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task shifting; peer volunteers; facilitators; barriers
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Ahmad I, Hanif M, Waqas A et al. Understanding the use of peers for mental health care: A meta-synthesis of qualitative evidence [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2023, 12:854 (https://doi.org/10.12688/f1000research.124792.1)
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Systematic Review
Understanding the use of peers for mental health care: A meta-synthesis of qualitative evidence
[version 1; peer review: 1 approved with reservations, 1 not approved]
PUBLISHED 19 Jul 2023
OPEN PEER REVIEW
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This article is included in the Health Services gateway.
Abstract
Corresponding author:
Mubashir Hanif
Competing interests:
No competing interests were disclosed.
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The author(s) declared that no grants were involved in supporting this work.
Copyright:
© 2023 Ahmad I et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Ahmad I, Hanif M, Waqas A et al. Understanding the use of peers for mental health care: A meta-synthesis of qualitative evidence [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2023, 12:854 (https://doi.org/10.12688/f1000research.124792.1)
First published: 19 Jul 2023, 12:854 (https://doi.org/10.12688/f1000research.124792.1)
Latest published: 19 Jul 2023, 12:854 (https://doi.org/10.12688/f1000research.124792.1)
Introduction
An ever increasing prevalence of mental disorders (MDs) in low and middle income countries has attracted attention both from academics and policy makers.1 This has given birth to several proactive measures ranging from global epidemiological surveys and community-oriented interventions. The Global Burden of Disease Study (2016) estimated that over 1.11 billion people are living with mental illnesses, accounting for 150 million years lived with disability, around the globe.2 It is estimated that mental illness accounts for 32.4% to years lived with disability and 13% to disability adjusted life years (DALYs).3 And by the year 2030, depression alone would be the third largest contributor to burden of diseases in low income countries and the second largest in middle income countries.4 A majority of 85% of global population belongs to 153 low and middle income countries (LMICs), accounting for 80% of the disease burden associated with mental disorders.5
The high prevalence of mental disorders together with an escalating shortage of psychiatrists presents a grand challenge in the third world.5,6 There are only 20,000 trained psychiatrists, 195,000 nurses and 147,000 counselors across the LMICs.7 This scarcity of mental health professionals (MHPs) translates to suboptimal treatment rates (35% to 50%) in the LMICs.7 In South Asia, India and Pakistan have 0.301 and 0.185 psychiatrists available for per 100000 individuals. In the African region the ratio is as low as 0.06 and 0.04.5 The World Health Organization (WHO) estimates that an additional workforce of 239,000 mental health professionals is required to reach optimal treatment rates for eight key mental disorders including depression, schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related to the use of alcohol and illicit drugs, and pediatric mental disorders.7
Academics and policy makers around the world have proposed various strategies to overcome the dual challenge of a high burden of MDs and shortage of MHPs. This grand challenge is further exacerbated by poor financing of mental health services in the LMICs.5 To combat these challenges, task shifting has been evaluated for its effectiveness in various countries.8–15 This approach leverages lay workers or peers that are integrated in the existing health systems,6 and it has so far shown a significant potential in the successful detection and identification of MDs and their management, in a cost-effective manner.16 The spirit of task shifting is truly reflected in the Mental Health Gap Action Plan (GAP) developed by WHO. The MH GAP is the package of low intensity psychological interventions delivered by non-mental health professionals or lay workers.17 In addition to mental health,8,12,14,18 there is an ample amount of literature showing the usefulness of task shifting in other specialties of medicine.19–21
The effectiveness of non-specialists’ work force delivered services has been demonstrated in improving global provision and capacity. Yet, there has been little work so far in scaling up of these interventions on national levels. This may be due to several challenges pertaining to their implementation that need to be tackled. These barriers and challenges include poor motivation levels and retention of non-specialist and volunteer work force.22 Moreover, for successful implementation and scale up, barriers related to recruitment, training and supervision of this valuable workforce need to be recognized.23 Un-packing these processes and their barriers and facilitators specific to the roles assigned to peer volunteers can be effectively answered in a qualitative investigation.24 The aim of the paper here is to inform implementation of these interventions by synthesizing evidence from qualitative studies by using meta-ethnography technique. Meta ethnography is well developed and useful way to synthesis the qualitative study.25
Methods
Data sources
In November 2017, we conducted an electronic search of two academic databases: Cochrane Central Registry for RCTs and PubMed. A comprehensive search strategy comprising of search terms including ‘peer’, ‘volunteer’, ‘Mental Health’, and ‘Qualitative Study’ was utilized to search academic databases from inception to November 2017, as shown in Table 1 below.
