The potential for dual roles and relationships need to be considered in formalised peer support. This term refers to scenarios where multiple roles exist between a practitioner and someone receiving support. The potential for this is increased because peer supporters have past or current experience of using mental health services.

For example, when a peer supporter starts in a post, they may know their new colleagues as past supporters or might have existing relationships with some people who access the service that they now work in.

Having a clear job description and ensuring that peer supporters are seen as integral and valued members of the team should help challenge any confusion. These types of dual roles can also create what has been described as ‘role confusion’ where people can act inappropriately or become confused by the peer supporter’s new role and identity.

Examples of this are when a colleague has a tendency to slip into a support role with a peer support worker, or when a person using peer services sees the relationship more as a friendship and finds it hard to understand why there are new boundaries or controls.

This role confusion can also lead to what has been described as role tension for the peer support worker, as they feel the pressure to ‘fit’ into both their identity as a paid or volunteer worker and as someone who uses services.

Role tension can also be created where a peer support worker becomes unwell and requires additional support. This is further exacerbated if that support is provided in the same location or service as the one in which they usually work.