The Evolution of the Peer Support Worker Role in Irish Statutory Mental Health Services

29th November 2017

Martha Griffin, Lecturer and Expert by Experience and Liam Mac Gabhann, Associate Professor, Mental Health Practice both from the School of Nursing & Human Sciences at Dublin City University, take us through the evolution of Peer Support Worker Roles in Irish Statutory Mental Health Services.

A Vision for Change

The Irish Mental Health Policy Document ‘A Vision for Change’ (Government of Ireland, 2006) provided the first ever mandate for users of mental health services to be involved at all levels of design, development and delivery of mental health services into the future. Ten years later a new grade of staff in the national mental health services was announced ‘Peer Support Worker’; and a national accredited professional training programme developed. The Mental Health Directorate of the Health Service Executive (HSE) invited applications for a newly established role of peer support worker in six regional areas during September 2016. The peer support workers were required to be people who would add their unique expertise deriving from their lived experience of mental health difficulties and receiving support for that. The HSE saw value in the new roles as leading on social inclusion for services users, facilitating better relationships between people who use and worked in the health services, leading on personal recovery planning, promoting positive goals and fostering hope especially for new users of the mental health system.

Prior to these initial thirty new positions there were some non-statutory peer support workers employed in Ireland. In Cork, the Cork Home Focus Team was established in 2006 as a collaborative initiative between the National Learning Network (NLN) (a national training organisation) and West Cork Mental Health Service, the Irish Advocacy Network (IAN) (the national peer advocacy service), the HSE Disability Guidance Services, Work Start West Cork and West Cork Community Project. The Home Focus team is funded under the Enhancing Disability Services Project Funding (EDS) of the Department of Justice, Equality and Law Reform and a peer worker was employed as a member of this team.

Some peer support workers were employed throughout the country in peer led organisations nationally: Gateway in Dublin;  Aras Follan in Tipperary; STEER in Donegal;  Peer Emotions in Clare; and Involvement Centres in Kilkenny and Carlow.

In 2010 – 2011 as part of the Dublin City University’s (DCU) Mental Health Leadership Programme a Mayo project team which comprised a service user, a carer/family member and a mental health service professional provider carried out a peer support worker needs analysis as their service improvement project in the local mental health service. Two years later seventeen peer support workers were recruited to work with this service and underwent peer support worker accredited training in DCU. These were the first peer support workers to work directly with people using statutory mental health services. However, they were not employed by HSE services, instead they worked for a national non-government organisation (NGO) Rehab Care who provided peer support services as a partnership initiative with Mayo Mental Health Services.

2013 onwards

From 2013 onwards there was an increased emphasis on introducing peer support working wherever possible into statutory mental health services. In the relative absence of prototype role and function within an Irish context the HSE commissioned a guidance paper for services planning to develop this role (Naughton, Collins, & Ryan 2015).

Once the HSE decided to create this new role in mental health teams the HSE undertook a significant amount of preparatory work prior to the recruitment process. A competitive tender process was put in place for the national peer support worker training course; Community Mental Health Teams were assessed for readiness to embrace the new role; and six services deemed prepared to receive the new peer support workers; working within these teams to support people who use the mental health services in their recovery.

Thirty trainee peer support workers were employed across the six regions: Cavan/Monaghan; Galway/Roscommon; Mayo; Cork/Kerry; Carlow/Kilkenny/South Tipperary; and Dublin North. These services worked in partnership with DCU, School of Nursing & Human Sciences the course providers to provide a practice based educational programme over a seven month period. Upon taking up post in February 2017 the peer support worker trainees started a  ‘Certificate in Peer Support Working in Mental Health’  in DCU; a 30 credit, level 8(ECT’s) Minor Award.

The course consisted of five intensive residential three day study blocks interspersed with time working with community mental health teams and supporting people using services. Support and development was provided though an adapted tripartite model of supervision (Proctor, 1986) where students worked through a practice portfolio throughout the course in collaboration with a designated practice supervisor from mental health team and academic supervisor from the core course team (comprising one mental health practice academic and two expert by experience lecturers). Monthly peer group supervision was also provided for the duration of the course. The second half of the course comprised of five interactive online learning study blocks with a final residential study day towards the end of the course. The course included three modules: Community Based Learning: Personal Growth and Community Engagement; The Principles and Practice of Peer Support Working in Mental Health; Mental Health Peer Support Practice Portfolio.

Although, there are well established models of peer support working, many of which contributed to the learning on this course, an opportunity arose in unchartered territory for this new grade of staff to develop their own approach to peer support working. Following regional meetings where trainee peer support workers and their multidisciplinary colleagues had the opportunity to explore working relationships, diversity of roles and how peer support workers might integrate with wider mental health teams, a consensus building workshop was held with the course participants. This was the beginning of a process of identity as peer support workers and a frame work by which this new role can evolve within.

Figure 1. Consensus building exercise

Consensus building proved challenging, given that participants were only three months into a new role, with the majority having no prior experience of peer support working. None the less a number of clusters of ideas and experiences provided a tentative set of characteristics of peer support working in Irish mental health services that all participants resonated with:

  • Respectful relationships
  • Non-judgmental
  • Sharing lived experience
  • Empowerment
  • Inclusive connection
  • Person led hope and recovery

Although, these characteristics are not novel in peer support working generally, they are derived from the value base and experiences of participants who seek to take ownership of their support roles in the Irish mental health system.  This new role in the mental health workforce is a radical shift in mental health policy implementation and the potential for positively impacting on overall service provision cannot be underestimated. As yet, it is too soon to judge, the initial cohort needs to be built upon and a planned evaluation of the impact of peer support working on the experience of people using services is taking place. However, it is an exciting stage to be at in a system trying to realise a vision of recovery orientated service provision.