Mainstreaming peer support to improve people’s experiences
In a recent article, we argued that a dominant theme in patient’s contemporary experiences of care is waiting – and that interventions should focus on enabling people to self manage their conditions whilst they wait. This blog is the third in a four-part series discussing how the health service could provide a new ‘offer’ of support for self management.
When we think of ‘patients’, we tend to imagine them in a healthcare context and interacting with health professionals. But for many patients, especially those with long-term conditions, GP consultations and hospital appointments constitute only a small fraction of their overall healthcare experiences. The reality is that patients often have limited direct contact with health professionals while waiting for consultations or treatment.
In these often long gaps between care episodes, where should patients turn for support? Sometimes the answer can be ‘to each other’. Peer support, which involves the sharing of experiential knowledge and advice between people with similar needs or conditions, has been shown to be an effective enhancement to usual clinical care. Indeed, NHS England recognises peer support as a component of support for self management, and provides a useful guide to its principles and implementation.
The strongest drive to develop peer support came initially from the service user movement in mental health from the 1970s onwards. Multiple systematic reviews have confirmed its benefits, and most professionals and mental health trusts need no convincing to include it within their care offer.
Proven models from mental health charities
Tried and tested models are available from mental health charities like Together UK and Mind. Together UK describes the benefits that people have reported as including increased confidence; feeling more in control to make decisions and self manage; feeling more accepted for their mental health; and experiencing reduced social isolation.
These outcomes are important to people in recovery but are equally valuable to anyone with a chronic or recurring physical or mental health conditions (or multiple conditions), especially when living with the uncertainty of a long wait for treatment.
Peer support in physical health: Lessons from HIV management
There is no shortage of knowledge about the use of peer support for physical health conditions. From as early as the 1980s people with HIV made it a crucial pillar of their self-determined approach to managing their health and advocating for better services: the use of peer support has grown and formalised over time, and a recent systematic review of 20 randomised controlled trials showed that “peer-support with routine medical care is superior to routine clinic follow-up in improving outcomes for people living with HIV”. Similarly, national charities supporting people with other conditions, such as Macmillan Cancer Support and Diabetes UK, link people into local peer support groups.
As the example of HIV in the 1980s shows, peer support can be particularly valuable for people with less common or rare conditions, especially those with limited medical options or awareness. Likewise, peer support has a role in tackling health inequalities. A 2016 systematic review found it to be “a broad and robust strategy for reaching groups that health services too often fail to engage”.
When National Voices and Nesta reviewed more than 1,000 research studies across all conditions they found similar evidence to Together UK: peer support helped people feel more confident, knowledgeable and happy, and less isolated and alone.
Integrating peer support into self management education
Education for self management, which we featured in our last blog, has a strong element of peer support built in, as people exchange their experiences and tips for better living. But continuing peer support – be that one-to-one or in groups; online or face-to-face – appears to have a particularly strong effect on the ‘confidence’ element of the ‘knowledge, skills and confidence’ trinity that supported self management builds.
Mainstreaming peer support in mental health services
Having proved its benefits, peer support is now an integral part of mainstream care in mental health. There is a national role definition for ‘peer support worker’, backed by a national competence framework, and a charity called ImROC (Implementing Recovery through Organisational Change) has trained over 2,000 such workers who can now be found in most adult mental health services.
Expanding peer support to all long-term conditions
This mainstreaming of peer support in mental health services has been facilitated by government policy to expand and improve these services. A similar push is now required to develop peer support for all long term conditions, working in partnership with relevant user groups and charities and learning from those who have pioneered the principles and models.
