Introducing peer support work in Latin American mental health services

Introduzindo o trabalho de pares nos serviços de saúde mental da América Latina


In the course of implementing a recently funded network of hubs for building capacities in mental health service development, training, and research (RedeAmericas), the peer support workers are being introduced into the mental health workforce in three Latin American countries for the very first time. They will be part of a team, along with community mental health workers, that provides a modified Critical Time Intervention to individuals with severe psychiatric disorders living in the community. This article reviewed the background of this increasingly widespread development, and discussed its merits, as well as potential obstacles within local contexts.

social support; schizophrenia; mental health

No decorrer da implementação de uma rede recentemente financiada para realizar capacitações na formação de profissionais, na pesquisa e no aprimoramento dos serviços de saúde mental na América Latina (RedeAmericas), os trabalhadores de apoio de pares estão sendo introduzidos na força de trabalho da saúde mental em três países latino-americanos pela primeira vez. Tais profissionais farão parte de uma equipe, juntamente com agentes comunitários de saúde mental, que fornece uma intervenção no período crítico, adaptada para indivíduos com transtornos psiquiátricos graves residentes na comunidade. Este artigo revisou o conhecimento prévio desta intervenção cada vez mais difundida e discutiu seus méritos, assim como os potenciais obstáculos nos contextos locais.

