In hospitals and community mental health centres across France, a shift is taking place. Peer support workers – people who use their lived experience of mental illness to help care users in their recovery – are becoming a formal part of multidisciplinary teams. With support from a national programme and training developed by the WHO Collaborating Centre for Research and Training in Mental Health in Lille, they are trying to ensure that mental health care remains focused on what is most important – that the person receiving treatment recovers on their own terms.
No typical day on the job
Freya, a peer worker in a psychiatric rehabilitation service, says that her day-to-day work is never quite the same. One day she might co-facilitate a recovery workshop, then spend the next day in an individual meeting to plan the next steps of someone’s recovery after they have left the hospital. “I don’t really have a typical day,” she says. “Sometimes it’s about meeting someone who needs to hear from someone who has been there that it’s possible to come out the other side of the service and recover.”
The workshops she runs may focus on understanding mental illnesses, such as depression or schizophrenia, or on what recovery is and how to work towards it.
“Generally, I only see someone once they are feeling a bit better,” Freya says. “But sometimes I have had people come to me who were supposedly doing better but were actually in crisis, so I had to bring a colleague – a nurse – to help, because I am not trained to deal with someone in crisis.”
“It can be quite hard for peer support workers to work with someone in crisis. In the moment, it’s okay, but afterwards I feel emotionally exhausted. It reminds me of the things I went through,” she continues.
Teamwork – a delicate balance
Peer support workers like Freya are neither medical staff nor care users – they’re somewhere in between. They are also often the only peer workers on their team.
“I felt very welcomed when I joined my team. They were actually open to having a peer support position before I even joined, which is helpful in making them understand the advantage of having me around,” Freya says.
She acknowledges that part of her role is knowing when and how to share her experience. “I deliberately did not mention my diagnosis at first,” she explains. “I did not want to be put in a box. Later, people learned about it through trainings and workshops, but it’s always a question of what you share and when.”
Being too open can backfire. “You have to be careful, especially in the first year,” says Berenice Staedel, who directs the WHO Collaborating Centre’s programme on peer work. “In clinical meetings, when you are discussing how to proceed with a patient, peer workers have to be very careful. You might share something about your experiences that you don’t want the whole team to know.”
A delicate balance is needed. As Freya recalls, “There’s a saying we learned during training: ni paillasson, ni hérisson – neither a doormat nor a hedgehog. Don’t be so quiet that you disappear or so confrontational that no one can approach you. That stuck with me.”
Turning experience into professional expertise
To support their role, peer workers in France undergo 1-year training as part of a bachelor’s degree programme, developed by the WHO Collaborating Centre in Lille and 2 French universities. The curriculum is based on an existing curriculum for social sciences, including courses on psychology, migration and health, law, and anthropology, while also adding courses on mental health systems and psychiatry as well as practical skills such as group facilitation. It also focuses on using lived experience professionally and ethically.
“The training aims to give trainees tools to reflect critically, not just from within the system, but also from the outside, as people who have experienced it.”
Freya began working before she could start the training due to administrative delays. “It was a bit of a baptism by fire,” she says. “But it made the course easier, because I had already experienced the challenges. The training helped me to see the bigger picture.”
Admission to the programme is deliberately flexible. “We don’t ask for medical records or proof of diagnosis,” says Berenice. “It’s a conversation. We try to assess how they relate to their mental health in a global way. We are looking for something we call la posture – how someone is going to assert their experience.”
Still, this openness comes with challenges. “Some candidates are quite young, in their early 20s, and self-diagnosed. But are they ready to support others in hospital settings, are they going to have any legitimacy for other users? Sometimes yes, sometimes no. It depends on how they’ve processed their experience.”
Reshaping the system
Peer support workers’ contributions can be subtle, but they can make all the difference in whether a person continues on their path towards recovery. As a peer worker, Freya might be able to explain why a user has stopped taking their medication or has been taking it inconsistently, which can shift how doctors and nurses respond to it.
“These are the kinds of moments that change how teams think,” Berenice says. “Not through confrontation, but by offering another perspective on the user’s situation.”
By communicating what users need but do not voice, peer support workers ensure a lasting therapeutic relationship and better adherence to treatment.
Still, resistance remains. “Some older staff feel uneasy,” says Berenice. “They see peer workers using recovery-oriented tools that they never got the opportunity to learn during their own training, which can be threatening to them.”
Nevertheless, for Freya and many of her peers, the programme has been transformative. “It helped me to feel supported and part of a community. I was able to make friends.”
That is the power of peer work: it is not just about helping others to recover, but about modelling what recovery and collaboration can look like within mental health systems, offering guidance, clarity and, above all, hope.
WHO support
The WHO Regional Office for Europe is actively supporting peer support work and other forms of lived experience expertise. Under its collaboration agreement with the European Commission, “Addressing mental health challenges in the European Union, Iceland and Norway”, a novel roadmap has been published providing governments and policy-makers with practical actions on how to integrate lived experience expertise into mental health policy, services and communities. The roadmap was co-created with people with lived experience, Mental Health Europe and Ireland’s Department of Health and Health Service Executive.
Over 200 peer support worker positions have been created by the national programme started by the WHO Collaborating Centre in Lille since 2012.
Questions about the process of developing the programme can be directed to the WHO Collaborating Centre in Lille at msp@ghtpsy-npdc.fr.