Innovation summary

A large number of people with severe mental illness receive no treatment1,2. This treatment gap is the largest in low- and middle- income countries (LMIC)3, with detrimental effects on individuals and societies.

Mental health peer support is an established intervention involving the delivery of mental health services by people in recovery from mental illness. Peers are an untapped resource in global mental health and there is a burgeoning body of evidence4 for the effectiveness of this approach when integrating into mental health service delivery.

UPSIDES aims to scale-up peer support interventions for people with severe mental illness in high-, middle- and low-resource settings under the following objectives:

  • Peer support will be implemented in the local context
  • Using a mixed-methods approach, the impact of peer support will be rigorously evaluated at the patient-, peer support worker-, services-, and implementation-levels
  • Evidence for best practice will be disseminated to local, national and international stakeholders ensuring sustainability and coverage.

Impact summary

The project will establish an international community of research and practice for peer support including peer support workers, mental health researchers, and other relevant stakeholders in Europe, Africa and Asia (8 study sites in 6 countries)

  • Training for at least 12 peer support workers per site; peer support for at least 50 service users per site
  • Evaluation with about 516 participants at the levels of service users and peer support workers, services, and implementation.
  • This includes outcomes such as social inclusion, empowerment, recovery and quality of life at the level of service users; professional development at the level of peer support workers; and recovery-related knowledge, attitudes and practices at the level of services. In addition, implementation outcomes such as acceptability, appropriateness, feasibility, costs, coverage, fidelity adoption and sustainability will be evaluated.

“UPSIDES will maximize performance of mental health services using the unique expertise of people with personal experience of mental illness in various resource setting, with a special focus on capacity building. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services.”

 
 

-Dr. Bernd Puschner, project coordinator

Innovation details

The aim of UPSIDES is to replicate and scale-up peer support interventions for people with severe mental illness, generating evidence of sustainable best practice in high-, middle- and low-resource settings through mixed-methods implementation research. The objectives for the UPSIDES project are:

  • To establish an international community of practice for peer support across high-, middle- and low-resource settings.
    A consortium of mental health researchers, providers and users will be established at eight study sites in six countries in Europe, Africa and Asia
  • To conduct a situational analysis of existing peer support initiatives in the participating countries.
    By developing and validating a conceptual framework for identifying the current stage of implementation of peer support
  • To scale up peer support models with a focus on vulnerable populations where pilot initiatives already exist
    The project will assess the current stage of implementation of peer support work at each site using a standardized measure that is based on the conceptual framework
    Will manualise existing interventions and build capacity in the co-production and co-delivery of demonstrations
  • To contextualize and adapt peer support models for those sites where there are no peer support initiatives.
    By adapting existing tools, materials and strategies from demonstration centres to ensure cultural and situational appropriateness, or creating new ones, as needed.
  • To rigorously evaluate inputs, processes and outcomes of implementation, including an assessment of process and contextual factors using mixed-methods
    We will conduct a multi-site pragmatic trial augmented with qualitative methods, which will assess user-, service- and system-level outcomes and investigate active ingredients and key barriers and facilitators for research and practice
  • To distil from case studies evidence of best practice for dissemination to local, national and international stakeholders in order to maximise sustainability and spread.
    By engaging with diverse national and local advisory boards including service users, carers, senior clinical staff members, representatives of Health Ministries, hospital directors, community leaders, and a Communications Taskforce.

Key drivers

Stakeholder Engagement

  • UPSIDES makes use of stakeholder knowledge by international researchers and national and local mental health policy makers being active in local and international advisory boards

Peer Involvement

  • UPSIDES goes beyond these traditional approaches of making use of stakeholder knowledge by explicitly involving peers in developing and delivering the study intervention, building on the lived experience of people with mental illness as a valuable resource

Challenges

Coordination across multiple sites

The major challenge is to coordinate the research across all sites in different countries. The current stage of peer support implementation and the key features of peer support vary between sites. At the same time, UPSIDES will benefit from this variance, as all sites will learn from each other.

Continuation

UPSIDES will make available a sustainable intervention by producing guidance for other low-, middle- and high- income countries to initiate peer support programmes.

The main UPSIDES deliverable, i.e. an evidence-based cross-cultural implementation strategy for peer support in mental health care settings, will be transferrable with some adaptations to other countries (mostly, but not exclusively low- and middle-income countries). This process will be facilitated by UPSIDES team members beyond the duration of the project and the UPSIDES dissemination strategy which will support sustainable change in policy and practice.

Partners

The research consortium involves the following partners: 

Funders

  • UPSIDES has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 779263
  • The information on this website reflects only the authors’ view. The Commission is not responsible for any use that may be made of the information it contains.
  • Funding for the Indian study site is provided by the Indian Council of Medical Research in collaboration with the Global Alliance for Chronic Diseases (GACD)

 

Evaluation methods

Using a mixed-methods approach, the impact of peer support will be rigorously evaluated using a range of sub-studies at the levels of patients and peer support workers (psychosocial and clinical outcomes), services (cost-effectiveness, return on investment), and implementation (adoption, sustainability, organisational change). These include the following methodological activities:

  • Expert panels to assess the view of local stakeholders
  • Key informant interviews and focus groups with service users, peer support workers, mental health workers and other stakeholders for intervention development and accompanying evaluation of peer support
  • A randomised controlled trial to assess the effectiveness and cost-effectiveness of peer support
  • A survey to assess changes in the organizational culture surrounding recovery and peer support

Cost of implementation

The UPSIDES project is subsidized over five years (2018 to 2022) with three million Euros (about $3.45 million) from the European Union (EU) Funding for the Indian study site is provided by the Indian Council of Medical Research in collaboration with the Global Alliance for Chronic Diseases (GACD).

Impact details

UPSIDES has started in January 2018. Research tasks in the early work packages to assess the current stage of implementation of peer support, intervention development and translation have already started. The project team is currently undertaking initial action to prepare the ground for the later work package evaluation.

Outcomes for the evaluation will include:

  • Social inclusion, empowerment, recovery and quality of life at the level of service users
  • Professional development at the level of peer support workers
  • Recovery-related knowledge, attitudes and practices at the level of services.
Additionally, implementation outcomes such as acceptability, appropriateness, feasibility, costs, coverage, fidelity adoption and sustainability will also be evaluated.

References

  1. The WHO World Mental Health Survey Consortium. (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the world health organization world mental health surveys. JAMA, 291:2581–2590.
  2. Wang PS et al. (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet, 370:841–850. doi:10.1016/S0140-6736(07)61414-7.
  3. Patel V et al. (2007) Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet, 370:991–1005.
  4. Davidson L, Bellamy C, Guy K, Miller R. Peer support among persons with severe mental illnesses: a review of evidence and experience. World psychiatry. 2012 Jun;11(2):123-8.
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