apoio social; saúde mental; esquizofrenia

  • 1
    Clark DW. Community Prevention and Control. In: Clark DW, MacMahon B, eds. Preventive and Community Medicine. Boston: Little, Brown and Company; 1957. p. 97-105.
  • 2
    Geiger HJ. Community-oriented primary care: a path to community development. Am J Public Health. 2002;92(11):1713-6.
  • 3
    Lehmann U, Sanders D. Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. [Internet]. Geneva: WHO, Evidence and Information for Policy, Department of Human Resources for Health Geneva; 2007. [cited 2102 Aug 11]. Available from:
  • 4
    Lewin SA, Dick J, Pond P, Zwarenstein M, Aja G, van Wyk B, et al. Lay health workers in primary and community health care. Cochrane Database Syst Rev. 2005;(1):CD004015.
  • 5
    Stoneking BC, McGuffin BA. A review of the constructs, curriculum and training data from a workforce development program for recovery support specialists. Psychiatr Rehab J. 2007;31(2):97-106.
  • 6
    Salzer MS, Katz J, Kidwell B, Federici M, Ward-Colasante C. Pennsylvania certified peer specialist initiative: Training, employment and work satisfaction outcomes. Psychiatr Rehab J. 2009;32(4):301-5.
  • 7
    Weingarten R. Brazil's mental health adventure. Psychiatr Rehabil J. 2003;26(3):303-5.
  • 8
    Vasconcelos EM. Tipologia e desafios dos movimentos socials e dispositivos participativos e de empoderamento de usarios, familiars e trabalhadores no campo de saude mental no Brazil recente. Rio de Janeiro: Escola de Serviço Social da Universidade Federal do Rio de Janeiro; 2004.
  • 9
    Minoletti A, Sepulveda R, Horvitz-Lennon M. Twenty years of mental health policies in Chile: lessons and challenges. Int J Mental Health. 2012. In press.
  • 10
    Davidson L, Chinman M, Sells D, Rowe M. Peer support among adults with serious mental illness: a report from the field. Schizophr Bull. 2006;32:443-50.
  • 11
    White WL. Peer-based Addiction Recovery Support: History, Theory, Practice, and Scientific Evaluation. Great Lakes Addiction Technology Transfer Center & Philadelphia Department of Behavioral Health and Mental Retardation Services. [Internet]. 2009. [cited 2012 Aug 10]. Available from:
  • 12
    Allen HA, Carpenter D, Sheets JL, Miccio S, Ross R. What do consumers say they want and need during a psychiatric emergency? J Psychiatr Pract. 2003;9:39-58.
  • 13
    Peer counselors support consumers in emergency rooms [Internet].; 2012. [cited 2012 Aug 9]. Available from:
  • 14
    Coatsworth-Puspoky R, Forchuk C, Ward-Griffin C. Peer support relationships: an unexplored interpersonal process in mental health. J Psychiatr Ment Health Nurs. 2006;13(5):490-7.
  • 15
    Hardiman ER, Jaffee EM. Outreach and peer-delivered mental health services in New York City following September 11, 2001. Psychiatr Rehabil J. 2008;32(2):117-23.
  • 16
    Burns-Lynch B, Salzer MS. Adopting innovations--lessons learned from a peer-based hospital diversion program. Community Ment Health J. 2001;37(6):511-21.
  • 17
    Ashcraft L, Anthony WA. Crisis services in the 'living room'. Behav Healthc. 2006;26(7):12-4.
  • 18
    Greenfield TK, Stoneking BC, Humphreys K, Sundby E, Bond J. A randomized trial of a mental health consumer-managed alternative to civil commitment for acute psychiatric crisis. Am J Community Psychol. 2008;42(1-2):135-44.
  • 19
    Robinson J, Bruxner A, Harrigan S, Bendall S, Killackey E, Tonin V, et al. Study protocol: The development of a pilot study employing a randomized controlled design to investigate the feasibility and effects of a peer support program following discharge from a specialist first-episode psychosis treatment centre. BMC Psychiatry. 2010;10:37-44.
  • 20
    Dixon L, Hackman A, Lehman A. Consumers as staff in assertive community treatment programs. Adm Policy Ment Health. 1997;25(2):199-208.
  • 21
    Clarke GN, Herinckx HA, Kinney RF, Paulson RI, Cutler DL, Lewis K, et al. Psychiatric hospitalizations, arrests, emergency room visits, and homelessness of clients with serious and persistent mental illness: findings from a randomized trial of two ACT programs vs. usual care. Ment Health Serv Res. 2000;2(3):155-64.
  • 22
    Felton CJ, Stastny P, Shern DL, Blanch A, Donahue SA, Knight E, et al. Consumers as peer specialists on intensive case management teams: impact on client outcomes. Psychiatr Serv. 1995;46(10):1037-44.
  • 23
    Rivera JJ, Sullivan AM, Valenti SS. Adding consumer-providers to intensive case management: does it improve outcome? Psychiatr Serv. 2007;58(6):802-9.
  • 24
    Lucksted A, McNulty K, Brayboy L, Forbes C. Initial Evaluation of the Peer-to-Peer Program. Psychiatr Serv. 2009;60(2):250-3.
  • 25
