Peer Support Amongst Mental Health Patients on Psychiatric Wards:

1. Peer Support Amongst Mental Health Patients on Psychiatric Wards: An Untapped Resource for Recovery Catherine Pugnaire Gros, RN, MSc(A) Assistant Professor, McGill University School of Nursing, Nurse Clinical Specialist, Douglas Institute Marjorie Montreuil, RN, MSc(A) Staff Nurse Lindsay Bouchard, RN, MSc(A) Staff Nurse 27e Colloque AQIISM; Levis, Qc, le 4 juin, 2010 We will present to you our project entitled: Peer support among inpatients in an adult mental health setting. This project was done with Lindsay Bouchard, and I�m Marjorie Montreuil. Our advisor is Catherine Gros, a nurse clinician specialist at the Douglas and faculty lecturer at McGill. The project received funding from the Minist�re de l��ducation, du loisir et su sport du Qu�bec, in association with McGill university. In addition, we received funding from the Douglas Institute. We will present to you our project entitled: Peer support among inpatients in an adult mental health setting. This project was done with Lindsay Bouchard, and I�m Marjorie Montreuil. Our advisor is Catherine Gros, a nurse clinician specialist at the Douglas and faculty lecturer at McGill. The project received funding from the Minist�re de l��ducation, du loisir et su sport du Qu�bec, in association with McGill university. In addition, we received funding from the Douglas Institute.

3. Study purpose and objectives To advance the practice and development of collaborative, strengths-based nursing by applying theory & evidence to clinical practice in tertiary care hospital settings To gain insight into the strengths & capacities of hospitalized patients To acquire new knowledge in a previously unexplored area of patient care To generate evidence for future nursing initiatives aimed at promoting patient recovery through peer support

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5. Caring for mental health patients in hospital settings remains an important challenge! Despite the ongoing shift toward community-based care: An estimated 190,000 Canadians are hospitalized annually for the treatment of mental illnesses Canadian Institute for Health Information (CIHI), 2008. Existing literature indicates that peer support is beneficial for people with mental illnesses and it plays an important role in recovery. However, previous research on peer support in the mental health field has focused on formalized peer support interventions within community health services. Very little research has been done in the inpatient setting. In Canada, the current average length of stay in psychiatric institutes is about 100 days, with a median of 26 days. Given this lengthy hospitalization period inpatients have the time and opportunity to interact with each other. Patients are sharing the same living space 24 hours a day, 7 days a week. In this context, we came up with the following question: �What are the perceptions and experiences of peer support among adults on an inpatient unit of a mental health institute during the period of their hospitalization?� Existing literature indicates that peer support is beneficial for people with mental illnesses and it plays an important role in recovery. However, previous research on peer support in the mental health field has focused on formalized peer support interventions within community health services. Very little research has been done in the inpatient setting. In Canada, the current average length of stay in psychiatric institutes is about 100 days, with a median of 26 days. Given this lengthy hospitalization period inpatients have the time and opportunity to interact with each other. Patients are sharing the same living space 24 hours a day, 7 days a week. In this context, we came up with the following question: �What are the perceptions and experiences of peer support among adults on an inpatient unit of a mental health institute during the period of their hospitalization?�

9. Call for research Research Question: What are the perceptions & experiences of peer support amongst adults hospitalized on in-patient mental health units?

10. A working definition of Peer Support: Interactions between or amongst patients: Naturally occurring; spontaneous Perceived as �helpful� , �supportive� Includes giving &/or receiving �support� For the purposes of this study, the definition of peer support is based on the conception of mutual and peer support from different authors. A relationship in which persons voluntarily and spontaneously interact to give and receive help, addressing individual issues or shared concerns. This support could be composed of �emotional, appraisal, and informational assistance�to address a health-related issue� (Dennis, 2003, p. 329). For the purposes of this study, the definition of peer support is based on the conception of mutual and peer support from different authors. A relationship in which persons voluntarily and spontaneously interact to give and receive help, addressing individual issues or shared concerns. This support could be composed of �emotional, appraisal, and informational assistance�to address a health-related issue� (Dennis, 2003, p. 329).

