1. What is Mental Health Peer Support?
Peer support is based on a relationship between people who have a lived experience in common. In the case of Mental Health Peer Support the experience that individuals have in common is in relation to a mental health challenge or illness. This common experience might be relative to their own mental health or that of a loved one. Within a workplace Peer Support Program, the peers and Peer Supporters also have the organization in which they are employed as a common ground.
Mental Health Peer Support is grounded in hopeful recovery and self-determination. It is valued for its authenticity because the Peer Supporter has also lived through a similar experience and has found their way to recovery.
Peer support is not based on academic designations or professional roles but rather is about people offering empathetic support in a manner that empowers another to acquire a mastery over their own mental health recovery processes. Peer support is focussed on health and ability rather than illness and disability. Peer relationships are built around a deep mutual understanding and trust, and are not built on the basis of power differentials such as those found within a patient-doctor relationship. Peer support is designed to be a compliment to traditional clinical care programs and not to replace them.
2. How does MHI get beyond an Organization’s concern regarding confidentiality when building a Workplace Peer Support Program? How do they stay within Confidentiality practices/ expectations?
- Creating a workplace Peer Support program requires a deliberate and gradual participative approach to build the trust of employees. A Peer Support program cannot and should not be created in corporate offices without significant degree of employee participations from the very onset.
- At the start of every project, MHI conducts workplace engagement sessions with front line employees and managers to properly assess specific mental health needs and also begin to establish the organizational readiness for a Peer Support program.
- MHI assumes nothing and conducts these sessions in a very authentic way. We ask employees for their input, opinions, and concerns and we listen. In all, a very healthy process that leaves an enduring positive feeling with participants, something to build on and set the conditions for aspiring Peer Supporters being comfortable in stepping up to volunteer for the program later on.
KEY FACTORS TO SUCCEED IN THIS PHASE ARE:
- The first step is determining how this program is communicated to employees. We work closely with clients, drawing from our past successes, to craft messages that are consistent with the corporate culture
- The approach to messaging must manage expectations yet resonate with those in the workplace likely to later apply to become peer supporters, those with lived experience
- The messaging does not explicitly state “come forward if you have/are experiencing mental health problems” it provides the context around the fact that the organization is looking into the potential of Workplace Peer Support and is looking to obtain employee feedback on this program before consideration. Context and background is provided as well as the “why” the organization is looking to obtain employee feedback.
- In communicating this way, we have found that the employees who understand mental health issues first hand do come forward.
NOTE: MHI has worked with several large organizations and has yet to find an organization that is unable to move beyond the concern of “confidentiality”. This issue is always challenging especially with police forces and in organizations which are regulated and where having a mental health problem may lead to employment limitations or consequences. Despite these realities, MHI’s approach has proven solid and effective and our track record is solid.
3. How do the “Peers” get selected?
The initial phases of workplace engagement described above serve many purposes:
- It serves the employees as they gain a solid appreciation regarding their organizations willingness to help them;
- It serves MHI as they obtain the information they need to move forward on assisting the employees and the organization to build their specific program;
- It serves the organization’s strategic purpose by collecting key data that can be used in improving their mental health strategy;
- It sets the foundation for trust by employees and builds a climate where employees will feel safe to later apply to become a Peer Supporter.
- MHI uses a gradual and phased approach to develop each Peer Support program. By the time employees are invited to apply to become Peer Supporters, a great deal of effort and communications has occurred. Solid program policies have been developed and employees can review these prior to applying. In doing so, they realize the seriousness of the program, the rigor of the program, and how policies address real concerns that resonate with them as employees.
KEY ELEMENTS OF THE SELECTION PROCESS
- MHI assists with the process of communicating to employees and inviting those interested in applying to become Peer Supporters;
- Employees apply to become Peer Supporters. They themselves come forward and are not picked by the organization or MHI;
- Employees complete an application form provided by MHI. This first step ensures a first level of screening for three main factors:
- Level of lived experience required to become a Peer Supporter;
- Baseline understanding about the applicants’ competencies;
- Level of personal recovery and personal readiness for this role;
- Applications are reviewed and appropriate candidates are selected for a formal interview (screenings can be done internally or by MHI as appropriate)
- Formal interviews are conducted by a joint MHI / Organisation panel using a competency tool specifically designed by MHI and in keeping with Canada’s national Standards of Practice for Peer Support
- Reference checks are conducted internally as the final stage.
NOTE: Employee consent is key throughout the process.
4. How and who trains the selected Peers?
- MHI and its associates has designed a solid workplace Peer Support course. MHI adapts the course, as required, to each organization as it prepares for this stage.
- MHI delivers the training – drawing from well over a decade of experience in this field.
- Depending on specific needs, the course is between 3 ½ to 5 days in length.
