Guidelines for the Practice

and Training of Peer Support

The insight and expertise found within this document originated from peer support
workers and peer support organizations across the country. Kim Sunderland was
primary author, with Wendy Mishkin as co-author on the Training Guidelines. Input,
direction and guidance was provided throughout from the Peer Leadership Group.

Acknowledgements
Project Team
Sapna Mahajan, Director Prevention and Promotion Stéphane Grenier, Peer Support Accreditation Certification
Initiatives, Mental Health Commission of Canada Canada and Mental Health Innovation
Kim Sunderland, Executive Director, Peer Support Wendy Mishkin, British Columbia Schizophrenia Society,
Accreditation Certification (Canada) Victoria Branch

Members of the Peer Leadership Group

PROVINCIAL AND TERRITORIAL REPRESENTATIVES

Diana Capponi, Ontario Karon-Ann Parsons, Newfoundland

Theresa Claxton, Ontario Patrick Raymond, British Columbia
Darrell Downton, Saskatchewan Debbie Sesula, British Columbia
Brian Eaton, Yukon Frances Skerritt, Québec
Eugene LeBlanc, New Brunswick Chris Summerville, Manitoba
Roy Muise, Nova Scotia Debbie Wiebe, Alberta

OTHER ADVISORS

Ella Amir, Action on Mental Illness, Québec Laurie Hall, MHCC Service Systems Advisory Committee
Ian Arnold, Peer Support Accreditation Certification Donna Hardaker, Workplace Peer Support Consultant
Canada Karen Liberman, Mood Disorders of Ontario
Liz Atkins, Canadian Mental Health Association, Edmonton Sandy Palinski, Ontario Ministry of Education
Shana Calixte, Northern Initiative for Social Action Deborrah Sherman, Ontario Peer Development Initiative
Andy Cox, The IWK Health Centre Rachel Thibeault, Peer Support Accreditation Certification
Joan Edwards Karmazyn, National Network for Canada and University of Ottawa
Mental Health Fiona Wilson, St. Joseph’s Healthcare, Hamilton
OTHER CONTRIBUTORS

Steve Lurie, Canadian Mental Health Association, London MHCC Service Systems Advisory Committee
Francine Knoops, Senior Policy Advisor, Mental Health
Commission of Canada

Training Guidelines Working Group

Diana Capponi, Centre for Addiction and Mental Health, Wendy Mishkin, British Columbia Schizophrenia Society,
Toronto Victoria Branch
Juan Cargnello, Psychology Consultant, Operational Stress Roy Muise, Self-Help Connection, Nova Scotia
Injuries National Network, Veterans Affairs Canada Don Palmer, British Columbia Schizophrenia Society,
Theresa Claxton, Ontario Association of Patient Councils Victoria Branch
Donna Hardaker, Canadian Mental Health Association Deb Sherman, Executive Director, Ontario Peer
York Region, York Region Development Initiative
John Massam, Coast Mental Health, Vancouver Chris Summerville, Manitoba Schizophrenia Society
and Schizophrenia Society of Canada

This report was prepared by Kim Sunderland with Wendy Mishkin as co-author for the Training Guidelines.

The Mental Health Commission of Canada provided funding.

CITATION INFORMATION
Suggested citation: Sunderland, Kim, Mishkin, Wendy, Peer Leadership Group, Mental Health Commission of Canada. (2013).
Guidelines for the Practice and Training of Peer Support. Calgary, AB: Mental Health Commission of Canada.|
Retrieved from: http://www.mentalhealthcommission.ca

© 2013-2016 Mental Health Commission of Canada

The views represented herein solely represent the views of the Mental Health Commission of Canada.
Production of this document is made possible through a financial contribution from Health Canada

Guidelines for the Practice and Training of Peer Support

Contents
Organization and Overview 4

Purpose 5

Development Of The Guidelines 6

Background 7
Peer Support 8
Value Of Peer Support 11
Using The Recovery Philosophy In Peer Support 12
Family–Based Peer Support 13
Practices Of Peer Support 14
Preparing For Peer Support Of A Formalized Nature 15

Part 1 – Guidelines for the Practice of Peer Support 17

Guiding Values And Principles Of Practice For Peer Support Workers 18
Principles Of Practice 19
The Requirement of Lived Experience and Recovery 21
Recovery 21
Skills, Abilities, And Personal Attributes Of A Peer Support Worker 22
A. Skills, Abilities and Personal Attributes that are derived from Lived Experience 22
B. Skills, Abilities and Personal Attributes that are related to Interpersonal Communication 22
C. Skills, Abilities and Personal Attributes that demonstrate Critical Thinking 22
D. Skills, Abilities and Personal Attributes that are related to Teamwork and Collaboration 23
E. Skills, Abilities and Personal Attributes that are related to Ethics and Reliability 24
 Knowledge And Training Recommendations 25
Knowledge And Skill Development 26
The Value of Connecting With a Community of Practice 26
Overcoming Accessibility Hurdles 26

Part 2 – The Guidelines for Peer Support Training 27

Training For The Two Types of Lived Experience 29
Lived Experience, Self-Awareness and Innate Ability 29
Training Themes 30
1. Fundamental Principles of Peer Support 31
2. Social and Historical Context of Peer Support 34
3. Concepts and Methods that Promote Effective Peer-To-Peer Effectiveness 36
Training Methods 41
Practical Considerations 42
Scheduling 42
Accessibility 42

Summary 43

Glossary 45

Notes 47
Organization and Overview
The introduction provides an overview of the background on peer support and outlines the purpose and preparation
of the Guidelines.

The document is comprised of two sets of guidelines.

Part 1, Guidelines for the Practice of Peer Support, Part 2, Guidelines for the Training of Peer Support,
provides an overview of the elements for the practice of focuses on the training of peer support workers and
peer support, along with the guiding values, principles of outlines the skills and knowledge to be included in training
practice, and skills and acquired abilities to be respected programs designed to prepare someone to provide peer
by all involved in peer support programs that offer a more support.
formal or intentional form of peer support.

Guidelines for the Practice and Training of Peer Support | 4

Purpose
The two sets of Guidelines are intended to provide direction to policy makers, decision makers, program leaders and the
Canadian public about the practice of peer support. The two sets of Guidelines offer elements for the practice of peer support
and an outline of the underlying values, principles of practice, skills and abilities of supporters.

We encourage prospective and practicing peer support workers to consider the set of Guidelines as a roadmap for personal
development, and we encourage administrators to consult the set of Guidelines as they develop or enhance peer support
programs within their organizations.

Both sets of Guidelines focus on a structured form of peer support that fosters recovery. The peer support worker 1 will have
lived experience 2 of a mental health challenge or illness, or is a family member or loved one of someone who does, 3 is in a
positive state of recovery 4 and has developed an ability to provide peer support.

The content of the Training Guidelines parallels the critical elements outlined in the Guidelines for the Practice of Peer Support.

The two sets of Guidelines support Changing Direction, Changing Lives: The Mental Health Strategy for Canada, developed by the
Mental Health Commission of Canada, and are meant to be consistent with its goals for achieving the best possible mental health
and wellbeing for everyone. In particular, Goal Five of the national strategy calls for people to have “equitable and timely access
to appropriate and effective programs, treatments, services, and supports that are seamlessly integrated around their needs.”
This goal recognizes the full range of services and supports, such as peer support, which may provide benefit. Peer support can
be a valuable component on the path of recovery for individuals with a mental health challenge or illness and for their family
members/loved ones.

“Peer support works because people who have experience with mental health problems
and illnesses can offer support, encouragement, and hope to each other when facing similar
situations. Peer support can be offered wherever people need it — at peer-run organizations,
work-places, schools or health care settings.”
MHCC, Changing Directions, Changing Lives: The Mental Health Strategy for Canada, 2012, Priority 3.4, p. 70

Guidelines for the Practice and Training of Peer Support | 5

Development Of The Guidelines
The Mental Health Commission of Canada (MHCC) acts as a catalyst for improving the mental health system and changing the
attitudes and behaviours of Canadians around mental health issues. Through its unique mandate from Health Canada, the MHCC
brings together leaders and organizations from across the country to accelerate these changes.

In September 2010, the MHCC released Making the Case for Peer Support. This report was based on a vast literature review,
as well as input from many of Canada’s peers 5 and peer support workers. The MHCC sought input from more than 600
people across the country in face-to-face consultations, and another 220 people through written and online surveys. The
recommendations of this report included a call for the creation of various sets of guidelines to support the development of
peer support within Canada. Making the Case for Peer Support is frequently referenced in these Guidelines as a source of more
comprehensive background information.

In 2010, the MHCC also launched the Peer Project to learn from the experience of peer support workers across Canada and to
promote peer support as an essential component of mental health services. These Guidelines are an outcome of that project.

The Peer Project hosted face-to-face consultations with peer support workers in seven Canadian cities, and one focus group with
clinicians between August and December 2010. An online survey was then sent to more than 300 people who expressed an
interest in the project, and their responses validated what had been noted during the consultations.

In the summer of 2011, the Peer Project asked more than 300 participants to recommend experienced and respected peer
support workers to represent Canada’s 10 provinces and three territories. As a result, a group was selected to engage in more
detailed consultation and leadership. This peer support leadership group consists of 12 people from 10 provinces and territories.
Other individuals were invited as advisors due to their areas of peer support expertise.

The training guidelines were developed in consultation with a working group of experienced peer support trainers from across
Canada who shared experiential knowledge and insights.

The substance of the two sets of Guidelines grew out of the expertise gained from the face-to-face consultations and the
online survey, and members of the peer support leadership group reviewed and enhanced these Guidelines at various stages
throughout their development.

“Peer support is a system of giving and receiving help founded on key principles of respect,
shared responsibility, and mutual agreement of what is helpful. Peer support is not based
on psychiatric models and diagnostic criteria. It is about understanding another’s situation
empathically through the shared experience of emotional and psychological pain.”
Mead, Hilton, & Curtis, 2001, p. 135

Guidelines for the Practice and Training of Peer Support | 6

Background
PEER SUPPORT

Peer support is a supportive relationship between people who have a lived experience in common. In the case of these two sets
of Guidelines, the experience that individuals or groups have in common is in relation to a mental health challenge or illness. 6
This common experience might be related to their own mental health or that of a loved one.

