Peer support projects

The benefits of involving people with lived experience in the delivery of mental health services to others is well documented, and one of the reasons why we’re committed to funding projects that meaningfully include them. The insight they bring is a form of expertise that should be valued alongside that of clinical staff. In 2022, we funded two projects to see how support from fellow service users could help solve some of the ongoing challenges facing South London and Maudsley NHS Foundation Trust.

Community-based support

The first centred around the Trust’s Home Treatment Teams (HTT). HTTs provide two to three weeks of community-based support for people who no longer require hospital care for their mental illness but need help as they transition back to life at home.

However, some service users have complex diagnoses, and their support needs cannot be fully met during their short time with the HTT, so they end up requesting assistance again just weeks or months later. In 2018, nearly one-third of referrals were for people who used the service more than once in a year. As HTT was only designed to provide short-term support, there simply aren’t enough staff to respond to these requests.

In January 2022, a Peer Support Team – three people with lived experience of mental illness – and a project coordinator joined Home Treatment Teams in Croydon and Lewisham. Repeat service users were offered help from a named peer support worker over the phone or face-to-face.

During the year, the peer support workers worked with over 100 people, mainly providing emotional support and coping strategies, drawing both from their own experience and from training provided by the programme. Service users reported that their peer support worker made them feel genuinely heard and understood and that they were role models who gave them hope for their own recovery.

Reducing inpatient aggression

The second project, Reducing Restraint and Restrictive Practice (R3P), sought to reduce violence and, therefore, the need for restrictive practices such as physical restraint or seclusion of inpatients at Bethlem Royal Hospital. These individuals are some of the most unwell, can often be in distress but are unable to cope with or communicate their feelings. They lash out, and for their safety and that of staff and fellow patients, restrictive practices are used as a last resort when all other attempts at de-escalation have failed.

This is not an outcome that anyone wants. Restrictive practices are understandably traumatic for the patient being restrained, as well as those who witness violence and its aftermath. Staff are left feeling shaken and potentially unsafe, and that potential breakdown in trust makes it more difficult to create the necessary environment for care.

Across South London and Maudsley, data shows that 4% of service users account for half of all violent incidents on the wards each year, whether verbal or physical.

During the project, three full-time peer support workers were employed at Bethlem to support patients with a history of violence within the service. They also worked with hospital staff to identify those on the ward showing signs of aggression, to offer support before their behaviour had the chance to negatively impact their recovery.

Immediate impact

The peer support workers had a hugely positive impact during the year, engaging 27 service users and becoming trusted allies by sharing their own experiences, offering emotional support and working on coping strategies. This support was part of a wider violence reduction programme that led to incidents of violence and aggression falling by 55% among their caseload, leading to a 61% drop in the use of restrictive practice against these individuals.

Both projects received national recognition. The Home Treatement Team project was nominated for a Positive Practice in Mental Health Award, while the R3P project was nominated for Patient Safety Pilot Project of the Year at the 2023 Health Service Journal Patient Safety Awards.

Together, these projects further demonstrate the invaluable contribution that peer support workers can make in empowering people to manage their mental illness. Its positive impact isn’t solely limited to the clients but to the peer support workers who gain confidence and a sense of purpose through helping others.