This section pulls together an overview of the key themes that arose in the two focus groups and five interviews.
Engagement
Both groups recognised the significant and unique benefits which come with peer support. A key aspect of peer support is the way it can establish and facilitate meaningful engagement with people experiencing isolation and exclusion, particularly those who may historically distrust services (eg people with convictions, care-experienced young people):
‘It’s very non-judgemental and the benefits are they understand we’ve been there, seen it, done it and that’s the unique selling point – where it gets a lot of buy in and a lot of engagement.’ (Peer mentor, Glasgow group)
‘We have found that engagement is completely different when it is peer-led. You can’t really put your finger on it but it feels different. People will engage differently, conversations are different, the dynamics are really different, and it’s worked really really well.’ (Worker, Support provider organisation, Glasgow group)
People working in public services also recognised a lack of engagement as a barrier to providing available support:
‘We have a housing support service but so many people don’t take it… they won’t engage… they shut us out’ (Council worker, Huntly group)
The features of peer support which help facilitate engagement include the ‘additional insight’ which lived experience provides and the ‘instant connection’ shared knowledge creates between people who have similar lived experiences. There’s perceived credibility to those in peer support worker roles – they know, they’ve ‘been there’. The fact that people experiencing homelessness can identify with the peer worker sitting across from them sets a tone of trust:
‘I sit there and listen to people describe exactly how I am at the moment… they’re explaining how my brain works and I’m thinking ‘he knows me’… It’s seeing someone and believing they were once the same as you.’ (Robert, Huntly group)
Peer workers can also recognise and empathise with the emotions people experiencing homelessness are facing. William, a person with lived experience who attended the Huntly group, described fear as ‘the common denominator’ between people who experience homelessness and how this ‘seems to be overlooked’ by services but can be understood by peers.
Part of the discussion in the Huntly group focused on the community-focused approach taken in the Aberdeenshire area. The basis of this approach was the belief that communities are the experts about their challenges and are able to generate their own solutions with the right support and funding. The approach focuses on empowering communities to do things for themselves and making it feel ‘safe, comfortable and achievable’ to have ideas and create solutions. A feature of the community focus is an inclusion to promote engagement:
‘We’re increasingly not using the terms ‘alcohol and drugs’… quite frankly, all of us, irrespective of our background or experience, we’re all in recovery from something, we’ve all got issues… substance misuse isn’t some strange three-headed creature, it’s part and parcel of humanity.’ (ADP worker, Huntly group)
Benefits
Both people delivering and accessing peer support benefit from the process and outcomes in profound ways. Experiences vary from improvements in confidence and self-esteem, through building relationships, to job opportunities which bring about sustained changes; and for some, it was seen as anchoring their recovery:
‘…my sobriety is dependent on me helping others. If I go back to being the selfish person I was before, and stop helping others, I will pick up a drink again and that’s a death sentence. I don’t think I would have another recovery in me.’ (Robert, interview)
‘My skills base has increased enormously. When I first got into this all I could speak of was my own personal experience of this, for example, signing on or this is what happens when you’re on job seekers allowance. I now understand the wider net of welfare rights and the welfare system.’ (Douglas, interview)
The discussions also highlighted the gains organisations can make from integrating peer approaches both in terms of new learning and improving services:
‘I think staff constantly learn from peer supporters… it works really well to do joint training.’ (Worker, Support provider organisation, Glasgow group)
‘Services improve the more confident the service users become… you have to evidence to your service user group – this is what you said, this is what we’ve done about it…’ (Worker, Support provider organisation, Glasgow group)
Organisations represented at the Glasgow group spoke of a keenness and necessity of learning from each other’s approaches to setting up and running peer support services, and of a new expectation from grant givers to share knowledge and experiences in order for funded projects to benefit from emerging good practice.
Readiness
The role of readiness came up in both groups as a prerequisite for effective peer support. Several examples of when it didn’t work included a lack of readiness in either the peer worker or the person accessing support. There seemed in both groups a kind of tacit knowledge based on experience about readiness. One of the Glasgow group referred to a ‘spidey sense’ about when a person wasn’t ready to become a peer support worker. Examples were cited about peer workers who lack readiness, struggling with boundaries, relapsing and becoming ‘too involved’. One such example was credited as a key learning experience which strengthened an organisation’s support mechanisms for peers, moving them from ‘winging it’ towards formalising their processes, through introducing training, handbooks and reporting procedures for the peer workers.
