This resource covers safety and risk in mental health, safety as a principle of peer support, the role of peer support workers, and safety for peer support workers. It was written by Alison Faulkner for NSUN, and was Commissioned by Health Education England.
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About this resource
In this thought piece, we outline the significance of safety for peer support. One of the key principles of peer support is that it offers a safe space for people experiencing mental distress to talk and to find support within a relationship of equality, where it is possible to feel understood and heard. It is for this reason that we explore the tensions that peer support workers face in maintaining that safe space when working within mainstream services, which are often risk-averse in the way they operate.
Key points
- Safety is widely recognised as a core principle of peer support
- Peer support (and Peer Support Workers (PSW)) has a role to play in challenging the risk-averse culture of mainstream mental health services
- With adequate support and recognition, PSWs can become powerful agents of change – from a culture of control and coercion to a culture of safety and sanctuary
- Services dominated by a risk-averse culture need to recognise the risks and threats they pose to service users, particularly those with a history of trauma and abuse
- Relationships of trust at the core of peer support can create and sustain feelings of safety
- Supportive peer relationships involve the negotiation of what emotional safety means to both parties, within a context of mutual disclosure. This can be achieved by discovering what makes each other feel unsafe, sharing rules of confidentiality, demonstrating compassion, authenticity and a non-judgmental attitude and acknowledging that neither has all the answers
- Safety within peer support is particularly important for people from marginalised and racialised communities, who experience higher levels of restraint and coercion within mental health services
- There are strong pressures on peer support and PSWs to operate within the same risk-averse practices as statutory services and staff; it is important to be aware of these and to find ways of mitigating their impact
- Training, support and supervision are essential in enabling PSWs to have the confidence to navigate risk in the context of helping people to feel safe
- PSWs should not be required to participate in control and restraint practices, as they need to maintain the equality, safety and trust at the heart of peer relationships; this does not affect the need for PSWs to have appropriate de-escalation training or to intervene when a life is at risk
Recommendations
- On completing this piece of work, we feel that further work is needed to explore safety and risk in services where peer support practice is well embedded; for example: monitor the rate of incidents and, crucially, evaluate the felt experience of safety amongst both service users and staff
- NHS Trusts and organisations need to work in partnership with VCSE organisations, in order to benefit from their skills and experience in developing a culture that respects individual safety, control and autonomy
- NHS Trusts and organisations should support the development of a distinctive body of peer practice as a foundation for the development of peer worker roles; they should communicate this throughout their workforce to ensure that everyone understands the role and value of PSWs
- For peer support workers to work effectively as agents of change within a risk-averse culture, they need access to solid support and supervision offered by people who understand the ethos of peer support and the challenges of the NHS culture
- Involving peer support workers and peer trainers in training NHS staff can enable a culture of safety and respect that militates against the use of control and restraint