Peer support in hospital: bridging the gap in mental health

Last year, Essex Partnership University NHS Foundation Trust (EPUT) launched the Peer Support Project to help people receiving care from mental health services.

The project is now nearing the end of its pilot year and has been proven highly successful, valuable and therapeutic for people with mental illness. The scope of the pilot includes 10 mental health wards across Essex covering a mix of services including children and adult mental health services (CAMHS), adult, older adult, and specialist and medium secure services.

Peer support has been slower to grow in statutory services such as mental health wards, and the Peer Support Project at EPUT is one of the first of its kind in England.

What is peer support?

In a nutshell, peer support is when people use their own experiences to help each other.¹ There are different types of peer support, but they all aim to bring people together who share experiences. This provides a space where people can support each other, helping them to feel accepted, listened to, heard and better understood.

Peer Support Workers are able to connect and empathise with people with mental health problems because the peer supporters all have lived experience of a range of conditions such as mental illness, neurodiversity and learning disabilities, history of drug and alcohol addiction and dementia care. Several of the Peer Support Workers at EPUT are also carers and/or have children with autism and special needs.

Indeed, Ben, a Peer Support Worker at EPUT, has a diagnosis of schizophrenia. Rather than this being a limitation as it might be in most occupations, these qualities enable a better understanding and appreciation of peer support work’s core values, principles and best practice.

This gives Peer Support Workers greater insight and empathy when working with people with mental health problems who sometimes have complex and severe mental health problems. All Peer Support Workers are trained with Implementing Recovery through Organisational Change (ImROC).

Julie Repper of ImROC describes the benefits of peer support very well: “It is through this trusting relationship, which offers companionship, empathy and empowerment, that feelings of isolation and rejection can be replaced with hope, a sense of agency and belief in personal control.”²

The role of a Peer Support Worker

Peer Support Workers fulfil many of the jobs that nurses and other staff are unable to do because they lack sufficient time. This includes:

Taking people on escorted leave off the ward when staff are too busy, which is especially helpful for those who are anxious of going out alone
Providing therapeutic engagement
Advocating for people or supporting them to advocate for themselves (especially at Mental Health Tribunals and ward reviews)
Assisting with ward reviews and discharge
Running peer groups (such as ‘Fashion Friday’ which brought in donated clothes for people with mental health problems to choose and wear, or a ‘Chew and Chat’ group that brought people together over coffee, chocolate and crisps)
Raising awareness of LGBTQ+ issues
Calming people having a panic attack
De-escalating situations, intervening and preventing need for restraint by staff. Also preventing aggression/ violence between people on the ward and toward staff
Listening and developing coping strategies and insight into trauma
Deflecting/ preventing suicidal thoughts
Encouraging drug/ alcohol cessation
Encouraging physical exercise (walking, dance, football, table tennis, basketball, etc), eating and self-care
Empowering people to think about and resolve issues at home in a practical and pragmatic way
Supporting nursing and other healthcare staff when they are feeling stressed and overwhelmed.

Perhaps most importantly, Peer Support Workers offer an empathetic ear and actively listen as a person talks through their recovery.

It should be emphasised that life on the ward can sometimes be slow, boring and lethargic, particularly when people are heavily sedated with medication, so it is important for Peer Support Workers to lead and engage people in group activities, such as music, dance and art therapies.

The benefits of peer support

Peer support acts as a form of social and emotional support for people with mental health problems. This is a vital and therapeutic connection between people that requires openness, dialogue and conversation with others, emotional honesty, empathy, philanthropy and caring for other people’s feelings and experiences on a journey towards recovery. Peer support shines a light in the darkness on mental illness and stops it from consuming them, inspiring hope.

This can have an array of benefits for patients, including:

Feeling listened to, valued, accepted, heard, understood and worthwhile
Better experiences and satisfaction with care
Promoting a safe environment and feelings of safety
Encouraging adherence to medication
Assisting with discharge and freeing up beds
Insight into hearing voices, hallucinations and delusions
Encouraging people to focus on their strengths and build upon them
Fostering skills and goals to offer a future in which recovery is planned for and achievable.

People in mental health wards who have been received support from a Peer Support Worker say they have benefitted immensely. As one person explains: “I tried to commit suicide by taking a lot of sleeping tablets with a bottle of spirits. I was hearing voices and had high anxiety. My Peer Support Worker was very kind and supportive. I felt I could talk to someone who had been through similar experiences to mine and who had gone through hard times mentally. My Peer Support Worker encouraged me to take up jogging again as I was very tired with the medication I was taking. For the first time in four months I went for a 3k jog.

“I have also been worried about being discharged, as I am frightened of what will happen when I get home. Me and my Peer Support Worker spoke and recommended home leave before being discharged, to test the water of how I’d be at home by myself. Also, taking up a walking or jogging group or such like to make more friends outside the hospital”.

Another person supported by the programme said: “I haven’t experienced anything as good as peer support before, and I have been in hospital a lot over the years. I usually become psychotic about once every three years. The Peer Support Workers take you out and about to have some time away from the chaos of the ward. They have personal insight, unlike other staff, and they have experience of mental illness.

“I feel like Peer Support Workers listen to me and understand my perspective more than the other staff. My Peer Support Worker said I should try art therapy, which I enjoyed, found relaxing and was less stress than being on the ward”.

Benefits for staff

As well as supporting people with mental health problems both emotionally and practically, running peer support groups, and putting the individual at the centre of mental health care through advocacy, Peer Support Workers have also supported nurses and healthcare assistants when they are very busy and/or feeling overwhelmed and burnt out.

This is perhaps not surprising given the long shifts of nurses and healthcare assistants, the number of tasks asked of them and a focus on observation, process and administration that creates a barrier because it shifts the focus away from the care of the person with mental health problems.

In the words of a nurse: “The Peer Support Workers have not only supported the service users by giving them hope and inspiration in their time of need… but also the staff, in so many different ways.

“They have helped to relieve some of the pressures and demands on staff with groups and various tasks… and also sat and listened when we have felt overwhelmed and burnt out. They have used their valuable knowledge from their lived experiences to help everybody on the ward, and we couldn’t imagine the hospital without them now”.

Bridging the gap

Peer support bridges the gap between nurses and people with mental health problems and compensates for understaffing in the busy and sometimes overstretched ward environment.

Peer support will be scaled up across EPUT and would be beneficial for other healthcare providers because of the benefits it brings to both nursing staff and people with mental health problems. Peer support has been proven to provide more person-centred, holistic and lived experience related care.

To sum up in once sentence: you get back what you give to other people, such as support, care, kindness and even a bit of love.

For further information on becoming a Peer Support Worker, please Email: [email protected]

References

Mind. About peer support. Available at: https://www.mind.org.uk/information-support/drugs-and-treatments/peer-support/about-peer-support/
Repper, J, (2013), Peer Support Workers: Theory and Practice, ImROC, UK.

Acknowledgements

The authors would like to thank the peer support team and other colleagues. Many thanks to Renee, Rosario, Charlotte, Olivia, Liz and Lauren.

Ben Gray is a Peer Support Worker at EPUT and a Research Ambassador and Lived Experience Researcher at Healthwatch Essex.

Matthew Sisto is a Peer Team Leader and Director of Patient Experience at EPUT.