The peer support worker provides emotional and social support to others who share a common experience. 7 The commonality
may not be in relation to a specific challenge or illness, but rather to the struggle and emotional pain that can accompany the
feeling of loss and/or hopelessness due to a mental illness. Each person is unique in their experience and path towards recovery.

Peer support is rooted in the knowledge that “hope is the starting point from which a journey of recovery must begin.” 8 Peer
support workers can inspire hope and demonstrate the possibility of recovery. They are valued for their authenticity because
they can relate to the challenge and have found their way to recovery.

Recovery focuses on people recovering a quality of life in their community while striving to achieve their full potential. 9
Recovery does not necessarily mean “cure.” It goes beyond the reduction of symptoms and considers an individual’s wellness
from a holistic point of view that includes their relationships, their involvement within community, their general wellbeing and
a sense of empowerment. Peer support focuses on health and recovery rather than illness and disability.

Peer support can be provided in both group and one-to-one relationships, and can take place in community groups, clinical
settings, and workplaces. This range of accessibility is important since living with a mental health problem or illness, or living
with a loved one who has a mental health challenge, influences a person’s day-to-day interactions in their communities, clinics,
workplaces and more.

The person who is seeking support is considered a “peer,” not only because of challenges related to mental health, but also due
to a past or current connection with the community, clinical setting or workplace.

Regardless of its setting, peer support is considered to have value, either on its own or as a complement to clinical care. For
some, peer support may bring all aspects of a person’s journey towards recovery into view. The peer support relationship
may be the first step that an individual takes towards recovery, or it may be introduced years into a person’s journey towards
wellness. The specifics of a peer support relationship will be a unique experience for each individual.

Guidelines for the Practice and Training of Peer Support | 7

VALUE OF PEER SUPPORT

Connecting with another person who has lived with similar problems, or is perhaps still doing so, can be a vital link for someone
struggling with their own situation. 10 Peer support can be an effective prevention strategy, can moderate the effects of life-
challenging events 11 and provide a sense of empowerment. 12, 13, 14 Research also indicates that peer support can help a person
gain control over their symptoms, reduce hospitalization, offer social support and improve quality of life. 15 The information,
empowerment and hope that come from someone who has been in their shoes can help a person better navigate the sometimes
complicated maze of treatments and other forms of assistance.

A peer support worker draws from their experiential knowledge—the happenings, emotions, and insights of their personal lived
experience—as they listen to, interact with and support peers. Research tells us this authenticity helps to create a shift in attitude
and results in greater feelings of empathy and connectedness with the peer support worker than what normally occurs in a
patient-therapist relationship. 16, 17, 18

A peer who interacts with a peer support worker will not only feel the empathy and connectedness that comes from similar life
experiences, but this interaction also fosters hope. Hope in the possibility of a recovery that includes health, wellbeing, quality
of life and resilience.

For family members, this hope is not only for their loved one, but of equal importance, it is also for their own recovery towards
health, wellbeing, quality of life and resilience. Peer support initiatives link families who have a loved one living with a mental
health challenge or illness. Family members, or those in a person’s circle of care, benefit from peer support in a variety of ways,
such as improving their understanding of the mental health system and their ability to support their loved one’s recovery, as
well as their ability to care for themselves. 19, 20, 21

Independent, peer-run organizations play a valuable role, both in providing direct support and by supporting peers working in
mainstream settings. It is imperative to recognize the value of peer-run organizations in this field.

The Mental Health Strategy for Canada recognizes that peer support for people living with mental health challenges and illnesses
can help to reduce hospitalization and symptoms, offer social support and improve quality of life; however, peer support gets
very limited funding. The development of guidelines and standards of practice for peer support will enhance the credibility of
peer support as an essential component of a transformed mental health system and encourage its use. 22, 23, 24

“It helps to be able to talk to someone who understands what you are going through
and who will not judge you.”
Cargnello, J. (nd). Peer Helper Training: A Trainer’s Manual; National Centre for Operational Stress

Guidelines for the Practice and Training of Peer Support | 8

Illness-Centred Approach
The diagnosis is the foundation.

e Begin with illness assessment

e Services are based on diagnosis and treatment needed

e Services work toward illness-reduction goals

e Treatment is symptom driven and rehabilitation is

disability driven

e Recovery from the illness sometimes results after the

illness, and then the disability is taken care of

e Track illness progress toward symptom reduction and cure

e Use techniques that promote illness control and reduction

of risk of damage from the illness

e Services end when the illness is cured

e The relationship only exists to treat the illness and must be

carefully restricted throughout, keeping it professional

Guidelines for the Practice and Training of Peer Support | 9

Person-Centred Approach
The relationship is the foundation.

e Begin with welcoming – outreach and engagement

e Services are based on the person’s experience and the

help they request

e Services work toward quality-of-life goals

e Treatment and rehabilitation are goal driven

e Personal recovery is central from beginning to end

e Track personal progress toward recovery

e Use methods that promote personal growth and

self-responsibility

e Peer support is voluntary; people engage or disengage

as they choose.

e The relationship may change and grow throughout and

continue even after services end

Adapted from Ragins, M., The Recovery Model. Handouts and Reference Materials, MHA Village Integrated
Service Agency, a program of the National Mental Health Association of Greater Los Angeles.

Guidelines for the Practice and Training of Peer Support | 10

USING THE RECOVERY PHILOSOPHY IN PEER SUPPORT

Peer support strives for recovery and, in doing so, it considers the wellness of the whole person. Empowering relationships,
engagement in meaningful activities, and an ability to experience happiness are all part of recovery. The reduction or elimination
of symptoms may be an important goal, but it is only one aspect of the person’s experience.

The philosophy of peer support is that each individual has an innate desire to find a path towards recovery, improved health and
wellbeing, and has within themselves the knowledge of what will work for them. The peer support worker supports that person
as they find that inner knowledge and reignite that hopeful desire.

This is also true for family-based peer support. A family member or loved one can benefit from support provided by someone
who has walked in their shoes as they discern the right path for themselves in relation to their loved one. For them, the recovery
path is not only about their own mental wellness, but also includes a greater level of confidence and trust in their loved one’s
abilities to move forward towards a more holistic and healthy life.

Peer support recognizes that wellness is a full life experience. Peer support is intended to complement traditional clinical care,
and vice versa.

Mark Ragins, MD, outlines his understanding of key differences between a holistic recovery approach and a more traditional,
illness-centred approach in “The Recovery Model.” 25 This comparison highlights the ways peer support workers can complement
a more traditional medical approach and, in turn, enhance the recovery experience for the peer.

Ragins refers to a recovery-oriented, person-centred approach, where the relationship (rather than the diagnosis) is the
foundation and services offered are focused on quality-of-life goals (rather than illness-reduction goals). Recovery-oriented
techniques promote personal growth, recognizing that the techniques used within an illness-centred approach are focused on
illness control. Some of the differences identified may seem subtle, but can have an important impact on the person who is
striving to find hope for a better outcome.

Recovery is “a process of change through which individuals improve their health and
wellness, live a self-directed life, and strive to reach their full potential.”
http://www.samhsa.gov/newsroom/advisories/1112223420.aspx

“Recovery is a process through which people find ways of living meaningful lives with or
without the ongoing symptoms of their condition. Helping someone recover is not just about
managing symptoms, it includes helping people find a job, getting them somewhere safe to
live and developing supportive relationships with family.”
http://www.centreformentalhealth.org.uk/news/2012_personalisation_paper.aspx

Guidelines for the Practice and Training of Peer Support | 11

Even as clinical practices strive towards a more balanced and person-centred approach, a peer support worker with lived
experience can offer a unique perspective and a more equal and empowering recovery-oriented relationship.

Empowerment and a recovery orientation of this nature are critical elements of peer support. The empowerment that results
from a greater sense of hope and kinship is supported by studies showing that the most powerful themes in recovery are
people’s own personal resourcefulness and relationships, or roles that reinforce their belief in themselves. 26

This holistic and empowering philosophy honours the uniqueness of each person’s experience and path towards recovery. What
matters most is the peer’s experiences and perceptions, and helping them to explore the paths towards recovery that they feel
are best for them.

The Making the Case for Peer Support report outlines the social determinants and consequences of mental health problems. Peer
support attends to the full complement of healthy living, recognizing that recovery from the consequences of poor mental health
is as important as recovering from the illness itself. Peer support considers recovery to include good health and a healthy quality
of life.

This orientation towards a holistic recovery is strengthened when conveyed by a peer support worker who shares a common
lived experience. A strong sense of connectivity and empowerment can result from hearing “I’ve been there and found my way,
and I believe you can too.” or “Like you, someone I love has challenges with their mental health.”

“Peer support is about providing all the tools besides medication — the tools for
the other 80% of your life.”
Mental Health Commission of Canada, Making the Case for Peer Support, 2010, p. 46

Guidelines for the Practice and Training of Peer Support | 12

FAMILY–BASED PEER SUPPORT

Peer support is often spoken of in relation to a person’s individual challenge with mental health. However, family-based peer
support is equally important. Founded on the same principles as peer support for people with their own mental health concerns,
family–based peer support recognizes the struggle that members in a person’s circle of support experience in relation to the
mental health challenge or illness of a loved one.

Family members often find themselves trying to understand the illness, and support their loved one, while striving to honour his
or her right for self-determination. In some cases, families are required to assume an even more intensive caregiving role when
the individual may be unable to care for him/herself.

This stress can be overwhelming and is associated with both the actual caregiving activities, and the emotional turmoil
associated with the illness.

