Mental Health Peer Support

Mental health peer support has been a long-established best practice recognized in Canada.1

The academic literature for peer support as a “best practice” thrives. A growing body of international and Ontario-based research captures the value of peer support as a best practice in crisis intervention, emergency departments, inpatient settings, discharge planning, case management and other community mental health settings.

In Ontario, consumer/survivor initiatives (CSIs)2 have been providing peer support to improve the quality of life for people with lived experience of mental health problems since 1991. As they do around the world, Ontario’s CSIs take many forms. Two examples of the evidence base for CSIs are described below.

The Longitudinal Study of Consumer/Survivor Initiatives (part of the Ontario Community Mental Health Evaluation Initiative) showed that participants in CSIs were more likely to be living in stable housing and less likely to use emergency rooms or to be hospitalized. CSI participants reported improved quality of life, less symptom distress, and feeling more empowered and supported by their peers. They also valued the CSI programs as places that were safe from stigma. CSIs reported that as a result of the findings of the study, one hospital increased its referrals to the local CSI and another brought peer support workers in to work in the hospital. CSIs have also been successful in addressing determinants of health such as poverty, for example getting municipalities to provide subsidized bus passes for their members.3

The Therapeutic Relationships Project (Forchuk et al., 2002) paired peer supporters with patients due for discharge from hospitals. This study found that using peer support for one year as part of a transition into the community created better outcomes in terms reduced hospitalization and emergency room use, improved quality of life and better functioning.4

The experiential knowledge of peer support workers and consumer/survivor organizations has implications beyond mental health self-care. Mental health peer support workers are in an ideal position to support their peers to understand their risk of diabetes, to learn and practice prevention strategies, and to self-manage diabetes. Given the shortcomings in the social determinants of health for this population (income, housing, and food in particular), strategies to support self-management and prevention must be accessible, affordable and practical. Mental health peer support workers know and understand this reality and have experience with supporting people to improve their health and quality of life under difficult circumstances.

The Diabetes and Mental Health Peer Support project will apply mental health consumer-survivor expertise in peer support for self-management of mental illness to support for self-management and prevention of diabetes. CSI’s are ideally situated to offer the type of peer support described by Heisler as community health workers (see Support for Diabetes Self-Management). That model involves peers who share a common culture though not necessarily experiencing the illness themselves. The peer support workers in CSIs share the experience of living with a mental health problem, though they may not share the experience of living with diabetes. CSI peer support may also take the form of formal structured groups, although a highly structured model such as the Stanford model is less common than more informal, flexible programming. Peer support workers also operate 1:1, similar to Heisler’s peer mentoring model.

Related Resources

CMHA Ontario, CAMH, OFCMHAP, and OPDI, “Consumer/Survivor Initiatives: Impact, Outcomes and Effectiveness,” March 2005.

Geoff Nelson et al., “Longitudinal Study of Consumer Survivor Initiatives (CSI) in Ontario 1997-2004,” Centre for Community Based Research.

Janet Peters, “Walk the Walk and Talk the Talk: A Summary of Some Peer Support Activities in IIMHL Countries,” November 2010.

Mary O’Hagan, Heather McKee and Robyn Priest, “Consumer Survivor Initiatives in Ontario: Building for an Equitable Future,” Report for CSI Builder Project, Ontario Federation of Community Mental Health and Addiction Programs, June 2009.

Mary O’Hagan, Céline Cyr, Heather McKee and Robyn Priest, “Making the Case for Peer Support: Report to the Peer Support Project Committee of the Mental Health Commission of Canada,” September 2010.

Mental Health Commission of Canada, Guidelines for the Practice and Training of Peer Support, December 2013.


[1] Health Canada, “Best Practices in Mental Health Reform: Situational Analysis” (Health Canada 1997), p 26-32.

[2] Consumer Survivor Initiatives (CSIs) are provincially funded organizations run by and for consumer/survivors. Peer support to improve mental health and quality of life is one component of what CSIs offer.

[3] CAMH, CMHA, OMHF, “Making a Difference: Ontario’s Community Mental Health Evaluation Initiative” (2004) p 25-26.

[4] Cheryl Forchuk et al., “Therapeutic Relationships: From Hospital to Community” (2002).