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Developing a change model for peer worker interventions in mental health services: a qualitative research study

  • S. Gillard (a1), S.L. Gibson (a1), J. Holley (a1) and M. Lucock (a1)
  • Please note a correction has been issued for this article.

A range of peer worker roles are being introduced into mental health services internationally. There is some evidence that attests to the benefits of peer workers for the people they support but formal trial evidence in inconclusive, in part because the change model underpinning peer support-based interventions is underdeveloped. Complex intervention evaluation guidance suggests that understandings of how an intervention is associated with change in outcomes should be modelled, theoretically and empirically, before the intervention can be robustly evaluated. This paper aims to model the change mechanisms underlying peer worker interventions.


In a qualitative, comparative case study of ten peer worker initiatives in statutory and voluntary sector mental health services in England in-depth interviews were carried out with 71 peer workers, service users, staff and managers, exploring their experiences of peer working. Using a Grounded Theory approach we identified core processes within the peer worker role that were productive of change for service users supported by peer workers.


Key change mechanisms were: (i) building trusting relationships based on shared lived experience; (ii) role-modelling individual recovery and living well with mental health problems; (iii) engaging service users with mental health services and the community. Mechanisms could be further explained by theoretical literature on role-modelling and relationship in mental health services. We were able to model process and downstream outcomes potentially associated with peer worker interventions.


An empirically and theoretically grounded change model can be articulated that usefully informs the development, evaluation and planning of peer worker interventions.

