A meta-ethnography of non-peer experiences of peer mentors, and a grounded theory analysis exploring the processes of integrating peer mentors into mental health teams

Employing people with lived experience of mental health difficulties, otherwise known as peer mentors, has been increasing over the past 20 years. Several benefits have been found in relation to services, service users and peer mentors themselves. However, there have been challenges noted in the literature, including some of which are related to non-peer staff. 'Non-peer' as a term is used to describe all those professionals not employed due to their personal experiences of mental health difficulties, thus distinguishing from peer mentors. With continued challenges being linked to non-peers, and previous research demonstrating that non-peer staff and existing teams can influence how successful the integration of peer mentors would be into a service, it is important to consider non-peers' experiences particularly when thinking of clinical recommendations to ensure a smoother implementation. This thesis focuses on non-peer staff experiences in two ways: general experience of working with peer mentors, and specifically how non-peers adapt existing practice to integrate peer mentors, including the identification of the processes underlying integration. Paper one presents a meta-synthesis focusing on qualitative research exploring non-peer experiences of peer mentors. Two meta-syntheses to date have focused on non-peer staff: one focusing on modifications of peer mentor roles, the other describing a meta-summary of peer, non-peer and service user experiences. In the meta-summary, positives were identified, however challenges included professional boundaries around the role and non-peer concerns of confidentiality. Through conducting a meta-ethnography, the current review aimed to provide new insights and a conceptual model of non-peer experiences of peer mentor roles which goes beyond the meta-syntheses in the area. A systematic literature search was conducted for both peer-reviewed and grey literature. A quality assessment was completed on all included studies, before studies were synthesised through conducting a meta-ethnography. Seven core concepts were identified: 'Existing Team', 'Readiness', 'Integration', 'Shift in Power', 'Wider System Support', 'Value of Lived Experience' and 'Services Embracing Recovery'. A conceptual model of these themes is created through a line-of-argument, expressed in both diagrammatic and narrative form. This depicts the non-peer journey from before peer mentors joined the team to after integration. The findings whilst echoing those found in one previous review, go further by also demonstrating key time points such as pre-implementation and integration, and key aspects such as a shift in power, which impact non-peer experiences. These findings mirror research exploring both general service user and recovery-based initiatives. The findings have clinical implications for organisations, particularly recognising the need for organisations to prioritise and value peer mentor roles, and provide support throughout the process of implementation. Paper 2 presents a grounded theory analysis exploring how non-peers modify or adapt their practice to integrate peer mentors into teams. Facilitators and challenges to integrating peer mentors have been well identified in the literature, demonstrating several factors which impact the relationship. Limitations of research which has focused specifically on integration processes have been linked to for example, transferability of findings across teams. Further, descriptive themes within the literature have been identified, but understanding the processes around integration are less known. The study aimed to understand and describe how non-peers working within statutory services and well-established teams, adapted their existing practice to integrate peer mentors into teams. Through using a social constructivist form of grounded theory, it aimed to ascertain the processes involved in the integration. Using theoretical sampling, eight non-peers participated. Nine core categories and theoretical concepts were identified: 'Team culture', 'Understanding Integration', 'Experiencing a sense of threat', 'How we all slot together', 'Finding commonalities and aligning values', 'Observed change in service delivery', 'Reconnection with values', 'We need to keep [peer mentor] protected' and 'Wider influences'. Non-peers identified multiple adaptations including engaging in more recovery-focused practice. Processes included identifying a need for change, which was an over-riding factor for moving non-peers towards an openness to explore how the peer mentor would 'fit'. Key relational processes were also identified including getting to know the 'person' behind the peer mentor role, which both supported non-peers to move from a place of threat to openness to the role, and was a catalyst for non-peers to reconnect with value-based working. Wider influences were recognised at various stages of the theoretical model. The findings echo previous understandings of processes at integration, but enhance understanding by specifically demonstrating non-peer experience. Relational and ecological models provide further understanding of the results. The findings have clinical implications for organisations, particularly the need to prioritise non-peers and peer mentors building relationships.