Highlight findings

• In a six-month period, the peer workers delivered 196 appointments to 25 people. The average number of appointments was 12, showing that once engaged, people tended to sustain their engagement.
• The decision to work with Penumbra, as experts in supporting recovery and peer-based approaches, was a key decision in understanding trust in the project and how the peer workers were equipped and supported.
• We saw evidence of strong relationship between people in receipt of the service and peer workers. Relationships were often built upon lighter touch and informal conversations, which set the conditions for a high degree of trust and mutuality which in turn supported change. This relational practice emerged as a 'golden thread' across our analysis, helping to explain why this way of working was experienced so positively by those using the service.
• Collaboration in service design and the network of service champions were important features of this work.

The Peer Support Test of Change started in February 2020, when East Renfrewshire HSCP funded Penumbra to work with them to develop and deliver the service. The HSCP and Penumbra worked together to develop the service with support from Matter of Focus, funded as evaluation partner to the test of change. Involving stakeholders including a small number of people using mental health services in early conversation was an important part of the service design process and led, critically, to building a network of champions to raise awareness of the service and support referrals.

The service was launched in September 2020 and was immediately positively received, considered at full capacity by December 2020 with 25 people using the service. As the following graph shows 36 people had been referred to the service by February 2021 and 42 by June 2021, with a waiting list in operation from December. We reflect on the possible tensions between increasing referrals and referral routes into the project and the project's capacity later in this report and one consequence of the level of demand for the service has been an increase in waiting times.

Figure 1. Flow of people into and out of the service

Due to Covid-19 restrictions the service has primarily been delivered one-to-one to people over the phone, meaning the groupwork element was not developed as intended. The use of well developed and tested recovery tools such as the HOPE model supports meaningful conversations about people's needs, wellbeing and recovery. The decision to work with an expert, outside organisation to deliver the service is a key contextual factor and a key decision to understanding this work and forms a thread in our analysis.

Between September and February 2021 the two peer workers had delivered 196 appointments to 25 people. On average people have attended 12 appointments, with four people exiting the service. The peer workers have also run one group session on zoom focused on sleep, and plan to run more over time.

We saw evidence that peer workers work with people to:

• create a peer relationship built on mutual respect and empowerment
• provide support, a safe space, motivation and structure for people
• promote recovery and a focus on people's strengths
• use tools such as I.ROC and the HOPE toolkit to help people to evaluate their lives and create positive changes for themselves

It is clear from the evidence that the Peer Support Service provides a different kind of space for people to come and get support, compared with support from formal or statutory services, as the following excerpts from peer worker reflective logs show. The special qualities of this relationship form a narrative thread that runs across this pathway to impact.

Highlight findings

• The Peer Support Service was delivered by two peer workers with experience of mental health issues and recovery; their role has been pivotal to design, delivery and evaluation of the service.
• People are typically referred to the service because of isolation, mental ill-health, anxiety, depression and low mood.
• The service has received referrals from a range of sources such as Adult Mental Health Teams (including psychiatrists), Community Addictions Teams and voluntary sector partners. 

The Peer Support Service is delivered by two peer workers. The first started taking referrals in September 2020 and the second in December 2020. Both peer workers have lived experience of mental health issues and recovery, which they bring to their professional role as peers supporting others in the recovery journey and see as critical to their role. The peer workers have played a vital role in developing, delivering and evaluating the service to date. 

To date, 32 people have benefitted from the service, with a further 10 people on the waiting list. There is a strong gender bias in favour of women in those accessing the service that requires further exploration. Additional recruitment provides a chance to review whether there is a benefit of recruiting according to specific experiences or identities.  Analysis of the referral information shows that social isolation is the most common issue that people are referred to the service for help with, followed by anxiety, depression and low mood and mental ill health. This is summarised in the graph below.

The service has benefitted from strong engagement with the HSCP staff and partners, evidenced by the wide range of referrals to the service from Adult Mental Health Teams, Community Addictions Teams as well as from voluntary sector partners RCA Trust and RAMH. In particular the service has had strong support from psychiatrists with more than half of referrals coming from the Adult Mental Health Teams coming from that source.

Several staff from the HSCP's Community Addictions Service, Adult Mental Health Teams, RCA Trust and RAMH acted as service 'champions' for the Peer Support Service. These champions shared information about the service, attended workshops to support its design and development and were on hand to answer questions from their teams about peer support.

Highlight findings

• People using the service valued the nature of the relationship and the holistic approach taken.
• People valued working with someone with lived experience because it helped them develop a sense of clarity and reflection on their own experiences. In this way of working connections can extend beyond the experience of mental ill-health or substance use to other experiences or passions.

