A new qualitative study published in the International Journal of Environmental Research and Public Health demonstrates the positive impacts of Peer Supported Transfer of Care (Peer-STOC), an Australian mental health peer worker-led initiative supporting individuals during their transition back to the community following inpatient psychiatric hospitalization.
The findings suggest that participation in Peer-STOC made service users feel cared for and hopeful and helped them to learn new skills and connect with community support.
Adults in Australia returning to their communities following inpatient psychiatric stays commonly experience many negative outcomes, including high rates of readmission, homelessness, and suicide within the first 30 days following discharge. Peer-STOC, a state-wide program funded by the New South Wales Ministry of Health in Australia, leverages the documented benefits of peer support programs to provide individuals with much-needed extra support during this critical window. A primary goal of the Peer-STOC program is to support service users by connecting to community-based services to prevent hospital readmissions.
The present publication reports findings from the qualitative arm of a broader mixed-methods evaluation study of the Peer-STOC program. To capture the perspectives of multiple stakeholder groups engaged in the Peer-STOC program, researchers collected open-ended questionnaires and interviews from service users themselves, Peer-STOC peer workers, and other workers from the mental health system who interacted with the Peer-STOC program. Participants were recruited by Peer-STOC program managers who shared information about the study opportunity with all former and current Peer-STOC service users, peer workers, and affiliated community-based mental health workers.
Data were collected from November 2020 to July 2021. In total, 82 people (12 service users, 20 peer workers, and 50 other mental health clinicians) anonymously completed an online questionnaire with open-ended questions about their experiences with Peer-STOC. Fifty-eight people (17 service users, 22 peer workers, and 19 other mental health clinicians) participated in interviews. Interviews were conducted by members of the research team who also identify as having lived experience of mental illness and as mental health service users. Data was analyzed as it was being collected using the constant comparative method so that responses from earlier interviews could inform subsequent interview questions. Throughout analysis, researchers reflectively considered their own lived experiences and engaged in discussions with A Lived Experience Advisory Panel (LEAP) to support data interpretation.
Perspectives from all stakeholder group participants service users, peer workers, and other mental health workers- converged on a series of perceived benefits of the Peer-STOC program. The authors identified the following seven positive service-user outcomes attributed to the program:
“(a) A better, less traumatic inpatient experience; (b) felt understood, cared about, and less alone; (c) easier to leave hospital; (d) easier to get back into life and daily routines; (e) built and re-established community connections; (f) gained new knowledge, strategies, and skills; and (g) felt more hopeful about my recovery.”
Repeatedly, service users described caring interactions with their peer worker while they were still in the hospital, which made them feel safer and more comfortable; for example, one participant shared:
“…having that experience, touching base with a peer worker . . . it made me feel at ease. It made me feel comfortable . . . they are really good assets for the hospital because . . . which gets back to this trust thing again . . . [they are the] go-betweens—between you and the doctor or you and any member of the hospital.”
Having a designated peer supporter who had a shared understanding of mental health services also helped individuals feel less isolated throughout their hospitalization and discharge experience:
“…He understands my situation . . . He’s had his own experiences with mental health, so it’s just a [opportunity] to talk to someone with the ability to empathize with the situation”.
Almost all service users described that the Peer-STOC program, particularly the continuity of working with the same peer worker they had connected with while still hospitalized, made it easier for them to leave the hospital. Many service users highlighted how different this experience was as compared to their previous experiences of hospital discharge without support. For example, one participant said:
“I’ve had stints where I’ve [been in hospital] for three and a half months at a time and then had to go home to an empty house by myself and manage [with] no support. That’s been really scary. . . it has made a hell of a difference in the recovery and getting back to what’s normal . . . it’s made the journey and the process a lot easier.”
Service users described how tangible supports and resources are provided by peer workers to help them manage, establish routines, and connect with community-based services, employment, and educational opportunities following discharge. Importantly, service users, peer workers, and other mental health workers all described Peer-STOC as “bridging the gap” between service users and community mental health services. Service users and peer workers also reported the importance of learning new skills for organization and assertive communication in order to manage responsibilities in the community. Peer workers (represented in the three quotes below) also discussed taking an empathic, strength-based approach to skill-building with the service users they worked with:
“PW5 described: ‘Reminding [service users] that they have the tools, or building the tools with them, on how to create boundaries with other people and take charge of these conversations that they are worried about.’
PW9 had: ‘connected with one consumer [service-user] who never had anyone to talk to about his voices at all. . . I was able to talk about strategies I have for managing voices that could hopefully help him.’
PWq62 valued: ‘having the opportunity to . . . help [people] understand what they can do for themselves to help make their lives better for themselves.’”
Ultimately, service users described the Peer-STOC program as making them feel more self-confident and optimistic regarding their own recovery.
A few critical limitations of the current study are noteworthy. The authors point out that a low proportion of former and current Peer-STOC program participants chose to partake in the qualitative study. Therefore, the present findings may not be representative of all service users.
Additionally, while researchers reported on some basic demographics of participants (e.g., age, gender, diagnoses), no participant racial or ethnic identity factors were reported. Given prior research that has highlighted racial and ethnic disparities in hospital readmissions, it is important to consider any potential differential impacts of programs such as Peer-STOC across identities of service users. Additionally, in the Australian context, where Indigenous people die by suicide at higher rates than non-Indigenous Australians, it may be particularly important for researchers to partner with Indigenous service users when designing and evaluating suicide prevention efforts, such as Peer-STOC.
The present study demonstrates the acceptability and utility of peer worker-led support programs for individuals during their transition home following hospitalization. The positive outcomes of Peer-STOC were perceived not only by service users but also by other mental health clinicians and peer workers themselves. Findings add to a growing body of evidence that has showcased the promise of incorporating peer support into mental health treatment contexts as a strategy to promote service-user recovery. Future publications by this research group will report on the quantitative outcomes of the Peer-STOC program.
Hancock, N., Berry, B., Banfield, M., Pike-Rowney, G., Scanlan, J. N., & Norris, S. (2022). Peer worker-supported transition from hospital to home—Outcomes for service users. International Journal of Environmental Research and Public Health, 19(5), 2743. (Link)