Table 1. Search strategy.
Definition of peer workers
The value of peer workers as an effective conduit for delivery of mental healthcare is recognized. For this study, peers volunteers in mental health were defined as lay workers having similar demographic characteristics as the target population or valuable lived experiences of a mental illness; working in a specific capacity in mental health care delivery after getting trained in the intervention; and lacking any professional medical or paramedical training.8,15,26 Having these commonalities with the target population enables the peers to perceive the participants as similar, and have a greater understanding of the issues being faced.27
Selection criteria
Eligible citations to be included in the final analyses were selected after a thorough screening process by two teams of reviewers working independently from each other. This process was followed by manual searching of bibliographies of eligible full texts. The inclusion criteria for meta-synthesis included (1) studies that used qualitative methods for data collection and analysis (2) studies that used a task shifting approach of mental health intervention by lay workers or peer volunteers or peer support worker or peers or volunteers (3) studies published in English. Books, reports, grey literature and articles with full text not available were excluded. No restrictions on date of publication were applied. Discrepancies between reviewers were resolved through discussion between reviewers to reach the final decision.
Data extraction and quality appraisal
Using a pre-tested Excel sheet, four reviewers performed extraction of qualitative data from eligible full texts. Data were extracted against a number of matrices spanning across a) lived experience of peer volunteers b) training and supervision processes c) motivation, facilitators and barriers of the task shifting approach and d) characteristics of the volunteers. These variables informed our thematic analysis: categorization of qualitative information into specific themes leading to formation first order constructs. These first order constructs thus represented lived experiences shared by peer volunteers. We also constructed second order constructs of motivations, barriers and facilitators of peer volunteer delivered interventions. These constructs were informed by the researcher’s perspective. Two reviewers cross-checked the extracted data for accuracy of the extracted data. Thirdly, quality appraisal of the included studies was done using the 13 criteria proposed by Atkins et al. (2008).28 Atkins’ (2008) criteria for appraisal of quality of qualitative studies spans across domains of study design, clarity in research questions and approach, study context, role of researchers in the study, and appropriateness of sampling methods and data collection and analysis procedures.28
Analysis
The current evidence synthesis approach was based on the framework of meta-ethnography proposed by Noblit and Hare (1988).29 This is a more accepted and frequently used technique for the qualitative synthesis. This approach treats results (participants’ experiences) as first order constructs and discussions and conclusions (researchers’ interpretations) as second order constructs distilled from primary studies. In the initial phase, we synthesized findings across studies that presented consistent results and. In this manner, first order constructs and second order constructs were identified. These were then compared across studies to construct new interpretations or third order constructs. In the next phase, we synthesized evidence for constructs that were presented as contradictory across studies.
Results
Screening process
A total of 841 non-duplicate titles and abstracts were retrieved from the electronic search of PubMed and Cochrane databases. Out of these 841 articles, 757 articles were excluded during title screening for reasons including quantitative study designs or focus on constructs other than mental health and non-original studies. A total of six studies were reviewed for full text screening and out of these, three studies30–32 were excluded because of their focus on intervention rather than task shifting. Three additional studies were added from searching reference lists of the included articles and a total of six studies were included for the review.
Characteristics of studies
There was a total of six studies published from different countries including the UK, Canada, Denmark and USA. The highest number of studies were contributed by the UK (n=3). The studies reported the use of focus group interviews (n=3), in-depth interviews (n=4) and semi-structured interviews (n=4). The studies aimed to explore heterogeneous aims: Rebeiro Gruhl et al. (2016)33 and Berry et al. (2011)34 sought to understand the mechanism for integration of PSWs within mainstream services in Canada and the UK; Jensen et al. (2017)35 sought to explore experiences of volunteer families; Nan Greenwood et al. (2013)36 focused on experiences of peer support service. Moran et al. (2013)37 explored challenges for peers working in diverse setting and roles while Gillard et al. (2015)38 focused on peer workers employed in the statutory sector, voluntary sector and in organizational partnerships. Atif et al. (2016)8 and Munodwafa et al. (2017) focused on understanding use of peer and CHWs in delivering task shifting interventions for perinatal depression (see supplementary file 139). All the included studies met the Atkin’s criteria of appraisal (see supplementary file 539).