The idea of recovery is approached from a slightly different perspective. The family member strives to recover from the
emotional turmoil, grief and/or fatigue that may result from caring for someone with a mental health challenge or illness. The
family member’s path to their own mental wellness or recovery is likely to be enhanced by a better understanding of their loved
one’s illness and through the development of more effective coping skills. Greater confidence, accepting the situation, and having
hope for their loved one will help them to be more effective caregivers and supporters, while also helping them to sustain their
own wellbeing. We refer to this as having achieved a level of readiness.

Family–based peer support often takes place in groups where empathetic understanding and experiential knowledge are shared
in a non-judgmental and supportive manner with others who are in similar situations. While someone with lived experience
provides peer support to an individual with a mental health challenge, family members of a loved one with lived experience
provide peer support to other families.

Family–based peer support workers may require slightly different preparation and/or skills to fully understand the unique needs
of caregivers.

Guidelines for the Practice and Training of Peer Support | 13

PRACTICES OF PEER SUPPORT

The following section provides a brief synopsis of the growing body of literature surrounding the various types of peer
support in order to more clearly specify the type of peer support being referred to within these two sets of Guidelines. For a
thorough review of the many approaches to peer support, please refer to the Making the Case for Peer Support report, found
on the MHCC website.

The various types or formats of peer support are often described as falling along a spectrum ranging from informal support
among acquaintances through to formal peer support within a structured organizational setting. One of the determinants in
defining the type of peer support is mutuality (the mutual benefit), which results from an equal and sharing relationship. Another
key factor is the degree of preparation, as well as an intention or plan to make oneself available for peer support work (see
Figure 1).

“Friendship” and “Clinical Care” are specified at either end of the spectrum. The range of peer support options begins with
“informal peer support” when acquaintances notice the similarity of their lived experience with mental health challenges and
therefore listen to and support each other. This type of interaction is more focused than a typical friendship may be. At the other
end of the spectrum is peer support within a structured clinical setting, in which there may be a program where peer support
workers make a connection with patients based on similarity of lived experience, and offer the opportunity for a supportive,
empowering relationship.

At the end of the spectrum closest to “friendship”, true mutual benefit is found when two or more people share similar challenges
(either personally or in relation to loved ones) as each strives to find a path towards wellbeing, while supporting one another.
Participants are drawn together by what they have in common and neither is more experienced or better prepared to offer
support than the other. Hence, the authentic nature and mutual benefit that comes from empathetic support is more identifiable.
This may be considered a more informal, less structured relationship providing peer support that is of a true reciprocal, (or give-
and-take), nature (see below).

The two sets of Guidelines are intended for the type of peer support that falls at the more formal end of the spectrum.

The types of organizations that intentionally offer peer support vary. Examples include clinical organizations, community
organizations and workplaces. There are many community organizations 27 that are very focused on providing peer support in
a structured manner, while others may have a different focus with peer support naturally happening on a more reciprocal, less
formal manner. Both approaches provide the benefits of hope, empowerment and community that are a part of peer support,
and each approach has unique advantages.

The values, principles of practice, and skills and abilities of peer support workers apply to all types of peer support and all
types of organizations that offer peer support.

Guidelines for the Practice and Training of Peer Support | 14

PREPARING FOR PEER SUPPORT OF A FORMALIZED NATURE

Peer support of a formalized nature assumes that a peer support worker will learn how to ensure that the critical aspects
of hopefulness, recovery-orientation, empowerment, non-judgmental acceptance, and trust are promoted within the peer
support relationship.

The complementary Training Guidelines provide additional information and considerations for preparing for the role of
peer support worker. In addition to the above, other important components include:

• knowledge about limits and boundaries for the sake of each individual within the relationship;

• an understanding of the importance of self-awareness and self-care to maintain wellness and resilience, and avoid
relapse as much as it is possible to do so; and

• an understanding of how to prepare with the peer for the end of the peer support relationship.

One challenge of this type of more formal peer support is that the relationship may become, or be perceived to be, unequal
where the supporter is considered to have an agenda for the other person’s recovery or more power in the relationship.
Adherence to the guiding values and principles of practice for peer support by the peer support worker will help to ensure
that an organic approach based on equality and self-determination is maintained within the relationship.

The two sets of Guidelines have been developed to help ensure that the approach to this more formal type of peer support
is fully understood by those involved in its delivery. It is critical to protect and promote the following guiding values and
principles of practice within peer support programs.

“Independent, peer–run community organizations play an essential role both by

providing peer support directly and by supporting peers working in mainstream settings.”
O’Hagan M., Cyr, C., McKee, H., & Priest, R. (2010). Making the Case for Peer Support: Report to the Peer Support Project
Committee of the Mental Health Commission of Canada. Calgary, AB: Mental Health Commission of Canada. Retrieved from
http://www.mentalhealthcommission.ca/English/document/445/making-case-peer-support

Guidelines for the Practice and Training of Peer Support | 15

 Figure 1: Spectrum of Types of Peer Support

INFORMAL PEER SUPPORT

Naturally occurring, voluntary, reciprocal relationship(s) with peers one-to-one
or possibly in a community

CLUBHOUSE/WALK IN CENTRE
Mainly psychosocial and social recreational focus with peer support naturally
occurring among participants
FRIENDSHIP

SELF-HELP, MUTUAL PEER SUPPORT

Consumer operated/run organizations/activities/programs, voluntary, naturally
occurring, reciprocal relationships with peers in community settings e.g., housing,
PEER SUPPORT

social/recreational, arts/culture, traditional/spiritual healing, recovery education/

work, anti-discrimination education/work, human rights/disability rights
education work

FORMALIZED/INTENTIONAL PEER SUPPORT

CLINICAL CARE

Consumer run peer support services within community settings (either group or
one-to-one) focusing on issues such as education, employment, MH systems
navigation, systemic/individual advocacy, housing, food security, internet,
transportation, recovery education, anti-discrimination work, etc.

WORKPLACE PEER SUPPORT These guidelines

are focused on
Workplace-based programs where employees with lived experience are selected
this segment
and prepared to provide peer support to other employees within their workplace that provides a
more formal and
COMMUNITY CLINICAL SETTING PEER SUPPORT intentional style
Peer support workers are selected to provide support to patients/clients that of peer support
utilize clinical services, e.g., Outpatient, A.C.T teams, Case Management, Counselling

CLINICAL/CONVENTIONAL MH SYSTEM-BASED PEER SUPPORT

Clinical setting, inpatient/outpatient, institutional peer support, multidisciplinary
groups, recovery centres, or Rehabilitation Centres Crisis response, Crisis
Management, Emergency Rooms, Acute Wards

Guidelines for the Practice and Training of Peer Support | 16

 Part 1:
Guidelines for the Practice
of Peer Support
These Guidelines are intended for peer support of a
formalized nature. They provide insight into the value of
lived experience and the importance of a peer support
worker’s skills, abilities, and personal attributes.

“When a person feels that they are truly accepted by another, as they are, then they are
freed to move from there and to begin to think about how they want to change, how they
want to grow, how they can become different, how they might become more of what they
are capable of being.”
Adapted from Thomas Gordon 1970, 1975, 2000 p. 38 http://www.gordontraining.com

Guidelines for the Practice and Training of Peer Support | 17

GUIDING VALUES AND PRINCIPLES OF PRACTICE FOR PEER SUPPORT WORKERS

These Guiding Values are designed to embody the main pillars of peer support and will inform the code of conduct and principles
of practice.

The Making the Case for Peer Support report notes that many peer support workers “are afraid that peer support values will be
destroyed if peer support becomes too professionalized. On the other hand people recognized that peer support needs to grow
and become more standardized, with nationally recognized training and standards that can be adapted at the provincial level.” 29

As with any role, it is possible that, over time, the peer support being offered may slip into a type of interaction that no longer
honours the original intent. This is one reason that these Guidelines have been created with guiding values. They may be used as
a checkpoint to remind and encourage all members of a peer support program of the critical elements that must be honoured.

Making the Case for Peer Support identified three primary values as consistent across the literature review and survey of peer
support workers:

• Self-determination and equality • Recovery and hope

• Mutuality and empathy

The following list of values best define peer support in the view of leaders involved in this project:

• Hope and recovery – acknowledging the power • Dignity, respect and social inclusion – acknowledging
of hope and the positive impact that comes from the intrinsic worth of all individuals, whatever their
a recovery approach background, preferences or situation

• Self-determination – having faith that each • Integrity, authenticity and trust – noting that
person intrinsically knows which path towards confidentiality, reliability and ethical behaviour are
recovery is most suitable for them and their honoured in each and every interaction
needs, noting that it is the peer’s choice whether • Health and wellness – acknowledging all aspects of
to become involved in a peer support relationship a healthy and full life
• Empathetic and equal relationships – noting that • Lifelong learning and personal growth – acknowledging
the peer support relationship and all involved the value of learning, changing and developing new
can benefit from the reciprocity and better perspectives for all individuals
understanding that comes from a similar lived
experience

Each organization should create its own list of guiding values; it may choose to incorporate other attributes as it sees fit.

Guidelines for the Practice and Training of Peer Support | 18

PRINCIPLES OF PRACTICE

The principles of practice flow from the guiding values and further define the intent of the support being provided. They embody
the character of the relationship and the philosophy of peer support work.

The principles of practice are written from the perspective of the peer support worker, but also direct the principles of practice
for a program or an organization. These principles should guide and inform program administrators in policy decisions.

