Peer Research and Complex Needs: A Mental Health Perspective

Agnes Hann comments on some of the themes of Revolving Doors’ recent literature review on peer research, and links it to the progress and debates surrounding peer research in mental health.

At the McPin Foundation, we specialise in collaborative work with experts by experience in various roles, including peer researcher, service user advisor, or lived experience board member. And so it was with great interest that I read Revolving Doors’ literature review exploring the application of a peer research model with severely socially excluded populations.

As the paper notes, mental health service users have been pioneers in peer research, which is now relatively well-developed in the mental health field. By contrast, peer research within a context of severe and multiple disadvantage is an emergent methodology – and, as the authors note, many of the studies reviewed fall under the heading of ‘grey literature’. This observation itself points to some of the underlying tensions that shape the practice of peer research – including the power and politics of ‘peer’ review – that mental health research has endeavoured to negotiate over the past decade. These tensions – theoretical, practical and ethical – are amplified in complex needs research, and are clearly and concisely laid out in the paper.

Challenging assumptions and conventions in research

Peer research, with its premise of a shared experience between researcher and researched, challenges the conventional paradigms of social research on every level: its social constructivist theoretical underpinnings, its roots in community-based participatory action research, its attempts to dismantle power dynamics in contemporary professional/academic contexts. It calls into question assumptions of objectivity and neutrality in the research process and is an inherently political exercise – ‘nothing about me without me’. The political imperative to conduct peer research is arguably most pronounced when researching the most marginalised communities, and the studies reviewed collectively highlight the benefits and successes of such approaches.

In mental health peer research, we are accustomed to emphasising some of these advantages of peer researcher involvement – above all, the improvement to the quality of the research that results from richer qualitative data and a more diverse sample of participants. Occasionally, there is some scope to explore some of the more abstract issues, for example, regarding the democratisation of knowledge.

Peer research’s personal benefits

One benefit of peer research highlighted by the paper that I feel sometimes falls by the wayside in our work is the personal (and professional) benefit to researchers in supporting their recovery journeys. This is something that we are very aware of as an organisation – but it seems to feature less prominently in our tenders or funding applications (although we try and create other platforms for discussing this aspect of our work). We are better at reflecting on how to use personal experience of mental distress within the research process, but as an organisation, we have not written much about the personal benefits of peer research.

Is this because, as peer research in mental health becomes more ‘mainstreamed’, with Patient and Public Involvement (PPI) increasingly a standard requirement for studies, it inevitably becomes less political? In our drive to meet criteria around ‘robustness’ and ‘validity’, do we feel obliged to focus less on the personal (and, lest we forget, the interface between the personal and the political lies at the very heart of peer research)?

The paper touches on some of these challenges, and emphasises above all the ‘call to action’ for academics to relinquish control raised by this body of research. In a mental health context, these debates have, in one sense, been progressed much further. But they are ongoing – views on what constitutes peer research, and how it should be done well, differ widely. At the McPin Foundation, our approach is primarily based on the principles of co-production, valuing the expertise of all involved, but acknowledging differences. In our experience, collaborative or peer-led research requires time to develop relationships and build capacity within the process to reflect, provide appropriate support to team members, and adapt established practices to be more inclusive and welcoming. In practice, and as the authors of the review observe, research that seeks to challenge the established structures of research institutions and funder norms has to be reconciled with practical considerations – above all the need to conduct research that is likely to have an impact and achieve change.

As the field of peer research with socially excluded populations advances, it will be important to ensure there are ongoing opportunities for reviewing, debating and critically reflecting on the ethical and methodological benefits and challenges of this model. We look forward to continuing these discussions within mental health research, as well as learning about different approaches from the emergent complex needs research sector. As the paper demonstrates, peer research is well-placed to borrow across fields as well as from within sector experience.

Dr Agnes Hann, Senior Researcher