— Older People and the Lived Experience Workforce
Summary
What constitutes a ‘peer’ or ‘lived experience’ is as complex and nuanced for older people as it is for any cohort. Given that this point has been highlighted across the other thought pieces on peer support written by Centre for Mental Health (Children and Young People, LGBTQ+ and Neuro Diversity), some careful thought needs to be given on how effective sustainable peer support can be delivered to all requiring it.
For the purposes of this paper, ‘Older People’s Mental Health’ covers both mental health problems and cognitive conditions such as dementia. The distinction between patient and carer is often blurred, and this was particularly felt by those who work with older people interviewed for this paper. For this reason, peer initiatives directed at carers are also considered.
Abstract
Background: There is an ample body of literature examining the experiences and outcomes of peer support services for mental health recovery in western countries. However, formal peer support is only recently adapted and piloted to alleviate depression among older people, and little is known about how the peer-to-peer model might be lived out in the older Chinese population. This qualitative study investigated peer supporters’ (PS) perspectives of their roles and experiences of rendering formal peer support to community-dwelling older adults at risk of or living with depression in Hong Kong.
Methods: The study adopted a qualitative design. Five semi-structured focus groups were conducted with 27 trained peer supporters between ages 54–74 (21 females and 6 males) who had provided peer-to-peer support to older adults at risk of or living with depression in the community for at least 12 months. Thematic analysis was employed to derive content and meanings from the focus group transcripts.
Results: Participants’ mean age was 61.9 years; two-thirds of them were retired and the rest still engaged in part-time or full-time employment. Four themes were identified in relations to the roles and experiences in rendering the peer support services: (1) peerness in health and age-related lived experiences; (2) companionship, social and emotional ties beyond formal support; (3) meaningful roles to facilitate older people’s functional ability; and (4) hopes and actions against the undesirable outcomes of aging. Being a PS might provide meaningful roles for persons in transition to or living in late adulthood, and enable community-dwelling older adults with depression to maintain functional ability. On the other hand, defining the concept of ‘peer’ beyond the shared experience of mental distress, ensuring a healthy boundary between the peers and the service users, maintaining a careful balance between time-limited formal support and stable social ties, and providing self-management training and on-going support appear crucial.
Conclusions: This study of PS’ perspectives and experiences offer insights into the age-specific dimension of the peer relationship. Despite the promising effects it might offer, careful implementation of peer support among older adults is warranted to safeguard against the ensuing loss of meaningful social ties and the potential emotional distress.
Not only are peer-to-peer support programs beneficial to the service users, they have also been shown to benefit the peer support workers. Over the past two decades, increasing evidence has shown that peer-to-peer support could increase sense of control and self-care, sense of community belongings, satisfaction with life and decreased mental distress among people in recovery. Recent reviews have also recognized the effectiveness of peer support in enhancing service users’ level of hope, feeling of being empowered, quality of life and mental wellbeing, as well as self-reported recovery, empowerment and social network support. On the other hand, peer support workers also attain a sense of hope and gain skills and knowledge useful in their own situations. Despite the positive outcomes, research has documented the multifaceted challenges and problems that peer support workers face. including role conflicts (being a friend vs. paraprofessional to the service users), poorly described role definitions and job structures, lack of sufficient and appropriate supervision and support and negative effects on their well-being. Moreover, the notion of ‘peer’ has been narrowly defined as basing on the lived experience of mental illness. To different people, who peer is may vary according to factors such as health condition, age, gender, class and culture.
Summary
The Older Persons Peer Support Program is a leading example of collaboration evident by government health services and community managed organisations utilising their strengths to assist people in their recovery to promote a holistic and individualised support service and network. Central Coast Primary Care (CCPC) employs older peer workers in either paid or unpaid (volunteer) roles. The peer workers provide an exclusive service to consumers of the Older People’s Mental Health Service (OPMHS), Central Coast Local Health District.
Abstract
Background: Developing countries are experiencing rapid population ageing. Many do not have the resources or formal structures available to support the health and wellbeing of people as they age. In other contexts, the use of peer support programmes have shown favourable outcomes in terms of reducing loneliness, increasing physical activity and managing chronic disease. Such programmes have not been previously developed or tested in African countries.
We piloted a peer-to-peer support model among vulnerable community-dwelling adults in a developing country (South Africa) to examine the program’s effect on wellbeing and social engagement.
Methods: A pre-post, pilot design was used to evaluate targeted outcomes, including wellbeing, social support, social interaction, mood, loneliness and physical activity. A total of 212 persons, aged 60+ years and living independently in a low-income area in Cape Town were recruited and screened for eligibility by trained assessors. Participants were assessed using the interRAI CheckUp, WHO-5 Wellbeing index, and the MOS-SS 8 instruments before and after the 5-month intervention, during which they received regular visits and phone calls from trained peer volunteers. During visits volunteers administered a wellness screening, made referrals to health and social services; built friendships with clients; encouraged social engagement; promoted healthy living; and provided emotional and informational support.
Results: Volunteer visits with clients significantly increased levels of self-reported wellbeing by 58%; improved emotional and informational support by 50%; decreased reports of reduced social interaction by 91%; reduced loneliness by 70%; improved mood scores represented as anxiety, depression, lack of interest or pleasure in activities, and withdrawal from activities of interest; and increased levels of physical activity from 49 to 66%.
Discussion: The intervention led to demonstrable improvement in client wellbeing. Policymakers should consider integrating peer-support models into existing health programs to better address the needs of the elderly population and promote healthy ageing in resource-poor community settings. Longer-term and more rigorous studies with a control group are needed to support these findings and to investigate the potential impact of such interventions on health outcomes longitudinally.
Abstract
Background: The development of peer work models that are integrated into health systems is at the heart of national and international reform agenda in mental health. Peer work differs from other mental health roles as it is provided by people who have a lived experience of mental illness and recovery and does not assume a medical model. Peer work in mental health services for older people is not well established and to address this gap we developed, implemented and evaluated a peer work model for older patients of a specialist mental health service.
Method: The findings discussed in this paper are part of a broader evaluation and consist of qualitative observations made by the peer workers during focus groups. Three focus groups were conducted during the first year of the project to identify the peer workers’ perspectives, feelings and thoughts around the developing peer work model and how they were impacted by the work. Data collection and analysis was inductive and informed by grounded theory principles. Observations from peer workers are discussed in relation to the literature as well as observations made by the researchers during project implementation.
Results: Analysis suggests that older peer workers have a level of maturity and experience with recovery that benefit the peer workforce in a number of ways namely (a) significant experience with recovery to draw on when helping others; (b) a well-established sense of identity and coping strategies that support wellbeing and (c) ability to cope with ambiguity and uncertainty inherent in peer work practice. We propose that having a strong sense of self or personal identity may be important in peer work, particularly as the peer work role is often challenged, questioned and unclear.
Conclusion: Older peer workers provide a valuable contribution to the peer workforce and bring with them an array of strengths that can help overcome some of the common peer work implementation barriers.