Evaluation of lived experience Peer Support intervention for mental health service consumers in Primary Care (PS-PC): study protocol for a stepped-wedge cluster randomised controlled trial.

BACKGROUND: The demand for mental health services in Australia is substantial and has grown beyond the capacity of the current workforce. As a result, it is currently difficult for many to access secondary healthcare providers. Within the secondary healthcare sector, however, peer workers who have lived experience of managing mental health conditions have been increasingly employed to intentionally use their journey of recovery in supporting others living with mental health conditions and their communities. Currently, the presence of peer workers in primary care has been limited, despite the potential benefits of providing supports in conjunction with GPs and secondary healthcare providers. METHODS: This stepped-wedge cluster randomised controlled trial (RCT) aims to evaluate a lived experience peer support intervention for accessing mental health care in primary care (PS-PC). Four medical practices across Australia will be randomly allocated to switch from control to intervention, until all practices are delivering the PS-PC intervention. The study will enrol 66 patients at each practice (total sample size of 264). Over a period of 3-4 months, 12 h of practical and emotional support provided by lived experience peer workers will be available to participants. Scale-based questionnaires will inform intervention efficacy in terms of mental health outcomes (e.g., self-efficacy) and other health outcomes (e.g., healthcare-related costs) over four time points. Other perspectives will be explored through scales completed by approximately 150 family members or carers (carer burden) and 16 peer workers (self-efficacy) pre- and post-intervention, and 20 medical practice staff members (attitudes toward peer workers) at the end of each study site's involvement in the intervention. Interviews (n = 60) and six focus groups held toward the end of each study site's involvement will further explore the views of participants, family members or carers, peer workers, and practice staff to better understand the efficacy and acceptability of the intervention. DISCUSSION: This mixed-methods, multi-centre, stepped-wedge controlled study will be the first to evaluate the implementation of peer workers in the primary care mental health care sector. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001189617. Registered on 17 November 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386715.

Pulmonary Manifestations of Sjögren's Disease.

Sjögren's disease (SjD) is a chronic, progressive autoimmune condition of exocrine and extraglandular tissues. It can present with isolated disease characterized by lymphocytic infiltration of salivary or lacrimal glands, but in approximately one-third of the patients, lymphocytic infiltration extends beyond exocrine glands to involve extraglandular organs such as the lungs. Pulmonary complications have been reported to occur between 9 and 27% of patients with SjD across studies. Respiratory manifestations occur on a spectrum of severity and include airways disease, interstitial lung disease, cystic lung disease, and lymphoma. Lung involvement can greatly affect patients' quality of life, has a major impact on the overall prognosis, and frequently leads to alteration in the treatment plans, highlighting the importance of maintaining a high index of clinical suspicion and taking appropriate steps to facilitate early recognition and intervention.

Exploring the lived experience of receiving mental health crisis care at emergency departments, crisis phone lines and crisis care alternatives.

BACKGROUND: Mental health crisis care includes emergency departments (EDs), crisis phone lines and crisis alternatives. Currently, there is an overreliance on EDs to provide mental health crisis care, with evidence that responses are often inadequate to meet the needs of people experiencing mental health crises. However, the complexities of how individuals experience crisis care across the varying contexts of EDs, crisis phone lines and crisis alternatives remain underresearched. METHOD: This study used a hermeneutical phenomenological approach to understand the lived experience of accessing care during a mental health crisis. Thirty-one Australian adults who had accessed crisis services at ED, phone lines and/or crisis alternatives participated in in-depth interviews. RESULTS: The findings are organised across the temporal narratives of participants' experiences from (1) point of contact, (2) positive and negative care experiences and (3) enduring impacts. Several themes were generated during these phases. The findings demonstrate the interrelated nature of care experiences and enduring impacts. With some exceptions, care received within EDs was harmful, resulting in lasting adverse effects. Responses from crisis phone lines were mixed, with participants appreciating the accessibility of after-hour phone support but finding standardised risk assessments unhelpful. Responses from crisis alternatives to ED were promising, aligning with the need for validation and human connection, but were not always accessible or easy to mobilise during a crisis. Notably, across all settings, positive effects were firmly attributed to the quality of the relationship with specific crisis providers. CONCLUSION: The findings bring into sharp focus the lived experience of people accessing crisis care and contribute to the shortage of literature on subjective experiences. Providers may better meet the needs of those experiencing mental health crises by understanding the enduring impact of these interactions and the role of human connection beyond a focus on risk assessment, thereby providing opportunities for a joint understanding of risk and meaning-making. Furthermore, understanding the subjective experience of crisis care can guide reforms to ED and develop crisis alternatives to better meet the needs of people in crisis. PATIENT OR CONSUMER CONTRIBUTION: The first author and the third author are in designated lived experience (Consumer) roles. The first author conducted the interviews and was explicit regarding their lived experience when engaging with participants. Service users were involved as advisors to the study and provided input into the design.