First and second order constructs
We have identified 22 first order constructs (see supplementary file 239) among the selected six studies. These are all responses of the respondents in each individual study. Key constructs are recruitment and training, supervision, role of PSWs, motivation, challenges and barriers.
Challenges
Volunteer-led initiatives are always challenging. Our extracted data from the included studies highlighted a number of challenges. Respondents reported that disconnection between the training they receive and the actual task they are doing results in burnout. Sometimes working with clients that are having similar problems as PSWs had in the past will remind them of their stressful time which can be upsetting. Another challenge is when a client is not improving and it becomes difficult for PSWs to establish a healthy relationship. Integration of peer led initiatives into the mainstream is also a challenge because of unclear roles and acceptance of their roles in mainstream health systems.
Recruitment and training
Peer support workers highlighted the importance of employing a formal recruitment process. They believe these processes make them recognize the importance and responsibility of their role. Insufficient training for PSWs is another issue that was reported. These PSWs are coming from different backgrounds with varied training needs. They are recruited at different time points in mental health services; those recruited at an earlier stage have more training compared to those recruited at a later stage of the program. The PSWs who developed better skill sets were assigned more responsibilities. The need for uniform training was highlighted. All the PSWs valued the importance of lived experience as a prerequisite for a role in the mental health service.
“I haven’t taken any training. I’m not even aware that it’s been offered up where I am…. I do not have a policy degree as a social worker or anything. I’m coming from the Centre where I was formerly a volunteer and that was it. So it’s lived experience plus I’ve been sent for crisis intervention, conflict resolution … those kinds of things. (NB04)33”
Supervision
Respondents emphasized the importance of quality supervision as an integral part of volunteer initiatives. PSWs reported that without supportive supervision it is very difficult to meet the expectations of their role.
In addition, peer providers should receive supplemental preparation and supervision specific to the job context above and beyond generic peer training programs.37
Ongoing supervision gives them the sense that they are not alone in their experiences and helped them think that many other people also have had similar experiences. They are made aware that people could share similar emotional journey including both positive and negative emotions. Moreover, it was highlighted that discussion during trainings help them realize that their experiences are not unexpected.
“It’s a perfectly normal, understandable reaction that no one is weird or freaky that they feel like that. There was anger in there too but having someone say ‘Yeah I felt like that too’ helped.36”
Role of peer support workers
PSWs reported concerns about their unclear and ambiguous role. Most of them reported they are performing a different role than they had been recruited for at the time of interview. Most of the time they were asked to do things they are not supposed to do. They reported that their role is not acknowledged in the organization and they are not treated equal to their co-workers. PSWs reported they like a role where they share their experiences, participate in trainings, communicate and work collaboratively with others, initiate, establish and maintain relationships with clients and help clients to set goals and work towards them. They are also working as change agents in diverse settings.
… it actually recognizes that the role is a proper job … if they go through a recruitment process they realize the importance and the responsibility the job brings.38
It’s a good start, but it doesn’t have support. It’s very difficult. When you say integrated, we’re trying, we’re trying to bring to the hospital let’s bring peer support into the hospital. We’re trying, but wow it’s a battle. And that battling sense is wrong. I really feel we should be able to be critical of the system. And that’s what is getting attention.33
Professionalism
Respondents reported the concept of professional boundaries is relative according to the situation and contextual factors determined by the PSWs. For the volunteer work, professionalism is defined as doing your work as best as you can.
It’s an important issue that they’re not as professional as a normal worker … if they were formal they would have a completely different appearance and approach to things than if they were informal …38
In one study, PSWs reported that the non-professional and prejudiced attitude of co-workers towards clients was a significant barrier. Having a structured peer support work team in an organization provides a professional outlook, promotes camaraderie and motivation. Most of the organizations have an unstructured peer support work process which may stigmatize the peer worker working with patients. According to Galia et al., without a structured and supportive environment peer support workers may also feel alone and emotionally distressed especially when they are going through their own recovery process
Motivation
PSWs reported that a sense of helping others is the primary source of their motivation. Peer support workers have a great fund of knowledge gained while recovering from their own mental illnesses. They also face (public and self) stigma associated with mental illnesses. During their recovery process, they also learn strategies to manage their symptoms and cope with sociocultural challenges. Therefore, PSWs can help people early in their course of illness by teaching them effective coping strategies. This can catalyze patients’ recovery from mental disorders.