There is strong evidence that the Peer Support Service has been well-received by people accessing support. There is consistent evidence that people accessing support value the nature of the relationship and the open approach to conversation which can focus on a range of topics - not just mental health or harmful alcohol and/or drug use issues. This creates opportunities for connection of all kinds, for example a shared love of the outdoors or of cats. In some instances, these different types of conversation seemed to encourage remarkable shifts in perspective. Whilst building trust with the service takes time, evidence from the peer workers shows that this has been realised in many cases, as the following excerpts from the peer worker case note reviews show. Contributions from people using the service suggest the importance of a neutral or non-judgmental approach and how also how reassuring they have found the conversations to be.

Highlight findings

• There has been significant learning from this peer support test of change for the people using the service, the peer workers and the HSCP.
• A common thread across the experiences of those using the service was that it supported greater self-awareness and knowledge, and therefore aided their own personal goals. In this evaluation we heard powerful testimonies of people using the service, sitting alongside more modest gains in quantitative indicators.

Through their work with the peer workers, people using the service have gained a deeper understanding of what matters to them, from building relationships to family members to having someone to talk to about their personal life, without judgement. Peer workers reflected that the peer support allowed people to explore their hopes and goals in a relaxed setting and often quickly identify areas to progress. This in turn helped people build confidence, self belief and hope for the future, seen both in modest improvements in I.ROC scores in these domains and in feedback from people supported by the service.  

In turn, peer workers have been able to identify a number of areas for improvement in the service, most crucially, the move to face to face engagement as Covid-19 restrictions allow. One peer worker notes the learning they have gained about their own recovery: "An awareness of how far I’ve come in my own recovery/self-actualisation that I’m in a position where I can do this work." Another entry described how the role had helped them: "become more confident as my relationships with people grow" and be more confident in, "the limits of my influence/responsibility (i.e. you can’t help someone with everything)" (Reflective Impact Log - Peer Worker 1). 

The test of change has enabled HSCP staff to understand the specific contribution that the Peer Support Service brings to their wider offering in helping people to 'open up'. Their trust in the quality of the service is an important thread through our analysis.

Highlight findings

• There was evidence from our review of case notes that people who engaged with the service used the space for open dialogue to understand what was important to them and to take positive steps forward.
• Awareness of peer support appeared to be growing in the area, with more practitioners becoming aware of the benefits and considering referrals.

There is considerable evidence that people engaged with the service are making changes in their lives as a result of the tools, knowledge and support. Examples include people being supported to stay sober, join a gym for the first time, feel safe in their own garden, better understand diagnoses, rebuild close family relationships, travel alone, reframe previous negative experiences and seek therapy for the first time. People were also supported to access new services and assert their rights within existing service relationships. Powerful case examples of being more able to process experiences and move towards positive change include a person challenging a service for better care, and another getting support around a personal experience of trauma while drawing from this experience to make a positive contribution to their community on safety issues. Some people using the service were linked into wider or more specialist supports. Being able to speak to someone was key to making these changes and I.ROC was identified as a helpful tool to support this, as the following quotation shows.

Elsewhere, such realisations were described as an "eye opener. [The peer worker] helps me break it down, my thoughts, my feelings, my emotions. Rather than keeping these deep, it's about speaking about them. It’s a much better, much healthier way".

In tandem the HSCP has taken the learning from this test of change and taken action to embed peer support as part of formal services. Crucially, in June 2021 the HSCP agreed to fund the service for the next three years and to extend the service, recruiting an additional peer support worker. Alongside this staff are continuing to support, discuss and refer people to the service, as one practitioner reflected. 

Highlight findings

• The Peer Support Service has provided a complementary service to people using mainstream addictions and mental health services, providing opportunities for informal conversation and connections of different kinds.
• There is evidence in this evaluation that people using the service have maintained or moved forward in their recovery, being mindful that recovery can be a long process for many people and one subject to many influences.

The evidence brought together in this report from people using the service, the peer workers and practitioners shows that some people have moved forward in their recovery and have improved quality of life as a result of their interactions with peer supporters. These have been described throughout this report and have included people becoming more financially independent, building and rebuilding social networks, becoming sober, taking up exercise and addressing long-standing and deeply complex challenges for the first time in their lives. We have also seen that it is possible to link many of these shifts in wellbeing and quality of life to the peer relationships, characterised by informality, trust and shared learning.

Recovery is a long process that involves ups and downs and therefore it is not necessarily to be expected that people will gain measurable improvements over a relatively short timeframe. Analysis of I.ROC data for ten people who completed the tool on assessment and then review shows modest improvements in some domains, with small steps back in others. This contrasts with, but to some extent balances the overwhelmingly positive qualitative feedback.

By implementing the Peer Support Service there is clear evidence that the HSCP have provided a complementary service to people using mental health and addictions services. Critically the Peer Support Service offers people someone to talk to about anything in life in a way that is completely non-judgemental and is able to draw on lived experience of how different kinds of service and supports helped with their recovery journey. There is extensive evidence that people using the service very much value this complementary support as the following quote shows.