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Table 2 Development of the content of the peer-facilitated self-management intervention (stages 1–3)

From: Development of a peer-supported, self-management intervention for people following mental health crisis

Concepts

Definition

Stage 1: evidence review findings

Stage 2: CRT service user interviews

Stage 3: focus groups

Illustrative quotes

Peer support

Support from a worker with a lived experience of mental illness

Interventions using peer support have currently inconclusive evidence of efficacy; however, they are widely used

Mutual support from a peer (27 respondents)

The PSW actively get to know the peer (5 respondents)

Befriending (7 sources)

Role-Modelling (8 sources)

Lived experience support beneficial (5 sources)

I think it’s great in a very different, unique kind of way. However experienced and qualified the staff are I don’t think anything is as supportive as somebody who’s been through the same services as a service user that you have. I think that’s a really unique opportunity and potentially really helpful. (stage 2 interview SU28)

Recovery

Recovery principles, e.g. addressing stigma or exploring personal meaning

A concept in 12 of 19 reviewed mental health self-management programmes

Recovery (9 respondents)

Recovery (6 source)

De-stigmatising (3 sources)

…generally things around recovery where you can gain knowledge and understanding about how to self-manage a condition to prevent the risk of relapse (stage 2 interview SU26)

And I think as much as we’re trying to pull away from the medical model and embrace the recovery model (stage 3 Staff Focus Group 4)

Psycho-education

Such as illness specific education, treatment information

A concept in all 19 reviewed mental health self-management programmes

Psycho-education (12 respondents)

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I had so much information running through my head and I couldn’t understand that information at all, and I think if somebody came to tell me and explain it to me that this is what happened to me, and it would be maybe completely different from me but it would be… they would be telling me that I had psychosis and these are the signs of psychosis, I would find it really helpful (stage 2 interview SU21)

Relapse prevention

Identifying signs of relapse and planning coping strategies

A concept in all 19 reviewed mental health self-management programmes

Relapse prevention (11 respondents)

Relapse prevention (7 sources)

Strategies to keeping well (3 sources)

If a peer support worker was to identify together with whoever was using the service what their warning signs were and to make sure they’re aware of their own because there’s a tendency to be, like, these are people’s general warning signs and in fact they can be really different for different people and to personalise it in that way because that’s, I think, what really makes a difference—when you feel like it’s relevant to you. (stage 3 Service User Focus Group 1)

Crisis planning

Planning service response in the event of future crisis

A concept in 11 of 19 reviewed mental health self-management programmes

Crisis planning (5 respondents)

Crisis planning (7 sources)

If it’s following the WRAP (TM) programme then it’s definitely good (stage 3 Staff Focus Group 4)

Signposting

Aiding access to various services by linking, referring or signposting

A concept in 17 of 19 reviewed mental health self-management programmes

Identifying supporters (4 respondents)

Signposting to resources (4 respondents)

Accessing community and social engagement (15 respondents)

Practical support to link to resources (15 respondents)

Signposting (7 sources)

Practical support (4 sources)

Social engagement (10 sources)

And maybe the peer support should have a little more information about other services that are there, just do the sign posting, because with some clients inevitably the first thing they’re going to talk about always is those issues (stage 3 Staff Focus Group 2)

Medication education or management

Aiding the participant to understand their medication and medication side effects. This may include planning psycho-education or specific medication management

A concept in 17 of 19 reviewed mental health self-management programmes

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Concerns around including medication management for this programme (3 sources)

I have seen people discourage people from taking medication when it’s been prescribed for them, oh, you don’t want that, and it’s an issue to have in mind because, as I say, there’re all kinds of opinions about medication

(Staff Focus Group 4)

Goals and wellness planning

Establishing personal goals/plans and/or mental wellness maintenance strategies

A concept in 13 of 19 reviewed mental health self-management programmes

Goal setting (7 respondents)

Wellness planning (14 respondents)

Focusing on the future (6 respondents)

Future plans and goals (4 sources)

Somebody who would come in after the home treatment team have seen you, just to help you focus on the future, and look forward. Yes, don’t focus on the negative, rather the positive. Yes, and just… let them, you know, let you know what’s out there for you, as a person, just things maybe you can do or not do whatever, you know? Setting goals really and very small steps.(stage 3 Service User Focus Group 3)