Principles of practice for the work of peer support:

• Recognize the importance of an individual • Use recovery-based language and interact in a manner
approach to recovery, respect where each that focuses on the peer’s journey to a more hopeful,
individual happens to be in their own journey of healthy and full life, rather than focusing on symptoms,
recovery, and recognize that the goals, personal diagnosis, and/or an objective set by someone other than
values, beliefs and chosen path of the peer may the peer
not be the same as their own • Share aspects of their lived experience in a manner that
is helpful to the peer, demonstrating compassionate
• Honour and encourage self-determination by
understanding and inspiring hope for recovery
working with the peer to co-create and explore
options rather than simply providing direction, and • Practice self-care, monitor their own wellbeing and be
empower the peer to take steps forward on their aware of their own needs for the sake of their mental
own rather than “helping” by doing it for them health, recognizing the need for health, personal growth,
and resiliency when working as a peer support worker
• Interact in a manner that keeps the focus on the
peer rather than on themselves, and maintain • Use interpersonal communication skills and strategies
a peer relationship that is open and flexible, to assist in the development of an open, honest, non-
making themselves available as necessary to a judgmental relationship that validates the peer’s feelings
reasonable extent and perceptions in a manner that cultivates trust and
openness

“Those of us who have been diagnosed are not objects to be acted upon. We are fully
human subjects who can act and in acting, change our situation. We are human beings and
we can speak for ourselves. We have a voice and can learn to use it. We have the right to
be heard and listened to. We can become self-determining. We can take a stand toward what
is distressing to us and need not be passive victims of an illness. We can become experts in
our own journey of recovery.”
Deegan, P. (1996). Recovery as a Journey of the Heart. Psychiatric Rehabilitation Journal, Vol. 19 Issue 3, pp. 91-97

Guidelines for the Practice and Training of Peer Support | 19

 • Empower peers as they explore possibilities • Collaborate with community partners, service providers
and find their path towards a healthier and and other stakeholders, and facilitate connections and
happier outcome with the eventual objective of refer peers to other resources whenever appropriate
encouraging disengagement from the peer support
• Know personal limits, especially in relation to dealing
relationship when the time is right for the peer with crises, and call for assistance (in a collaborative
• Respect the various positive interventions that manner) when appropriate
can play a role in promoting recovery • Maintain high ethics and personal boundaries in relation
• Respect professional boundaries of all involved to gift giving, inappropriate relations with peers (e.g.,
when exploring with the peer how they might romantic or sexual intimacy), and/or other interactions
interact with these other professionals when or activities that may result in harm to the peer or to the
questions or concerns arise image of peer support

• Participate in continuing education and personal

development to learn or enhance skills and strategies
that will assist in their peer support work

“For me a key principle of peer support means working from a position of choice and therefore
respecting the choices each individual makes. It is a principle of peer support to encourage
self–determination and respect the fact that people will make their own choices, whether or
not I, as their peer support worker, agree or would choose the same for myself. I hold respect
for every human being; for their capabilities, their possibilities, their hopes and dreams, for
the humanity that connects everyone, so I can respect a field or an intervention because
there are people behind it, and a peer has identified it as their choice.”
Theresa Claxton, Ontario Association of Patient Councils

“The principle of self-determination is equally important for family-based peer support, however
it stems from the recognition that the focus of the support is the family caregiver (rather than
the ill loved one). The family peer support worker helps family caregivers understand their own
needs and options, so they can decide what is best for their situation. As they determine what’s
right for them, family caregivers also understand and respect their ill loved one’s right for self-
determination. This is often a fine balance and unique for each situation.”
Ella Amir, AMI Québec

Guidelines for the Practice and Training of Peer Support | 20

THE REQUIREMENT OF LIVED EXPERIENCE AND RECOVERY

For a peer support worker, lived experience with a mental health challenge or illness (either personally or in relation to a family
member or loved one) is a fundamental requirement.

The peer support relationship is based on the connection and understanding that comes from having experienced a similar challenge.
It is for this reason that those with personal lived experience support others who are in the midst of their own illness or challenges,
and those with lived experience as a family member or loved one support others who also are family members or loved ones.

Peer support is focused on striving for recovery rather than on the specific illness or symptoms. Therefore, the peers do not
necessarily need to share the same diagnosis, but rather will find common ground in the challenges and issues that may accompany
the illness or mental health challenge, such as stigma, loss of career or family, and/or loss of independence and hope.

An equally important aspect of lived experience is the degree of recovery and readiness of the peer support worker. The peer
support worker will have lived through not only ill health and the issues that accompany it, but also a transition towards hopefulness
and onto a path of recovery. The recovery aspect of their life journey also provides many insights and will help to inform their
knowledge as they support others.

The guideline for lived experience and recovery should not be diagnosis-based, but rather assessed by discussion about past
experiences and emotions, and their relevance to the environment in which they will be working.

Recovery
Recovery will also be assessed through discussion about self-care and resiliency strategies, as well as an ability to determine
when stressors or stress levels are reaching an unhealthy level. 30

Recovery is a dynamic process, therefore a peer support worker is said to be on a path of recovery and considered to be far
enough along on that path when they have an ability to detect when they are in need of a health break.

Describing recovery or readiness within the context of peer support is done in an individual manner that considers factors such
as personal growth and the environment in which the person will be interacting.

Recovery would incorporate:

• a sense of hope for the future, rather than • a self-awareness that allows a person to know when
hopelessness, allowing peer support workers to stressors or stress levels are becoming unhealthy
be beacons of hope for others • a confident and empowered sense of self within their
• a sense of mastery over one’s life that includes relationships and their community that contributes to
self-care and resiliency strategies to help maintain quality of life
a sense of wellness and emotional health, even if • a readiness and ability to share aspects of their own
mental health challenges and/or symptoms are lived experience in a manner that is helpful to the peer
still present and keeps the focus on the peer’s experience

Guidelines for the Practice and Training of Peer Support | 21

“You cannot truly empathize with the recovery process by only studying or reading about it, the same
way that you cannot truly empathize with the impact of hopelessness unless you have lived it”
Diana Capponi, Centre for Addiction and Mental Health, Toronto

SKILLS, ABILITIES, AND PERSONAL ATTRIBUTES OF A PEER SUPPORT WORKER

Peer support workers will demonstrate innate abilities and acquired skills that make them suitable for peer support of this more
formal nature.

A. Skills, Abilities and Personal Attributes that are derived from Lived Experience
The primary personal attribute necessary to provide quality peer support is lived experience with a mental health challenge or
illness (either personally or through a loved one), accompanied by the experience of finding a path of recovery.

Skills, abilities and attributes include:

• a sense of hopefulness and a strong belief in the • an ability to detect when their own stressors or triggers
possibility of recovery may be resulting in unhealthy or unwanted attitudes
or behaviours, coupled with a willingness to request
• a personal commitment to self-care through stress
assistance and/or take steps to work towards recovery
management and resiliency strategies to maintain
health and wellbeing, and a recognition that each • an ability to relate to the experience and challenges of the
peer whom they support will need to find their peer as a result of their own life experience
own unique approach to self-care

B. Skills, Abilities and Personal Attributes that are related to Interpersonal Communication
Interpersonal communication is critical to building open, honest, non-judgmental and trusting peer relationships.

Skills, abilities and attributes include:

• a personal demeanour that is warm, empathetic • interactions that respect the peer’s right to self-
and non-judgmental, demonstrating a genuine determination and empower the peer to explore options
interest in their peer and valuing their peer as an and co-create new ideas on how to proceed, rather than
equal and a whole person providing advice or having a personal agenda of what
should be accomplished
• communication and listening skills that
encourage honesty, openness and clarity for full • an ability to know when the time is right to share aspects
understanding of the situation being discussed, of their own lived experience in a manner that provides
while honouring personal integrity relevant insight and/or hopefulness while keeping the
focus on the peer and their situation

Guidelines for the Practice and Training of Peer Support | 22

C. Skills, Abilities and Personal Attributes that demonstrate Critical Thinking
Critical thinking is used when a peer support worker engages a peer and tries to understand as clearly as possible the issue that
is being discussed. This may include working with a peer to uncover other possible underlying issues when and if the peer is
ready to do so.

Skills, abilities and attributes include:

• an ability to encourage open and forthcoming • unconditional respect for whatever issue a peer may
dialogue with a peer using communication styles bring forward, recognizing that it is important to the peer
and skills to improve understanding, and help a and should not be judged as serious or minor, coupled
peer to discuss other concerns that the peer may with an ability to turn a request for advice into an
initially find difficult to share opportunity for the peer to explore options

• an ability to determine the true needs of the peer, • an ability to detect when a peer is in or approaching
including if the peer only wishes to talk about a crisis situation, working with the peer to explore
their stressors or if they are ready to explore alternative paths if possible, and/or knowing when
options and consider how to initiate changes the situation has escalated to a point where additional
resources are required

D. Skills, Abilities and Personal Attributes that are related to Teamwork and Collaboration
Teamwork and collaboration is shown when a peer support worker works with a peer to explore the potential benefits of
connecting with other community and clinical options. It also includes respecting the limits and boundaries of the peer support
role. Peer support workers understand the benefits that can come from collaborating with others and use resourcefulness and
good judgment while doing so.

Skills, abilities and attributes include:

• an ability to learn about other community support • a degree of self-confidence and initiative, coupled with
systems, understand how they may help, and a desire to learn from others, that results in an ability
provide the information as an option for the peer to both give and receive opinions and a commitment to
to consider, while respecting the peer’s right to work through whatever challenges might arise
self-determination

• a clear understanding of a peer support worker’s

area of responsibility and expertise compared to
the responsibility and expertise of others, such
as clinical professionals, when collaborating and/
or when discussing with the peer the advice of
others

Guidelines for the Practice and Training of Peer Support | 23

E. Skills, Abilities and Personal Attributes that are related to Ethics and Reliability
Personal integrity and an authentic compassion for the peer will ensure that the relationship is grounded in ethical and
trustworthy attitudes and actions, including an unwavering support of the personal growth of the peer.