Differences and Similarities Between Consumer- and Caregiver- or Family-Informed Peer Roles in Mental Health.

OBJECTIVE: Peer workers are widely employed across the mental health sector in Australia, and these positions increasingly include people with experience as a service user (consumer peer workers) and people with experience as a family member (caregiver peer workers). The authors explored similarities and differences between the consumer and caregiver peer workforces and considered positions designed to combine consumer and caregiver perspectives. METHODS: A mixed-methods design was used to analyze data from a nationwide Australian survey (N=882), including responses from peer staff with consumer and caregiver perspectives (N=558), and from mental health staff not designated as peer workers (N=324). RESULTS: Most participants viewed the two perspectives as different in terms of values or goals (51%) and work practices (59%), with fewer stating that the two workforces had similar goals or values (45%) and work practices (37%). Qualitative findings provided insight into these differences and similarities, identifying differences in perspectives, priorities, and work practices but highlighting similarities in values between the two workforces. Qualitative data also revealed potential risks of employing peer workers in roles designed to use both kinds of experience for direct support roles but indicated potential for the combined perspective in other contexts. Both qualitative and quantitative data indicated that participants with consumer experience perceived greater differences between the role types than those with caregiver experience only. CONCLUSIONS: The findings indicate similarities and differences between staff with consumer or caregiver perspectives and highlight the need for greater role clarity and the potential for conflict in positions where peer workers combine both perspectives.

Cross-Sectional Study of the Physical Fitness and Anthropometric Profiles of Adolescent Hurling, Camogie, and Gaelic Football Players.

ABSTRACT: Byrne, LM, Byrne, PJ, Byrne, EK, Byrne, AP, and Coyle, C. Cross-sectional study of the physical fitness and anthropometric profiles of adolescent hurling, camogie, and Gaelic football players. J Strength Cond Res 36(12): 3422-3431, 2022-The primary aim of this study was to identify the physical fitness profile of Irish adolescents playing hurling, camogie, and Gaelic football according to age and gender. To establish relationships between the physical fitness tests and anthropometry for these male and female adolescents. This cross-sectional study design included 311 adolescents between age of 13-18 years. Subjects completed a physical fitness test battery of 9 tests which included the following: height, body mass, modified sit and reach (SR), seated medicine ball throw (MBT), countermovement jump (CMJ), standing long jump (SLJ), 15-m sprint, 505 agility, and a 6-minute modified Cooper test (m-CT). Female subjects scored significantly higher in the SR than males, and older adolescents scored significantly higher than younger adolescents ( p < 0.05). In the remaining fitness tests (MBT, SLJ, CMJ, 15-m sprint, agility, and m-CT), males outperformed females, males had greater anthropometry scores than females, and older adolescents outperformed and had higher changes in anthropometry than younger counterparts ( p < 0.05). Normative data for gender and age-specific percentile values (5th, 10th, 25th, 50th, 75th, 90 th , and 95th) for these tests in these adolescent players are provided. These data are useful for clubs, parents, coaches, clinicians, and secondary schools in monitoring adolescents and to provide training programs that develop athletic performance.

Peer support work for people experiencing mental distress attending the emergency department: Exploring the potential.

