Title: ENRICH into practice: informing the successful introduction of peer workers into mental health services (ENRICHMENT)
Funder: Department of Health and Social Care

Abstract: Background Peer support is rapidly being introduced into mental health services internationally. Increasing numbers of people with personal experiences of using mental health services are being employed as peer workers, driven by healthcare workforce policy. Evidence suggests that receiving peer support can improve personal recovery, empowerment and strengthen social networks, outcomes associated with longer term clinical recovery. However, systematic reviews indicate that these benefits are not always realised, with other research suggesting that appropriate training and support for peer workers is not always in place. The complexities of how peer support might work in different cultural contexts, and in specialist clinical services are little understood. These issues all impact the implementation of peer support into practice and therefore limit potential patient benefit. The ENRICH programme (RP-PG-1212-20019) developed and trialled a peer worker intervention to improve outcomes of psychiatric discharge. Results indicate that while there was no overall effect on readmission (our primary outcome), people who engaged with a minimum level of peer support were significantly less likely to be readmitted, as were black participants. Qualitative data suggested that support from peer workers who had used similar clinical services might be beneficial. Aims and Objectives This study aims to build on learning from ENRICH to understand the best way to implement peer support and so maximise patient benefit. We will coproduce an online version of the ENRICH handbook, training manual and fidelity index, with enhanced guidance on implementing peer support in mental health services, and new training modules on diversity and peer support in complex needs services. Development work questions The study asks: 1. what implementation factors are associated with service user engagement with peer support? 2. how is peer support best implemented to maximise benefits for people from Black and Minority Ethnic (BAME) communities? 3. how is peer support best implemented to maximise benefits in different clinical settings? Development work plan WP1 (months 1-7): update the ENRICH systematic review, conducting a rapid synthesis of data addressing implementation issues in peer support, including in different cultural and clinical contexts. WP2 (months 1-7): conduct additional analyses of trial data (n=590), exploring predictors of engagement with peer support, including the impact of matching peer worker and participant by ethnicity and diagnostic group. Conduct further analyses of qualitative interview data with peer workers, service users they supported and their supervisors (n=79), exploring experiences of support for peer workers, diversity and peer support in different clinical settings. WP3 (months 7-12): conduct additional in-depth interviews (n=32) to develop focused understanding of specific implementation questions raised in WPs1-2. WP4 (months 8-18): work with lived experience and clinician advisory panels to coproduce and test, using findings synthesisd from WPs1-3, our applied outputs. Anticipated Impact and Dissemination We will use our clinical, service user and policy networks to promote access to new guidance and training. Applied outputs will improve implementation of peer support in the NHS, maximising patient benefit including in BAME groups and complex needs services. Academic outputs will inform future efficacy and implementation studies of peer support.

Lay abstract: Background to the research When people with shared experiences of mental distress or using mental health services support each other this can be called peer support. Increasing numbers of people are being trained and employed as peer workers to provide peer support in mental health services. Research suggests that receiving peer support can help people with their personal recovery. Other research says that peer workers are not always provided appropriate training and support, limiting the benefits of peer support. There is a lack of understanding of how peer support works in different cultural communities, and in specialist services for people with different mental health diagnoses. We have completed a research programme (ENRICH) evaluating peer support to improve people s experiences and outcomes of discharge from inpatient to community mental health care. Nearly 300 people received ENRICH peer support. We collected in-depth information about their experiences, and those of 40 peer workers and managers. Our research showed that peer support reduced readmission to hospital for people who received at least two sessions of peer support, and that black people were more likely to benefit. Aims of the research We aim to build on this research to understand the best way to deliver peer support in the NHS and maximise the benefits for people using mental health services. Design and methods used We will: 1) Look in-depth at the ENRICH research to understand why some people engaged in more peer support than others. 2) Look at published research that describes how peer support is best implemented, including in different cultural and clinical contexts. 2) Re-analyse interviews we did with peer workers and the people they supported to understand how peer support works best for people from different cultural communities and with different diagnoses. 4) Interview clinicians, peer workers and the people they support to work out how to maximise the benefits of delivering peer support. We will work with lived experience and clinician advisory groups to develop: Guidance for NHS Trusts on the best way to provide peer support; New peer worker training modules on cultural diversity and peer support in complex emotional needs services; An online tool for checking that peer support is being provided as well as it can. Patient and public involvement Three members of the team bring personal experiences of mental distress to their roles, and we will employ and properly support service user researchers to undertake the research. A lived experience advisory group will guide the project and be involved in stakeholder workshops. Dissemination We will share findings with our clinical, academic and policy networks. We will make our findings accessible to service user and peer support audiences by working with our partner organisation, National Survivor User Network.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH