Background
Methods
Data collection procedures
Data analysis approach
Descriptors | Major themes | Subthemes |
---|---|---|
What worked well | Perceived benefits of implementing TDM | Promoting client autonomy |
Establishing a safety net | ||
Peer support offers hope to clients | ||
Reducing readmissions and the cost of healthcare | ||
Ensuring consistent presence | ||
Roles of peer supporters | Helping clients to build their capacity and develop a routine | |
Attending regular on-ward and community meetings | ||
Accompanying clients to appointments | ||
Working with clients to develop and to set goals | ||
Overall experience of involvement in TDM | Peer support is fulfilling | |
TDM as a different and exciting model | ||
Fostering own recovery | ||
What did not work so well | Hindrances to the involvement of peer supporters | Lack of understanding and appreciation of peer support roles |
Issues with matching peer supporter to clients | ||
Issues of stigma | ||
Concerns about personal safety and vulnerability | ||
Fear of thinking about own triggers | ||
Clients dropping out of the peer support program | ||
Suggestions for improvement | Strategies for effective involvement of peer supporters | Dealing with matching issues |
Clarifying peer supporters’ roles | ||
Improving communication | ||
Providing appropriate training | ||
Bending information sharing rules |
Results
Perceived benefits of implementing TDM
Promoting client autonomy
…I will listen to them about whatever they need to talk about but I incorporate it into, let’s go for a walk, let’s go to the mall, I initiate that with them, I can’t force them, but I encourage them very strongly that they need to be getting out and doing something other than focusing on the fact that they have a mental illness.
I’m helping her co-facilitate art groups, because I want to help her pursue a dream in terms of art and her creativity.
There are a lot of things they don’t get to do there, you know, their day is so long and dreary, and you know, for us just to offer them that little bit of, you know, conversation.Peer supporters shared skills with clients that helped them to better cope with their condition.I gave her [client] some of the skills that I use, and she has actually implemented a few of them, and said oh my God that works, you know, that makes me feel better.
Establishing a safety net
I think it’s beneficial, I really feel that the project is good in the sense that….a lot of people fall off the radar in terms of their mental health needs after they leave the hospital, and I hope their needs will be addressed ongoing….because I think so many people, after they are discharged from the hospital, they just fall through the cracks.
One person said to me, who is doing, I feel, doing really well, said ‘you’re a safety net for me, I just feel that you’re someone I can call because in other services, I’m sort of, taken off the books so to speak’, and I said, ‘absolutely’, I said even, you know, your file may have the word, I might call it closed….if we don’t hear from them, you can always call us.Our program’s established, so we have a model in place already, so traditionally we would have met with somebody several times before they go out to the community so we do feel that it’s a safety net…
Peer support offers hope to clients
When they hear that we’ve gone through these things, that we’ve failed, or, not failed, but we’ve stumbled, and we’ve gone through these things in life, and we’ve lost jobs, or we’ve, you know, had these life struggles, and they’re like, you know, we’ve gone through these things too, and they see that…. we’re surviving, and we’re out in the community, and we’re here to help….it’s okay to talk to us, and it gives them hope.
Reducing readmissions and the cost of healthcare
I got some stuff online and the amount of money that’s saved by places that are using it [TDM], I forget the dollar amount but it was quite substantial because it [TDM] saved on readmissions.
He [referring to client] says this made a huge difference, he feels a lot better, he feels that he’ll have a more lasting recovery this time given all of the extra supports he was given.
Ensuring consistent presence
[client] …was originally paired with [peer supporter]…we took it [relation] further…really clicked…that’s what she needs right now…I’m doing one to one with her.
…phone visits…I could not get a hold of one…eventually found out that she was re-admitted…perhaps I can do visits…these people…system so many years…can’t abandon them…there to help them.…I think for me…it’s something [peer support] they can look forward to…they’re under-socialized…to have someone…it really helps them.
Peer supporter’ roles
Helping clients to build their capacity and develop a routine
…for me…my focus [is] to teach them how to have fun…I will listen to them…incorporate…I initiate that with them…I can’t force them…doing something other than focusing on the fact that they have a mental illness…..I don’t mind…I’m looking at the clock…if I can keep him busy and happy for 2 hours.
Attending regular on-ward and community meetings
We meet in the morning with coordinator but then in the afternoon we come up with an assortment of people on the ward …We do have the staff one person is always here [hospitals] and they will jump in but that’s the part that worried me that these people are still so needy… I read that we would be meeting like this.
After being there consistently, when some of the volunteers and myself would end up at the door of the room marked to go in, they’d be waiting, and they were excited, and at the end of the group, they’d say, oh when are you coming again?
Accompanying clients to their appointments
Certain personality things make the top of the list, and if you’re at the top of the list, with a couple personality disorders, every door is the wrong door, so you’re already feeling invalidated as a human being, and now mental health services is continuing to invalidate you, so to have that peer support connection that can help you advocate to get into the group that makes sense for you.
Working with clients to develop and to set goals
A lot of the work that I’ve been doing with individuals [clients] is creating goals, and recovery goals, really part of people’s journey I think, is goal setting.Part of the recovery is those goals setting, and making those goals, finding employment and returning to school, I find the major goals in the majority of individuals.And again a lot of goal setting and that started with the groups I do on the unit, and starting that discussion, and continues on, after you know, we see each other in the community and touch base 1 on 1.