OBJECTIVE: This study explored the benefits and limitations of employing peer support workers, who utilise their own lived experience of mental distress and recovery, to support people experiencing mental distress who are attending the ED. METHODS: This co-produced qualitative study utilised four phases: (i) assemble a collaborative multi-disciplinary research team and Expert Panel, of which at least half identified as having lived experience; (ii) a site visit to an ED; (iii) focus groups with consumers, support persons and ED staff; and (iv) a learning workshop for peer workers. RESULTS: Focus groups were run for consumers (n = 7), support persons (n = 5) and ED staff (n = 7). Eleven consumer peer workers participated in the learning workshop. Four themes were identified and triangulated: the individual in distress, peer support work, a 'Peers in EDs' service and the ED context. Overall, findings suggest that peer support workers contribute important skills including listening, de-escalation, relationship-building and empathy. CONCLUSIONS: This study identified that peer support workers would bring important skills to an ED (e.g. empathetic support, de-escalation). However, significant workforce and organisational support would be required.

Effective Peer Employment Within Multidisciplinary Organizations: Model for Best Practice.

This study sought a clearer understanding of organizational mechanisms reinforcing effective peer employment and organizational change from the perspectives of peer workers, non-peer staff and management in multidisciplinary mental health and substance use recovery services. Findings were used to develop a model for organizational best practice for peer employment and associated organizational change to promote recovery-oriented and person-directed services. Qualitative research was undertaken, involving 132 people participating in 14 focus groups and eight individual interviews. These people were employed across five U.S. multidisciplinary organizations providing mental health and substance use recovery services and deemed by a panel of experts to provide effective employment of peer workers. Study findings include the articulation of an interactive working model of best practice, comprising organizational commitment, organizational culture and effective organizational strategies necessary for a "whole-of-organization" approach to support authentic peer work and enable organizational transformation, to actualize recovery-oriented values and person-driven services. Strategies include Human Resources engagement, peers in positions of senior organizational authority, recurring whole of workforce training, along with peer training and peer-led supervision. Findings suggest whole-of-organization commitment, culture and practice are essential for the organizational transformation needed to support effective employment of peers in multidisciplinary environments.

To disclose or not to disclose? Peer workers impact on a culture of safe disclosure for mental health professionals with lived experience.

The presence of peer workers in multi-disciplinary environments has rapidly increased in recent years, yet the impact of peer work on other mental health roles is largely unknown. This article explores the presence of peer workers within multi-disciplinary environments, with a specific focus on the possible impact of this presence on the culture of disclosure for mental health professionals with lived experiences of mental health challenges. Semi-structured focus groups and interviews were conducted with 132 participants at five organizations across the United States. Participants self-identified as being employed in a range of roles including management, mental health professionals, designated peer workers, and designated peer leadership positions. Findings suggest intentionally employing peers and using peer values to address stigma toward mental health professionals improves the culture of disclosure. In work environments where peer-led initiatives were featured, mental health professionals felt safer disclosing their own lived experience to their colleagues and supervisors. Recommendations include the use of parallel strategies to promote the perceived value of peers and to implement peer-led training for both supervisors and professionals to model a workplace culture that promotes and supports self-disclosure in the organization. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Supporting the Sharing of Mental Health Challenges in the Workplace: Findings from Comparative Case Study Research at Two Mental Health Services.

Personal experience with mental health (MH) challenges has been characterized as a concealable stigma. Identity management literature suggests actively concealing a stigma may negatively impact wellbeing. Reviews of workplace identity management literature have linked safety in revealing a stigma to individual performance, well-being, engagement and teamwork. However, no research to date has articulated the factors that make sharing MH challenges possible. This study employed a comparative case study design to explore the sharing of MH challenges in two Australian MH services. We conducted qualitative analyses of interviews with staff in direct service delivery and supervisory roles, to determine factors supporting safety to share. Workplace factors supporting safety to share MH challenges included: planned and unplanned "check-ins;" mutual sharing and support from colleagues and supervisors; opportunities for individual and team reflection; responses to and management of personal leave and requests for accommodation; and messaging and action from senior organizational leaders supporting the value of workforce diversity. Research involving staff with experience of MH challenges provides valuable insights into how we can better support MH staff across the workforce.

