A systematic review and meta-analysis of randomised controlled trials of peer support for people with severe mental illness

BACKGROUND: Little is known about whether peer support improves outcomes for people with severe mental illness. METHOD: A systematic review and meta-analysis was conducted. Cochrane CENTRAL Register, Medline, Embase, PsycINFO, and CINAHL were searched to July 2013 without restriction by publication status. Randomised trials of non-residential peer support interventions were included. Trial interventions were categorised and analysed separately as: mutual peer support, peer support services, or peer delivered mental health services. Meta-analyses were performed where possible, and studies were assessed for bias and the quality of evidence described. RESULTS: Eighteen trials including 5597 participants were included. These comprised four trials of mutual support programmes, eleven trials of peer support services, and three trials of peer-delivered services. There was substantial variation between trials in participants\u27 characteristics and programme content. Outcomes were incompletely reported; there was high risk of bias. From small numbers of studies in the analyses it was possible to conduct, there was little or no evidence that peer support was associated with positive effects on hospitalisation, overall symptoms or satisfaction with services. There was some evidence that peer support was associated with positive effects on measures of hope, recovery and empowerment at and beyond the end of the intervention, although this was not consistent within or across different types of peer support. CONCLUSIONS: Despite the promotion and uptake of peer support internationally, there is little evidence from current trials about the effects of peer support for people with severe mental illness. Although there are few positive findings, this review has important implications for policy and practice: current evidence does not support recommendations or mandatory requirements from policy makers for mental health services to provide peer support programmes. Further peer support programmes should be implemented within the context of high quality research projects wherever possible. Deficiencies in the conduct and reporting of existing trials exemplify difficulties in the evaluation of complex interventions

Crisis resolution and home treatment: stakeholders\u27 views on critical ingredients and implementation in England

BACKGROUND: Crisis resolution teams (CRTs) can provide effective home-based treatment for acute mental health crises, although critical ingredients of the model have not been clearly identified, and implementation has been inconsistent. In order to inform development of a more highly specified CRT model that meets service users\u27 needs, this study used qualitative methods to investigate stakeholders\u27 experiences and views of CRTs, and what is important in good quality home-based crisis care. METHOD: Semi-structured interviews and focus groups were conducted with service users (n = 41), carers (n = 20) and practitioners (CRT staff, managers and referrers; n = 147, 26 focus groups, 9 interviews) in 10 mental health catchment areas in England, and with international CRT developers (n = 11). Data were analysed using thematic analysis. RESULTS: Three domains salient to views about optimal care were identified. 1. The organisation of CRT care: Providing a rapid initial responses, and frequent home visits from the same staff were seen as central to good care, particularly by service users and carers. Being accessible, reliable, and having some flexibility were also valued. Negative experiences of some referral pathways, and particularly lack of staff continuity were identified as problematic. 2. The content of CRT work: Emotional support was at the centre of service users\u27 experiences. All stakeholder groups thought CRTs should involve the whole family, and offer a range of interventions. However, carers often feel excluded, and medication is often prioritised over other forms of support. 3. The role of CRTs within the care system: Gate-keeping admissions is seen as a key role for CRTs within the acute care system. Service users and carers report that recovery is quicker compared to in-patient care. Lack of knowledge and misunderstandings about CRTs among referrers are common. Overall, levels of stakeholder agreement about the critical ingredients of good crisis care were high, although aspects of this were not always seen as achievable. CONCLUSIONS: Stakeholders\u27 views about optimal CRT care suggest that staff continuity, carer involvement, and emotional and practical support should be prioritised in service improvements and more clearly specified CRT models

Recovery in a mental health setting: an Interpretative Phenomenological Analysis of how an individual experiences a Peer-Supported Self-Management Intervention.

Peer support workers are people with lived experience of mental health distress who provide mental health interventions or services to people with mental health problems who are at an earlier stage in their recovery journey (Davidson et al., 2006). Disclosing personal strategies with a recipient is seen as one beneficial aspect of the peer support model. However minimal research has been conducted to explore how the individual experiences this relationship. This remains an important question due to the increase in recovery-orientated services operating peer support models in UK mental health settings. Literature Review: The act of self-disclosure (SD) within the peer model may be seen as a critical ingredient to the models success. Qualitative studies examining client’s perception of therapist SD were reviewed using the meta-ethnographic process. Seven studies were found to meet inclusion criteria. Themes identified were that SD could simultaneously strengthen and also impede the alliance formed between therapist and client. Findings overlap with the salient components of effective therapeutic alliance, but also that SD can trigger early unhelpful attachment experiences leading to alliance ruptures. Research Report: Little is known about the circumstances in which the peer support model works (Repper & Carter, 2011). Semi-structured interviews were conducted with seven individuals who had been in receipt of peer support self-management intervention as part of a Randomised Controlled Trial. Interviews were analysed using interpretative phenomenological analysis. Findings indicated that internal and external stigmatising attitudes and concealment of mental health identity contributed to ambivalent identification with the peer. Contrary to this, individuals also used the relationship to challenge stigmatising attitudes. Results are also considered in light of criticisms of the recovery model. Critical Appraisal: Critique of the research methodology and limitations are discussed. The trainee reflects on a psychology of humanistic values, counter to the experimental/positivist psychological tradition

Additional file 1: of Crisis resolution and home treatment: stakeholders’ views on critical ingredients and implementation in England

Contains additional methodological details. (DOCX 15 kb