Corresponding author
* Address for correspondence: Dr S. Gillard, Social & Community Mental Health, Institute of Population Health Research, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK. (Email:
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Bach, S, Della Rocca, G (2000). The management strategies of public service employers in Europe. Industrial Relations Journal 31, 8296.
Bandura, A (1977). Social Learning Theory. Prentice-Hall: Englewood Cliffs, NJ.
Bandura, A (1997). Self-efficacy: The Exercise of Control. Freeman: New York.
Bordin, E (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy 16, 252260.
Bowlby, J (1973). Attachment and Loss, Vol. 2: Separation. Basic Books: New York.
Bozeman, B, Feeney, MK (2007). Toward a useful theory of mentoring: a conceptual analysis and critique. Administration and Society 39, 719739.
Catty, J, Cowan, N, Poole, Z (2011). Attachment to the clinical team and its association with therapeutic relationships, social networks, and clinical well-being. Psychology and Psychotherapy 85, 1735.
Coatsworth- Puspoky, R, Forchuk, C, Ward-Griffin, C (2006). Peer support relationships: an unexplored interpersonal process in mental health. Journal of Psychiatric and Mental Health Nursing 13, 490497.
Corrigan, P (2006). Impact of consumer-operated services on empowerment and recovery of people with psychiatric disabilities. Psychiatric Services 57, 14931496.
Creswell, JW (2013). Qualitative Inquiry and Research Design: Choosing Among Five Approaches. Sage: Thousand Oaks, CA.
Daniels, A, Grant, E, Filson, B, Powell, I, Fricks, L, Goodale, L (2010). Pillars of Peer Support: Transforming Mental Health Systems of Care through Peer Support Services. The Carter Center: Atlanta.
Davidson, L, Chinman, M, Sells, D, Rowe, M (2006). Peer support among adults with serious mental illness: a report from the field. Schizophrenia Bulletin 32, 443450.
Department of Health (2012). No Health without Mental Health: Implementation Framework. HMSO: London.
Festinger, L (1955). A theory of social comparison processes. Human Relations 7, 117142.
Gillard, S, Simons, L, Turner, K, Lucock, M, Edwards, C (2012). Patient and public involvement in the coproduction of knowledge reflection on the analysis of qualitative data in a mental health study. Qualitative Health Research 22, 11261137.
Gillard, S, Edwards, C, Gibson, S, Owen, K, Wright, C (2013). Introducing peer worker roles into UK mental health service teams: a qualitative analysis of the organisational benefits and challenges. BMC Health Services Research 13, 188.
Gillard, S, Edwards, C, Gibson, S, Holley, J, Owen, K. (2014) New ways of working in mental health services: a qualitative, comparative case study assessing and informing the emergence of new peer worker roles in mental health services in England. Health Service Delivery Research.
Green, J, Thorogood, N (2004). Qualitative Methods for Health Research. Sage: London.
Griswold, KS, Pastore, PA, Homish, GG, Henke, A (2010). Access to primary care: are mental health peers effective in helping patients after a psychiatric emergency. Primary Psychiatry 17, 4245.
Hustoft, K, Larsen, TK, Auestad, B, Joa, I, Johannessen, JO, Ruud, T (2013). Predictors of involuntary hospitalizations to acute psychiatry. International Journal of Law and Psychiatry 36, 136143.
JCPMH (2012 a). Guidance for Commissioners of Acute Care – Inpatient and Crisis Home Treatment. Royal College of Psychiatry: London.
JCPMH (2012 b). Guidance for Commissioners of Community Specialist Mental Health Services. Royal College of Psychiatry: London.
Kaufman, L, Brooks, W, Steinley-Bumgarner, M, Stevens-Manser, S (2012). Peer Specialist Training and Certification Programs A National Overview. University of Texas: Austin, Texas.
Kelly, E, Fulginiti, A, Pahwa, R, Tallen, L, Duan, L, Brekke, JS (2013). A pilot test of a peer navigator intervention for improving the health of individuals with serious mental illness. Community Mental Health Journal 50, 435446.
Killaspy, H, Banerjee, S, King, M, Lloyd, M (2000). Prospective controlled study of psychiatric out-patient non-attendance. Characteristics and outcome. British Journal of Psychiatry 176, 160165.
Lawn, S, Smith, A, Hunter, K (2008). Mental health peer support for hospital avoidance and early discharge: an Australian example of consumer driven and operated service. Journal of Mental Health 17, 498508.
Martin, A, Buchheim, A, Berger, U, Strauss, B (2007). The impact of attachment organization on potential countertransference reactions. Psychotherapy Research 17, 4658.
McCabe, R, Priebe, S (2004). The therapeutic relationship in the treatment of severe mental illness: a review of methods and findings. International Journal of Social Psychiatry 50, 115128.
Mead, S (2006). Peer support: what makes it unique. International Journal of Psychosocial Rehabilitation 10, 2937.
Mead, S, Hilton, D, Curtis, L (2001). Peer support: a theoretical perspective. Psychiatric Rehabilitation Journal 25, 134141.
Medical Research Council (2008). Developing and Evaluating Complex Interventions: New Guidance. Medical Research Council: London.
Mental Health Commission (2012). Blueprint II: Improving Mental Health and Wellbeing for All New Zealanders – Making Change Happen. Mental Health Commission: New Zealand.