Skills, abilities and attributes include:

• high regard for the emotional and physical safety • a commitment to personal development and learning
of the peer, ensuring that confidentiality is always more about the practice of peer support, taking
protected within legal limits advantage, whenever possible, of relevant educational
and training opportunities.
• a commitment to ensure all interactions with
a peer are appropriate (e.g., interactions are • consistent demonstration of a belief in the guiding values
empowering and trustworthy and never sexual and principles of practice found in these Guidelines, as
or romantically intimate), and are intended to well as a genuine willingness to follow a Code of Conduct
protect and promote the safety and recovery of based on these values
the peer

• unconditional respect for the peer, their efforts

and their time by working with them to develop
a relationship that is dependable, flexible and
considerate of the needs of both the peer and the
peer support worker

“And so we go into doing peer support with a focus on learning rather than helping, with an
attention to the relationship rather than on the individual and onto creating opportunities for
hope and possibility rather than fear and power and control…or at least we try.”
Shery Mead, http://www.peersupportvic.org/research-directory/research-directory/ips-a-personal-retrospective

Guidelines for the Practice and Training of Peer Support | 24

KNOWLEDGE AND TRAINING RECOMMENDATIONS

Peer support workers should be encouraged to gain knowledge and further develop skills when opportunities are available.
This may mean introductory training, and ongoing learning and skills development throughout the duration of being a peer
support worker.

An introductory peer support knowledge and training session can assimilate the skills, abilities and personal attributes identified
in these Guidelines. The Training Guidelines for Peer Support Workers provides additional information that could be included in
a basic peer support training course.

A full complement of training modules would include:

• Basic peer support training, to provide an • A peer support program that values ongoing
overview of the role and responsibilities of a development will also include annual training
peer support worker and to enhance the worker’s workshops to:
communication, interaction, decision making and • facilitate networking of peer support workers,
support skills
• promote ongoing self-care, and
• Family peer support training, to provide an
• provide additional skills training opportunities
overview of the special circumstances that may
arise within family/circle of care support

• Crisis management training, to provide knowledge

on how to identify and safely manage a crisis
situation

“A Community of Practice (COP) exists when a group of peer support workers who value peer
support of this intentional nature meet on a regular basis (preferably face-to-face) to support
each other, share knowledge and experiential learning, and, most importantly, keep each
other committed to, and consistent with, the values and principles of practice of mental health
peer support.”
Kim Sunderland, Peer Support Accreditation and Certification (Canada)

Guidelines for the Practice and Training of Peer Support | 25

KNOWLEDGE AND SKILL DEVELOPMENT

The following components are important to consider:

• Knowledge – Learning the concepts of recovery, • Skill Development – The development of skills in areas
resilience, self-determination and emotional such as interpersonal communication, supporting
wellbeing will inform an ability to support change, collaboration and critical thinking is the ultimate
peers. In addition, learning the key concepts objective of the training.
related to building supportive relationships
and interpersonal communication will assist in
skill development. Being aware of local support
systems will also better prepare peer support
workers for the role.

THE VALUE OF CONNECTING WITH A COMMUNITY OF PRACTICE

Ongoing personal development will occur over time as a peer support worker strives to improve and learn from all peer
interactions. However, there is a risk of stagnation, burnout and/or straying from the authenticity of peer support. Peer support
workers working somewhat independently over time, possibly within challenging environments, may lose sight of some of the
critical characteristics of peer support, such as self-determination, non-judgmental empathy and recovery-oriented hopefulness.

It is for this reason that maintaining a connection with a “community of practice” is recommended. The camaraderie experienced
within a group of like-minded individuals who share similar values and lived experience can help to maintain the health,
hopefulness and wellness of its members, provide opportunity for learning and the sharing of wisdom, and remind each other of
peer support’s guiding values.

Organizations with peer support programs should facilitate and encourage their peer support workers to maintain a connection
with a peer support community of practice.

OVERCOMING ACCESSIBILITY HURDLES

Even though peer support is becoming widely known and more accessible, there are still many regions without formal peer
support programs and many groups of people who are unaware of, or unable to connect with, a peer support worker.

Making the Case for Peer Support refers to the challenge of accessibility in more detail. These Guidelines wish to highlight the
challenge of accessibility for the purpose of encouraging decision makers, peer support program managers and peer support
workers to determinedly and creatively strive to overcome accessibility issues wherever possible.

Guidelines for the Practice and Training of Peer Support | 26

Part 2:
The Guidelines for
Peer Support Training
Peer support is grounded in the values of hope, recovery,
empathy and self-determination, with a recognition that
interpersonal communication skills, critical thinking and
an ability to support personal growth can enhance a
peer relationship. Underlying these values and skills is
a strong commitment to ethics, an understanding of the
peer support role and a non-judgmental approach.

Guidelines for the Practice and Training of Peer Support | 27

Respect for Ethics and the Peer Support Role
Non-Judgemental Approach

A self-aware training participant

will already instinctively know
the value of hope, recovery,
empathy and self-determination as
Hope Interpersonal
a result of their lived experience,
Recovery communication
but one purpose of training is to
Empathy Critical thinking better understand the impact on
Self-determination Supporting change their peers of supporting these
principles. Peer support training
will enhance understanding and
skill development of these and
many more principles.

Guidelines for the Practice and Training of Peer Support | 28

TRAINING FOR THE TWO TYPES OF LIVED EXPERIENCE

The recommended training components within these Guidelines are relevant for all peer support workers, whether they have
personal lived experience with mental health challenges or illness, or lived experience as members of a person’s circle of support.

Organizations will choose whether to integrate the two groups into one training group depending on the populations they serve.

LIVED EXPERIENCE, SELF-AWARENESS AND INNATE ABILITY

The formal objectives of training are to share knowledge and develop skills, but the reality is that each participant contributes
to the learning and development process in a very personal and insightful manner. With the criteria of lived experience, the
participants will grow and develop through the recognition and integration of several components:

• Lived Experience 31 – The recollection of, and insights gained from, each participant’s personal experience and recovery
path will enhance their understanding of concepts being presented. As discussions and experiential learning occurs,
participants will also learn from the insights shared by others.

• Self-Awareness – Each participant will enter training with a certain degree of awareness of their personal stressors,
resilience strategies, areas of strength and areas still requiring attention. This self-knowledge has likely been heightened
as a result of their lived experience and recovery path, and training has the potential to further develop each person’s
ability to be more self-aware.

• Innate Interpersonal Communication Skills – Interacting with and supporting others is a normal social function.
Participants will likely have already been in supportive relationships and have discovered an innate ability and a strong
desire to help others. The goal in training is to further enhance each person’s natural approach, making them aware of
potential pitfalls and different strategies so they can build on their existing strengths.

Recognizing the gifts that each participant brings will encourage a training opportunity that promotes mutual benefit and
authentic support.

To speak and truly understand the relevance of the material, not only should a training facilitator have excellent training skills
and a strong ability to facilitate group learning, but lived experience with mental health challenges or illness and recovery should
also be represented. Two or more facilitators may be required to ensure all facets of experience (lived, peer support and training/
facilitation) are incorporated, but it is preferable that each facilitator possesses all three qualities.

.
“When the groups are combined there is an opportunity to learn from each other’s perspective.
However, it is recommended that for role play or other experiential activities, family supporters
pair up with family supporters and those with personal lived experience pair up with others
with personal lived experience. This will enhance the practice experience for both.”
Juan Cargnello, Psychology Consultant, OSINN, Veterans Affairs Canada

Guidelines for the Practice and Training of Peer Support | 29

TRAINING THEMES

The recommended training components within these Guidelines are relevant for all peer support workers, whether they have
personal lived experience with mental health challenges or illness, or lived experience as members of a person’s circle of support.

1. Fundamental Principles of Peer Support

Discussion of how fundamental principles such as the gift of lived experience, the power of hope, the concept of recovery
and the value of self-determination set the stage for the remainder of peer support topics. An understanding of peer
support values and ethics, and the range of settings in which peer support can take place, also enhances a prospective
peer support worker’s understanding of their role.

2. Social and Historical Context of Peer Support

Peer support happens in the context of human relationships where each person brings the impact of their life experience.
This lived experience might include discrimination, stigma, social exclusion, poverty, trauma and much more. A peer
support worker who understands the broader social and historical context of these experiences and grasps their potential
impact will be better prepared to support others.

3. Concepts and Methods that Promote Peer-to-Peer Effectiveness

Peer support relies on interpersonal communication, building trust within relationships and supporting another person
as they choose to take steps towards change and recovery. Peer support workers often have an innate ability to do this,
but these skills can be enhanced through sharing knowledge and learning through experience. Other areas of importance
include negotiating limits and boundaries within a peer relationship, collaborating with community resources and building
resilience through self-care. Resilience and self-care are equally important for the peer support worker to foster their own
wellness as they do this important work.

Each of these themes is expanded upon and discussed in more detail in the sections that follow.

.
“Peer support is not scripted. It does not follow steps. It is about relationship. It comes from the
heart through insight and knowledge gained from experience.”
Wendy Mishkin, Peer Support Consultant, BCSS Victoria

Guidelines for the Practice and Training of Peer Support | 30

1. FUNDAMENTAL PRINCIPLES OF PEER SUPPORT

1.1 Lived Experience, Hope, and Recovery

Hope, recovery and the credibility that comes with common lived experience are distinguishing characteristics of peer support.
Whether the common experience is one’s own mental health challenge or that of a loved one, a peer support worker mirrors a
hope-filled vision of future possibilities and can inspire the peer to take steps towards recovery from the experience.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• understanding recovery and how this holistic, • promoting and maintaining a recovery-orientation
person-centred approach complements a purely within a peer support relationship
clinical approach to mental health • understanding how the recovery vision also applies
• awareness of how the peer support worker to those who are within a person’s circle of support.
provides credibility and mirrors hope

“Peer support is not scripted. It does not follow steps. It is about relationship. It comes from the heart
through insight and knowledge gained from experience.”
Wendy Mishkin, Peer Support Consultant, BCSS Victoria

1.2 Self-Determination and How to Foster It

Self-determination is an individual’s right to determine their own fate, including courses of action, treatments and supports. This
principle requires the peer support worker to ensure that the peer’s choice is honoured while working together with the peer to
explore options.

