Background: Peer support roles in mental health services are rapidly increasing in the UK and internationally. However, there is wide variation in these roles and limited research exploring the ways in which Peer Support Workers (PSWs) are currently working. We aimed to explore: 1) the distinctive features of PSWs approaches in mental healthcare; 2) the values underpinning the role and 3) the perceived impact of the role. Methods: We conducted semi-structured qualitative interviews with paid mental health PSWs working across a range of settings. We took a co-produced, participatory approach: interviews were carried out by researchers with lived experience of mental health conditions and data were analysed using collaborative methods, guided by general principles of thematic analysis. Results: We interviewed 35 PSWs. Overarching themes identified from iterative analysis included: 1) The centrality of an individualised, flexible, approach, facilitating recovery through sharing lived experiences and building connection. PSWs advocated for service-user needs and most worked in non-clinical ways, offering holistic, recovery-orientated support. Tensions could arise with more clinical approaches. 2) Underpinning values included: i) Recovery is possible: bringing hope, role-modelling and encouraging change, ii) Mutuality: sharing lived experiences to bring empathy and build connection, iii) Person-centred approach: adapting ways of working to the individual, iv) Empowering instead of ′fixing′ service users. 3) the role had benefits for participants′ own recovery, although its emotional demands could lead to burnout. Participants thought that peer support helped service users feel understood, leading to greater openness and facilitating recovery, although some felt that it may not be right for everyone. Participants felt that PSWs could bring systemic improvements to services and use their lived experience to help teams -meet service user needs. Conclusion: PSWs work in a range of ways, but, a unifying feature is a flexible, person-centred approach, facilitating recovery through shared lived experience. A range of potential benefits of peer work were identified for PSWs and for service users, as well as reports of positive systemic change. These could be facilitated by recovery-orientated models in services, space for shared learning with PSWs, and flexibility to incorporate PSWs ′ unique ways of working.

JR is the CEO of ImROC, a provider of peer support training nationally and internationally and is currently one of the organisations commissioned to provide peer support training by NHS England (NHSE). KM is Director of With-You Consultancy, a provider of peer support training nationally and internationally and is currently one of the organisations commissioned to provide peer support training by NHSE.

This paper presents independent research commissioned and funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme, conducted by the NIHR Policy Research Unit in Mental Health (MHPRU). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or its arm's length bodies, or other government departments. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Research Ethics Commitee of University College London (UCL) gave ethical approval for this work (REF: 19711/001, obtained 9th January 2023). All participants provided informed consent prior to enrolment in the study, including consent for publication of anonymised quotes.

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The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.