Min, SY, Whitecraft, J, Rothbard, AB, Salzer, MS (2007). Peer support for persons with co-occurring disorders and community tenure: a survival analysis. Psychiatric Rehabilitation Journal 30, 207213.
Moran, GS, Russinova, Z, Gidugu, V, Yim, JY, Sprague, C (2012). Benefits and mechanisms of recovery among peer providers with psychiatric illnesses. Qualitative Health Research 22, 304319.
Moran, GS, Russinova, Z, Gidugu, V, Gagne, C (2013). Challenges experienced by paid peer providers in mental health recovery: a qualitative study. Community Mental Health Journal 49, 281291.
Mowbray, CT, Moxley, DP, Collins, ME (1998). Consumers as mental health providers: first-person accounts of benefits and limitations. Journal of Behavioral Health Services & Research 25, 397411.
Muesser, KT, Corrigan, PW, Hilton, DW, Tanzman, B, Schuab, A, Gingerich, S, Essock, A, Tarrier, N, Morey, B, Vogel-Scibilia, S, Heerz, MI (2002). Illness management and recovery: a review of the research. Psychiatric Services 53, 12721284.
Nelson, G, Ochocka, J, Janzen, R, Trainor, J (2006). A longitudinal study of mental health consumer/survivor initiatives: part 1 – literature review and overview of the study. Journal of Community Psychology 34, 247260.
Ochocka, J, Nelson, G, Janzen, R, Trainor, J (2006). A longitudinal study of mental health consumer/survivor initiatives: part 3 – a qualitative study of impacts of participation on new members. Journal of Community Psychology 34, 273283.
Olfson, M, Haya Ascher-Svanum, MPH, Faries, DE, Marcus, SC (2011). Predicting psychiatric hospital admission among adults with schizophrenia. Psychiatric Services 62, 11381145.
Patton, M (1990). Qualitative Evaluation and Research Methods. Sage: London.
Pitt, V, Lowe, D, Hill, S, Prictor, M, Hetrick, SE, Ryan, R (2013). Consumer-providers of care for adult clients of statutory mental health services. Cochrane Database of Systematic Reviews 3, 175.
Pollitt, A, Winpenny, E, Newbould, J, Celia, C, Ling, T, Scraggs, E (2012). Evaluation of the Peer Worker Programme at Cambridgeshire and Peterborough NHS Foundation Trust. RAND Europe: Cambridge.
Priebe, S, McCabe, R (2006). The therapeutic relationship in psychiatric settings. Acta Psychiatrica Scandinavica 113, 6972.
Repper, J, Carter, T (2011). A review of the literature on peer support in mental health services. Journal of Mental Health 20, 392411.
Repper, J, Watson, E (2012). A year of peer support in Nottingham: the peer support workers and their work with individuals. Journal of Mental Health Training, Education and Practice 7, 7984.
Resnick, SG, Rosenheck, RA (2008). Integrating peer-provided services: a quasi-experimental study of recovery orientation, confidence, and empowerment. Psychiatric Services 59, 13071314.
Ruggeri, M, Lasalvia, A, Bonetto, C (2013). A new generation of pragmatic trials of psychosocial interventions is needed. Epidemiology and Psychiatric Sciences 22, 111117.
Rüsch, N, Müller, M, Ajdacic-Gross, V, Rodgers, S, Corrigan, PW, Rössler, W (2014). Shame, perceived knowledge and satisfaction associated with mental health as predictors of attitude patterns towards help-seeking. Epidemiology and Psychiatric Sciences 23, 177187.
Schrank, B, Riches, S, Bird, V, Murray, J, Tylee, A, Slade, M (2013). A conceptual framework for improving well-being in people with a diagnosis of psychosis. Epidemiology and Psychiatric Services 111. [Epub ahead of print].
Scott, A, Doughty, C, Kahi, H (2011). Peer Support Practice in Aotearoa New Zealand. Self-Commissioned: Christchurch.
Simpson, A, Quigley, J, Henry, SJ, Hall, C (2013). Evaluating the selection, training, and support of peer support workers in the United Kingdom. Journal of Psychosocial Nursing and Mental Health Services 52, 3140.
Strauss, A, Corbin, J (1998). Basics of Qualitative Research. Techniques and Procedures for Developing Grounded Theory, 2nd edn. Sage: London.
Tennant, R, Hiller, L, Fishwick, R, Platt, P, Joseph, S, Weich, S, Parkinson, J, Secker, J, Stewart-Brown, S (2007). The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcomes 5, 14771525.
Thompson, RA (2000). The legacy of early attachments. Child Development 71, 145152.
Thornicroft, G (1991). Social deprivation and rates of treated mental disorder. Developing statistical models to predict psychiatric service utilisation. British Journal of Psychiatry 158, 475484.
Trachtenberg, M, Parsonage, M, Shepherd, G (2013). Peer Support in Mental Health Care: Is It Good Value for Money? Centre for Mental health: London.
Van der Post, LF, Peen, J, Dekker, JJ (2013). A prediction model for the incidence of civil detention for crisis patients with psychiatric illnesses; the Amsterdam study of acute psychiatry VII. Social Psychiatry and Psychiatric Epidemiology 49, 283290.
Webber, M, Huxley, P (2004). Social exclusion and risk of emergency compulsory admission: a case-control study. Social Psychiatry and Psychiatric Epidemiology 39, 10001009.
Yanos, PT, Primavera, LH, Knight, EL (2001). Consumer-run service participation, recovery of social functioning, and the mediating role of psychological factors. Psychiatric Services 52, 493500.
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