Skip to main content
Log in

Einsatzmöglichkeiten von Peerbegleitung in der psychiatrischen Versorgung

Models of peer support in psychiatric care

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

In der Psychiatrie findet seit einiger Zeit ein Wandel hin zu einer verstärkt recovery-orientierten Versorgung statt. Recovery (Genesung) umfasst einen subjekt- oder personenorientierten, ganzheitlichen Ansatz im Umgang mit einer Erkrankung. Die Arbeit von Peerbegleiterinnen und -begleitern als Form der Unterstützung durch andere Betroffene (Peersupport) leistet in der Psychiatrie diesbezüglich einen wichtigen Beitrag. Mit ihren eigenen Genesungs- oder Krisenerfahrungen können sie Patienten und Angehörigen neben ihrem Wissen auch Hoffnung auf Genesung vermitteln.

Der vorliegende Beitrag gibt einen Überblick über die Einsatzmöglichkeiten der Peerbegleitung, die Evidenz solcher Interventionen sowie den aktuellen Stand der Implementierung in unterschiedlichen psychiatrischen Kontexten. Es werden ausgewählte, aktuelle Publikationen vorgestellt. Zudem wird aus der Hamburger Praxis der EX-IN-Ausbildung zur Genesungsbegleitung, dem Trialog zwischen Betroffenen, Angehörigen und Professionellen und der Psychoseseminare berichtet sowie Praxisbeispiele und Erfahrungen aus verschiedenen Feldern der Versorgung werden gegeben.

Genesungsbegleitung kann in verschiedenen Bereichen der psychiatrischen Versorgung erfolgreich eingesetzt werden, z. B. in der ambulanten Einzelbegleitung, in Gruppenangeboten, Krisenintervention sowie zur Verringerung von Zwangsmaßnahmen.

Obwohl sich Genesungsbegleitung in vielen verschiedenen Kontexten als erfolgreich gezeigt hat, wird vielfach auch von Schwierigkeiten bei der Implementierung in der psychiatrischen Praxis berichtet. Diese können nur mit einer Veränderung im gesamten System und in der Arbeit mit allen Teammitgliedern überwunden werden.

Abstract

In the past decades, psychiatric care has changed from the traditional medical model to a more person-centered and recovery-focused approach. In this process, peer support workers are essential, because with their lived experience of crisis and recovery they are able to spread hope.

This article gives an overview of the recent literature describing the current change model of peer support, reporting the evidence of peer support, as well as the current stage of implementation of peer support in different psychiatric contexts.

An overview of the current state of research, selected by the authors, based on repeated systematic literature searches in peer support research projects, is given. Additionally, some examples of user involvement from the Hamburg EX-IN Curriculum, trialogs between sufferers, relatives and professionals, as well as the so-called psychosis seminars are described in more detail.

Peer support has shown promising results in one-to-one and group settings, case management, crisis interventions, and the reduction of coercive measures.

Although there are promising results of peer support in various clinical contexts, multiple challenges in the implementation of peer support are reported. They need to be overcome by the inclusion of all staff members in the change process of the system in order to further develop user-oriented and recovery-oriented psychiatric care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Aderhold V (2016) Neuroleptika minimal – warum und wie. In: Merod R (Hrsg) Psychotherapie und Psychopharmaka in der Behandlung von Menschen mit schizophrenen Psychosen. DGVT Verlag, Tübingen

    Google Scholar 

  2. Maslej MM, Bolker BM, Russel MJ et al (2017) The mortality and myocardial effects of antidepressants are moderated by preexisting cardiovascular disease: a meta-analysis. Psychother Psychosom 86(5):268–282

    Article  PubMed  Google Scholar 

  3. Murray R, Quattrone D, Natesan S et al (2016) Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics? Br J Psychiatry 209(5):361–365

    Article  PubMed  Google Scholar 

  4. Leamy M, Bird V, Le Boutillier C, Williams J, Slade M (2011) Conceptual frame-work for personal recovery in mental health: systematic review and narrative synthesis. Br J Psychiatry 199(6):445–452