It’s not that I don’t want to help people in Africa, I would love to. But I kind of like to give a piece of myself to someone. Give something to a person who really needs it.35
PSWs highlighted that happiness and sense of achievement felt by helping and supporting other people is a big source of their motivation for their participation in such programs.
All the families pointed to the personal joy and sense of reward generated by supporting and caring for another person, as a huge motivation for entering and staying in the programme.35
Lived experiences
PSWs reported being helpful to others is the most satisfactory thing in their work. Shared experiences are helpful in helping others. Meeting new people and working with them is a pleasurable activity, and training and exposure enhances their personal skill set.
“I think that one of the most important things that has trained me for my job description is the lived experience. I have a degree in education; I have a degree in psychology. I have all kinds of diplomas in education background and I have been an educator for most of my life, but having the lived experience of severe mental illness has given me a lot of insight, and patience, and tolerance and compassion … the lived experience is the most important thing that I bring to the table. (NB09)33”
Second order constructs
Second order constructs are researchers’ interpretations of included studies. We have identified 26 second order constructs (see supplementary file 339). These constructs are very similar to first order constructs and grouped under almost same themes that were used for first order constructs. Additional constructs included insufficient training, uniformity of training, terms and conditions for PSWs.
Recruitment and training
All studies except one report that there is a strong support for lived experiences for the PSW role. It was concluded that PSWs are not recruited following more formalized recruitment methods, PSWs are recruited at different time points and for a limited time period depending on the activity for which they are being hired. Support for the training and wellbeing of PSWs working in the complex environment was needed.
“In addition peer providers should receive supplemental preparation and supervision specific to the job context above and beyond generic peer training programs.37”
Role of PSWs
Data indicated that participants felt the role of PSWs is unclear, and that the clarity of their role and job description is very important. PSWs are performing varied roles and they are spending more time on indirect activities rather than direct mental health services. PSWs are expected to perform the challenging role of a change agent.
“A mismatch between the PSS professional identity and the actual role seemed to be associated with “othering” of the PSS worker by the team, but also a simultaneous denial of the specialism of the role. Therefore, the current findings provide more explanatory power to recommendations for previous research concerning the need for clearly defined peer support roles.34”
Professionalism and motivation
The importance of a professional approach in such voluntary initiatives is highlighted in included studies. The studies reported that training on workplace ethics and maintaining professional boundaries should be given to PSWs.
“Thus, feeling forced into the consumer movement, or being pigeonholed as a “peer poster boy”, may be confining and ultimately lead to burn out and lack of intrinsic motivation.37”
Challenges
It was concluded that involving PSWs in indirect activities results in a low level of PSW satisfaction. Physical distance from urban centers and an unclear job description also adds to their dissatisfaction. PSWs are not treated equally to paid staff and they are expected to work as per traditional values. Paid staff felt insecure and think that PSWs might take their role, which leads to the isolation of PSWs.
“PSS workers were in a vulnerable position of having to challenge workers of a higher pay banding, often in a resistant environment, and with limited support.34”
Facilitators
Helping others is the most satisfying thing for PSWs, and it has positive effects for their self-esteem, confidence and recovery. Supportive supervision from senior management is another facilitator. Training opportunities help in developing capacity and leadership skills of the PSWs. It was also concluded that acceptance from both PSW and their clients to provide and receive help, helps in creating a positive relationship.
“Additionally, relationships were more supportive if both people were willing to provide and receive support and had gained some distance from their own situation, so that they were able to help each other think through solutions, rather than simply give advice based on their own experiences.33”
Contradictions
Although most of the literature suggests that lived experience is a perquisite for the role of PSW, one study concluded that lived experiences are not necessary if a PSW had all the basic characteristics to enable them to perform the role.
