Perspectives and Experiences of Stakeholders on Self-Disclosure of Peers in Mental Health Services

• Published in: Community mental health journal 2024-10, Vol.60 (7), p.1308-1321
• Main Authors: Ben-Dor, Inbar Adler, Kraus, Eran, Goldfarb, Yael, Grayzman, Alina, Puschner, Bernd, Moran, Galia S.
• Format: Article
• Language: English
• Subjects: Attitudes; Community and Environmental Psychology; Competence; Confusion; Experience; Health services; Influence; Integrated care; Medicine; Medicine & Public Health; Mental health; Mental health services; Occupational roles; Organizational change; Original Paper; Peer influence; Peers; Preferences; Professionalism; Psychiatry; Recovery; Self disclosure; Skill development; Stakeholders
• ISSN: 0010-3853; 1573-2789; 1573-2789
• DOI: 10.1007/s10597-024-01287-2

   With the movement towards recovery-oriented mental health (MH) services, individuals with MH lived-experience are increasingly employed as peer providers (peers). Peers are unique in that they bring knowledge from experience and eye-level connection to service users that enhance the quality of services and humanize MH systems’ culture. In Israel, hundreds of peers are employed in various roles and settings across the MH system. However, peer integration into MH services faces challenges. One issue involves the use of self-disclosure (SD) in MH services which varies with explicitness across roles and settings. This study sought to understand perspectives and experiences regarding peers’ SD (use & sharing of knowledge from experience) among different stakeholders in MH health services. Six focus groups and 4 semi-structured interviews (N = 42) were conducted as a part of a larger international project (UPSIDES; ERC Horizon 2020, Moran et al., Trials 21:371, 2020). Data was transcribed verbatim and analyzed using thematic analysis. Four categories and 7 themes were identified regarding current perspectives and experiences with peers’ SD in MH organizations: (i) Restrained or cautious organizational approach to SD; (ii) Attitudes of peers to SD approach; (iii) The influence of designated peer roles on SD; and (iv) Unwarranted SD of peers working in traditional roles. The findings reveal that peers’ SD in MH services is a complex process. Organizational approaches were often controlling of non-designated peers’ SD practices; participants had diverse attitudes for and against peers’ SD; SD occurred according to personal preferences, specific peer role and the director’s approach to peers’ SD; Conflictual SD dilemmas emerged in relation to service users and staff. SD sometimes occurs unwarrantely due to ill mental health. The presence of peer-designated roles positively impacts peers' SD. We interpret the current mix of views and general conduct of peer SD practice in statutory MH services as related to three aspects: 1. The presence of a traditional therapeutic SD model vs. a peer SD model – with the former currently being dominant. 2. Insufficient proficiency and skill development in peers’ SD. 3. Stigmatic notions about peer SD among service users and staff. Together, these aspects interrelate and sometimes create a negative cycle create tension and confusion. A need to develop professionalism of peer SD in statutory services is highlighted alongside enhanc