Our Home Treatment Teams work around the clock, 365 days per year to provide intensive support to people at home and help them stay well and out of hospital.
Three Peer Support Workers (PSWs) were recruited to help with a research study looking at how people with lived experience of mental ill-health could help bridge the gap between crisis and continuing care services.
Our Home Treatment Teams work around the clock, 365 days per year to provide intensive support to people at home and help them stay well and out of hospital.
Three Peer Support Workers (PSWs) were recruited to help with a research study looking at how people with lived experience of mental ill-health could help bridge the gap between crisis and continuing care services. This transition period has traditionally been a time when people are vulnerable to relapse and it was felt that peer support, could help empower people to continue to recover. Peer support focuses on the importance of empathising with another person through a shared experience of emotional pain – rather than having a basis in psychiatric theory or diagnostic criteria. The idea is to inspire hope by demonstrating that recovery is possible in others.
Surrey and Borders Partnership was one of six Trusts to take part in the study, focusing on our Home Treatment Teams serving the boroughs of Surrey Heath in Surrey and Hart and Rushmoor in north east Hampshire in particular. PSWs who had experienced mental health difficulties and used mental health services were recruited and employed on a part- time paid basis by the Trust, giving them an opportunity to gain paid work experience and help them back into the world of work.
They attended an introductory programme of training arranged and delivered by the study team. The PSWs then provided a structured programme of support over 10 weekly visits, with the aim of supporting people within three months of the person leaving crisis services. The PSW listened sympathetically and shared skills and coping strategies acquired in their own recovery journey.
A self-management workbook was provided to people to support the sessions, exploring topics such as: ‘Moving on after a crisis’. ‘Keeping Well’, ‘Managing ups and downs’ and developing ‘Goals and Dreams’. Participants in a control group received the workbook but no additional guidance or peer support to help in using it. The aim was to test out whether a peer-provided, self-management programme for people leaving crisis resolution teams can reduce relapse and promote recovery.
Feedback from both peer support workers and participants alike has been very positive and after the success of this study, opportunities to embed peer support in mental health services elsewhere are now being developed in our organisation.
The CORE (Crisis resolution team Optimisation and RElapse prevention) study is a five year (2011-16) National Institute of Health Research funded programme directed by UCL, and managed by Camden and Islington NHS Foundation Trust.
Surrey and Borders Partnership was involved in phase three of the study: The development and testing of a peer-delivered self-management intervention to bridge the gap between crisis and continuing care. The self-management workbook supplied by the University College London was adapted from recovery resources complied by Dr Rachel Perkins and colleagues at South West London and St Georges NHS Foundation Trust which were informed by self-management resources by self-management resources such as the Wellness Recovery Action Plan and relapse prevention interventions.
The PSWs were also partners in the delivery of this service as without them it would not be possible. Home Treatment Team Manager Stanley Masawi says of them: “They have each been very brave, willing to share their own personal stories to aid other people’s recovery. The team have been responsive and engaged well with all those that they have worked with and this has been greatly appreciated. We are immensely privileged to have them work with us.
“Recruitment of peer support workers was massive success. There is growing evidence that peer support is beneficial to recovery and taking part in this study has given us the opportunity to embed this approach further within our Trust.” – Andy Erskine, Director of MH and Social Care, SABP.
This initiative is based on the principle of involvement and it’s mutually therapeutic value both for the peer support workers and for participants.
As well as contributing to a national study and improving the wider understanding of how Peer Support can support people through mental health crisis, Dr. Brynmor Lloyd-Evans, Lecturer in Mental Health and Social Care, UCL said: “This is a great service innovation in Surrey and Borders Partnership (SABP) to support people with Crisis Resolution Home Treatment Team discharge and through the crisis care pathway. And it’s contributed to a national research study and developing evidence about supporting people in crisis. SABP had the best participant retention rate of all our sites, a clear indication it was valued by service users.”
The study has made noticeable differences to people experiencing mental health crises, helping to bridge the gap between clinicians and people who use services.
Tom*, a person who has used the peer support service, said “It was really good to talk to someone that had experienced mental health themselves. I could relate to my peer support worker immensely.”
The experience brought benefits to the peer support workers themselves in the increase of self-esteem, confidence and personal recovery. It also increases the chances of further employment, personal development and achievements of some life goals.
One of our peer support workers said: “I’ve found it beneficial to share the skills and strategies that I’ve developed through coping with my own mental illness, but I’ve also been able to use skills my clients have shared with me. It’s been a really good two way learning process.”
Feedback from the PSWs about our Trust five day induction, which is standardised for all employees, was that it wasn’t always mindful of people who might have lived experience of mental ill-health or still be in receipt of services. We would consider whether it is relevant for them to attend all the sessions as one week is quite long or whether reasonable adjustments could be made to make it easier for them to attend – such as starting at a later time for example.
We would also consider developing a digital format of the workbook – which may be helpful for some and allow easy changes to the plan.
As well as the benefits of the role, the Peer Support Workers reported several challenges, including:
• It was daunting to go into someone else’s home for the first time in a semi- professional capacity.
• Having lived experience of mental ill-health can help to break down the barriers between the professionals and those receiving services but it can also blur boundaries between peer support and friendship.
• Limit the support to a structured programme over a given period of time (10 weeks in this case)
• Set realistic expectations from the outset, acknowledging that it wouldn’t be possible to resolve every issue in this time.
Three substantive part-time posts have been created for the Home Treatment Teams that took part in the study, they have weekly supervision from a senior practitioner. Since receiving such overwhelmingly positive feedback from this study, Peer Support is now an accepted pathway for those being discharged from the acute care service to be referred for peer support.
PSWs are now in place within our drug and alcohol services. The approach is being built into the development of new Trust services such as our Recovery Colleges, which provide short courses to equip people with skills to better manage their mental health condition, and our innovative Safe Havens – a network of six drop in centres open during evening and weekends for users of the service and or carers to walk in and talk to someone in a relaxed and non-clinical environment.
Thirty five participants were recruited to this phase of the CORE project. 18 to receive peer support and 17 to take part in the control group. Of these, two from the peer support group relapsed, needing support from acute care services (such as an inpatient psychiatric admission) whereas the number was more than four times greater for the control group with nine people needing support from such services within six months of completing the course of 10 sessions.
People receiving the peer support gave very positive feedback about their experiences, saying that they felt:
• That the PSWs could communicate easily with them e.g. “You guys have the time to sit down and listen”
The results are due to be published as part of the overall research study. In the meantime, we are continuing to embed this approach within our organisation.
Peer support also now has the backing of our Trust board and a proposal for recruiting a pool of PSWs who can be supported into roles across the Trust’s Community Mental Health Recovery Services and crisis services including Home Treatment Teams and Safe Havens is now being considered.
Our PSWs also recently presented their approach at our county-wide multi-agency Emotional Health and Wellbeing Board to demonstrate to leaders in the wider health, social care and voluntary sector how peer support can help people with mental ill-health.
The Peer Support Workers recently won Team of the Year (Gold) award in the Trust’s CARE Awards for staff, volunteers and partners in service delivery.
More information on the study is available at: https://www.ucl.ac.uk/core-study