- The training program highlights of a full 5 day programs are attached in Annex A. The overarching themes covered during training include boundaries, self care, resilience and communications. We recommend that the Annex be reviewed as many of the sub topics are key enablers to proper Peer Support.
- Yearly professional development training for Peer Supporters is strongly recommended for a program to remain effective, relevant and sustainable.
5. Do we have evidence that it works?
Research has shown that peer support alleviates stigma and fosters healthier coping strategies (O’Hagan & al, 2010). This outcome is linked to what is called experiential knowledge. Experiential knowledge, the capacity to draw from one’s lived experience to guide a peer, creates a shift in attitude and increases empathy and connectedness to a higher level than what is usually observed in the patient-therapist relationship (Provencher, Gagné & Legris, 2012; Chinman, Young, Hassell & Davidson, 2006; Coatsworth-Puspokey, Forchuk, and Ward-Griffin, 2006).
These elements combine in a synergy that appears to not only enhance empowerment (Corrigan, 2006; Dummont & Jones, 2002; Resnick & Rosenheck, 2008) but also control over one’s symptoms (Ochocka, Nelson, Janzen, and Trainor, 2006). Studies on depression have shown that peer support can be in some cases as effective as group cognitive behavioral therapy (Pfeiffer et al, 2011).
Seven randomized control trials (RCTs) on the effectiveness of peer support, reported by Repper and Carter (2011), yielded evidence as to peer support translating into stronger social networks, increased self-confidence, lower readmission rates and longer community tenure. The RCTs also highlighted the fact that receiving peer support is associated with a higher rate of employment. The sense of hope for a better future, conveyed by the peer support worker further along in his or her recovery, should not be underestimated. Having a positive role model often provides the needed impetus to make constructive, life-changing choices (Ratzlaff et al., 2006).
6. What is lived experience?
Lived experience refers to the experience that someone has had with a mental health challenge or illness, either their own or in relation to a loved one, and includes their experience towards a path of recovery and/or readiness to support others. Lived experience is a key requirement of a peer supporter’s background.
Those who have experienced a mental health challenge or illness are peers to others suffering mental ill-health, while family members of those affected are peers to other family members.
7. What are the benefits of peer support?
A quality Peer Support Program can have a positive impact on the peers (those that are struggling), the Peer Supporters, the workplace culture, and the organization’s bottom line.
Peer support can help a person navigate the intricacies of treatment options and support systems which, to someone experiencing mental illness, can seem to be overwhelming and complicated. A Peer Supporter, as a real-life model, can help others regain a sense of independence and mastery over their own mental health recovery process. It can literally save lives. Tremendous hope comes from simple words: “You can get past this. I did.” Or, “Someone I love has it too.”
In a recent study by the Mental Health Commission of Canada, people who had benefitted from peer support cited:
- better coping skills
- better understanding of mental health issues and services
- less isolation and more engagement at work and in their community
- greater ability to reach life goals and experience a sense of accomplishment
- increased quality of life
- fewer crises and hospitalizations
These individual benefits accumulate and can have a significant impact on the organization.
The outcomes that an organization may notice include:
- Improved employee engagement throughout the accommodation and return-to-work phase leading to shorter disability terms and lower occurrences of relapse
- Positive impact on the bottom line via reduced disability costs, less absenteeism, and less presenteeism
- Increased employee satisfaction and retention leading to less turnover and improved reputation
- Greater understanding of mental health within the organization leading to greater sense of normalization around mental health & stress challenges, rather than debilitating stigma
Over time these outcomes will translate into increased productivity, lower costs, and an improved workplace environment. Some clients report decrease in long term disability costs and decreased utilisation of sick leave for mental health reasons.
8. How can we assess our Peer Support Program?
Evaluation of the impact of the Peer Support Program on the peers, Peer Supporters, and the organization will be completed using organization surveys and individual case reports.
The evaluation methodology has been developed through a partnership between Peer Support Accreditation and Certification Canada (PSACC) an accreditation body for peer support in Canada, and the University of Windsor, the University of Ottawa as well as the US Centre for Disease Control and Prevention (CDC) in Atlanta Georgia.
9. What is the difference between a Peer Support Program and an Employee Assistance Program?
Peer support and Employee Assistance Programs (EAP) complement one another by providing different, but necessary support services. Peer support can add value to EAP services and expands the range of support opportunities available to employees. Together, EAP and peer support contribute to an integrated and comprehensive approach for a healthy workplace.
|Peer has a similar lived experience||Clinician may not have lived experience|
|Informal setting, as needed||Formal clinical setting, scheduled meetings|
|No predetermined number of interactions||Determined number of sessions|
|Is therapeutic, but not therapy||Therapy|
|No perceived power differential||May be perceived power differential|
|Reaches out to people||People reach out to the service|
|Based on hope with recovery as the goal||Based on treatment options|
|Open to discussing issues beyond mental health||Addresses issues broader than mental health|
10. What does a Peer Supporter do?
Peer support takes many forms depending on the needs of the organization and its peers. The day to day tasks of a Peer Supporter will vary depending on the scope and mandate of each program.
