Creating Impactful Peer Worker Co-production Roles: A Qualitative Study of Peer Workers in Norwegian Mental Health and Substance Use Services

Abstract

The increasing global prevalence of mental health needs demands more effective and socially inclusive services. Unfortunately, current responses to these needs have proven inadequate. The current health policy agenda advocates for close collaboration with service users and citizens to ensure that public services meet the needs of the people they serve. This not only increases the responsibility of service organizations but also boosts their innovation capabilities through user interactions. Nonetheless, forming effective co-production roles for citizens and service users is challenging and necessitates further development. In the mental health sector, this issue is being addressed by employing individuals who have personal experience with mental health or substance use issues and have utilized these services to work alongside professionals. These roles go by various names, including “experts by experience”, “consumer providers”, and “peer workers”, with the term “peer workers” used consistently throughout this thesis.

This research, conducted in Norway, focuses on the relatively new realm of employing peer workers. More knowledge is needed on how to effectively integrate these workers into service organizations, leveraging their skills and expertise to enhance service quality. The project has two objectives: firstly, to comprehend how peer workers can participate substantially in co-creating effective, socially inclusive mental health and substance use services, and secondly, to generate knowledge that helps craft more significant roles for them.

The thesis consists of three studies, each embracing a qualitative exploratory approach. It delves into the roles of peer workers, their level of involvement, and their interactions and relationships with collaborative partners. All three studies have been developed and analyzed within a theoretical framework emphasizing co-creation to stimulate innovation in public service organizations. An understanding of the difference between co-production and co-creation is crucial for comparing peer workers’ partnerships across various contexts and case studies. Co-production refers to their engagement in collaboration during service delivery, whereas co-creation happens when peer workers participate in the planning or design of new or enhanced service solutions, which they later help implement or provide.

The initial research employed a scoping review methodology to map out the characteristics and roles of peer workers’ involvement. It applied the specified definition of co-creation to analyze articles on the roles and outcomes associated with peer worker involvement. The inquiry aimed to answer How are peer workers involved in co-production and co-creation in mental health and substance use services, and what are the described outcomes? Findings indicated that peer workers are predominantly involved in service co-production and delivery. Yet, their participation in the early stages of the service provision cycle seemed absent. The research also showed a varied degree of involvement, signifying a potential to influence service delivery and development. In conclusion, the research suggests that optimal utilization of peer workers’ potential is overlooked due to a narrow interpretation of their roles.

The second study investigates management’s view on the roles of peer workers and their assessment of their significance. The query presented is: How do managers in Norwegian mental health and substance use services experience, relate to, and make use of the inclusion of peer workers in these services? In this study, managers identify peer workers as a productive strategy to devise a more inclusive and efficient service. They elect to involve peer workers in a variety of collaborative processes within their organizations, including at strategic levels - to plan, prioritize, design, and assess services. Managers value peer workers for their service user knowledge and ability to bridge gaps. Despite acknowledging the difficulties of establishing co-creation practices with peer workers, managers prioritize their participation as co-creation partners, directing significant attention to ensure their effective involvement.

The third empirical study explores the role of peer workers within service organizations and the mechanisms through which they influence service delivery and development. The research question posed is: How do managers, health professionals, and peer workers experience ways peer workers affect mental health and substance use services? The findings suggest that peer workers fill various roles, from initiating and designing services to implementing solutions. Their influence can be felt in the workplace culture and service co-production, often challenging traditional service arrangements. Peer workers, while serving on the frontline, frequently recognize areas for service improvement and directly engage managers to initiate changes. The position of peer workers is fluid. They can be low in the service hierarchy but still be perceived as knowledgeable service users, granting them expert status. Expert status allows them to define themselves and create distance from institutional constraints allowing them more agency than other workers.

The thesis enhances the field of mental health and substance use by offering pertinent insights about how to effectively utilize peer workers roles and contributions. It can guide service organizations aiming to employ peer workers in collaborative roles, thus optimizing their skills and expertise to improve and innovate their services.