Overall experience of involvement in TDM
Peer support is fulfilling
It was very rewarding for me to hear her say, it’s nice to talk to somebody who has actually gone through, some of the same things I have, like I told her, I said, I haven’t walked in your shoes, but I know a bit about what you’re going through, your journey is different from mine, but it’s nice to know that, you know, somebody says thank you for listening to me, that’s rewarding to me.
I enjoy working in this field immensely….I gain a lot of knowledge from my peers (referring to other workers)….it’s very fulfilling….I totally enjoy what I’m doing.
Once you do bond with somebody, you really do seem to keep that bond with that person; you seem to keep that closeness with that person throughout the hour….
Training was phenomenal. The course was good. The information was sound. The training itself was fantastic. The way the book was put together. [I] really loved it.
TDM as a different and exciting model
It’s very gratifying to see people doing so well, and….going to work, and school…finding they need less support actually as they continue on.When I found out about the TDM model, I got quite excited actually because I thought, oh okay, this is something different, I’m really um getting out there and seeing more than just what’s in this little box.
Fostering own recovery
I think it’s for both people, not just for the person who’s transitioning.It’s been really beneficial at least for me, and for her I hope.I was worried about triggers, that was my thing, I was like okay, is this going to trigger me back….but no, it’s actually…helped, we’ve kind of helped each other.
Hindrances to the involvement of peer supporters
Lack of understanding and appreciation of peer support roles
I don’t think the staff have been educated about what we’re doing.It’s so important, it’s not the nurses… is better than the peer support [it’s not about nurses being better than peer support], the goal is about patient care, and that’s what people need to be focused on, is the care of the patient.There’s going to be that mind-set, there’s certain people involved at the hospital that have a formal education, that figure that their formal education, they’re better suited to deal with the people on the ward than people who have lived experience.
Issues with matching peer supporter to client
As to picking the person that I was paired with initially…we clicked for some reason. She was so positive and she gave me her number at home …and we met once and we talked and that was the end and she didn’t want any more. She is in another group now and she is getting the help she needs.
Well I don’t want an old person. I’m 50 years old… if I could give some of my knowledge to younger people, they could use my knowledge and that’s how I see it.
Issues of stigma
It’s very difficult because depending on the field that people work in, a lot of people the stigma still keeps them from coming out, and doing this volunteer work, because you don’t see too many lawyers, or doctors coming out and offering to be peer support to other colleagues.We all know they’re out there, so trying to break that stigma down and get them involved.
Concerns about personal safety and vulnerability
It frightens me…we’re vulnerable…I think I’m still vulnerable…at the community meeting…we were attacked verbally…it scares me in a way.[Referring to the peer supporters] will be involved with somebody with no [idea of his/her] background history because we’re not privy to that type of information. So that’s why you could run into a lot of emotional problems with people coming in because you don’t know their vulnerability and, you do have to tread carefully I suppose, … be very careful about what you say, how you react to different situations and so on with somebody that you don’t know really anything about them. So that’s the problem for me.
Fear of thinking about own triggers
You know…..could be that…. I mean last, when I did all those interviews [Client-peer supporter sessions] that week it was very difficult for me because I was reliving and reliving and reliving and, and I phoned my doctor and then I went to see him Monday, my appointment is next Monday, but I needed to…We have to be very careful of ourselves. So that’s really good. So I’m aware of the [my own triggers].
Clients dropping out of the peer support program
My experience has been that…some of the people being discharged from the hospital may feel overwhelmed… and then they back out for whatever reason.[Some clients] just not show up…they are nervous [and] never follow through.
Strategies for effective involvement of peer supporters
Dealing with matching issues
It’s easier for guys to have ‘guys talk’ and ‘girls to talk to girls’.
Like people are matched. If someone likes tennis [is matched] with someone who likes tennis or someone who likes old movies with someone who likes old movies, not because both people had schizophrenia or both people had depression.
Clarifying peer supporters’ roles
A client could be complaining to the nurse, or complaining to the doctor, like maybe speaking to the psychiatrist, and then they could say, well we do have peer support here, and the peer support are educated and trained in recovery models, and you know, can maybe work with you, and have a one-on-one with you, get to know you, and maybe help you once you leave here…. like that’s just an example, I don’t believe things like that are said. So then, it’s just kind of me, going out there being like ‘hey guys, guess who I am, my name’s (name), I have lived experience, I was where you are.
We don’t have that expertise, only as patients [past patients]…we’re not staff, and we’re not patients.
Improving communication
I would have to work with them (social workers) to find out when discharges were, so that I could…. make the relationships, have a time frame.,…before they’re discharged making the contact information, and talking about, you know, what, how they envision, the transitional support with peer support.
Make sure there is a communication binder (such as the ARTIC binder they have) and ensure someone is in charge of it would help communicate discharge plans in advance.
Providing appropriate training
With the training, um, most of it was reading through the manual and a lot of stress put on listening, listening and I suggested at one point that, um, there should be a little bit of some play acting on some of the problems that might (emphasized) …you know, what might somebody say to us and how would we react to it… role playing, you know listening is not enough.There’s endless possibilities… we have to rely on training as much as possible, we don’t want to have situations where people are triggered.
Bending information sharing rules
…and she calls the ambulance on herself. By herself. And they don’t want to take her because they know her at the hospital, she’s only faking. What is not funny is that I’m not told. I wasn’t told…the match maker made a mistake… I’d rather work with a person when you tell me the right stuff before I…We’re not allowed to go to their homes [clients]…that are the problem… I think we should be allowed to go into their homes…it’s going to be impossible to get them to leave their home.