While working in various statutory mental health care settings in Germany, where I am training to become a clinical psychologist, I only once met a peer support worker. In my experience, in Germany, peer support is mostly practised outside standard mental health care settings. Coming to the UK on a research visit however, I found that here, peer support is more often integrated into statutory mental health care. This made me curious about how peer support workers experience their role across mental health care settings.
Peer support work, where a person offers their help to others living with a mental health condition by drawing on their own lived experience, has been regularly featured in our blogs. Originally, peer support work was driven by service users outside of traditional mental health care services, sometimes as a critical alternative to it (Ruiz-Pérez et al., 2025). It has recently gained international recognition for its recovery-oriented approach (WHO, 2021).
Despite peer support becoming an important part of standard mental health care in various countries (Cooper et al., 2024), the NIHR Policy Research Unit in Mental Health (MHPRU) from University College London and King’s College London observed a lack of clarity around what peer support workers do and what helps them deliver their work. They therefore conducted interviews with peer support workers to find out. The findings of these interviews are reported in two studies:
- What values do peer support workers hold, what is distinct about peer support work, and what is the impact of peer support work? (Cooper et al., 2026)
- What are barriers and facilitators to peer support work on an individual, organisational, and systemic level? (Foye et al., 2025)
Methods
The research teams interviewed paid peer workers across various mental health care services in England, e.g. in the NHS, or charities and education settings. Interviews were conducted by lived experience researchers, who were part of the research team and had experience of mental health conditions and/or caring for people with experience of mental health conditions, and sometimes with peer support work. In total, 35 peer support workers were interviewed, most of them being aged between 35 and 44, white, and most had <1 to 5 years of work experience in the peer role.
Interviews were analysed according to principles of thematic analysis, a qualitative research method looking to develop common themes that are derived to summarise and interpret multiple interviews.
Results
First, let’s look at the paper by Cooper et al., 2026: Values, distinctive features and impact of peer support work.
Themes around the values underpinning peer support work
- The belief that recovery is possible
- Mutuality of experience, which can lead to empathy and connection
- Person-centred approach to care
- Empowering instead of “fixing” service users
Themes around the distinctive features of peer support work compared to other clinical roles
- Individualised, adaptive sessions
- Supporting service users holistically: Support can come in practical forms (e.g. a session in a café or the gym) to strengthen community connections.
- Sharing lived experience with service users
- Navigating boundaries around disclosure of lived experience: Despite a potentially similar experience, peer support work is not a friendship with service users
- Cultural inclusiveness
- Working clinically as well as non-clinically: Working in a clinical setting could lead to peer support workers taking on more generic clinical roles, to organisational restrictions like spending less time with service users, and to challenges in team meetings
Themes around the impact of peer support work
Impact on service users
Interviewees thought that service users feel understood and gain confidence and openness from peer support. Yet, peer support is not right for everyone, e.g. service users may not want to share experiences with peers.
Impact on peer support workers
Peer support workers felt this work can help their recovery through bringing joy and learning from clients.
Impact on care systems and non-peer staff
Interviewees thought that peer support can bring about systemic change and provide different perspectives for non-peer staff, for example, peer support workers can help foster empathy among colleagues and raise awareness about systemic shortcomings.
Next, let’s look at the paper by Foye et al., 2025: Barriers and facilitators to peer support work.
Individual barriers and facilitators (micro-level)
- Facilitator: Being open but boundaried with sharing experiences
- Facilitator: Working differently than clinical staff, with shared experience as a core element
- Facilitator / Barrier: Flexibility and structure both facilitate peer support, but also act as barriers (e.g. unclear expectations due to too much flexibility, or assimilation to clinical roles due to too much structure)
Organisational barriers and facilitators (meso-level)
- Facilitator: Good support and supervision
- Facilitator/ Barrier: The wider team can facilitate (e.g. good relationships with colleagues) or impede (e.g. fear of assumptions from clinical co-workers)
- Barrier: Heterogeneity of peer support, so peer workers might be asked to do tasks outside their role
Systemic barriers and facilitators (macro-level)
- Barrier: limited funding and resources for training, office spaces, long-term posts
- Barrier: low pay and lack of progression can lead to stagnation of the role and peer support workers leaving the role
- Barrier: working in complex systems that can be hard to navigate, e.g. due to specific language or policies
Conclusions
The 35 peer support workers interviewed for this study conducted various tasks as part of their peer roles, still the authors identified some unifying features of their work, like a recovery-oriented, person-centred approach and the sharing of experiences with service users. According to this study, peer support can have an impact on service users, peer support workers themselves as well as the wider care system.
