Effectiveness of peer support for people with severe mental health conditions (UPSIDES-RCT)

Bernd PUSCHNER¹, Juliet NAKKU², Ramona HILTENSPERGER⁶, Grace RYAN⁷, Mike SLADE³

¹Ulm University, Ulm, Germany
²Butabika National Referral Hospital, Kampala, Uganda
³School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
⁴Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
⁵Ifakara Health Institute, Dar es Salaam, Tanzania
⁶Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
⁷Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
⁸Department of Social Work, Ben Gurion University of the Negev, Be’er Sheva, Israel

Background: Peer support involves a person in recovery from a mental health condition supporting others with mental health conditions. Some trials have evaluated peer support in high-income, mainly English-speaking countries, but the quality of the evidence is weak, and no trials have been conducted in low- or middle-income countries. This paper presents findings of a multi-centre randomised controlled trial testing whether participants who received UPSIDES peer support experienced improvements in social inclusion (primary outcome), empowerment, hope, recovery, and health and social functioning (secondary outcomes), when compared to a wait-list control group.

Methods: We report a pragmatic multi-centre parallel-group wait-list randomised controlled trial which tested the effectiveness of UPSIDES peer support at three measurement points (baseline, 4 and 8 months). Participants were adults with severe mental health conditions recruited at six study sites comprising two sites in Germany, and one each in Uganda, Tanzania, Israel, and India. The trial was pre-registered (ISRCTN26008944).

Findings: 615 participants were recruited. 305 were randomised to the intervention group, and 310 to the control group. Those allocated to the intervention group received an average of seven sessions of peer support over four months. Intention-to-treat analysis showed effects on two of the three subscales of the Social Inclusion Scale (SIS), Empowerment Scale, and Hope Scale. Per-protocol analysis showed an effect on the primary outcome.

Discussion: Peer support beneficially impacts on social inclusion, empowerment and hope of people with severe mental health conditions across diverse settings. As social isolation is a key driver of mental ill-health, and empowerment and hope are both crucial for recovery, peer support can be recommended as an effective component of mental health care.

Funding: EU H2020, GA 779263.