Using the Double Diamond model to co-design a dementia caregivers telehealth peer support program.

We aimed to develop a telehealth peer support program for isolated dementia caregivers. This paper reports the co-design process by telehealth and the impact and experiences of participants. The Double Diamond model guided the co-design process, which has four phases, with participants reflecting on their caregiving experiences. Group meetings were recorded, notes compiled with inductive thematic analysis undertaken for phases one to three. Each phase findings were presented to the group for verification and refinement. Semi-structured interviews with participants were completed at the end of the project. Six dementia caregivers were recruited from dispersed locations with diverse characteristics. The process identified eight key topics to be included in a program to be delivered by telehealth. Participants reported the technology did not detract from the co-design and at times aided it, despite some technical problems. All reported high levels of group connectedness, feeling supported and transfer of knowledge and skills. One participant would have liked more understanding of the process. The group continued to meet without professional input for 2.5 years following the completion of the project. Telehealth can be a mechanism to support diverse populations in participating in co-design projects.

Subjective Experiences of Mental Health Crisis Care in Emergency Departments: A Narrative Review of the Qualitative Literature.

Mental health presentations to the emergency department (ED) have increased, and the emergency department has become the initial contact point for people in a mental health crisis. However, there is mounting evidence that the ED is not appropriate nor effective in responding to people in mental health crises. Insufficient attention has been paid to the subjective experience of people seeking support during a mental health crisis. This review aims to describe the qualitative literature involving the subjective experiences of people presenting to the ED during a mental health crisis. The method was guided by Arksey and O'Malley's framework for scoping studies and included keyword searches of PsycINFO, CINAHL, Medline and Embase. A narrative analysis, drawing on the visual tool of journey mapping, was applied to summarise the findings. Twenty-three studies were included. The findings represent the experience of accessing EDs, through to the impact of treatment. The review found points of opportunity that improve people's experiences and characteristics associated with negative experiences. The findings highlight the predominance and impact of negative experiences of the ED and the incongruence between the expectations of people presenting to the ED and the experience of treatment.

Skin in the game: The professionalization of lived experience roles in mental health.

The lived experience workforce has moved from being a grassroots support and activist movement to become the fastest growing workforce within mental health. As lived experience work becomes assimilated within mainstream mental health service delivery, it faces mounting pressure to become more professionalized. Professionalization has evoked both optimism and fear, with diverging views within the lived experience workforce. In this paper, an assessment of the existing professionalization of the lived experience workforce is undertaken by drawing on theoretical positions and indices of what constitutes a profession. The arguments for and against professionalization are explored to identify the risks, benefits, and considerations for the lived experience workforce. The drive for professionalization has largely occurred due to the clinically focused mental health systems' valuing of professional identity. The argument in favour of professionalization is motivated by a need for credibility within the views of that system, as well as greater regulation of the workforce. However, tensions are acknowledged with concerns that professionalization to appeal to the clinically focused system may lead to erosion of the values and uniqueness of lived experience work and nullify its effectiveness as an alternative and complementary role. Given mental health nurses are increasingly colleagues and often line managers of lived experience workers, it is important at this stage of lived experience workforce development that mental health nurses understand and are able to advocate for lived experience roles as a distinct professional discipline to help avoid the risks of co-option to more dominant clinical practice.

Lived Experience, Research Leadership, and the Transformation of Mental Health Services: Building a Researcher Pipeline.

In recent years, investment in participatory research methods within mental health services research has grown. Participatory efforts are often limited in scope, however, and attention to research leadership is largely absent from discourse about stakeholder involvement in the United States. This Open Forum calls for investment in building a pipeline of researchers with significant psychiatric disabilities and intersecting lived experiences frequently studied in public sector services research, including homelessness, incarceration, comorbid health problems, structural racism, and poverty. A series of concrete steps are described that faculty and research leadership can take now.

