Peer support in perinatal mental health: evidence review

Annex 3: Case Study: Peer support workers in a Mother and Baby Unit MBU – Jasmine Lodge MBU, Devon Partnership NHS Trust

Introduction

Jasmine Lodge Mother and Baby Unit (MBU) is a specialist inpatient perinatal mental health unit for mothers and babies from 32 weeks of pregnancy up to one year after birth. It is a brand new purpose-built unit which opened in May 2019 and has capacity for eight mums and their babies. The unit is part of Devon Partnership NHS Trust and is based in Exeter.

Jasmine Lodge includes an open-plan living/kitchen/dining area, activity rooms, baby-centred spaces, en-suite bedrooms, a purpose built office space, landscaped gardens and extra facilities for supporting families including two apartments for visiting family members.

The team consists of a perinatal psychiatric consultant, occupational therapist, clinical psychologists, a ward manager, deputy managers and a team of experienced mental health nurses, social workers, support workers, peer support workers and nursery nurses who care for the mums and their babies during their recovery. The team is supported by an experienced admin team. A full-time Band 4 Peer Worker role is split as a job share between 2 peer workers.

History of peer workers in the service

The community perinatal mental health service has been operational for the last 10 years, and since inception has incorporated the experience of mums. The focus on the involvement of peer workers is based on the clinical experience of staff in recognition of the benefits of peer work for mothers using the service.

When the process of making a bid to operate the Mother and Baby unit began around 3 years ago, the Consultant Perinatal Psychiatrist and Perinatal Service Manager ensured that a full time Band 4 Peer Worker role was costed into the proposal. When presenting the bid, a mother who had been supported by the service shared her experience, which was instrumental in the successful bid.

Recruiting, training and integrating peer workers

• Through consultation with other MBUs who had peer workers in place, a job description was developed and the job was advertised on NHS Jobs England.
• As part of the recruitment process, people who had used the service were contacted to let them know about the opportunity.
• As part of the feedback process on their experience in the MBU, people who have used the service are asked if they would like to be kept up to date with any future opportunities to be involved in the service in a voluntary capacity. This information is retained to aid recruitment to peer roles of people with experience of the service.
• After the recruitment process, Peer Workers took part in a two-day training course based on the principles of Intentional Peer Support, facilitated by Recovery Devon, a local Community Interest Company focused on recovery in mental health.

Managing and supervising peer workers

• Peer workers have both line management supervision and clinical supervision in their role.
• Peer workers access supervision with a clinical psychologist on a monthly basis, and also have access to clinical supervision as and when required.
• Formal line management is provided by an operational manager, for example, the ward manager. This helps to support the role of the peer worker as the ward manager has an overview of all the specialist staff on the ward.
• Peer workers also have links to informal support from more senior members of staff with peer experience, in a mentoring approach.
• Line management and support for peer staff is really important, as peer workers can feel isolated, especially when they are the only peer worker in their team.
• As peer work is highly autonomous and to counteract this isolation, it's important that managers and senior staff are proactively inclusive of peer workers and communicate the purpose and boundaries of the peer role to the wider team as peer work is often not well understood.

Advice and lessons so far

• Ensure that the peer worker and the wider team share a clear vision of the job role and purpose.
• Line managers should structure the first few weeks to ensure a smooth start and transition for peer workers and avoid role conflict.
• There should be a proactive approach to integration of peer workers into the team. This is especially important if the peer worker will be working alone.

While flexibility and autonomy are key in peer work, some ongoing structure is useful to support peer workers and help to define their role for the wider team.

Views from peers, mums and wider staff

Peer workers say:

‘Because we have been through it, we can sit with mothers in their distress, knowing that it will pass.’

‘Being a peer worker has brought me wider understanding of mental health diagnoses and the wider impact of trauma and adverse childhood experiences’

‘Full time peer work would be really challenging for emotional and mental health. Sharing a full time post means both peer workers are able to manage their own wellbeing and patients benefit from two peer workers with different experiences pf perinatal mental health problems.’

Mums say:

‘Peer Support Workers make you believe that you can get through the hardest time of your life. They have first-hand experience of how you feel and what you are going through from their own experience. They are living proof that hope should not be lost’

‘The Peer Support Worker walked with me as I got better. She made me feel normal and like I wasn’t the only one – she was as bad as me and she still got better”

‘She was like a bridge between the staff and me – I felt I could talk to her about anything with no judgements being made.’

Other staff say:

‘Peer support benefits the ward because it offers something unique that no other member of staff can offer, despite the skills and relationships they have with the mothers. Peer support offers a walking, talking, real life example of a recovery story. The role benefits the ward massively by offering groups that are intuitive to the current mothers on the ward. Peer support benefits the ward by contributing into multi-disciplinary meetings, handovers, clinical notes and risk assessing.’ (Ward Manager)

‘It is vital that we have peer support worker to be the mums’ voice in staff only meetings to ask the difficult but needed questions about why is the service the way it is? Why do we keep doing the same as before?’ (Clinical Psychologist)