Fostering psychological safety and resilience in the ICU: implementing structured peer support

Psychological distress, moral injury, and burnout are prevalent among intensive care unit (ICU) professionals, impacting individual well-being, team dynamics, and patient safety. Structured peer support programmes, delivered by trained colleagues rather than mental health professionals, could be implemented as low-threshold, scalable interventions to promote psychological safety and resilience. This review outlines five foundational pillars for implementing peer support in the ICU, including formal programme design, training, inclusivity, confidentiality, and continuous evaluation. It also addresses practical strategies to overcome cultural and institutional barriers, such as stigma, time constraints, and hierarchical norms. Drawing on current evidence and recent unpublished survey data from North American critical care cardiologists, the article provides a practical framework for integrating peer support into ICU culture. Peer support represents a complementary approach to formal mental health services and offers tangible benefits for clinician well-being, retention, and quality of care.