‘The first PSS worker stressed that, while obviously a prerequisite to the position and valuable, lived experience of mental health problems should not entirely define the role; “I mean there will be times where I meet people who I’ve met in a different role, but my role is here, as a Peer Support Specialist worker, and what’s happened in the past is not an issue […] I’m very clear about my own boundaries and space” (P1)’34.
Third order constructs
Our interpretations are represented as third order constructs (see supplementary file 439). This is based on first order constructs and second order constructs along with recommendations.
Standardized procedures for recruitment, training and supervision
There is a need for formal and standardized procedures for the recruitment of PSWs for mental health services. They should be assigned very precise and clear roles and responsibilities. Standardized training in terms of content and duration will be helpful to PSWs in delivering standardized care. More structured supervisions are also needed. All PSWs should receive same level of supervision with same intensity.
Challenges and barriers
One of the barriers to the success of peer led programs is the dissatisfaction of PSWs. Unclear job description, involving them into indirect activities, burnout and unfavorable working conditions are the main reasons for their dissatisfaction. A lack of acknowledgment and acceptance of PSWs’ contributions towards better health outcomes, lack of standardization and unclear roles are the barriers for integration of such initiatives into mainstream health systems.
Facilitators and motivators
Emotional satisfaction by helping others is a great motivator for PSWs. PSWs learn new skills, gain confidence, and their role boosts their self-esteem. Shared and lived experiences are helpful and facilitating factors while delivering such type of intervention. Positive social interaction also brings good feeling to PSWs as well.
Discussion
The present review meta-synthesizes evidence aims to understand the use of peers and their integration in mental health services. Several facilitators and challenges for peer led programs were identified during this exercise. We demonstrate that the procedures applied for recruitment and training of peers are inadequately structured. The desire to help others and opportunities for personal development are prime motivators for PSWs. Integration of peer led programs into mainstream mental health services presents a grand challenge in this domain. Additional difficulties faced in traditional mental health organizations were direct and covert displays of prejudice among coworkers, interpersonal issues, a lack of a recovery-oriented work atmosphere, and serving as the only peer provider in the organization. Excessive work and poor working conditions were common. Lack of training and inadequate training were also identified.10
Several studies highlighted the importance of standardized and well-defined procedures for recruitment of PSWs in successful implementation of intervention programs. PSWs were assigned less formal positions at organizations due to the nature of their commitment, however it is important that they must be assigned well-defined roles with clear objectives. Our results showed that in such programs, trainings are less structured and poorly standardized. And this lack of standardization in trainings leads to varied levels of competence of the PSWs and ultimately their performance. Standardization, both in terms of content and duration, should be ensured for better quality and deliverability. Training of PSWs is a highly important aspect for the success of any mental health services delivered through peers’ support.12 It was highlighted that PSWs are recruited at different time points of the programs and they have different background and predispositions. Individuals that are inducted in on-going trainings have fewer opportunities to learn and practice; since they are offered the same training, their individual needs which affect their job performance are not considered. In addition, poor supervision from specialists and senior colleagues was another hindrance in provision of poor mental healthcare.
Some important challenges pertained to lack of skills for using one's life story and lived experience, and stigma and negative connotations associated with carrying a peer provider label. Moreover, personal mental health challenges were exacerbated by overwork and sometimes led to reporting of symptom recurrence among peer volunteers.37 These challenges hinder emotional satisfaction, self-esteem and confidence and capacity building. According to Moran et al., shared experiences among peer volunteers are important facilitating factors that should be channelized to provide important insights into the condition and treatment.37
In addition to these challenges, a clear job description and role clarification was lacking in a number of interventions – these should be fully standardized by key stakeholders (including program administrators, supervisors, and potential coworkers), with relevant competencies, and a clear policy for evaluating competencies and job performance.9 This lack of clear job description is an important predictor of poor satisfaction among Peer|Volunteers (PVs). Effective integration of peer support requires consideration of the work role, unique needs of the worker, and the overall workplace environment. Integrating peer support providers is a process that evolves over time and does not end once someone is hired.11 Corroboratory evidence suggests that poorly defined job structure, lack of policies and practices and administrative support lead to poor integration of PVs in the healthcare systems.40
We included only qualitative studies, due to inherent methodological constraints these studies have reported few limitations, which mainly include reporting bias, limited generalizability and heterogeneity of the sample. The search for the included studies was conducted in 2017 and there is a possibility that the body of knowledge may have evolved in this time period. Another limitation of the current study is that only two search engines were searched for inclusion of the relevant studies in the meta-synthesis whereas findings could be more robust if multiple search engines were explored.
