Weekly Research Digest: Peer Support Strengths, Challenges, and Co-option by Biomedical Models

This week, Mad in America examines three articles around peer support in mental healthcare settings, including the creation of successful peer support programs for young adults, an investigation of the strengths and challenges faced by peer support workers in the field, and a critique of creeping professionalization and co-option of peer support roles in the US and Canada.

Developing A Trauma-Informed Peer Support Framework for Young Adults (TIPS-YA): Building on Lessons from the Field

A new study published in the Psychiatric Rehabilitation Journal finds that four “pillars” are necessary for successfully developing and providing trauma informed peer support to young adults (18 to 34 years old): safety, mutuality and shared decision making, empowerment, and a focus on historical, cultural, and societal factors impacting young adult mental health. The current work, led by Kiara L. Moore of New York University, also finds that current peer support training and conceptualization for young adults is lacking some of these basic principles.

The authors detail some of their experiences in the field as well as their development of trauma informed peer support for young adults (TIPS – YA), and offer a framework that can inform current young adult peer support programs as well as assist in developing new ones that incorporate safety, mutuality, empowerment, and context.

In order to develop a trauma informed peer support framework for young adult service users, the authors performed a narrative review of studies related to peer support, identified components from the literature that overlapped with their own experiences in the field, identified these components in their own trials of mental health interventions targeted towards young adults, and built a consensus for developing and training for their TIPS – YA program.

The development of the TIPS – YA program detailed in the current work spanned over a decade. This included weekly meetings where peer support roles were discussed with multiple stakeholders and two months of critical dialogue and negotiation that culminated with unanimous agreement on the four pillars necessary for successfully training peer support workers and implementing peer support programs for young adults.

Pillar one, safety, involves physical, emotional, and psychological safety for both peer support workers and service users. Informed consent for peer support workers about expectations around disclosing personal experiences is an important part of safety. This should occur from the very first recruitment attempts and throughout supervision. The authors recommend alternate titles to “peer support specialist” to avoid unwanted disclosure of psychological suffering. They suggest titles such as “transition support specialist” and “recovery role model” so that these workers can, for example, list their experience on job applications without being forced to disclose their psychological suffering.

Structured sharing can also negate some of the risks of self disclosure by allowing space for peer support staff to prepare, practice, and process their disclosure. The authors also recommend professional development opportunities around handling triggering situations in peer support work as well as formal and informal debriefing procedures after exposure to difficult situations or stressful events.

Pillar two, mutuality, involves leveling power dynamics rather than relegating peer support specialists to subservient roles beneath other mental healthcare staff. Pillar three, empowerment and voice, refers to helping service users build on their strengths in order to take ownership of their own mental healthcare. The authors note that this is especially important for young adults, as many do not have a strong sense of self-efficacy.

Pillar four, context, involves acknowledging that both peer support specialists and service users are heavily impacted by historical, cultural, and societal factors. This pillar would include discussions of inequality, racism, classism, sexism, etc and is especially important for young adults from marginalized communities. The authors note that these discussion of context can also serve to build rapport between peer support specialists and service users with similar backgrounds.

“Is the Service Ready?”: Integrating Peer Support Workers Within Community Mental Health: An Ethnographic Study from Trieste and its Region

A new study published in the Community Mental Health Journal finds that peer support work can be valuable in community mental health settings. Peer support work can lead to enhanced empathy, stronger engagement, and social inclusion through recovery and community focused care. The current work, led by Giulia Pollice from the University of Modena and Reggio Emila in Italy, also finds that peer support work comes with several challenges, including role ambiguity, institutional under-recognition, and professional resistance.

The aim of this research was to investigate the integration of peer support workers (PSW) in a northeastern region of Italy, examine challenges and strengths of including PSWs in mental health services, and to outline how to best leverage PSWs’ experiences to improve mental health services in the future.

The lead researcher did six months of observation in PSW meetings and events. While engaged in observation, the author conducted 22 hour long, semi-structured interviews with PSWs (12) and other mental health professionals (10). These interviews were focused on the role of PSWs, positive outcomes of peer support work, issues with peer support work, and appropriate resilience strategies.

