Peer support during a pandemic – key learnings
- Online Peer Support
- Person-centred care
- Digital health and care
- Health inequalities
As the hosts of the national Peer Support Hub, National Voices has a longstanding commitment to sharing evidence and learning around effective peer support. We know that the COVID-19 pandemic has precipitated a period of intense adaptation and learning and we wanted to find ways to tap into that learning.
As the country went into lockdown, organisations and individuals who were involved in peer support started to examine the implications for their work – as face-to-face meeting became impossible organisations rapidly adapted to remote ways of working. Everyone has been experimenting, testing, trying, failing and trying again and on 15 September we brought a wide range of people together to reflect upon, and capture some of what we’ve learnt so far.
The starting point for our discussion was the new report from Alison Faulkner which draws together the learning from a group of organisations and individuals in the mental health arena (convened by our partners in this webinar) who have been meeting together fortnightly through the pandemic to share learning. We wanted to understand whether their learning was shared across the wider peer support world.
Key themes from Alison’s report helped frame our discussions:
Upholding the values and principles of peer support
Over recent years significant work has gone into articulating the core values of peer support – there are various frameworks but values such as mutuality, choice and control, equity and safety, are key. We heard that translating these values into remote environments has required considerable thought. Critical issues such as power need rethinking, for example in online environments significant power is automatically given to “hosts”.
Developing remote and online options
We heard that many organisations had successfully developed online peer support offers, but that this was neither the only nor the best version of remote delivery. Many organisations had developed effective support by telephone or even by post, and we heard how the best models had been co-produced, with change happening at the pace of people’s growing confidence with remote tools.
We heard that many had been pleasantly surprised by the effectiveness of remote delivery and for some groups online and telephone-based options were more attractive than face to face – including for those with some communication difficulties, people who do not live in urban centres, and people who struggle in face-to-face settings.
We also recognised that there are some groups for whom remote connection has been the default for a long time – including members of the Deaf community, and people involved in informal peer support groups over Facebook etc.
However, while we have learnt a lot about the potential of remote peer support during this period, we should be very cautious about allowing this to become the default mode, or being seen as a cheaper option.
Managing the online space
Participants agreed that moving peer support online was not a case of simply doing the same things as you would face to face – a whole range of issues needed more thought. Gaining consent and agreement to ways of working across all participants was crucial and groups needed to find their own ways, but many organisations had found it helpful to allow people to join in via the chat or by speaking and to agree an approach to cameras and microphones across a group before starting.
We heard that facilitating remote peer support was demanding. Most participants found that remote meetings required more than one facilitator – with roles including managing the “chat” and dealing with technical issues. We heard that organisations were establishing new methods of supporting their facilitators – whether they were staff or volunteers – including offering more opportunities for peer support between them and more supervision. One positive of moving to a remote environment was that it was making the delivery of this support for group leaders more efficient.
Creating and maintaining safety and security
Moving to remote delivery had raised new data protection and safeguarding concerns. Organisations had rapidly developed new protocols, but there are challenges in balancing protecting people with enabling connection that works for them. We heard from the Stroke Association that they had developed data protection guidelines to support peer support group members in connecting with one another –and that this was helping to reduce pressure on group leaders.
We also talked about the challenges in providing “safe spaces” remotely. It was recognised that this is now more challenging as participants may be forced to join meetings from environments in which there are others with whom they feel less comfortable opening up, and you don’t know who else may be able to hear what you say in discussions.
Creative ways of connecting
Participants shared their hints and tips for helping online environments feel more friendly and welcoming – including encouraging participants to bring objects to the discussions, having a “tea break” where everyone gets a drink and chats informally, and also structuring discussions around activities, including crafts, quizzes and even fancy dress.
We also talked about ways of mitigating the “harsh” endings of online meetings, and trying to generate as much informality as possible – for example, by keeping microphones on to avoid the stiltedness that comes from muting and unmuting.
Recognising the strains of the current situation and of forms of communication that were often more intense was a core theme in discussions. During our call participants recognised their own need to feel connected and give each other space to share what had been difficult times. And we heard that some people still felt overwhelmed by the new environments in which we are now working.
We discussed the need to recognise that, for some people, remote support has not worked out well – some have not been able to participate at all (we heard of one group that had gone from 150 regular attendees to 10), and others have found it less supportive. There were also concerns that remote options may work less well for those who are newly engaging with support.
Returning to face-to-face and other options
Our discussions took place as new regulations for the “rule of six” had been published in England. These rules explicitly excepted self-help groups, and this had accelerated plans to restart some face-to-face meetings.
However, we recognised that many people with long-term conditions were very anxious about meeting again in person, not just due to fear of the virus, but also because of loss of social skills and confidence. Organisations envisaged running blended models for the foreseeable future and many are thinking about how to connect remote and face-to-face environments.
We also talked about the risk that the innovation born of necessity during lockdown might lead to unintended consequences if remote provision is perceived as a cheaper substitute. Participants were clear that we need to ensure that remote peer support is developed alongside face-to-face options.
Inclusion and cultural competency
Looking beyond the themes of the report, another key theme was the need for more work on inclusion.
The digital divide was recognised as a clear barrier – and we heard that people may be increasingly slipping through the net of support if they lack access to technology and there was a strong commitment to ensuring that addressing the digital divide remained a priority.
COVID-19 has also laid bare further inequalities – in particular the vulnerabilities of some BAME communities. And we heard about significant gaps in the provision for people with long-term conditions during the lockdown period – for example, the failure to make available a helpline providing basic advice and information in community languages.
While peer support can be a lifeline for people from Black, Asian and minority ethnic communities, and peer support has filled gaps in statutory provision, it was recognised that there is more to do to improve the inclusivity of peer support and to work on cultural competence.
As peer support is brought into the mainstream of provision – as part of the universal personalised care commitment – we need to work hard to keep the commitment to bottom-up development and co-production and be open to a conversation across the community about who is not around the table.
Finally, while it is easy to focus on the eye-catching shift to digital provision, this has not been the only shift the pandemic has brought. We have also seen new working relationships between organisations in the community and health sectors. We recognised the need to cement these relationships and to avoid a return to siloed working in future.