Facilitators to delivering peer support included good supervision and keeping boundaries while remaining open as a peer. Most barriers to delivering peer support were identified on the organisational and systemic level, like frictions with the wider team or limited funding.
Strengths and Limitations
Strengths
This extensive research informs us about the needs of the peer support workforce and the local and systemic changes needed to facilitate their work. By taking a qualitative approach, including the voluntary sector and several types of peer support work in their research, it adds to previous research on the topic (e.g. Cooper et al., 2024; Gillard et al., 2022).
The qualitative approach lends itself very well due to the explorative research questions and the broad field of peer support work. Including lived experience researchers shows that the relationship between researcher and participant was taken into careful consideration by the research team: participants may have been more open and direct about their experience and trusted the interviewers more, as some of them had worked as peer support workers.
Despite the findings being extensive, the researchers manage to clearly lay them out in reader-friendly graphics that make them understandable. To add relevance and help the reader take away practical implications from their findings, the researchers draw actionable conclusions from the barriers they identify, which can inform organisations and policy on how best to support peer support workers.
Limitations
The results suffer from certain biases as most interviewees had only worked in peer support for less than 5 years; however, given this study’s finding of little opportunities for progression in the role, it may be harder to find peer support workers who have worked in their role for longer. Future research should include service users’ views, especially on the perceived impact of peer support from their perspective, as this would add to the findings on peer support workers’ experiences reported here.
Despite including peer support workers from the voluntary sector, the research team missed the opportunity to interview unpaid peer support workers, who might have added insightful perspectives, especially when we think about peer support originally encompassing a critical perspective towards the mental health care system. On this note, it is also worth keeping in mind that while the inclusion of lived experience researchers in this work adds a participatory and holistic aspect, it might still not include all views from people with lived experience; certain groups of people with lived experience may not get the opportunity or may not want to work in mental health research, for example due to unpleasant experiences connected to the mental health care system.
Implications for practice
There are several practical implications to take away from this research that could improve peer support work. As good support and supervision were identified as facilitators to delivering peer support, organisations should provide these when employing peer support workers. For peer workers to be better integrated into heterogenous teams in the complex health care system, training should be offered to non-peer staff. This might help inform about the peer role and foster a positive working culture, so that peer support workers and non-clinical staff can learn from one another.
To help peer support workers orient themselves in the broad role, organisations may want to set up specific guidelines for the respective peer role in their service. On a systemic level, sustainable funding could be a key to add place value on peer support work, provide opportunities for role development and progression in the role, and ensure peer support workers can make use of resources.
However, some barriers identified in this research may be more difficult to overcome. Participants in this study saw the danger of peer support work being too assimilated to clinical roles, e.g. due to organisational restrictions. Also, some of the problems identified seem to point to general shortcomings in mental health care systems that do not only impact peer support workers, like discriminatory opinions from clinical staff towards service users, which were mentioned by some interviewees.
A more general question remains. Even if organisations ensured more trainings, fostered exchange between peer and non-peer staff and set up clear guidelines for peer support roles, can the original, sometimes critical approach of peer support work be maintained when integrated into standard mental health care services? Or would peer support work have to be conducted outside statutory mental health care services for its original approach to be maintained? Without having a clear answer to these questions, I believe that there are threats as well as opportunities to integrating peer support work into standard mental health care services. I agree that we should be careful not to use peer support workers as a “silver bullet”, as mentioned by one of the lived experience researchers in response to the article by Foye et al. (2025, p.12). Also, peer workers should not be hired instead of clinical non-peer staff to save financial resources.
