Table 5 Synthesis of quantitative and qualitative analyses

1. Peer worker wellbeing is generally good and remains so over time in the role

Peer worker wellbeing scores post-training were similar to those of the general public and remained so over 12 months

Peer worker burnout scores post-training higher than comparable healthcare professionals and remain so over 12 months

Days absent from work for peer workers were similar to wider UK mental health workforce

Mental health and wellbeing service use for peer workers was generally low and changed little over 12 months

Feeling valued and rewarded, and a transformative sense of empowerment, purpose and self-worth - gained through acquisition of skills, training and experience of supporting others and being able to make use of own experiences of mental health - were important impacts of working in the peer worker role

The peer worker role could be emotionally demanding, or the sense of value and self-worth undermined where peer workers felt unable to offer enough support or the people they worked with discontinued peer support

2. Job satisfaction for peer workers and experiences of multi-disciplinary teamworking are generally good and remain so over time in the role

Peer worker job satisfaction and multi-disciplinary team working scores post-training were similar to comparable groups of healthcare professionals and remained so over 12 months

Proper remuneration in the peer worker role was symbolic of value and recognition although this could be undermined where clinicians did not understand or acknowledge the peer worker role

3. Peer worker wellbeing and some aspects of job satisfaction can drop, and some feelings of burnout increase over the first few months in post, but then stabilise as peer workers adjust to, and are properly supported in the role

There was a significant drop in wellbeing, personal satisfaction and satisfaction with workload, and an increase in the depersonalisation burnout subscale at four months (only the latter was maintained at 12 months, and all scores remained comparable to or better than norms)

Peer workers could find the emotional and practical demands of the role difficult to manage in the first few months in post, but could find balance in the role through adapting and adjusting their approach and workload with the support of their supervisor

4. Peer worker satisfaction with job prospects and training can drop over time where job certainty and career development opportunities are unclear

The was a significant drop in peer workers’ satisfaction with job prospects scores at four and 12 months in the post, and in satisfaction with training at 12 months

Peer workers were initially extremely optimistic about ongoing job prospects – whether that involved more peer support or moving into other work - while over time peer workers became less optimistic, expressing hope that their contracts would be continued in the face of uncertainty

Initial training was very well received. Peer workers expressed interest in further training and career development opportunities

5. An enhanced sense of connection to self and others, within and beyond work, is an important impact of working in the peer worker role

(Note: good communication with clinical colleagues is needed as part of that sense of feeling well connected in the peer worker role)

De-personalisation subscale scores on the burnout measure are more than one SD lower than a comparable group of healthcare professionals

While non-significant, there was a reasonably large reduction the communication subscale of the multi-disciplinary team measure at four and 12-months in post

Connecting with people they were supporting and the peer workers they worked alongside was a learning experience for peer workers, enabling peer workers to better connect with their own mental health

The close connection experienced through offering peer support could be demanding, although a strong sense of connection with the peer worker team, developed while training together and further experienced through supervision, was supportive

There could be a positive knock-on effect on improved connection with family and friends

There was sometimes a need to improve communication and a sense of connection with the clinical teams that peer workers worked alongside