    Article  PubMed  Google Scholar 

  5. Slade M, Amering M, Farkas M et al (2014) Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry 13(1):12–20

    Article  PubMed  PubMed Central  Google Scholar 

  6. Amering M, Schmolke M (2012) Recovery – das Ende der Unheilbarkeit. Psychiatrieverlag, Köln

    Google Scholar 

  7. World Health Organization (2017) Providing individualized peer support in mental health and related areas – WHO Quality Rights training to act, unite and empower for mental health (pilot version). WHO, Geneva (WHO/MSD/MHP/17.12)

    Google Scholar 

  8. Walker G, Bryant W (2013) Peer support in adult mental health services: a meta-synthesis of qualitative findings. Psychiatr Rehabil J 36(1):28–34

    Article  PubMed  Google Scholar 

  9. Faulkner A, Basset T (2012) A helping hand: taking peer support into the 21st century. Ment Health Soc Inclusion 16(1):41–47

    Article  Google Scholar 

  10. Chinman M, George P, Dougherty RH et al (2014) Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatr Serv 65(4):429–441

    Article  PubMed  Google Scholar 

  11. Mahlke C, Krämer U, Becker T, Bock T (2014) Peer support in mental health services. Curr Opin Psychiatry 27(4):276–281

    Article  PubMed  Google Scholar 

  12. Shepherd G, Boardman J, Slade M (2008) Making recovery a reality. Sainsbury Centre for Mental Health, London

    Google Scholar 

  13. Davidson L, Ballamy C, Guy K, Miller R (2012) Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry 11(2):123

    Article  PubMed  PubMed Central  Google Scholar 

  14. Daniels AS, Bergeson S, Fricks L, Ashenden P, Powell I (2012) Pillars of peer support: advancing the role of peer support specialists in promoting recovery. J Ment Health Training Educ Pract 7(2):60–69

    Article  Google Scholar 

  15. Bock T, Priebe S (2005) Psychosis-seminars, an unconventional approach for how users, carers and professionals can learn from each other. Psychiatr Serv 11(1):441–443

    Google Scholar 

  16. Mahlke C, Priebe S, Heumann K, Daubmann A, Wegscheider K, Bock T (2017) Effectiveness of one-to-one peer support for patients with severe mental illness—a randomised controlled trial. Eur Psychiatry 42:103–110

    Article  CAS  PubMed  Google Scholar 

  17. Utschakowski J (2016) Die Ausbildung von Experten durch Erfahrung. Das Projekt EX-IN. In: Utschakowski J, Sielaff G, Bock T, Winter A (Hrsg) Vom Experten aus Erfahrung. Peer-Arbeit in der Psychiatrie. Psychiatrie-Verlag, Bonn, S 82–92

    Google Scholar 

  18. Hegedus A, Seidel E, Steinauer R (2016) Participants’ employment status and experiences in the year after the Experienced Involvement training. Int J Soc Psychiatry 62(3):214–220

    Article  PubMed  Google Scholar 

  19. Gillard S, Gibson SL, Holley J, Lucock M (2015) Developing a change model for peer worker interventions in mental health services: a qualitative research study. Epidemiol Psychiatr Sci 24(5):435–445

    Article  CAS  PubMed  Google Scholar 

  20. Bowlby J (1973) Attachment and Loss, 1. Aufl. Bd. 2. Basic Books, New York

    Google Scholar 

  21. Catty J, Cowan N, Poole Z et al (2012) Attachment to the clinical team and its association with therapeutic relationships, social networks, and clinical well-being. Psychol Psychother Theory Res Pract 85(1):17–35

    Article  Google Scholar 

  22. Davidson L, Bellamy C, Guy K, Miller R (2012) Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry 11(2):123–128

    Article  PubMed  PubMed Central  Google Scholar 

  23. Byrne L (2013) A grounded theory study of lived experience mental health practitioners within the wider Workforce. Central Queensland University, PhD thesis

