interest from funders and policy makers, is it becoming redefined as the starting point for a career path in health care?
Historically, peer support has been a potential route in for people who had been marginalised by their experiences, particularly experiences which had an impact on education and employment. Whereas I’m told that many applicants now have psychology degrees, and that their lived experience might not be related to the specific service they’ll be employed in. Is this the right direction? I also worry that, with the emphasis on health care funding, we are losing the social care aspect of peer support. With its origins in mutual support within communities, how do we ensure peer support remains unique and distinct, true to its radical roots of social change? Or with the move towards digital technologies, will we see a shift towards chatbots instead, or to peer-supported digital technologies?
What next for peer support?
Peer support has been recognised for some time now as an important component of mental health care. But has that recognition come with the necessary resources, understanding of its distinctive value(s), and commitment to coproduction that are so essential to its success?
The views and experiences expressed in this blog make it abundantly clear what peer support means to people. It’s not an intervention that is ‘done to’ people but a very personal way of bringing hope and meaning to life, of tackling structural violence and oppression, and of challenging discrimination and disempowerment.
It can both complement and challenge professionally-led services and approaches. Like any radical movement, when it interacts with mainstream structures and processes, it faces challenges of its own. Does it seek to change the system from within, or keep a bit of distance and offer an alternative vision? As it builds hierarchies and career opportunities, how does it avoid becoming like the systems it was designed to be different to?
Policymakers, commissioners and health services crave clarity, certainty and consistency. Peer support can’t do that. It needs to be given the space and the resources to grow. But it’s also complex, it’s ever-changing, and it can’t be squeezed into cookie-cutter models that can be imposed all over. It needs to be able to retain its critical edge, to be a dissonant voice sometimes, and to be an authentic expression of lived and living experience. So what next? Peer support must be recognised in mental health policy as needing a fully supported and respected workforce. It must be at the heart of mental health care for people of all ages and communities. It needs to be supported both inside and outside statutory services, and valued equally in both. And those in positions of power need to commit to listen, to learn, to reflect, and to adapt, to ensure it has a bright and powerful future.
This blog follows a recent “Mental Health Question Time” event discussing the role of peer support in mental health care – watch it back here.