When providing family-based peer support, it is important to help an individual balance their need to do what they feel is best
under a given circumstance, while helping them to learn more about the potential value of respecting their loved one’s choices
(if they are ready to do so). 32

The objective of training is to increase awareness, teach concepts and develop skills related to:

• understanding the concept of self-determination • ensuring that it is the peer’s needs, not those of the
and how to support it throughout the peer peer support worker, that are being addressed
relationship • recognizing that “individuals are unique with distinct
• identifying and overcoming the challenges of using needs, strengths, preferences, goals, cultures, and
a self-determination approach backgrounds (including trauma experiences) that
affect and determine their pathway(s) to recovery” 34
• using strategies that empower the peer (e.g., using
strategies which support their peers to have
increased power and control over their own lives 33)

Guidelines for the Practice and Training of Peer Support | 31

“Peer support is an ideal fit with a self–determination approach because people make good decisions
when they are free of shame and blame. A fundamental aspect of peer support is that it provides
a relationship and ongoing exchange that purposely avoids shame and blame. Within this safe and
non–judgmental space peers are more likely to make positive, healthy decisions. In a peer support
relationship peers are heard and valued, and regarded as whole human beings.”
Hardaker, D. (2012). Self-Determination and Peer Support. www.donnahardaker.com

1.3 Peer Support Values, Ethics and Principles of Practice

Acting in an ethical and honourable manner helps a peer support worker to create and maintain a safe, trusting and effective peer
support relationship. Aligning with the values and principles of practice found in the Guidelines for the Practice of Peer Support, and an
organizational Peer Support Code of Conduct or Ethics consistent with these values, is critical.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• understanding the meaning, significance and • understanding the elements of a Code of Conduct or Ethics
implications of the values and principles of practice for peer support workers and critically analyzing where
challenges and uncertainties may arise, especially in
ambiguous situations

1.4 Trauma-Informed Practice

A peer support worker who understands the impacts of trauma and uses trauma-informed practices 35 will be less likely to
unintentionally re-traumatize a peer and more likely to support healing. Providing a safe opportunity for a peer to talk about what
happened to them, rather than what is wrong with them, if they choose to do so, can be validating and healing for the peer. It can also
help to ensure that causes of psychological distress are not overlooked.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• recognizing the prevalence and impact of trauma • understanding how a peer’s trauma may affect a peer
on people with mental health challenges and its support worker, possible signs this is happening, and
implications for recovery and healing 36 strategies for a peer support worker to manage it

• understanding how healing can occur through

healthy relationships, such as peer support, that
honour mutuality, equality and the freedom to
openly share one’s story

Guidelines for the Practice and Training of Peer Support | 32

“Sensitivity is extremely important when working with someone who is dealing with trauma.
In many cases the person has blamed themselves for the traumatic situation. Often they ask for
help long after the incident has occurred and their feelings are deeply entrenched. You have
to go very slow since the likelihood of full disclosure in the first meeting is very slim and until
you know the nature of the trauma it is very easy to re–traumatize the person. Patience is an
important attribute when working with a peer that has been impacted by trauma.”
Michael Lloyd, Peer Support, Chatham-Kent Consumer and Family Network, Chatham Ontario

1.5 Applying Peer Support Principles in Diverse Environments

Peer support occurs in a wide range of environments, such as community organizations, schools, clinical care organizations,
general workplaces and various diverse social, cultural and geographic settings. However, the underlying philosophy and
practice of peer support is the same, even though each environment presents its own opportunities and challenges. Learning
more about the environment in which he/she will be working will help a peer support worker to be better prepared.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• becoming familiar with the range of • understanding the potential advantages and
environments and organizations in which challenges of peer support within a group structure
peer support may be offered and the potential rather than one-on-one
opportunities and challenges of each • understanding the unique needs and perspectives
• strategies for working effectively within teams of a family member/ loved one, or care–giver.
or work groups or strategies to create team • strategies for facilitating peer support groups
support when working in isolation (as required)

Note: This topic is covered only for the purposes of introductory awareness and recognizing that the same principles of peer
support apply in all environments. More depth on a specific area of interest, such as clinical-based peer support or workplace-
based peer support, can be provided in supplemental training, as required.

Guidelines for the Practice and Training of Peer Support | 33

2. SOCIAL AND HISTORICAL CONTEXT OF PEER SUPPORT

2.1 The Historical Context of Peer Support

The philosophy of peer support and its values of hope, self-determination and recovery were, in part, a response to the historic
prevalence of social injustice and stigma towards those with mental health challenges. Understanding the historical context can
help to explain challenging issues, such as why some may be reluctant to disclose their illness and/or seek treatment or support.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• understanding the historical context of social • understanding the current environment related
injustice, including outdated cultural beliefs to mental health and mental illness, including its
and treatment practices, and the value of a challenges and its progress 37, 38 and how that might
peer support relationship that validates and relate to peer support workers and peers.
empowers

• understanding the history and principles of

the peer support and consumer/survivor
movements and how these are represented in
today’s environment

“An awareness of the historical context of mental illness serves as a foundation for
understanding the legacy of oppression and discrimination out of which current trends in peer
support developed.”
Eugene LeBlanc, Our Voice/Notre Voix

2.2 Prejudice, Discrimination and Stigma

Dealing with prejudice, discrimination and stigma, in addition to the challenges of ill health, makes recovery more difficult.
Understanding the origins of stigma and being able to support peers as they deal with it will have a positive impact on recovery.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• identifying the three types of stigma: public • identifying understanding the effects of stigma and
stigma (negative beliefs about a group of developing strategies to mitigate and recover from
people), internalized or self-stigma (negative its impact
beliefs about oneself), and stigma by • understanding the impacts of internalized stigma,
association (negative beliefs about those how it may affect one’s role as a peer support worker
who associate with members of the and developing strategies to manage it
stigmatized group)

Guidelines for the Practice and Training of Peer Support | 34

2.3 Diversity and Social Inclusion
Social exclusion can be a barrier to recovery. Participation in community life (“a home, a job, a friend” 39) can have a positive
impact on recovery. Honouring diversity and cultural differences strengthens a peer relationship and an important part of
the peer relationship is supporting the peer as he/she builds their community life. A lack of understanding of these concepts
may result in barriers in the peer support relationship.

The objective of training is to increase awareness, teach concepts, and develop skills related to:

• recognizing the impact of social exclusion • supporting peers to become engaged in community
on an individual’s recovery and supporting life, which may include housing, employment, and
the peer’s steps toward participating in social activities
community life • understanding the importance of, and approaches to,
• understanding social injustices that are respecting diversity and cultural differences within a
inherent in society relating to social factors peer support relationship
such as race, culture, sexual orientation, • understanding that each individual has a unique
class, disability, and others, and how these perception of the world and that there is no one way
can affect the peer and the peer support to approach life’s challenges
relationship

“When in a supportive relationship with my peers, I find it valuable both for myself and for
those who I am supporting to recognize the various experiences they bring to the table and
to validate their struggles with realities such as poverty and systemic racism. By looking
at the power dynamics inherent in our society (and in our connection as well), I am able to
provide a much richer and fuller peer support relationship, that honours their experiences and
recognizes that social justice must be a factor in mental health recovery.”
Shana Calixte, peer advocate and Executive Director, NISA/Northern Initiative for Social Action, Sudbury, Ontario

Guidelines for the Practice and Training of Peer Support | 35

2.4 Social Determinants of Health
The holistic approach to health and wellbeing implicit to recovery requires an awareness of the social factors that can
determine one’s health. Some examples of these factors include income and housing. Peer support workers require
knowledge and resources to support their peers to overcome challenges they may have in these areas.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• understanding the social determinants of • recognizing the impact of specific challenges on a

health, how they are inter-related and their peer and supporting the peer as he/she determines
impact on mental health and wellbeing 40
how to manage or improve their circumstances

• collaborating with community partners as

appropriate

3. CONCEPTS AND METHODS THAT PROMOTE EFFECTIVE PEER-TO-PEER EFFECTIVENESS

3.1 Interpersonal Communication Principles and Methods

Interpersonal communication is basic to all human interactions whether they occur in person, by phone, in writing or online.
Good communication skills foster key components of peer support, such as trust, self-determination and recovery, and are
an important factor in building effective relationships. Communication skills are an area of expertise that can be developed
and improved through training and practice.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• interpersonal communication principles and • identifying and mitigating potential

relationship-building skills misunderstandings and/or barriers to communication

• communication skills such as the use of • an awareness of the impact of non-verbal

O.A.R.S. 41
and other strategies that build communication and the environment in creating
trust and promote open and compassionate a welcoming, comfortable and non-judgmental
communication 42
interaction

• using effective communication skills to calm • enhancing communication and avoiding pitfalls when
stressful situations not meeting in person

Guidelines for the Practice and Training of Peer Support | 36

3.2 Building Supportive Relationships
A successful peer support relationship will leave the peer feeling more empowered and hopeful about the future. The value
of the relationship is derived from a sense of connection through the shared experience of living with a mental health
challenge or being a loved one of someone who does. The message “I’ve been there and found my way, and I believe you
can too” or “Like you, someone I love has challenges with their mental health” embodies this concept.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• strategies for a first meeting with a peer • recognizing that each peer is unique and therefore
the evolution of the relationship will be unique
• strategies for creating an environment of
trust and openness, including a discussion • identifying the peer’s strengths and celebrating his/
about confidentiality her progress and successes

• determining when it is advantageous for the • strategies and principles to prepare for an ending of
peer support worker to share aspects of their the relationship
own lived experience while keeping focus on • balancing the use of effective strategies with
the peer, and how to do so in a manner that authentic and empathetic listening and kindness
supports and inspires hope

“To support your peer is more than to listen and to talk. It’s more than effective questioning.
It’s more than sharing your story. Those are mechanics. To be truly present is to communicate
in a whole new way. It’s as if, each time, with each conversation, you’re hearing the story for
the first time...and it’s the most important story you’ve ever heard.