20. Outcomes for peer support recipients Better emotional state Improved outlook on current situation Positive behavioral changes �I tell her: �What is it that you wanted to finish saying? And what do you want to explain?� And I try to see what she wants to say; what she�s trying to make me understand, or to make others understand � [Now] she talks a little more, she�s starting to add a bit more words to her sentences.�

21. Health outcomes for peer support recipients Improved emotional state; feeling less alone, less anxious, less stressed Improved outlook on current situation � [I have] A better understanding of my situation�[I feel] more in control� Positive behavioral changes Greater participation in group activities Adopting healthy lifestyle choices �He invites me to take walks outside; [something] I wouldn�t want to do by myself�

22. Health outcomes for peer support recipients Improved Functioning �I tell her: �What is it that you wanted to finish saying? And what do you want to explain?� And I try to see what she wants to say; what she�s trying to make me understand, or to make others understand � [Now] she talks a little more, she�s starting to add a bit more words to her sentences.�

24. Context of Peer Support Patient characteristics Traits, skills, experiences can encourage peer support �[Another patient] understood what I was going through, because she went through it herself.� Can give & receive peer support despite mental illness �It always makes me feel good to look after somebody. Even if I�m sick myself, and I do it.� �Even if they [other patients] have problems, you have to help them.�

25. Context of Peer Support Group dynamics �One good turn deserves another.� �.. �There are little [cliques] in the group. But there�s still a good team spirit�Good friendships are formed here.�

26. Context of Peer Support Staff attitudes & Beliefs Little or no recognition of peer support; limited knowledge & understanding of health benefits Focus on risks & patient vulnerabilities As a result: Health care interventions are geared toward protecting patients from possible harmful outcomes �[The nurse] told me: ��Don�t help him [another patient], he�s not going to help you.� �

27. Discussion Previous research highlights patient deficits such as the limited social skills for persons with depression (Tse & Bond, 2004) or schizophrenia (Couture et al., 2006; Peljert et al., 1995). This study challenges those ideas; suggesting that peers offer a unique form of support that health professionals or others cannot provide.

29. Conclusions Study findings favor the application to practice of collaborative, strengths based nursing care, consistent with approaches such as Recovery & the McGill Model of Nursing. These approaches focus on the strengths & self-care capacities of clients & families who are viewed as experts; responsible for their own health & well being. (Allen, et al, 2002; Gottlieb,et al. 2005, Gros et al 2007) . �

30. Clinical Implications & Practice Recommendations Refocus nursing interventions on collaborative processes aimed at developing care-giving partnerships with clients & families Recognize & Facilitate peer support by: Exploring, identifying, & reinforcing the means by which hospitalized patients offer & receive support from one another.

31. Clinical Implications & Practice Recommendations Acknowledge & recognize the essential role that hospitalized patients play in their own recovery as well as in the health & recovery of others. Be a �Strengths Detective�! Learn from patients by observing, listening & searching for strengths & competencies Be an expert witness. Reflect observations related to positive & supportive interactions to occur amongst patients Highlight gestures of support offered to & received by peers & work in partnership to explore & evaluate the resulting outcomes & benefits Celebrate together with patients the positive outcomes of peer support

32. and Continue Building Bridges�  Amongst Patients Between Patients & Staff From Classrooms to Clinical Settings From Nursing Research to Nursing Practice�

33. References Allen, M & Warner, M. (2002). �A Developmental Model of Health and Nursing�. Journal of Family Nursing, vol 8, 2002, p. 96-135 Bouchard, L., M. Montreuil, & C. Gros (2010). Peer support among inpatients in an adult mental health setting. Issues in Mental Health Nursing, 31, 589-598. Gottlieb, L. N., Feeley, N., with Dalton, C. (2005). The Collaborative Partnership Approach to Care: A Delicate Balance. Toronto, ON: Elsevier-Mosby. Gros, C. P., & Young, L. (2007). �Teaching the McGill Model of Nursing and client-centered care: Collaborative strategies for staff education and development�. In L. E. Young & B. L. Patterson (Eds.), Teaching Nursing: Developing a Student Centered Learning Environment Philadelphia: Lippincott, Williams & Wilkins. p.190-221. Dennis, C. L. (2003). Peer support within a health care context: A concept analysis. International Journal of Nursing Studies, 40, 321�332.