LAUSR

Purpose Peer support and other consumer-provided services have burgeoned within the USA during the past 30 years and are now a central component of mental health services nationally. However, their growth has been uneven and somewhat dependent on state initiatives, policies, and funding. Recent programs have matured along myriad paths, resulting in a variety of program typologies, service structures, and funding streams, but with common values, missions, and principles. The paper aims to discuss these issues. Design/methodology/approach The landscape of peer specialist services in the USA, as well as innovations afoot, is reviewed. The empirical information that speaks to the efficacy of peer support and the need to better understand the mechanisms by which it is effective is described. Findings Although peer support has grown exponentially across the USA, its growth has been uneven. Evidence suggests that peer specialists experience role ambiguity within many existing programs and systems. Though the empirical evidence for peer services has grown, research has been most favorable for manualized, group interventions. There is still a need to better understand how individual peer support is beneficial and effective, and how individual peer support can best be utilized to promote the best outcomes for those served. Research limitations/implications In order for the workforce of peer support specialists to continue to grow and for services to be responsive and innovative, we need to better understand the mechanisms by which peer support is beneficial and how it can be structured and delivered to promote the best outcomes for those served. The “core conditions” of helping relationships promulgated decades ago by Rogers along with research on self-disclosure may be useful frameworks for understanding and researching the effectiveness of peer support. Practical implications More research is needed to better understand the effectiveness of peer support services and how best to insure that they are well-integrated into the mental health programs and systems in which they serve. Originality/value There is a need to understand why peer support is effective and how best to sustain peer specialists in their roles within the mental health system.