An exploration of the implementation of peer work across multiple fields in Ireland
| Date | 03 February 2023 |
| Pages | 485-504 |
| DOI | https://doi.org/10.1108/MHSI-12-2022-0082 |
| Published date | 03 February 2023 |
| Subject Matter | Health & social care,Mental health,Social inclusion |
| Author | Daryl Mahon,Danika Sharek |
An exploration of the implementation of
peer work across multiple fields in Ireland
Daryl Mahon and Danika Sharek
Abstract
Purpose –Peer support work is increasingly becoming part of the delivery of health and social care
services. However, in an Irish context, there is a paucity of research in this area. This study aims to
investigatethe experiences of peers and other key stakeholdersacross four sectors in Ireland.
Design/methodology/approach –Qualitativeinterviews (N= 35) were conducted with key respondents
in mental health, substance use, migrant health and homelessnesssectors. Data were analysed using
thematicanalysis and reported using an ecological framework.
Findings –Peer work is a slowlyemerging area of practice, although mental healthis further ahead in this
journey. Findings suggest that peers are important additions to service delivery but also have various
support and development needs. Organisations can encourage and support peers into employment
through enacting human resource policy and practices, effective supervision, management and
maintaininga positive working culture. Helping other professionalsto understand the peer role and how it
can function within the wider team is highlighted. National policy and governance structures can also
supportthe emergence of the peer role, which existsin a highly complex arena.
Research limitations/implications –Peers can play a meaningful role in supporting service users in
four sectors of health and socialcare in Ireland. Structures and processes to help embed these roles into
systems are encouraged across micro, meso and macro levels. Implications and limitations are
discussedfor moving forward with peer work.
Originality/value –To the best of theauthors’ knowledge, this is the first study to includethese four areas
of practicesimultaneously.
Keywords Peers, Peer work, Lived experience, Experiential knowledge
Paper type Research paper
1. Introduction and background
Peer support is increasingly being recognised internationally as an essential component of
service provision across health and social care settings. In an Irish context, peer support is
beginning to slowly emerge in human services. However, the processes, procedures and
structures involved in developing and embedding this role into systems of care is not fully
understood. Equally, the concept of peer and peer work is not always defined or
conceptualised in a consistent way, leading to misunderstanding of what it is that peers do
when supporting others.
Peer support involves a relational and mutual exchange of practical and emotional support,
based on a shared understanding of a specific type of lived experience, respect for
autonomy, instillation of hope and empowerment (Burke et al., 2019;Fuhr et al.,2014;
Lloyd-Evans et al.,2014;Mead et al., 2001). These processes are generally the specific
ingredients found in peer support work regardless of the field of practice where peers are
working. Said another way, the principles, practices and ingredients of peer work are trans-
theoretical in nature and span across the various environments where peers offer support.
For example, hope and self-determination over one’s life and the use of lived experience
knowledge are essential ingredients (King and Simmons, 2018;Repper and Carter, 2011;
Daryl Mahon and
Danika Sharek are both
based at the Genio, Dublin,
Ireland.
The authors would like to
express their gratitude to all
research participants,
especially those with lived
experience of being peers.
DOI 10.1108/MHSI-12-2022-0082 VOL. 28 NO. 5 2024, pp. 485-504, ©Emerald Publishing Limited, ISSN 2042-8308 jMENTAL HEALTH AND SOCIAL INCLUSION jPAGE 485
Solomon, 2004), as is the concept of shared responsibility (Chien et al.,2019;Lloyd-Evans
et al., 2014;Mead and MacNeil, 2006). Ultimately, whether the peer is working to support
some type of condition or experience, the underlying process involved is the use of
experiential knowledge to help support others. While the extant literature has an ever-
increasing body of research in various areas of peer work, evidence synthesis is the gold
standard for making sense of research and policy decisions with regards to this field of
practices. On this note, the literature points to various reviews demonstrating a host of
outcomes across differentmetrics and aspects of peer work.
Previous systematic review and meta-analyses have provided evidence for peer support
with depression (Bryan & Arkowitz, 2015) or with what is often termed serious and
“enduring” mental health difficulties (Chien et al.,2019;Fuhr et al.,2014). A more recent
meta-analysis assessing the effectiveness of peer support work across various mental
health issues concluded that peers not only impact outcomes such as hope and recovery,
but impact on clinical outcomes too(Smit et al.,2022).
Other evidence reviews have demonstrated that peers’ impact on similar outcomes in
various other fields. For example, previous meta-analyses (Du Plessis et al.,2020;Eddie
et al., 2019) in the substance use sector report that peers contribute to reduced substance
use and relapse rates, while improving relationships between treatment providers and
service users, increased retention in treatment and overall satisfaction by service users.
Similarly, two systematicreviews of peer support in homelessness services found thatpeers
impacted outcomes such as quality of life, substance use and social supports (Barker and
Maguire, 2017). Other research suggests that peers working with refugees and asylum
seekers positively impact outcomes such as resettlement, acculturation, emotional support
and the social determinants of health. Peers in these settings can make the support
culturally responsive through a shared understanding of language spoken and ways to
reduce stigma, especially around mental health and some of the cultural nuances
associated with it. This is achieved by co-producing models of peer work in conjunction with
peers and civil society actors (Gower et al.,2022;Mahon, 2022).
Other studies have focused on more nuanced or specific outcomes. For example, White
et al. (2020) examined peer support delivered as a one-to-one intervention, finding support
for psychosocial outcomes. Peer support has also been assessed as delivered in group
settings in substance use (Tracy and Wallace, 2016),in mental health settings (Lyons et al.,
2021;Smit et al.,2022) and in work with refugees (Mahon, 2022),where the benefit of group
work is acknowledged. Other studies examined the cost benefit of peer support (Bagnall
et al.,2015
;Huang et al.,2020;Smit et al.,2022) and the relative benefit of peer support
measured against other support roles (Bellamy et al.,2017;Pitt et al., 2013). It must be
noted that not all research replicates these findings, and while almost all research does
have some positive findings questions around bias and methodological concerns are
sometimes noted (Lloyd-Evans, 2014;Thompson et al., 2022;White et al., 2020).
Notwithstanding these issues,there is a broad base of evidence supporting peer work, and
if we are to accept this research as valid, then the question arises as to how we can
meaningfully deploy peers into systems of care and what are some of the challenges
encountered.
1.1 Implementation considerations
If peer support work is to be fully embraced as a meaningful endeavour, then the structures
to support peer work need to be considered. The international literature tends to converge
with regards to several areas that would seem to be important predictors of a successful
outcome with regards to the uptake and implementation of this role. At the individual peer
level, some concerns have been noted withregards to their emotional wellbeing because of
stressful work environments (Pitt et al.,2013;Mirbahaeddin and Chreim, 2022;Zeng and
McNamara, 2021). Human resourcepolicy that is supportive of peer work can help facilitate
PAGE 486 jMENTAL HEALTH AND SOCIAL INCLUSION jVOL. 28 NO. 5 2024
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