The connection is made, not with the ears, not with the tongue. Not even with the brain.
The connection is made with the heart.”
Karen Liberman, Mental Health Advisor and former Executive Director, Mood Disorders of Ontario

Guidelines for the Practice and Training of Peer Support | 37

3.3 The Process of Recovery and Change
The process of recovery doesn’t follow a straight line and involves personal growth and risk-taking as steps are taken
towards ever-increasing wellness. This process begins with hope for the future and a belief that something new and
different is possible. The peer support worker plays a role in inspiring hope, fostering empowerment and encouraging
personal growth through change and adaptation.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• understanding processes of recovery 43 • understanding the wellbeing continuum and the

and change 44
emotions associated with movement between ill-
being and well-being
• understanding the power of hope to inspire
a peer towards risk-taking in his/her steps • supporting peers wherever they are in the process
towards change, and the peer support of recovery, and gauging their readiness to attempt
worker’s role in this process something new in a manner that builds on their
strengths and promotes self-determination

3.4 Building Resilience through Self-Care and Wellness Plans

Building resilience, maintaining wellness, and planning ahead for crisis situations is important for those who have dealt
with their own or their loved one’s mental health challenges. Learning more about resilience and self-care will help peer
support workers to maintain their own health while working in potentially stressful situations, and also enhance their
ability to explore with others what is most suitable and effective for them.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• understanding what fosters resilience and • understanding the importance of wellness plans and/
how to develop it or other resources that incorporate a personalized
strategy to identify and deal with potential triggers
• understanding the aspects of wellness:
or early signs of relapse 45
physical, emotional, intellectual, social/
cultural, environmental, occupational • exploring with peers how to create a self-care plan
and spiritual that builds on natural strengths and/or discovers
new areas of interest

Guidelines for the Practice and Training of Peer Support | 38

3.5 Limits and Boundaries
Peer support workers need to assess and manage personal and role-oriented limitations and boundaries. These may be explicit,
as in a code of conduct or workplace protocol; they may be implicit, such as the unwritten rules, possibly in relation to other
care providers (e.g., clinicians or community services) or the environment; or interpersonal in nature in relation to the peer
being supported (e.g., meeting times). Some of these boundaries may not be flexible, such as in a code of conduct, while others
will be assessed as each situation arises.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• understanding the role of a peer support worker • learning more about a peer’s boundaries and
and the limitations and boundaries inherent in respecting that they may not be the same as their own
this role, whether they be explicit (e.g., code of • communicating and negotiating personal limits and
conduct) or implicit (e.g., a peer support worker boundaries with the peer, recognizing the vulnerability
does not take the place of a clinician, but may of both the peer and the peer support worker, to
explore with the peer how to discuss treatment create a safe and trusting relationship
advice they may not agree with)
• identifying when a boundary has been crossed and
• identifying ambiguous situations in relation determining how to respond
to boundaries and using critical thinking to
determine how best to proceed

“Respecting and maintaining personal and role-oriented boundaries is critical to one’s success
as a peer support worker.”
Frances Skerritt, Peer Supporter, Wellington Centre for the Douglas Hospital, Québec

3.6 Crisis Situations and Strategies

The term crisis may be used to describe a wide range of situations with respect to severity. The similarity throughout is that the
peer perceives the situation to be beyond their ability to cope. The role of a peer support worker includes understanding the
situation, appreciating the perception of the peer, recognizing the severity of the problem and responding in an appropriate manner.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• understanding the specifics of the crisis and the • supporting a peer through the crisis in a manner that
perception of the peer, as fully as possible ensures safety while helping them develop a plan and

• recognizing the severity of the crisis and a more hopeful outlook

following life-saving protocols when necessary • exploring options such as community resources

Note: Additional training on suicide awareness and suicide intervention is required as a follow-up session to this basic training.

Guidelines for the Practice and Training of Peer Support | 39

3.7 Connecting with Community Resources
A well-prepared peer support worker will enhance their ability to support peers by maintaining a list of local
community resources that a peer might use and, over time, will develop collaborative relationships with people
within these local services.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• understanding the range of relevant supports • exploring the option of utilizing a community or
and services available in their community or care resource with the peer in a way that fosters
region and understanding potential barriers empowerment
to accessing community resources • interacting with other care/support providers in a
• learning more about mental health laws and manner that promotes partnership/teamwork, and
human rights laws in their jurisdiction resolving conflict or difference of opinion when it
may occur
• collaborating with community support
resources and/or traditional care services

Note: Additional training on suicide awareness and suicide intervention is required as a follow-up session to this
basic training:

3.8 Awareness of Possible Symptoms and Potential Side Effects of Medication

The focus of peer support workers is always on recovery, holistic health and the peer’s self-described experience.
However, background knowledge of the general range of possible symptoms and side effects due to ill health and
medication will provide a peer support worker with an awareness of potential issues that may arise. The symptoms
should not be associated with specific illnesses, or side effects related to specific drugs, rather it is the awareness of the
range of experience that might occur that is important.

The objective of training is to increase awareness, teach concepts and develop skills related to:

• understanding the general range and • exploring with the peer how they might discuss
potential severity of side effects and these types of issues with their health care provider
symptoms that may arise for peers • knowing where to seek other forms of support
• discussing these issues and experiences with
a peer, when the peer feels the need, and
balancing this discussion with the overall
objective of focusing on the person and their
recovery journey

Guidelines for the Practice and Training of Peer Support | 40

Training Methods

“Tell me, and I will forget. Show me, and I may remember.
Involve me, and I will understand.”
– Confucius, 450 BC

The transition of knowledge into skill is enhanced with experiential

learning that includes opportunities to practice, such as the use of role
playing. The participatory approach to training, in which learners are
directly engaged in their own learning, is more empowering and has
READ
the best results with adults.46 This means there is less in the way
of lecture and more experiential activities such as interactive PASSIVE
discussion, small group exercises, individual reflection and LEARNING
HEAR WORDS
journaling, role playing and learning from demonstrations
(recorded or live) of role play scenarios. These varied
activities also accommodate participants’ differing SEE PICTURES OR GRAPHICS
learning styles.

Prior to developing or delivering a training session,

adult education theories and approaches should be SEE AND HEAR A FILM
researched to ensure an effective learning OR DEMONSTRATION
opportunity is provided for all participants.

SAY – TAKE PART IN A DISCUSSION ACTIVE

OR GIVE A TALK LEARNING
AFTER TWO WEEKS WE REMEMBER
MORE OF WHAT WE ACTIVELY
LEARNED RATHER THAN WHAT DO – TAKE PART IN A ROLEPLAY OR SIMULATION,
WE PASSIVELY LEARNED. DO IT FOR REAL

Adapted from: “Facilitating Participatory Workshops”, http://www.seedsforchange.org.uk/facilwsh.pdf, p. 2

Guidelines for the Practice and Training of Peer Support | 41

Continued development of skills occurs through practice in real-life situations. If the opportunity exists, a new peer support
worker can benefit from observing and functioning in the role with guidance from an experienced worker as a follow-up to
training. This allows for a progression from role-playing, through shadowing, to practice opportunities with close supervision
and support, and finally to working on their own.

PRACTICAL CONSIDERATIONS

Scheduling
Determining the duration and schedule of a course is dependent on several factors, the most impactful being the needs of
the participants.

Training may occur in one span of several days or be spread out across a period of time. This is dependent on the preference
of the training organization and the needs of the participants.

Some prospective peer support workers may require flexibility in terms of in-class duration and/or pace or progression of
training to fully comprehend and integrate the knowledge being offered. The ability of the person to learn within a classroom
environment does not necessarily predict their success as an empathetic and supportive peer worker.

Accessibility
Prospective peer support workers will come from a wide variety of situations, geographic regions, cultural norms and income
groups. If we are to meet the goal of increasing access to peer support, then we also need to consider how to overcome
challenges that prospective peer support workers may have to participate in training.

We encourage training facilitators and organizations to respect and learn from the insights that each person brings from their
geographic area or cultural background and to innovatively find ways to meet their specific needs.

Guidelines for the Practice and Training of Peer Support | 42

Summary
Changing Directions, Changing Lives: The Mental Health Strategy for Canada indicated that peer support can be a valuable
component on the path of recovery for people with a mental health challenge and for their family members and loved ones.
Section 3.4.3 of the Strategy calls for the development of guidelines of practice for peer support to enhance the credibility
of peer support as an essential component of a transformed mental health system. These Guidelines for the Practice of Peer
Support have been developed in collaboration with peer support workers and peer support organizations from across Canada.

National recognition of these two sets of Guidelines is a first step in the process of growing respect for, and accessibility to,
peer support. People who have lived with mental health challenges or illness and found their way to a path of recovery have
powerful insights. The pain and strain of mental ill health is known to too many Canadians. Let us go to these individuals
who have firsthand experience with hope and recovery to empower others in finding their own path towards holistic health
and wellness.

The many peer support workers involved in this project honour all those who have come before them who, with heart and hard
work, helped build respect for the field of peer support as we know it today. They were too often unnoticed, unrecognized and
underappreciated. From their passion we have learned how to offer hope, empowerment and recovery to others.

Peer support training will not only build an understanding of the value of these key elements, but will also provide strategies
and experiential learning opportunities to foster the development of hope and self-determination, and to interact in a manner
that promotes self-directed change towards a path of recovery and resiliency.

The practical skills related to interpersonal communication, maintaining limits and boundaries, managing crisis situations and
fostering resilience through attention to self-care and self-awareness are also critical and incorporated as key components of
training.

There are many paths that a prospective peer support worker may take towards becoming fully prepared, but it is expected
that acquiring the knowledge specified within these two sets of Guidelines, coupled with an opportunity to further develop
these skills in a practice setting, will be a part of their preparation for the role of peer support worker and a fulfilling life of
supporting others.

“Peer support is a system of giving and receiving help founded on key principles of respect,
shared responsibility, and mutual agreement of what is helpful. Peer support is not based
on psychiatric models and diagnostic criteria. It is about understanding another’s situation
empathically through the shared experience of emotional and psychological pain.”
Mead, Hilton, & Curtis, 2001, p. 135

Guidelines for the Practice and Training of Peer Support | 43

“We are at a pivotal moment in time—and have perhaps a once in a lifetime opportunity—
to seize the experience, the wisdom, the success, the learning, the passion of all those years
and make them truly count, to capture the essence of peer support and help transform the
mental health system in ways we’re yet to discover. More importantly, one day soon, every
person who struggles with mental ill–health will have someone in their life who ‘gets it’…
a peer support worker.”
Karen Liberman, Mental Health Advisor and former Executive Director, Mood Disorders of Ontario

“At a time when society is arguably more fragmented than ever before, and technology and
social media have overtaken face–to–face communication, the power of human interaction
has never been greater. Nowhere can it have more impact than in the lives of people
experiencing mental health challenges.

