Peer-focused self-management programmes in public mental health
The Mental Health Foundation has been a key innovator in developing and implementing programmes following peer-mentoring, peer-support, or peer-led self-management models for prevention of mental ill health.
These programmes have involved individuals from a range of backgrounds: service users; prison inmates; single mothers; refugees and asylum seekers; elderly people living in care; and individuals with learning disabilities, among others. This model is effective in promoting positive behaviours among at-risk populations and reducing the risk of mental health problems.
The Foundation will continue implementing peer-focused self-management support programmes and holds intellectual property rights over the peer-focused self-management approach in mental health. In this section, we are providing a general overview of our experience in peer-focused self-management. We have also prepared a Theory of Change and Implementation Manual, outlining an effective strategy for developing and implementing such interventions.
We are happy to provide additional information or offer comprehensive training and consultancy on request. Contact Antonis Kousoulis at [email protected].
What is a 'peer'?
A peer is a person’s equal—they may be the same age or come from the same background.
Peers are individuals who have similar lived experiences. They may be from similar ethnic or socioeconomic backgrounds, or they may be living with the same mental or physical health concern.
Peers allow empathetic and compassionate communication as they understand one another’s issues and experiences on a deeper level. A peer could share views of recovery or treatment or other demographic characteristics.
In peer-led and peer-support programmes, both the facilitators and the participants benefit from bi-directional sharing and support. Through a focus on ‘peer-ness’ and commonalities, individuals concentrate on how they can help one another, rather than on how they can diagnose or treat (Crepaz-Keay & Cyhlarova, 2015).
What does ‘self-management’ mean in this context?
Through ‘self-management’ an individual takes control over their own health and wellbeing.
Through self-management, agency is transferred from a clinician to the patient or participant. The focus on the condition, diagnosis, or treatment is minimised, as the patient is given control over their life and decision-making processes. Individuals at risk for or living with long-term mental health conditions are supported and given the skills, strategies, and confidence to manage their own schedule and achieve objectives.
Effective disease self-management can empower the patient and aid in promoting a person's dignity, self-determination, and wellbeing. At the same time, self-management can help realise savings within healthcare systems through reduced utilisation (Kousoulis et al, 2014).
Categories of interventions
1. Peer-led self-management
Through peer-led self-management, peer facilitators teach self-management in group-settings to effectively improve well-being and healthy behaviours. It can, and has, been successfully implemented with black and ethnic minorities (BME), women, single parents, prisoners, and individuals living with a range of mental health problems.
2. Peer-support and self-management
While still applying principles of peer work and self-management, peer-support and self-management programmes are led by counsellors or professionals with experience working with the given population. These programmes still employ goal-setting, problem-solving, and peer support. In some situations, group participants may have opportunities to co-lead or present during sessions, while most sessions are run by professionals.
3. One-on-one peer mentoring
In one-on-one peer mentoring, sometimes called buddying (Crepaz-Keay & Cyhlarova, 2015), volunteers are trained as mentors. Following the initial training period, mentors are paired with a peer in a similar life circumstance. While difficult, it is important to match the pairs on multiple demographic features. For example, if the mentor is a young adult carer supporting a parent, the match would be most successful with another young adult carer supporting a parent.
The Mental Health Foundation has led 11 peer-focused self-management programmes in the past decade, reaching a total of 1,569 participants.
Eight programmes were majority female and they targeted the full age range, from youth to elderly. In the evaluations, most interventions reported improvements in wellbeing, self-esteem, and in setting and achieving goals.
Participants and programme coordinators described best practice during project evaluation: sharing experiences, partnering with local organisations, and facilitating in a non-judgmental and empathetic manner. A range of recommendations have been made, including costs of implementation, identifying and overcoming barriers, methods of evaluation etc.
Case study: why does peer-led self-management work?
Individuals in a variety of life situations or living with mental health problems can feel socially isolated. For example, single mothers in the Creating Connections programme commented on a lack of social support due to their circumstances. The peer-support element helps individuals gain back social connections. Peer groups from many projects have continued to stay in touch past the end of the project.
The programme team was designed for single parents to gain control over their lives and develop skills to maintain their health and wellbeing, using the peer-led self-management technique.
Mostly targeting single mothers, the programme evaluated wellbeing with the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and goal attainment with the Goal Attainment Scale (GAS). A substantial portion of group meetings centred on goal identification and achievement. Parents' goals primarily related to employment, education, or volunteering, and the large majority (83%) achieved at least one goal.
The programme reached 206 single parents and successfully improved their mental wellbeing, social functioning, and self-esteem. Parents built self-efficacy and benefited from peer support both during and outside of group sessions..
Funded by the Big Lottery Fund and delivered by the Mental Health Foundation and Gingerbread, a single parent charity, the Creating Connections pilot project ran from 2014 to 2016 in Cardiff and Newport, Wales. The programme was shortlisted for a National Lottery Award.