Peer Supporters provide emotional and empathetic support on an as-required basis; support others as they explore options; support individuals as they develop and follow through on goals and action plans; provide encouragement to re-establish social networks, decreasing isolation and supporting interpersonal skills.
These support activities happen in various ways ranging from having a casual conversation over a coffee to possibly accompanying someone to a clinical appointment. Depending on the scope of the program, Peer Supporters may also facilitate small group meetings of peers. The implementation modalities are determined and adapted for each setting based on organizational needs and culture.
An important aspect of peer support is maintaining the Peer Supporters’ well-being through what is called self-care. Self-care becomes a key aspect of healthy living and sets the example for others reflecting the philosophy behind peer support.
11. How do we know if our organization is ready for a Peer Support Program?
It is important that your organization be an environment in which Peer Supporters feel safe disclosing personal lived experience with mental health challenges. While mental health stigma is present to some degree in most workplaces, ‘MHIC’ workplace readiness assessment will help you to determine if your organization has the policies, leadership, and culture in place to support the transparency required for this type of program, and therefore, mitigate the possibility of doing harm to Peer Supporters who step up to support others.
Due to the importance of this work, we will not become involved in ‘pushing’ a Peer Support Program into your organization if we feel it is not ready or safe to do so. Rather, we will work with you to design policies and to develop a pathway for a stigma-free mindset within the organization in preparation for the eventual implementation of a peer support program.
12. What will peer support look like in my organization?
Implementation of a Peer Support Program will vary for each organization depending on the needs and resources of the organization. Some organizations may choose to implement a model where Peer Supporters are in paid full-time positions because of the high stress nature of the work. Others may opt for a model where staff provides peer support as part of their current responsibilities, on an as needed basis. This model will require a flexible accountability structure that allows Peer Supporters to meet with staff, as needed.
13. How is peer support supervised or managed?
Governance will vary depending on the model. A ‘champion’, in the form of a senior executive who actively supports this transformational initiative, coupled with a centralized Program Manager is ideal.
The Program Manager role may be assigned to a senior leader as part of their corporate responsibility and does not need to be a separate, independent role. Depending on the implementation model, a flexible accountability framework may be necessary to allow Peer Supporters the ability to support peers during their work day, as and when needed.
The work of a Peer Supporter involves dealing with sensitive issues and as such, Peer Supporters must be trusted to work at arms-length and not be required to report on cases or asked to share details of cases with management. While peer support is NOT a clinical function, the nature of the relationship means that Peer Supporters must respect confidentiality and only breach this trust when harm to self, harm to others, or child abuse is suspected. The organization culture must be accepting of this reality in order for the peer support function to work.
Key responsibilities of a Peer Support Manager may include:
- Assessing program requirements, conceptualizing, and developing program frameworks, plans, goals and objectives to ensure the development, on-going evaluation and advancement of peer-based programs within the organization is effective
- Planning, developing and overseeing a strategy for cultural change to address stigma and discrimination related to mental health
- Leading a multi-disciplinary project team in the development, implementation and improvement of peer-based programs and services
- Leading the development of policies, standards, processes and systems, as well as operational and communication guidelines to launch and support a sustainable peer program
- Taking the lead in managing crises when necessary and providing expertise and coaching
- Developing and maintaining positive and mutually beneficial partnerships within and external to the organization to support the advancement and success of peer-based programs, services and initiatives
14. What are the liabilities for the organization should something go wrong?
In this day and age where mental health issues have surpassed any other medical condition as the leading cause of workplace disability, the question can only be fully answered if we are prepared to ask ourselves what the liability is if additional services are not put in place to support employees who struggle.
MHI is committed to working with organizations that are prepared to develop innovative ways to support employees in our fast paced modern world.
To ensure quality peer support, and therefore mitigate liability issues, your workplace Peer Support Program will be built on a solid framework with a rigorous phased-in process which includes workplace consultation, a readiness assessment of the organization, and program policy development. Peer Supporters will be selected using an interview tool that is based on the core competencies of a Peer Supporter and then trained using the knowledge standards of the National Standards of Practice being developed by Peer Support Accreditation Certification (Canada). Services are then delivered in a way which is consistent with the known core values and principles of practice of quality Peer Support Programs.
While all this will not prevent something wrong from ever happening, together we will do all that we can to minimize risk, and more importantly, to focus on developing a workplace Peer Support Program to support the needs of your employees and your organization.