    Google Scholar 

  24. Lloyd-Evans B, Mayo-Wilson E, Harrison B (2014) A systematic review and meta-analysis of randomised controlled trials of peer support for people with severe mental illness. BMC Psychiatry 14:39

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pitt V, Lowe D, Hill S (2013) Consumer-providers of care for adult clients of statutory mental health services. Cochrane Database Syst Rev 3:CD4807

    Google Scholar 

  26. Cabassa LJ, Camacho D, Vélez-Grau CM et al (2017) Peer-based health interventions for people with serious mental illness: a systematic literature review. J Psych Res 84:80–89

    Article  Google Scholar 

  27. Rogers ES, Teague GB, Lichenstein C et al (2007) Effects of participation in consumer-operated service programs on both personal and organizationally mediated empowerment: results of multisite study. J Rehabil Res Dev 47(6):785–799

    Article  Google Scholar 

  28. Sledge WH, Lawless M, Sells D, Wieland M, O’Connell MJ, Davidson L (2011) Effectiveness of peer support in reducing readmissions among people with multiple psychiatric hospitalizations. Psychiatr Serv 62:541–544

    Article  PubMed  Google Scholar 

  29. Stastny P, Lehmann P (2007) Statt Psychiatrie. Antipsychiatrieverlag, Berlin

    Google Scholar 

  30. Corrigan PW, Larson JE, Michaels PJ (2015) Diminishing the self stigma of mental illness by coming out proud. Psychiatry Res 229(2):148–154

    Article  PubMed  Google Scholar 

  31. Cook J, Copeland M, Jonikas J (2011) Results of randomized controlled trial of mental illness self management using Wellness recovery action planning. Schizophr Bull 34:214–222

    Google Scholar 

  32. Druss B, Zhao L, von Esenwein S (2010) The Health and Recovery Peer (HARP) Program: a peer led intervention to improve medical self management for persons with serious mental illness. Schizophr Res 118(1–3):264–270

    Article  PubMed  PubMed Central  Google Scholar 

  33. Van Gestel Timmermans H, Brouwers E, Van Assen M (2012) Effects of a peer run course on recovery from serious mental illness: a randomized controlled trial. Psychiatr Serv 63(1):54–60

    Article  PubMed  Google Scholar 

  34. Castelein S, Bruggeman R, van Busschbach J (2015) The effectiveness of peer support groups in psychosis: a randomized controlled trial. Acta Psychiatr Scand 118(1):64–72

    Article  Google Scholar 

  35. Lawn S, Smith A, Hunter K (2008) Mental health peer support for hospital avoidance and early discharge: An Australian example of consumer driven and operated service. J Ment Health 17(5):498–508

    Article  Google Scholar 

  36. Wakefield PA, Randall GE, Richards DA (2011) Identifying barriers to mental health system improvements: an examination of community participation in assertive community treatment programs. Int J Ment Health Syst 5:27

    Article  PubMed  PubMed Central  Google Scholar 

  37. Craig T, Doherty I, Jamieson-Craig R, Boocock A, Attafua G (2004) The consumer-employee as a member of a Mental Health Assertive Outreach Team. I. Clinical and social outcomes. J Ment Health 13(1):59–69

    Article  Google Scholar 

  38. Easter MM, Swanson JW, Robertson AG (2017) Facilitation of psychiatric advance directives by peers and clinicians on assertive community treatment teams. Psychiatr Serv 68(7):717–723

    Article  PubMed  Google Scholar 

  39. Sherman PS, Porter R (1991) Mental health consumers as case management aides. Hosp Community Psychiatry 42(5):494–498

    CAS  PubMed  Google Scholar 

  40. Nikkel RE, Smith G, Edwards D (1992) A consumer-operated case management project. Hosp Community Psychiatry 43(6):577–579

