Multicultural Implementation-Experiences of Peer Support Workers in MH Services: Qualitative Findings of UPSIDES...

Mental health peer support is growing as an essential recovery-oriented occupation that can help alleviate the burden of mental health (MH) conditions. Despite its international growth, there is lack of cross-cultural knowledge about peer support workers' (PSW) implementation experiences. This study explored PSWs' implementation experiences of Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) innovative intervention-a multi-country project designed to empower and scale-up peer support in low-, middle- and high-income countries (LMIC & HIC).

Nine focus groups totaling 38 PSWs were conducted at six study sites: Ulm and Hamburg (Germany), Kampala (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Pune (India). Transcripts were analyzed using qualitative analysis and MAXQDA software.

Four domains were identified: (i) PSWs' experiences of recovery; (ii) PSWs' experiences of vocational development; (iii) PSWs' experiences with staff  and work-role in MH systems;and  (iv) PSWs' strive to influence broader circles. In low-and-middle-income countries specifically, PSWs experienced gains for illness management, access to care, employability and financial standing. They also engaged in active interactions with stakeholders in the community (e.g., relatives, police, etc.) promoting social-educative and anti-stigma influences. In high-income countries, experiences related to self-disclosure and peer-vocational development issues. Across sites PSWs' expressed challenges and needs related to lack of role clarity, relations with MH staff and integration into services.

The findings reveal the potential of mental health peer support workers (MH PSWs) to aid in mental health recovery and systemic change. However, implementation experiences vary across cultures, highlighting the need to further develop the PSW role and integrate it into mental health systems across different sites.   Trial Registration: ISRCTN26008944.