Organisational readiness was equally important when the peer worker programme is a success and individuals are able to use their experience to move into paid employment elsewhere. Letting go of volunteers, and not being ready to take in new ones put a temporary hold on one Glasgow-based organisation’s ability to provide a peer support service:
‘One thing we are not short of are peers, and people who are interested in doing that. Our issues is more the capacity of staff that are managing the programme. That’s where we’ve struggled’ (Worker, Support provider organisation, Glasgow group)
Those with lived experience are expert at recognising the readiness of the people who access their support, and will adapt their response accordingly:
‘When people that have made the active step… making steps into recovery, they are easier to talk to… They won’t stop until they actually decide that they want to. And then it’s really easy. (Des, interview)
‘It is absolutely pointless, we’ve found, attempting to help somebody that doesn’t actually want the help. That can be actually counterproductive.’ (Robert, interview)
Evidencing outcomes
The difference peer support makes can present a challenge to evidence because ‘the key thing is the outcome’ (Peer mentor, Glasgow group). Research highlights the challenges of measuring outcomes and impact. Real change can take time and it can be difficult to find out what legacy support has had on an individual:
‘The impact we have on people, it’s hard to say… sometimes you’ll never know, it could be ten years down the line…’ (Worker, Support provider organisation, Glasgow group)
‘… a measure is when a peer approach would have been more or less successful. That’s very difficult to measure.’ (Worker, Support provider organisation, Glasgow group)
However, it is evident that the peer workers themselves started out on their road to stability through reaching out to someone whom they felt heard and understood them. That first connection was vital to their progress.
Both groups agreed that capturing and sharing people’s stories is the most influential proof:
‘The most powerful bit is when people themselves talk about it… you can have performance indicators and all the bits we need to do but… for people that use services, they’re not interested in stats, they’re interested in real stories that will actually mean something to them…’ (Worker, Support provider organisation, Glasgow group)
In contrast, workers from statutory services in the focus groups were acutely aware that they are measured differently:
‘Our statutory duty, what we get measured on by all our stats and targets, by the Government, is that we have to get people out of temporary accommodation and into permanent housing…’ (Council worker, Huntly group)
The disconnect between outcomes and outputs was particularly apparent in the Huntly focus group when both sides of the story of statutory support were highlighted. Robert, a person with lived experience of homelessness, shared a snapshot of his story:
‘Some of the help I got, I’m sober and well today despite it… I was diagnosed as chronic Post Traumatic Stress Disorder (PTSD) and alcohol dependent… I was housed in a wee room over a bar… it was sheer hell… The person allocating the house wasn’t aware that the two major triggers to my PTSD were blue flashing lights and sirens – I’m housed 100 yards from a fire station… Wouldn’t it be wonderful if we could take account of those things so other people didn’t have to go through that?’ (Robert, Huntly group)
In stark contrast, a council worker provided her perspective:
‘We’re focusing on what our job is, and what we’ve been trained to do which is getting a house – possibly giving ourselves a pat on the back when we find them a house whether it’s in the middle of nowhere or not, because we think we’ve done our job. We’ve done what we’ve set out to do. We maybe don’t necessarily understand that actually we’ve just put somebody in there to be really lonely, to not have anybody round about them or friends, because that’s just not what we’re trained to do.’ (Council worker, Huntly group)
What this exchange illustrates is the danger of providing support which is not person-centred and the risk of addressing homelessness with a one-dimensional solution. A person with lived experience talked about the importance of not focusing on the ‘wrong solutions’ and thinking that homelessness in all its complexity can be solved with the provision of housing:
‘I think it’s really important when having discussion like this that we have as many people with lived experience round the table as we can… It’s really easy to fall into the trap… having the emphasis on the housing problem… we’ve got to deal with gaps, we’ve got to deal with shortages… but I think we’ll miss solutions because sometimes we’re thinking that the solution appears to be that we get more housing and then that’s going to solve the problem…’ (Des, Huntly group)
A key observation about the Huntly group discussion was that the people around the table with lived experience were particularly keen to focus on solutions. They acknowledged the enduring issues of housing shortages and the challenges of a rural context discussed in detail by those working in statutory services, but were keen to bring the conversation around to improvements in the face of the problems. For example, in response to Robert’s story about being housed in a situation which exacerbated his PTSD, one of the people with lived experience suggested a ‘vulnerability indicator’ as a way of flagging up issues which could make it harmful for some people to be housed in particular accommodation.