Yet, this research provides suggestions for a thoughtful integration of peer support work into standard mental health care, for example through sustainable funding and consistent supervision for peer support workers. The positive impact of peer support work has been pointed out by previous research (Høgh Egmose et al., 2023; Smit et al., 2022) and statutory mental health care services might have the resources to make use of it. By providing a service user experience and addressing organisational and systemic shortcomings, peer support work in statutory mental health care may help bridge-building between service users and non-peer staff and possibly contribute to positive systemic changes in mental health care over time.
Statement of interests
During the development of this blog, Alina Unkelbach was on a research visit with the Division of Psychiatry at University College London, which the MHPRU who published the papers are also a part of. She worked with another working group at the Division of Psychiatry and had no involvement in the research described.
No AI was used in the development of this blog.
Edited by
Simon Bradstreet.
Links
Primary papers
Cooper, R. E., Lyons, N., Jeffreys, S., Jeynes, T., Nicholls, V., Foye, U., Shah, P.,Mitchell, L., Machin, K., Chipp, B., Grundy, A., Pemovska, T., Ahmed, N., Appleton, R., Repper, J., Lloyd-Evans, B., Simpson, A., & Johnson, S. (2026). Understanding the roles and experiences of mental health peer support workers in England: a qualitative interview study. BMC Psychiatry 26(263).
Foye, U., Lyons, N., Shah, P., Mitchell, L., Machin, K., Chipp, B., Jeffreys, S., Jeynes, T., Persaud, K., Nicholls, V., Cooper, R. E., Grundy, A., Pemovska, T., Ahmend, A., Appleton, R., Repper, J., Johnson, S., Lloyd-Evans, B., & Simpson, A. (2025). Understanding the barriers and facilitators to delivering peer support effectively in England: a qualitative study. BMC Psychiatry 25(480).
Other references
Cooper, R. E., Saunders, K. R. K., Greenburgh, A., Shah, P., Appleton, R., Machin, K., Jeynes, T., Barnett, P., Allan, S. M., Griffiths, J., Stuart, R., Mitchell, L., Chipp, B., Jeffreys, S., Lloyd-Evans, B., Simpson, A., & Johnson, S. (2024). The effectiveness, implementation, and experiences of peer support approaches for mental health: A systematic umbrella review. BMC Medicine, 22(72). https://doi: 10.1186/s12916-024-03260-y
Gillard S, Foster R, White S, Barlow S, Bhattacharya R, Binfield P, Eborall, R., Faulkner, A., Gibson, S., Goldsmith, L. P., Simpson, A., Lucock, M., Marks, J., Morshead, R. Patel, S., Priebe, S., Repper, J., Rinaldi, M., Ussher, M., & Worner, J. (2022). The impact of working as a peer worker in mental health services: a longitudinal mixed methods study. BMC Psychiatry 22(1):1–18. https://doi.org/10.1186/s12888-022-03999-9
Høgh Egmose C, Heinsvig Poulsen C, & Hjorthøj C., Skriver Mundy, S., Hellström, L., Nørgaard Nielsen, M., Korsbek, L., Serup Rasmussen, K., & Falgaard Eplov, L. (2023). The effectiveness of peer support in personal and clinical recovery – systematic review and meta-analysis. Psychiatric Services 74, 847-858. https://doi.org/10.1176/appi.ps.202100138
Ruiz-Pérez, G., Küsel, M., & von Peter, S. (2025). Changes in attitudes of mental health care staff surrounding the implementation of peer support work: A qualitative study. PLOS One 20(4). https://doi.org/10.1371/journal.pone.0319830
Smit D, Miguel C, Vrijsen JN, Groeneweg B, Spijker J, & Cuijpers P (2022). The effectiveness of peer support for individuals with mental illness: systematic review and meta-analysis. Psychological Medicine 53(11), 5332–5341. https://doi:10.1017/S0033291722002422
World Health Organization. (2021). Peer support mental health services: Promoting person-centred and rights-based approaches. World Health Organization. https://www.who.int/publications/i/item/9789240025783