Conclusion and future direction
Most PSWs experienced difficulty in describing what they did, and why the mental health system needed peer support. This did little to make explicit their unique contribution to mainstream mental health services, or why they should be hired if they are engaging in mental health treatment and prevention. Peer support is particularly important for the mental health system as it provides compassion, empathy, listening, validation, and hope for those with mental illnesses. Future training/supervision should embrace authenticity and any standardization of peer support work should be based in it.
The need for an investment in structured and standardized training/supervision is paramount to peer support systems. The findings highlighted inconsistent training, which is especially problematic. It is advised to set a minimum level of training for PSWs that reflects the viewpoints and capabilities of the peer workers. The findings also highlight the significance of setting up a network of resources to help the peer support workforce thrive in the mainstream system and, most importantly, to collectively struggle for its credibility. Some people see integration as a way to get better recognition and job prospects. The increasing integration of the PSW inside conventional mental health services can be advantageous. This in turn will bring value to PSWs.
Data availability
Underlying data
All data underlying the results are available as part of the article and no additional source data are required.
Extended data
Figshare: Understanding the use of peers for mental health care: A meta-synthesis of qualitative evidence, https://doi.org/10.6084/m9.figshare.21202499.39
Reporting guidelines
Figshare: PRISMA checklist and flowchart for ‘Understanding the use of peers for mental health care: A meta-synthesis of qualitative evidence’, https://doi.org/10.6084/m9.figshare.21202499.39
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how to cite this article
Ahmad I, Hanif M, Waqas A et al. Understanding the use of peers for mental health care: A meta-synthesis of qualitative evidence [version 1; peer review: 1 approved with reservations, 1 not approved] F1000Research 2023, 12:854 (https://doi.org/10.12688/f1000research.124792.1)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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PUBLISHED 19 Jul 2023
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How to cite this report:
Byrom NC. Reviewer Report For: Understanding the use of peers for mental health care: A meta-synthesis of qualitative evidence [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2023, 12:854 (https://doi.org/10.5256/f1000research.137025.r210951)
The direct URL for this report is:
https://f1000research.com/articles/12-854/v1#referee-response-210951
https://f1000research.com/articles/12-854/v1#referee-response-210951
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 17 Nov 2023
Approved with Reservations
VIEWS 1
This was a fascinating read and is a much needed piece of work. The introduction is powerful and compelling. We really do need a better understanding of what peer support is and why it is so hard to get enthusiasm
... Continue reading
CITE
HOW TO CITE THIS REPORT
Byrom NC. Reviewer Report For: Understanding the use of peers for mental health care: A meta-synthesis of qualitative evidence [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2023, 12:854 (https://doi.org/10.5256/f1000research.137025.r210951)
The direct URL for this report is:
https://f1000research.com/articles/12-854/v1#referee-response-210951
https://f1000research.com/articles/12-854/v1#referee-response-210951
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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How to cite this report:
Norton MJ. Reviewer Report For: Understanding the use of peers for mental health care: A meta-synthesis of qualitative evidence [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2023, 12:854 (https://doi.org/10.5256/f1000research.137025.r215084)
The direct URL for this report is:
https://f1000research.com/articles/12-854/v1#referee-response-215084
https://f1000research.com/articles/12-854/v1#referee-response-215084
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 01 Nov 2023
Not Approved
VIEWS 4
Dear Authors
Many thanks for submission of this article for review. Please see my comments below
This article attempts to provide a meta-synthesis of peer led interventions within mental health discourse. However, the review is poorly ... Continue reading
Many thanks for submission of this article for review. Please see my comments below
This article attempts to provide a meta-synthesis of peer led interventions within mental health discourse. However, the review is poorly ... Continue reading
CITE
HOW TO CITE THIS REPORT
Norton MJ. Reviewer Report For: Understanding the use of peers for mental health care: A meta-synthesis of qualitative evidence [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research 2023, 12:854 (https://doi.org/10.5256/f1000research.137025.r215084)
The direct URL for this report is:
https://f1000research.com/articles/12-854/v1#referee-response-215084
https://f1000research.com/articles/12-854/v1#referee-response-215084
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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