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Using Peer Support In Developing Empowering Mental Health Services

Periodic Reporting for period 2 - UPSIDES (Using Peer Support In Developing Empowering Mental Health Services)

Reporting period: 2019-07-01 to 2020-12-31

What is the problem/issue being addressed?
A large number of people with severe mental illness (SMI) receive no treatment. This treatment gap is largest in low and middle income countries (LMIC), with detrimental effects on individuals (social role, quality of life, stigma) and societies (equity, costs). Peer support is an established intervention involving a person in recovery from mental illness being employed to offer support to others with mental illness. Peers are an untapped resource in global mental health.There is a need to explore the effectiveness and feasibility of peer-delivered interventions for people with severe mental illness in LMICs. Peer support offers great promise to health sytems with few resources where standard care is often of lower quality and coverage. There is also a lack of peer support for people with SMI in specific components of mental health systems in high income countries (HIC), e.g. acute care.

Why is it important for society?
UPSIDES will transform mental health care, by using the expertise of people with personal experience of mental illness as a new source of recovery support. Peers carry the potential for a distinct contribution not possible from traditional mental health professions such as psychiatry, psychology and nursing. As they de-stigmatise mental illness, offer alternative viewpoints in understanding clients, and strengthening a person-focused (rather than a pathological-focused) discourse, their function is vital for users’ recovery processes as well as the enhancement of system change towards a recovery orientation.
Scale-up of peer support through UPSIDES will lead to a larger group of citizens with mental illness benefiting from the intervention, and will alleviate the global burden of mental disorders by improved functioning of health care systems, promoting recovery-orientation, reducing stigma, and increasing health equity. UPSIDES will make available a sustainable intervention by producing guidance for other low-, middle- and high-income countries to initiate PSW programmes. This includes European additional benefit because the major UPSIDES deliverables, i.e. an evidence-based cross-cultural implementation strategy for peer support in mental health care settings, will be transferrable with some adaptation to other countries (mostly, but not exclusively LMIC). This process will be facilitated by UPSIDES team members beyond the duration of the project which will also strengthen European capacity to compete in the field of Global Mental Health.

What are the overall objectives?
The major aim of UPSIDES (Using Peer Support In Developing Empowering Mental Health Services) is to replicate and scale-up peer support interventions for people with severe mental illness, generating evidence of sustainable best practice in high-, middle- and low-resource settings. Scale-up will be achieved via sequential objectives:
(1) To establish an international community of practice for peer support in high-, middle- and low-resource settings.
(2) To conduct a situational analysis of existing peer support initiatives in the participating countries.
(3) To scale up peer support models with a focus on vulnerable populations where pilot initiatives already exist.
(4) To contextualize and adapt peer support models for those sites where there are no peer support initiatives.
(5) To rigorously evaluate inputs, processes and outcomes of implementation, including an assessment of process and contextual factors following a theory of change approach using mixed-methods.
(6) To distil from case studies evidence of best practice for dissemination to local, national and in-ternational stakeholders in order to maximise sustainability and spread.
Significant progress has been made on achieving all objectives during the second reporting period. All WPs working towards realising these objectives have started, with some of the early WPs close to completion.
(1) A consortium of mental health researchers, providers and users has been established at eight study sites in six countries in Europe, Africa and Asia (WP1, WP5). During this second reporting period, collaborative ties have been consolidated and strengthened.
(2) Current stage of development of peer support has been established, and organisational and cultural considerations of the peer support worker role which may impact development have been identified (WP2, WP3, WP5).
(3) The UPSIDES peer support training manual and workbook has been finalised, by manualising existing interventions and building capacity in co-production and co-delivery of demonstrations (WP3).
(4) All study materials have been cross-culturally validated and translated, in line with a novel proportionate translation methodology (WP4).
(5) The UPSIDES implementation manual has been continuously updated, ensuring high-quality initiation and continuation of UPSIDES peer support as part of the UPSIDES cross-site RCT (WP5).
(6) Recruitment for the UPSIDES-RCT has started and is approaching completion. Intensive risk management took place due to Covid-19 and is ongoing, to balance safety of study staff and participants with the need to continue research tasks and methodological rigour. Challenges due to
the pandemic have been tackled well, with many parts of the UPSIDES-RCT having made significant progress (recruitment, data collection, qualitative research, preparing cost-effectiveness analysis) (WP6, WP7).
(7) Dissemination has progressed by engaging diverse national and local advisory boards including service users, carers, senior clinical staff members, representatives of Health Ministries, hospital directors, community leaders, and creating a Communications Taskforce (WP8). Many results of
UPSIDES research have been published and presented at conferences.
UPSIDES will improve the lives of large numbers of citizens in Europe and LMIC by modifying mental health systems using the expertise of people with personal experience of mental illness. Utilising peers will provide an essential driver in low-income settings relieving the scarcity of human capital. Performance of mental health services will be maximised through actively involving and empowering service users, generating system changes towards patient-centeredness, recovery orientation, and community participation. UPSIDES will transform health systems towards realizing mental health as a human right.
UPSIDES poster training development (Nixdorf et al.), also see https://t1p.de/ktv4