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The ways in which Scotland’s network of mental health peer-support groups navigated the COVID-19 pandemic could provide valuable lessons to create better services for both online and offline users, a new report suggests.
 
Human-computer interaction specialists from the University of Glasgow prepared the report, which examined the experience of seven mental-health support groups from across Scotland’s central belt.
 
Their findings, set to be presented at the ACM Conference on Human Factors in Computing Systems in Germany this week, reveals for the first time the infrastructural work that is required for effective peer-support services and suggests a framework that could help deliver better services in the future.
 
Scotland has an unusually well-resourced peer-support structure for mental health services, with several significant investments in services made by the Scottish Government in the years since devolution, including the establishment of Scottish Recovery Network in 2004 to support the development and delivery of peer support services.
 
Unlike peer-support naturally occurring online or other settings, in these more formalized peer-support settings, trained peer-support workers who lived with their own mental health problems are hired to offer advice and support from their own lived experience.
 
Dr Xianghua (Sharon) Ding, of the University of Glasgow’s School of Computing Science, led the research. Dr Ding said: “Peer support for mental health is a well-established practice in Scotland – it’s one of the world-leaders in finding ways for people to help each other, augmenting clinical support from health services.
 
“When the pandemic lockdowns began, many of these peer-support services were forced to move online and start working in different ways.
 
“What we wanted to explore was what that change meant to both the service users and the peer-support workers – what worked for them about the new ways of supporting each other online, what were the challenges, and what could they keep doing once the lockdowns were finished?”
 
To answer those questions, the researchers interviewed a total of 22 service users, support workers and volunteers from seven mental health support groups about their experiences of using, managing and maintaining the services. The ages of the interviewees ranged from those in their 20s to those in their 70s.
 
The discussions revealed what the researchers called the ‘infrastructural work’ underpinning service delivery – previously under-discussed details of how people engage in a continuous process of setting up and managing the conditions for peer-support to take place, beyond directly offering advice and support to service users.
 
The researchers suggest four key considerations for the design of digital peer-support services in the future.
 
Firstly, they should aim to provide an engaging online space which provides different methods of participation. While online services are often based on talk therapy, where users speak directly to each other, that level of interaction can be too challenging when users’ energy levels are low. A ‘hangout’ service which also supports text and image sharing can help users engage with each other in a way that suits their own needs, in their own time.
 
Secondly, designers should take into account the potential impact of the challenges of picking up on social cues in online spaces. While a support worker might easily notice a change in a service users’ mood in-person, it is much more difficult when they are physically separated. Support workers should be aware of the value of reaching out when users’ moods are low. Service users could also volunteer to share their stress levels non-verbally using wearable devices like fitness trackers, which could trigger an intervention by a support worker.
 
Thirdly, services can offer better support when users are placed into groups which they feel reflect their own experiences and needs. A ‘bottom-up’ approach where service users can find others who share their interests and form mutual support groups within services can help to maximise the effectiveness of peer support.
 
Finally, service users should be regularly assessed to determine whether online or in-person services are most appropriate for their circumstances, either through self-assessment or by a peer-support worker. Setting boundaries on what users are comfortable sharing with others, either online or in-person, before it becomes more appropriate for them to be directed to one-on-one counselling or other services like applying for social benefits, is key to providing a service which works for them.
 
Dr Ding added: “While pandemic lockdowns may be behind us for now, many are still living with mental health issues as a result. The ongoing energy and economic crises are contributing to further problems which clinical models of mental health support simply aren’t resourced to completely address, making the need for effective peer-support services more acute than ever.
 
“We hope that the work we’ve done provides a useful framework for other organisations who offer mental health peer-support services to consider how best to shape their services. I’m also keen to continue working with the groups who contributed to this study to explore the possibility of building a prototype of a brand-new online system which incorporates our recommendations.”
 
The team’s paper, titled ‘Infrastructural Work Behind The Scene: A Study of Formalized Peer-support Practices for Mental Health’, is published in Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems.

First published: 24 April 2023