Factors Affecting Mental Health Professionals' Sharing of Their Lived Experience in the Workplace: A Scoping Review.

OBJECTIVE: Research has suggested that some mental health professionals (MHPs) continue to hold stigmatized beliefs about persons with emotional distress. These beliefs may be amenable to contact-based interventions with similar peers. To inform future interventions, policy, and research, this scoping review examined existing literature to identify factors that affect disclosure of lived experience by MHPs to colleagues and supervisors. METHODS: A systematic search was conducted of four online databases, gray literature, and the reference lists of included articles. Primary research studies of any design conducted with MHPs with lived experience of emotional distress and their colleagues were included. The findings of included studies were inductively coded within the themes of enabling, constraining, and intrapersonal factors influencing disclosure. RESULTS: A total of 23 studies were included in data extraction and synthesis. Factors that influenced MHPs' sharing of their lived experience in the workplace were categorized into five overarching themes: the "impaired professional," the "us and them" divide, the "wounded healer," belief in the continuum of emotional distress, and negotiating hybrid identities. MHPs with lived experience described feeling conflict between professional and service user identities that affected the integration and use of their clinical and experiential knowledge. Enabling factors reflected best-practice human resource management, such as organizational leadership, access to supervision and training, inclusive recruitment practices, and the provision of reasonable accommodations. CONCLUSIONS: Findings of this scoping review suggest that organizational interventions to support MHPs in order to share their lived experience may improve workplace diversity and well-being, with implications for service users' experience.

How much 'lived experience' is enough? Understanding mental health lived experience work from a management perspective.

Objective The aim of this study was to explore management understanding of the lived experience required for designated lived experience or peer roles within mental health. Method This qualitative study used semi-structured interviews and one focus group with 29 participants employed in diverse management roles from the public and not-for-profit health and community sector in Queensland, Australia. Results The findings indicate a lack of consensus in defining 'lived experience', including what lived experience is required to be eligible for designated roles. Although some participants were clear on what designated roles added to the workforce, uncertainty and attempts to avoid stigma led to some participants questioning the need for designated roles. Conclusion This study suggests the ongoing expansion of the lived experience workforce is affected by challenges in defining 'lived experience' as a requirement for designated roles and fears regarding stigmatised identities. What is known about the topic? In the mental health sector, opportunities and challenges exist in attempting to effectively incorporate the emerging lived experience or peer workforce. Research has highlighted the need for support from senior management, the need for role clarity and the risk of 'othering' for the lived experience workforce. What does this paper add? This paper responds to the gap in existing research on the experiences of management in defining and articulating their understanding of lived experience and potential impact of uncertainty and inconsistency in understanding for the lived experience workforce. What are the implications for practitioners? This study identifies the need to strengthen management understanding of lived experience to facilitate ongoing development of lived experience roles.

How mental health care should change as a consequence of the COVID-19 pandemic.

The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.

'You don't know what you don't know': The essential role of management exposure, understanding and commitment in peer workforce development.

The peer workforce has increased significantly in recent years; however, structured development and support for the roles are lacking. This paper explores the role of executive and senior management understanding in the employment of peer roles. In-depth, semi-structured interviews and one focus group were conducted with 29 participants from a range of nongovernment and public mental health services within Queensland, Australia. Findings of this study suggest management exposure to and understanding of peer work are essential to the development of an effective peer workforce. Exposure and understanding of peer roles reportedly led to greater acceptance and commitment from management. This commitment inspired action in the form of; enhanced support including advocacy/championing, increased development of roles and influenced culture within the organization to be more accepting of peer work. There was a perception that developing an 'accepting' organizational culture supported the integrity and expansion of peer roles including designated 'peer management' positions. Development of peer management positions is suggested as an effective means of improving the impact of peer perspectives, advocating for peer work and providing ongoing and timely supervision. Recommendations include the need for training and information for management on the unique function, purpose and value of peer roles; and the development of networks, including mentoring opportunities, for organizations with limited experience to gain support and advice from those with greater experience developing peer roles.