Evidence points to social support, more specifically the lack thereof, as being a primary
risk factor for the development of mental illness. It makes sense to invest time and energy
to develop robust social support programs to provide an antidote to what is a natural
occurrence and phenomena for so many affected by mental ill–health, that is isolation.

Peer support, as clearly stated throughout these Guidelines, is not intended to replace
clinical programs but was established as a complement to traditional care. Considering the
potential return on investment resulting from such initiatives, it makes sense for Canada to
pay particular attention to peer support as it continues to improve mental health services
and programs.”
Stéphane Grenier, Lead Consultant, MHCC Peer Project and co-founder of Peer Support Accreditation and Certification (Canada) (PSACC)

Guidelines for the Practice and Training of Peer Support | 44

Glossary
Changing Directions, Changing Lives: The Mental Health Strategy for Canada – A national strategy for improving the mental
health system released in 2012, this document was created by the Mental Health Commission of Canada in consultation with
dozens of individuals and organizations across the country.

Community of Practice – A Community of Practice exists when a group of peer support workers meet on a regular basis to
support each other, share knowledge and experiential learning, and keep each other committed to, and consistent with, the
values and principles of practice of mental health peer support.

Experiential Knowledge – The information and wisdom gained as a person goes through various life experiences. A peer support
worker will often draw on their experiential knowledge as they interact with, and provide support to, their peers.

Formalized Peer Support – Peer support that is offered by trained and/or experienced peer support workers within a structured
setting. Peer support workers interact with people based on similarity of lived experience, and offer the opportunity for a
supportive, empowering relationship.

Informal Peer Support – Less structured support provided by participants who are drawn together by what they have in
common, with none more experienced or better prepared to offer support than the other.

Lived Experience – A person’s experience of mental health challenges or illness and/or their experience of having a family
member or loved one who has mental health challenges or illness.

Making the Case for Peer Support – A 2010 report by the Mental Health Commission of Canada based on a literature review and
input from peers and peer support workers. The report’s recommendations included the creation of guidelines to support the
development of peer support.

Guidelines for the Practice and Training of Peer Support | 45

Peer – A person who is seeking support from a peer support worker in relation to a mental health problem or illness.

Peer Support – A supportive relationship between people who have a lived experience in common in relation to either their own
mental health challenge or illness or that of a loved one.

Peer Support Worker – The term “peer support worker” refers to a person who provides peer support to those with mental
health challenges or illness, or to those who have a family member or loved one with mental health challenges or illness.

Recovery – A journey of healing that goes beyond the reduction of symptoms and considers an individual’s wellness from a
holistic point of view that includes their relationships, their involvement within community, and their general wellbeing. People
on a path of recovery are empowered to make informed choices about the services, treatments and supports that best meet their
needs. Recovery does not necessarily mean “cure”.

Self-Awareness – A person’s understanding and anticipation of their personal stressors, their means of handling such challenges,
as well as awareness of their areas of expertise and areas that could be further developed.

Self-Determination – Self-determination is a person’s right to decide what his or her own fate should be, including courses of
action, treatments and supports. This principle requires the peer support worker to ensure that the peer’s choice is honoured
while working together with the peer to explore options.

Guidelines for the Practice and Training of Peer Support | 46

Notes
1. The term “peer support worker” refers to a person 6. Some within the peer support community refer
who provides peer support to those with mental to “mental health challenge or illness” rather than
health challenges or illness or to those who have “mental health problem or illness” as found in other
a family member or loved one with mental health MHCC communications. Both terms will be used in
challenges or illness. these Guidelines.

2. The term “lived experience” refers to a person’s 7. The value of common experience is maximized when
experience of mental health challenges or illness those with personal lived experience support others
and/or their experience of having a family member who are impacted by their own illness or challenges,
or loved one who has mental health challenges or and those with lived experience as a family member
illness. or loved one support others who also are family
members or loved ones.
3. Peer support is most effective when people support
others with similar experiences: that is, those with 8. Toward Recovery and Well-Being, A Framework for a
mental health challenges support others with mental Mental Health Strategy for Canada, MHCC, p. 28
health challenges, and family members support 9. Toward Recovery and Well-Being, A Framework for a
family members or others within a person’s circle of Mental Health Strategy for Canada, MHCC, p. 111
support. Within these Guidelines, the term “family
10. Creamer et al. (2012). Guidelines for Peer Support in
member” will be used to describe all those who are
High-Risk Organizations: An International Consensus
within a person’s circle of support, which includes
Study Using the Delphi Method. Journal of Traumatic
family members and significant others.
Stress, 25, p. 134–141.
4. Throughout these Guidelines, the term “recovery”
11. Figley, C.R. & Nash, W.P. (2007). Introduction: For
refers to a holistic journey of healing and wellbeing.
those who bear the battle. In C.R. Figley & W.P.
This applies to both personal and family-based
Nash (Eds.) +Combat Stress Injury Theory, Research,
lived experience. A family peer support worker will
and Management, pp. 1-10. New York: Routledge
use “recovery” to mean having recovered a state of
Psychosocial Stress Book Series.
wellbeing that includes a balance of hope, insight,
and healthy acceptance in relation to their loved 12. Corrigan, P.W. (2006). The impact of consumer-
one’s challenge or illness. operated services on the empowerment and
recovery of people with psychiatric disabilities.
5. The term “peer” refers to a person who is seeking
Psychiatric Services, 57, p. 1493-1496.
support from a peer support worker in relation to a
mental health problem or illness. 13. Dumont, J.M. Jones, K. (2002). Findings from a
consumer/survivor defined alternative to psychiatric
hospitalization. Outlook. pp. 4-6

Guidelines for the Practice and Training of Peer Support | 47

14. Sandra G. Resnick, Robert A. Rosenheck. (2008). 20. Pickett-Schenk, S.A., Lippincott, R.C., Bennett, C., &
Integrating Peer-Provided Services: A Quasi- Steigman, P.J. (2008). Improving knowledge about
experimental Study of Recovery Orientation, mental illness through family-led education: The
Confidence, and Empowerment. Psychiatric Services. journey of hope. Psychiatric Services, 59 (1), 49–56.
DOI: 10.1176/appi.ps.59.11.1307 21. Dixon, L., Lucksted, A., Stewart, B., Burland, J., Brown,
15. Ochocka, J., Nelson, G., Janzen, R., Trainor, J. (2006). C.H., Postrado, L., & Hoffman, M. (2004). Outcomes of
A longitudinal study of mental health consumer/ the peer-taught 12-week family-to-family education
survivor initiatives: Part III – A qualitative study of program for severe mental illness. Acta Psychiatrica
impacts on new members. Journal of Community Scandanavica, 109 (3), 207–215.
Psychology, 34, pp. 273-283. 22. O’Hagan M., Cyr, C., McKee, H., & Priest, R.
16. Provencher, Gagné & Legris. (2012). l’intégration de (2010). Making the case for peer support: Report
pairs aidants dans des équipes de suivi et de soutien to the Peer Support Project of the Mental Health
dans la communauté: points de vue de divers acteurs. Commission of Canada. Calgary, AB: Mental
Rapport final de recherche (version sommaire). Health Commission of Canada. Retrieved from
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17. Chinman, Young, Hassell & Davidson. (2006). Toward 23. Topor, A., Borg, M., Mezzina, R., Sells, D., Marin, I. &
the Implementation of Mental Health Consumer Davidson, L. (2006). Social relationships as a decisive
Provider Services. The Journal of Behavioral Health factor in recovering from severe mental illness.
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10.1007/s11414-006-9009-3. 336–347.

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(2006). Peer support relationships: an unexplored Changing Directions, Changing Lives: The Mental
interpersonal process in mental health. Journal of Health Strategy for Canada. Calgary, AB: Author,
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27. Community organizations range from volunteer- 33. Linhorst, D. (2006). Empowering people with severe
based, small, informal organizations to larger, mental illness: A practical guide. New York: Oxford
structured organizations with formal policies, University Press.
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34. “Guiding Principles of Recovery.” Substance Abuse and
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led or as a consumer-survivor initiative, (CSI). Some
35. Blanch, A., Filson, B., Penney, D. (2012). Engaging
have a strong focus on peer support, while others
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find that peer support is a valuable by-product of
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28. Adapted from Davidson, L., Chinman, M., Sells, D., EngagingWomen/PEGFull_Document.pdf
and Rowe, M. (2006) Peer Support Among Adults
36. Paraphrased from “Trauma-Informed Response and
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Intentional Peer Support” presentation by Shery
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30. A local consumer/survivor community organization 37. Mental Health Commission of Canada. (2012).
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guidance. Health Strategy for Canada. Calgary, AB. Priority 3.4,
31. Throughout these Guidelines, the term “lived (p. 51)
experience” is used to refer to each person’s 38. O’Hagan M., Cyr, C., McKee, H., & Priest, R. (2010).
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is always on the family member that he/she is A Survival Guide to Mental Health Care in Canada.
interacting with. It is realized that in some extreme Toronto; McLelland and Stewart, LTD.
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40. O’Hagan M., Cyr, C., McKee, H., & Priest, R. (2010). 43. Powell, Ike. (2009). What is this thing called recovery?
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reflective listening and summarize; adapted for non- habits and moving your life positively forward. New
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Mental Health Commission of Canada

Suite 1210, 350 Albert Street

Ottawa, ON K1R 1A4

Tel: 613.683.3755
Fax: 613.798.2989

[email protected]
www.mentalhealthcommission.ca