Options, complexity and collaboration
A shared theme across both groups was what was perceived as poor accommodation options for some people (eg prison leavers, people with addictions), particularly because most people presenting as homeless are single adults, and most frequently male.
‘You’re better off on the street than heading into a hostel half the time’ (Stuart, Huntly group)
‘Some people honestly feel they’re better off in prison’ (Worker, Support provider organisation, Glasgow group)
‘…the flat itself was a hovel…the standard of housing is shocking…’ (Worker, Support provider organisation, Glasgow group)
Those working in statutory services shared the frustration and recognised the limitations of what support they are able to offer. As one put it:
‘If you’ve only got a box of chicken nuggets, you’re never going to able to serve someone a steak.’ (Council worker, Huntly group)
Compounding this frustration was the complexity of the needs homelessness can present. Workers found it daunting when faced with a barrage of issues:
‘You get people that don’t fit any kid of criteria and it’s really difficult to try and figure out how to support them’ (Council worker, Huntly group)
‘Sometimes you get about six issues fired at you at the same time’ (Council worker, Huntly group)
This highlights the complexity of homelessness and it was agreed in the focus groups that ideally the best response would be holistic and person-centred. For this to happen, services need to be well connected so they can signpost or refer people to additional help, including peer support. There were mixed perceptions on the extent to which services are currently connected. There was a view that the rural nature of the Aberdeenshire area meant that support services needed to rely more on partnership working and creativity:
‘Some colleagues in other parts of the country are flabbergasted at what we’re able to deliver here because of that make do and mend type of attitude’ (ADP worker, Huntly group)
Although there were examples of effective collaboration cited by the Huntly group, mention was also made of ‘competition’ between services and local services around the table being unaware of each other. In the Glasgow group, individuals seemed to be almost effortlessly aware of each other, however, not necessarily of what each other’s services deliver. In the urban environment there are more opportunities for services to meet up at events and conferences. The increased requirement for services to learn from each other and to demonstrate their learning to funders was viewed as an opportunity to develop timely and appropriate services.
Geography
Not unexpectedly, the Huntly group discussion was dominated by the impact of their geographical location which wasn’t an issue for the Glasgow group.
A range of challenges linked to rurality were outlined including:
1. Accommodation options spread out over a vast area
‘…we have to get them [housing applicants] to add as many areas as possible onto a housing application to get a house, it’s not ideal… but if you’re waiting for one specific area, it could take you five years…’ (Council worker, Huntly group)
2. Housing shortages
This was recognised as a common problem across the country but ‘in rural areas, it’s magnified because everything’s spread out’ (Council worker, Huntly group)
3. Lack of specialist units in rural areas
‘Because Aberdeenshire is such a huge area… they concentrate the more specialised units in areas which are bigger, and there’s more need… We just have to use what we’ve got, we realise it doesn’t suit everybody but we have to do the best that we can’ (Council worker, Huntly group)
4. Lack of access to other agencies / support services
‘When you’re in a city and someone has a crisis… you have a list this long of services you can phone up just like that, and if one can’t do it, the next one can and that doesn’t happen in a rural area.’ (Council worker, Huntly group)
5. Poor transport links contributing to isolation and creating barriers to employment
‘It’s not a housing issue, it’s a transport issue… you might want to work but you’ve no way of getting to work unless you have some kind of transport to get there’ (Des, Huntly group)
6. Technology poverty (eg lack of broadband and mobile phone signal in some areas)
Even if you do have access to a computer, if you’re homeless one of those with lived experienced asked: ‘Where do you plug in a computer in a cardboard box?’
7. Difficulties recruiting people into posts due to a range of factors including expensive housing in some rural areas
‘Cuts means cuts to salaries so no one is moving to the area. For eight months we had no staff so people couldn’t get a service. People can’t afford the house prices so they aren’t applying for the jobs therefore we struggle to get people into the sector.’ (Third sector support provider, Huntly group)