    Fukui S, Davidson LJ, Holter MC, Rapp CA. Pathways to Recovery (PTR): Impact of peer-led group participation on mental health recovery outcomes. Psychiatr Rehab J. 2010;34(1):42-8.
  • 26
    Mowbray CT, Chamberlain P, Jennings M, Reed C. Consumer-run mental health services: results from five demonstration projects. Community Ment Health J. 1988;24(2):151-6.
  • 27
    Simpson EL, House AO. Involving users in the delivery and evaluation of mental health services: systematic review. BMJ. 2002;325(7375):1265. Review.
  • 28
    Chinman M, Lucksted A, Gresen R, Davis M, Losonczy M, Sussner B, et al. Early experiences of employing consumer-providers in the VA. Psychiatr Serv. 2008;59(11):1315-21.
  • 29
    Gates LB, Akabas SH. Developing strategies to integrate peer providers into the staff of mental health agencies. Adm Policy Ment Health. 2007;34(3):293-306.
  • 30
    Katz J, Salzer M. Certified Peer Specialist training program descriptions. UPenn Collaborative on Community Integration. [Internet]. 2006. [cited 2102 Aug 11]. Available from:
  • 31
    Vasconcelos EM. Do hospício à comunidade: mudança sim; negligência não. Belo Horizonte: Segrac; 1992.
  • 32
    Mosquera M, Zapata Y, Lee K, Arango C, Varela A. Strengthening user participation through health sector reform in Colombia: a study of institutional change and social representation. Health Policy Plan. 2001;16(2):52-60.
  • 33
    Davidson L, Tondora J, O'Connell MJ, Kirk T Jr, Rockholz P, Evans AC. Creating a recovery-oriented system of behavioral health care: moving from concept to reality. Psychiatr Rehabil J. 2007;31(1):23-31.
  • 34
    Olmos-Gallo PA, Starks R, Lusczakoski KD, Huff S, Mock K. Seven key strategies that work together to create recovery based transformation. Community Ment Health J. 2011. [Epub ahead of print]
  • 35
    Zachariah F, Ford N, Philips M, Lynch S, Massaquoi M, Janssens V, et al. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg. 2009;103(6):549-58.
  • 36
    Vasconcelos EM. Derechos y empoderamiento (empowerment) de usuários y familiares en el terreno de la salud mental, y su difusión en países de origen latino. Átopos. 2001;11:23-44.
  • 37
    Fusar-Poli P, Bruno D, Machado-De-Sousa JP, Crippa J. Franco Basaglia (1924--1980): three decades (1979--2009) as a bridge between the Italian and Brazilian mental health reform. Int J Soc Psychiatry. 2011;5(1):100-3.
  • 38
    Costa NR, Siqueira SV, Uhr D, Silva PF, Molinaro AA. [Psychiatric reform, federalism, and the decentralization of the public health in Brazil]. Cienc Saúde Col. 2011;16(12):4603-14.
  • 39
    Pitta AM. [An assessment of Brazilian psychiatric reform: institutions, actors and policies]. Cienc Saúde Col. 2011;16(12):4579-89.
  • 40
    Lüchmann LH, Rodrigues J. O movimento antimanicomial no Brasil [The anti-asylum movement in Brazil]. Cienc Saúde Col. 2007;12(2):399-407.
  • 41
    Vasconcelos EM, Cavalcante Paes Leme CC, Weingarten R, Novaes PR. Reinventando a vida. Narrativas de recuperacao e convivencia com o trastorno mental. Rio de Janeiro: EncantArte; 2005.
  • 42
    Vasconcelos EM. Manual de ajuda e suporte mutuos em saude mental. Brasília: Ministerio de Saude; 2011.
  • 43
    Martínez Ferretti JM. [Legal framework of psychiatric hospitalization in Buenos Aires regarding laws 22914 and 448]. Vertex. 2006;17(65):35-42.
  • 44
    Washington DC. Ruined lives: segregation from Society in Argentina's Psychiatric Asylums: Disability Rights International; 2007. [Internet]. [cited 2012 Aug 11]. Available from:
  • 46
    Cohen H, Natella G. Argentina: el programa de salud mental en la provincia Rio Negro. In: Rodríguez J, ed. Salud Mental en la Comunidad. Washington: PALTEX, PAHO; 2009. p. 357-78.
  • 47
    Collins PY. Waving the banner of the mental health revolution: Psychiatric reform and community mental health in the Province of Rio Negro, Argentina. In: Caldas de Almeida JM, Cohen A, eds. Innovative Community Mental Health Services in Latin America and the Caribbean. Washington, D.C.: PAHO; 2008. p. 1-32.
  • 48
    Collins PY, Lumerman J, Conover S, Susser E. Using local resources in Patagonia: A model of community-based rehabilitation. Int J Men Health. 1999;28(3):17-24.
  • 49
    Agrest M, Druetta I. El concepto de recuperación: la importancia de la perspectiva y la participación de los usuarios. VERTEX Rev Arg Psiquiat. 2011;12:56-64.
  • 50
    Ardila S. La inclusión de la perspectiva de los usuarios en los servicios de salud mental. Vertex. 2011;22(95):49-55.
  • 51
    Zaccaria A, Minoletti A. Plan nacional de salud mental en Chile: 10 años de experiencia. Rev Panam Salud Pública. 2005;18(4-5):346-58.
  • 52
    Minoletti A. Abogacía para mejorar las políticas públicasen salud mental en Chile. Átopos. [Internet] 2011;(11):84-93. [cited 2012 Aug 12]. Available from:
