On: Attachment theory and psychoanalysis.

Background: A growing gap has emerged between people with mental illness and health care professionals, which in recent years has been successfully closed through the adoption of peer support services (PSSs). Peer support in mental health has been variously defined in the literature and is simply known as the help and support that people with lived experience of mental illness or a learning disability can give to one another. Although PSSs date back to several centuries, it is only in the last few decades that these services have formally evolved, grown, and become an integral part of the health care system. Debates around peer support in mental health have been raised frequently in the literature. Although many authors have emphasized the utmost importance of incorporating peer support into the health care system to instill hope; to improve engagement, quality of life, self-confidence, and integrity; and to reduce the burden on the health care system, other studies suggest that there are neutral effects from integrating PSSs into health care systems, with a probable waste of resources.
Objective: In this general review, we aimed to examine the literature, exploring the evolution, growth, types, function, generating tools, evaluation, challenges, and the effect of PSSs in the field of mental health and addiction. In addition, we aimed to describe PSSs in different, nonexhaustive contexts, as shown in the literature, that aims to draw attention to the proposed values of PSSs in such fields.
Methods: The review was conducted through a general search of the literature on MEDLINE, Google Scholar, EMBASE, Scopus, Chemical Abstracts, and PsycINFO. Search terms included peer support, peer support in mental health, social support, peer, family support, and integrated care.
Results: There is abundant literature defining and describing PSSs in different contexts as well as tracking their origins. Two main transformational concepts have been described, namely, intentional peer support and transformation from patients to peer support providers. The effects of PSSs are extensive and integrated into different fields, such as forensic PSSs, addiction, and mental health, and in different age groups and mental health condition severity. Satisfaction of and challenges to PSS integration have been clearly dependent on a number of factors and consequently impact the future prospect of this workforce.
Conclusions: There is an internationally growing trend to adopt PSSs within addiction and mental health services, and despite the ongoing challenges, large sections of the current literature support the inclusion of peer support workers in the mental health care workforce. The feasibility and maintenance of a robust PSS in health care would only be possible through collaborative efforts and ongoing support and engagement from all health care practitioners, managers, and other stakeholders.

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Peer Support in Mental Health: Literature Review

Psychometric theory : Nunnally and Bernstein, 3rd edition

Peer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions. We searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data. Twenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery. Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support. One-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support. Prospero identifier: 
CRD42015025621

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The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis.

Cognitive-Analytic Therapy - Active Participation in Change - RYLE, A

We aimed to evaluate the feasibility of Cognitive Therapy (CT) as an intervention for internalised stigma in people with psychosis. We conducted a single-blind randomised controlled pilot trial comparing CT plus treatment as usual (TAU) with TAU only. Participants were assessed at end of treatment (4 months) and follow-up (7 months). Twenty-nine participants with schizophrenia spectrum disorders were randomised. CT incorporated up to 12 sessions over 4 months (mean sessions=9.3). Primary outcome was the Internalised Stigma of Mental Illness Scale - Revised (ISMI-R) total score, which provides a continuous measure of internalised stigma associated with mental health problems. Secondary outcomes included self-rated recovery, internalised shame, emotional problems, hopelessness and self-esteem. Recruitment rates and retention for this trial were good. Changes in outcomes were analysed following the intention-to-treat principle, using ANCOVAs adjusted for baseline symptoms. There was no effect on our primary outcome, with a sizable reduction observed in both groups, but several secondary outcomes were significantly improved in the group assigned to CT, in comparison with TAU, including internalised shame, hopelessness and self-rated recovery. Stigma-focused CT appears feasible and acceptable in people with psychosis who have high levels of internalised stigma. A larger, definitive trial is required.

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Cognitive therapy for internalised stigma in people experiencing psychosis: A pilot randomised controlled trial

Peer support is sometimes formalized and offered as an intervention in mental health services and organizations Evidence suggests that empowerment, self-efficacy, and internalized stigma are theoretically linked and implicated in the change processes involved in peer support This review aimed to s

The effects of peer support on empowerment, self-efficacy, and internalized stigma: A narrative synthesis and meta-analysis.

Internalised shame and self-esteem have both been proposed to play an integral role in the relationship between stigma and its negative psychological sequelae in people who experience psychosis, but there has been little quantitative exploration to examine their roles further. The aim of this study was to examine the relationship of stigma (experienced and perceived) with emotional distress and recovery in psychosis, and to examine internalised shame and self-esteem as potential mediators. A total of 79 participants were included for the purposes of this study. Participants were administered a battery of assessment measures examining experienced and perceived stigma, internalised shame, self-esteem, depression, hopelessness, and personal recovery. Results illustrated that stigma (experienced and perceived) was significantly associated with internalised shame, low self-esteem, depression, hopelessness and poor personal recovery. Stigma (experienced and perceived) and its relationship with depression, hopelessness and personal recovery was mediated by both internalised shame and low self-esteem. In conclusion, stigma can have significant negative emotional consequences and impede recovery in people with psychosis. This may indicate that stigma needs to be addressed therapeutically for people with psychosis with a particular emphasis on addressing internalised shame and low self-esteem.

/pdf/the-impact-of-stigma-on-emotional-distress-and-recovery-from-1adi3cr7fg.pdf

The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalised shame and self-esteem.

Background: Individual Cognitive Behaviour Therapy for psychosis (CBTp) is the first line recommended psychological intervention for adults diagnosed with schizophrenia. However, little is yet known about service users’ subjective experiences of CBTp. Aims: This study aimed to conduct a systematic review of qualitative literature to examine service user perspective of CBTp. Method: A thematic synthesis of qualitative studies examining service users’ experiences of CBTp was conducted. A total of six studies were included in the analysis. Results: Three superordinate themes were identified: therapeutic alliance; facilitating change; and challenges of applying CBTp. Conclusion: Overall, CBTp is a helpful and acceptable therapeutic approach to service users. Developing a collaborative therapeutic relationship is essential. The applications of CBTp can be problematic and the therapist and client need to work together to overcome these difficulties.

Individual cognitive behavioural therapy for psychosis (CBTp): a systematic review of qualitative literature.

Background: Psychosis is associated with a high degree of stigma. There is relatively little qualitative research exploring service users’ experienced, perceived and internalised stigma and its impact on their lives.Material: Data from semi-structured interviews with 12 service users with experience of psychosis were subjected to secondary qualitative analysis.Discussion: Six overarching themes were identified concerning: understandings of psychosis; experiences of stigma; impacts on self; emotional responses; behavioural responses; and impact on recovery.Conclusions: Stigma is a key concern for service users with psychosis. Detailed assessment of stigma should be considered in clinical services and interventions developed to reduce stigma.

Eilish Burke

Papers

Cognitive therapy for internalised stigma in people experiencing psychosis: A pilot randomised controlled trial

The effects of peer support on empowerment, self-efficacy, and internalized stigma: A narrative synthesis and meta-analysis.

The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalised shame and self-esteem.

Individual cognitive behavioural therapy for psychosis (CBTp): a systematic review of qualitative literature.

Experiences of stigma in psychosis: A qualitative analysis of service users’ perspectives