    CAS  PubMed  Google Scholar 

  41. Dixon L, Krauss N, Lehman A (1994) Consumers as service providers: The promise and challenge. Community Ment Health J 30(6):615–625

    Article  CAS  PubMed  Google Scholar 

  42. Mowbray CT, Moxley DP, Collins ME (1998) Consumers as mental health providers: First-person accounts of benefits and limitations. J Behav Health Serv Res 25(4):397–411

    Article  CAS  PubMed  Google Scholar 

  43. Tsai J, Rosenheck RA (2012) Outcomes of a group intensive peer-support model of case management for supported housing. Psychiatr Serv 63(12):1186–1194

    Article  PubMed  Google Scholar 

  44. Bartels SJ, Aschbrenner KA, Rolin SA, Hendrick DC, Naslund JA, Faber MJ (2013) Activating older adults with serious mental illness for collaborative primary care visits. Psychiatr Rehabilitation J 36:278–288

    Article  Google Scholar 

  45. Lorig K, Ritter PL, Pifer P, Werner P (2014) Effectiveness of the chronic disease self-management program for persons with a serious mental illness: a translation study. Community Ment Health J 50:96–103

    Article  PubMed  Google Scholar 

  46. Henderson C, Farrelly S, Moran P, Borschmann R, Thornicroft G, Birchwood M (2015) Joint crisis planning in mental health care: The challenge of implementation in randomized trials and in routine care. World Psychiatry 14(3):281–283

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ruchlewska A, Wierdsma AI, Kamperman AM et al (2014) Effect of crisis plans on admissions and emergency visits: A randomized controlled trial. PLoS ONE 9(3):e91882

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  48. Swanson JW, Swartz MS, Elbogen EB et al (2008) Psychiatric advance directives and reduction of coercive crisis interventions. J Ment Health 17(3):255–267

    Article  PubMed  PubMed Central  Google Scholar 

  49. Schulz G, Uhlig R, Mahlke C (2019) Unterstützung bei PatientInnenverfügung, Vorsorgevollmacht und Behandlungsvereinbarung. Unabhängigkeit, Umsetzung und institutionelle Unterstützung. In: Zinkler M, Mahlke C, Maschner R (Hrsg) Selbstbestimmung und Solidarität. Unterstützte Entscheidungsfindung in der psychiatrischen Praxis. Psychiatrieverlag, Bonn (in press)

    Google Scholar 

  50. Ashcraft L, Blossom M, Anthony WA (2008) The development and implementation of “no force first” as a best practice. Psychiatr Serv 63(5):415–417

    Article  Google Scholar 

  51. Ash D, Suetani S, Nair J, Halpin M (2015) Recovery-based services in a psychiatric intensive care unit—the consumer perspective. Australas Psychiatry 62(5):591–597

    Google Scholar 

  52. Hurley J, Cashin A, Mills J, Hutchinson M, Kozlowski D, Graham I (2018) Qualitative study of peer workers within the ‘Partners in Recovery’ programme in regional Australia. Int J Ment Health Nurs 27:187–195

    Article  PubMed  Google Scholar 

  53. Repper J (2013) Peer support workers: theory and practice. Centre for Mental Health and NHS Confederation Mental Health Network, London

    Google Scholar 

  54. Vandewalle J, Debyser B, Beeckman D, Vandecasteele T, Van Hecke A, Verhaeghe S (2016) Peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services: A literature review. Int J Nurs Stud 60:234–250

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Candelaria Mahlke.

Ethics declarations

Interessenkonflikt

C. Mahlke, G. Schulz, G. Sielaff, R. Nixdorf und T. Bock geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahlke, C., Schulz, G., Sielaff, G. et al. Einsatzmöglichkeiten von Peerbegleitung in der psychiatrischen Versorgung. Bundesgesundheitsbl 62, 214–221 (2019). https://doi.org/10.1007/s00103-018-2875-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00103-018-2875-z

Schlüsselwörter

Keywords

Navigation