Recognizing peer support initiatives organized outside of the clinical setting: insights from a Belgian Delphi method with peer supporters, patients and mental health professionals

Abstract Background: Peer support in mental health involves individuals with lived experience of mental illness providing assistance and encouragement to others facing similar challenges. This care practice is endorsed in best practice guidelines and has been shown to enhance individual-centered, recovery-focused, and rights-based mental health care, according to the World Health Organization (WHO). In Belgium, there is currently no well-defined framework supporting the practical implementation of peer support in mental health practice, including role descriptions and training needs. Moreover, the added value of peer support compared to formal care is not thoroughly examined at individual and societal levels. This research aims to explore the role and organization of peer support in the mental health care system, focusing on intentional, asymmetric peer interactions organized outside the clinical setting. Methods: The Delphi method gathered insights from peer supporters, mental health professionals, and patients. Three rounds of data collection and analyses achieved consensus on key statements regarding the added value of peer support and the requirements for a framework enabling peer support as a valid care practice outside clinical settings. Results: Participants agreed that peer support can play a significant role in various stages of the recovery process, complementing clinical care. They agreed that peer support offers benefits for both patients and peer supporters. Requirements for a framework include logistical, financial, and human resources support, as well as training and status recognition. Consensus emerged on many statements, but divergent views surfaced on the peer supporter’s role limitations in the healthcare system, the balance between regulation and preserving the informal nature of peer support, and the roles of remuneration and training. Conclusions: This study achieved consensus on 38 statements, outlining requirements to optimize the organization of intentional, asymmetric peer interactions organized outside clinical settings. It underscores the added value of such peer support in Belgian mental health care. Trial registration: Ethical approval was not required as experts freely shared their experiences on peer support within a national expert group, contributing to policy recommendations and publications.