  • 53
    Pemjean A. El proceso de reestructuración de la atención en salud mental y psiquiatría en Chile (1990-1996). Cuad Med Soc. 1996;37:5-17.
  • 54
    Minoletti A. Perspectivas de desarrollo de la salud mental en Chile en el siglo XXI. Rev Psiquiatr. 2003;19:88-98.
  • 55
    Funk M, Minoletti A, Drew N, Taylor J, Saraceno B. Advocacy for mental health: Roles for consumer and family organizations and governments. Health Promot Int. 2005;2(1):70-5.
  • 56
    Alvarado R, Minoletti A, Torres González A, Moreno Küstner B, Madariaga C, Sepúlveda A. Development of community care for people with schizophrenia in Chile. 2012. in press.
  • 57
    Cavalcanti MT, Carvalho MC, Valência E, Dahl CM, Souza FM. Adaptação da "Critical Time Intervention" para o contexto brasileiro e sua implementação junto a usuários dos centros de atenção psicossocial do município do Rio de Janeiro. Cienc Saúde Col. 2011;16(12):4635-42.
  • 58
    Susser E, Valencia E, Conover S, Felix A, Tsai WY, Wyatt RJ. Preventing recurrent homelessness among mentally ill men: a" critical time" intervention after discharge from a shelter. Am J Public Health. 1997;87(2):256-62.
  • 59
    Herman D, Opler L, Felix A, Valencia E, Wyatt RJ, Susser E. A critical time intervention with mentally ill homeless men: impact on psychiatric symptoms. J Nerv Ment Dis. 2000;188(3):135-40.
  • 60
    Delgado-Gallego ME, Vazquez-Navarrete L. Barreras y oportunidades para la participación social en salud en Colombia: percepciones de los actores principales. Rev Salud Pública. 2006;8(2):128-40.
  • 61
    Valencia E, Susser E, Torres J, Felix A, Conover S. Critical time intervention for homeless mentally ill individuals in transition from shelter to community living. In: W. B, J. T, eds. Mentally Ill and Homeless: Special Programs for Special Needs. Newark, NJ: Gordon and Breach Science Publishers; 1997. p. 75-94.
  • 62
    Herman D, Conover S, Draine J. Critical time intervention. In: Rubin A, Springer D, eds. Psychosocial Treatment of Schizophrenia. Hoboken, NJ: John Wiley & Sons, Inc.; 2010.
  • 63
    Draine J, Herman DB. Critical time intervention for reentry from prison for persons with mental illness. Psychiatr Serv. 2007;58(12):1577-81.
  • 64
    Valencia E, Van Hemert AM, Van Hoeken D, Van der Plas A. Gestructureerde zorgtoeleiding met. Crit Time Interv Soc Psych. 2006;78:41-7.
  • 65
    Kasprow WJ, Rosenheck RA. Outcomes of critical time intervention case management of homeless veterans after psychiatric hospitalization. Psychiatr Serv. 2007;58(7):929-35.
  • 66
    Cavalcanti MT, Dahl CM, de Carvalho MCA, Valencia E. Criteria for admission and continuity of health care in psychosocial healthcare services, City of Rio de Janeiro, Southeastern Brazil. Rev Saúde Pública. 2009;43(1):1-6.
  • 67
    Dixon L, Goldberg R, Iannone V, Lucksted A, Brown C, Kreyenbuhl J, et al. Use of a critical time intervention to promote continuity of care after psychiatric inpatient hospitalization. Psychiatr Serv. 2009;60(4):451-8.
  • 68
    Gates LB, Mandiberg JM, Akabas SH. Building capacity in social service agencies to employ peer providers. Psychiatr Rehabil J. 2010;34(2):145-52.
  • 69
    Vieira M, Durao AV, Raposo Lopez M. Para além da comunidade: trabalho e qualificação dos agentes comunitários de saúde. [Internet]. Rio de Janeiro: Escola Politécnica de Saúde Joaquim Venâncio/Fiocruz; 2011. [cited 2012 may 8]. Available from:
  • 70
    Spaniol L, Koehler M, Hutchinson D. Recuperando la esperanza, Libro practico. In: Restrepo-Toro ME, editor. Boston, MA: Center for Psychiatric Rehabilitation, Sargent College for Health and Rehabilitation Sciences, Boston University; 1999.
  • 71
    Restrepo-Toro ME. Entrecruzando nuestros caminos. Entrenamiento para companeros-promotores de recuperacion y rehabilitacion. Boston, MA: Boston University Center for Psychiatric Rehabilitation; 2010.
  • 72
    Repper J, Carter T. A review of the literature on peer support in mental health services. J Ment Health. 2011;20(4):392-411.
  • 73
    NY. Peer Bridger Project [Internet]. New York: Troy Web Consutling; 2010. [cited 2012 Apr 12]. Available from:
  • 74
    Saavedra M, Francisco J. Cómo encontrar un lugar en el mundo: explorando experiencias de recuperación de personas con trastornos mentales graves. Hist Cienc Saúde. 2011;18(1):121-39.

Publication Dates

  • Publication in this collection
    15 Aug 2013
  • Date of issue


  • Received
    27 Apr 2012
  • Accepted
    02 Aug 2012
Instituto de Estudos em Saúde Coletiva da Universidade Federal do Rio de Janeiro Avenida Horácio Macedo, S/N, CEP: 21941-598, Tel.: (55 21) 3938 9494 - Rio de Janeiro - RJ - Brazil