עמיתים עם ידע מניסיון: האתגרים המרכזיים והגורמים העשויים לקדם יישום מיטבי של תמיכת עמיתים בשירותי בריאות הנפש

Background: In recent years, a recovery-oriented approach has been implemented in the mental health system, of which a central component is the employment of peer providers (peers). Optimal integration of peers in MH services contributes to service users, peers and organizations, in promoting personal recovery and a recovery-oriented and person-centered approach in organizations. However, many organizational challenges curtail the potential contribution of peers. Objective: To identify the challenges and critical components for implementing optimal peer support in Israel based on a recovery orientation. Research method: As part of the international UPSIDES project, qualitative research was implemented with 68 different stakeholders in the mental health rehabilitation system through 10 focus groups and 12 interviews. A thematic analysis was performed using MAXQDA 2020 software. Analysis was guided by the CFIR conceptual framework used to explain intervention implementation (Damschroder et al., 2009). Findings: Challenges were identified under five areas of the CFIR framework: characteristics of the intervention, external setting, internal setting, stakeholder involved and implementation factors. These included for example: lack of adequate policy, crises, lack of professionalization and stigma. In addition, promoters were identified in all areas of CFIR apart from the characteristics of the intervention. These included for example: directors, commitment, adjustments, supervision, opportunities for expressing unique knowledge. Conclusions and implications for practice and policy: Optimal implementation of peer support requires full organizational commitment that includes a directed organizational culture alongside organizational practice – arrangements and infrastructures including training, supervision and guidance for all parties in the organization. To support organizations, there is a need for policy that translates into the development of designated roles and the allocation of resources that will contribute to the establishment of recovery-oriented and person-centered rehabilitation services.