Participants were recruited through the observed PSW meetings and events. To take part in the interviews, PSW participants had to have worked within the Friuli Venezia Giulia region of Italy. Non-PSW mental healthcare professionals had to have worked with PSWs. The authors transcribed the interviews and coded them for recurring themes.

The current work identified five strengths of peer support work within mental healthcare settings. Peer support workers were able to (1) foster hope and reduce self stigma in service users, (2) support social inclusion, (3) bridge the communication gap between mental health professionals and service users, (4) advocate for service user rights, and (5) enhance their own recovery.

The authors identified four main challenges faced by PSWs in their roles within mental healthcare systems. PSWs had to deal with (1) stigma and prejudice from other mental healthcare professionals and being viewed primarily as a former service user rather than a teammate, (2) being assigned menial tasks unrelated to peer support and being viewed as a cheaper substitute for other mental health professionals, (3) power imbalances between PSWs and other mental healthcare professionals, and (4) being used as a tool to “hook users” and “increase user compliance” with treatment.

As a primarily ethnographic study, the results of this research may have limited generalizability to populations outside of the Friuli Venezia Giulia region in Italy. The research team, while familiar with peer support work and participatory research, had no one that had done peer support work. The authors also note that while this research found that PSWs could transform mental health services in positive ways, their ability to do this was directly proportional to administration and other mental health professionals’ willingness to allow for changes to happen.

Protecting Peer Support Values and Ethics Through Community-Engaged Bioethics

A new article published in the Canadian Journal of Bioethics examines the interconnectedness of peer support in the US and Canadian context. The authors, led by Lee de Bie of McMaster University in Canada, also criticize the professionalization and co-option of the peer support role by more biomedically focused institutions.

The authors start by pointing to the US and Canada’s shared history around peer support work in mental healthcare settings. Movements critical of psychiatry and biomedical narratives of mental health from the US inspired the adoption of peer support in Canada as an alternative to the harmful practices common in mental health settings in the 1960s and 70s. Similarly, Judi Chamberlin, a central US figure in the psychiatric survivor movement, was inspired by the Mental Patients Association in Vancouver. Mad studies, a movement that has informed peer support work in the US, was pioneered in Canada.

Professionalization of the peer support role, moving from an informal alliance between people with lived experience of psychological distress to a paid role within mental healthcare systems, is a growing concern to scholars in both countries. Where Canada has a peer support worker led training program, the US has established many state-approved peer support training programs.

The entanglement of government with peer support training in the US is concerning to some experts as this is likely leading to a loss of self-governance and peer focused training. For example, one study has pointed to a lack of training around the core values and history of the grassroots movements in peer support work in the US. Some experts fear that state approved peer support education focuses more on clinical training, ignoring the experiential knowledge central to peer support. This can result in the co-opting of peer support work. Essentially, states may be training people with lived experience to be junior clinicians rather than peer support workers.

The authors also point to the demand for peer support workers to maintain more professional boundaries with service users as problematic. This can completely change the dynamic between peer support workers and service users, undermining the creation of trusting relationships which is essential in peer support work.

To combat professionalization and co-option of the peer support role, the authors recommend the creation of specific guidelines for the peer support role informed by the core principles of peer support work. They are also working towards developing a peer support code of ethics.

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de Bie, L., Knopes, J., Dunning, A., Theodorou, A., & Fortier, B. (2026). Protecting peer support values and ethics through community-engaged bioethics. Canadian Journal of Bioethics, 9(1), 29–34. (Link)

Moore, K. L., Rodwin, A. H., Narendorf, S. C., Railey, J. A., & Munson, M. R. (2025). Developing a trauma-informed peer support framework for young adults (TIPS-ya): Building on lessons from the field. Psychiatric Rehabilitation Journal. (Link)

Pollice, G., Bodini, C. F., Menchetti, M., Da Mosto, D., Negrogno, L., Betti, L., Furlan, M., & Quaranta, I. (2025). “is the service ready?”: Integrating peer support workers within community mental health: An ethnographic study from Trieste and its region. Community Mental Health Journal, 62(1), 177–189. (Link)