When I started my PhD study, before the Covid pandemic, I’d get asked why I was looking at how peer supporters use digital technologies. Back then, as I later heard from some of my participants, peer supporters were struggling to be accepted, the NHS relied on paper and outdated technologies, and voluntary sector organisations saw face-to-face conversations as the heart of their offer. Why would I choose this topic? But how times have changed.
Peer supporters are now established within the mental health workforce across England (NHSE, 2020) and a recent systematic umbrella review of peer support, previously featured in these woodlands, has described its effectiveness as well as barriers and enablers to implementation (Cooper et al, 2024). In relation to digital, the latest NHS 10-year plan promises a shift from analogue to digital, “from bricks to clicks” (NHS, 2025).
But with the rapid speed of developments associated with digital, I question how this shift might feel from a lived experience perspective, and if mental health care risks substituting a medical model with a digital model. So, I was interested to look at a recent review from Yeo and colleagues which combines the two topics of digital and peer support.
What does a shift ‘from bricks to clicks’ mean for peer support workers?
Methods
The authors of this review searched academic databases for trials of digital peer support to address questions about the effects of: different sources of the peer support including informal and formal; features of digital peer support such as dosage and platforms; and factors related to individuals and countries. They were specifically interested in the impacts on healthy people, for either mental health or physical health.
They narrowed their search down from over 60,000 unique records to 120 studies and then turned to analyse the quantitative data. Their meta-analysis combined the results across the studies to measure the impacts that addressed their questions.
How do we connect digitally with other people in peer support?
Results
The results suggest that digital peer support had stronger positive effects on mental health than on physical health, and that digital interventions which include informal, naturally occurring peer support may be more effective than more formal options for healthy people. Effectiveness seemed to decrease with longer durations, with suggestions that this might be because “extended periods of intervention result in negative interactions with peers” (p.6). For both physical and mental health, more interactive platforms were more effective: apps, social networks and video conferencing were more effective than forums and discussion boards, websites and others (emails, texts and phone).
The impact of digital peer support was not affected by the age of the participants, and the effect did not reduce with increasing severity of existing physical or mental health conditions. Because there were not enough studies to compare individual countries, the authors compared Western (e.g. Australia, Canada, Germany, United States) and Eastern (e.g. China, Pakistan, Singapore, Taiwan) countries. Digital peer support interventions had greater effects on increasing mental health in Eastern countries, and on improving physical health in Western countries.
Three limitations were identified: that the studies in the review combined peer support with different treatment components; that other potentially important moderators (such as specific settings) were not considered; and that the included studies were mainly Western and didn’t report on ethnicity.
Conclusion
The authors conclude that their study:
advances understanding of effective digital peer support for healthy populations beyond previous reviews and meta-analyses that focused on individuals already diagnosed with clinical conditions (p.7).
How do we define ‘digital peer support’?
Strengths and limitations
I have a long-standing frustration about the lack of a definition of ‘digital peer support’ – it is not confined to this review. An early commentary about peer support in digital psychiatry suggested that peer support is increasingly offered in synchronous and asynchronous technologies and “artificially via avatars and chatbots” (Venegas et al., 2019, p.222). A later systematic review defined digital peer support as “live or automated services delivered through technology media” (Fortuna et al., 2020, p.2). Aside from fundamentally questioning the peer-ness of artificial or automated support, when I searched the literature for my PhD, I concluded that most studies were looking at, what I generously term, peer-supported digital interventions. This means the focus of the researchers was on creating digital interventions, and they involved people with lived experience to support other people to use them. Their publications gave details about the digital interventions, but rarely described how, or if, lived expertise was used in support, or questioned the experience required to be considered a peer. This did not feel true to peer support values and principles.
Within this current review, I was confused by the inclusion of some of the primary studies. For example, I had never understood the Enrich study (Gillard et al, 2022) as being about digital peer support. Their peer support intervention included an option of phone calls, but it didn’t feel central to their study. Another example was a study about the impact of peer support training delivered online in June 2020 during the initial pandemic precautions (Pavarini et al, 2023). The primary outcomes were related to the ability to provide support, and secondary outcomes were related to wellbeing, but outcomes were related to receiving training not peer support. A third example was a study of an interactive story-telling app with no human interaction (O’Dea et al, 2020), where the word peer was only mentioned as a challenge for young people, in phrases like “peer victimisation” (p.899) and “peer conflict” (p.902). These are just a few examples of a broad and unhelpful lack of specificity about what constitutes digital peer support.
I was also confused about definitions related to healthy people and people with clinical conditions in the initial search. The review intended to test if digital peer support might be more effective for healthy people, so I could appreciate the need for a comparison with people who were not healthy. But an exclusion in the search terms of “individuals with clinical conditions” led to me questioning the inclusion of studies where participants were clearly currently or recently using services such as inpatient psychiatric services and cancer services. Definitions and an explanation are important to understand the populations who might benefit from digital peer support.
Another concern about the search was the lack of clear boundaries for publication date. Searches were conducted in December 2023 and May 2024, but twenty-three of the mental health studies were from before 2014, including one from 1990. Digital platforms, the implementation of peer support, and, to some extent, our perspectives on mental health, have all changed in recent years, so that the studies were across different contexts. I question if they would all be considered relevant to today’s practice.
All these questions (and more) left me with serious doubts about this study and what it might add to current practice and understanding. I acknowledge that some of my doubts may stem from cultural differences for an international study, and that the language and understandings of peer support itself might vary across countries (for example, see Ma, 2025).
Without a clear and agreed definition of digital peer support, it is not possible to conclude from this review what features of the digital interventions might make them effective.
Lived experience involvement
Peer support is fundamentally about lived experience: about people of equal standing providing support to each other (Mead et al., 2001). In relation to mental health, peer support has a long, activist history with roots in user groups and mutual aid. It is only recently that services are adopting it by employing paid peer support workers or recognising the value of the mutual aid we might provide informally to each other, including in online forums. But as services, and researchers, move into our spaces, there is a risk that the essence of peer support is lost, diluted into just another intervention.
There was no statement of positionality within this review to suggest if any of the team were working from a lived experience perspective. Admittedly, the researchers may not have wanted to disclose their own experiences (Baldawi et al, 2025). However, if peer support is about lived experience, then we need to be visible and central to studies about it, not just as participants, but as active researchers, advisors, and as part of the peer review teams for funders and journals. Gillard (2019) points to the need to think again about the impact of research methods on the development of peer support, and there is published advice for journal editors and reviewers with useful questions to be asked about participation (Colder Carras et al, 2022).
All in, there is no reason for journals to publish studies about peer support that aren’t explicit about including a lived experience perspective.
There are enough concerns about the professionalisation of peer support as it gets absorbed into systems without the misappropriation of the phrase into a digital model. Moving forwards, as we are pushed ‘from bricks to clicks’ and developers rush in, we all have a responsibility to ensure that the radical roots of peer support are not lost in the process.
Is ‘digital peer support’ being defined without involving us?
Implications for practice
With my interest in digital and peer support, I have become increasingly alarmed at the potential for a digital model to cause significant harms. With stories including the high profile and growing concerns around 7 cups, the National Eating Disorders Association’s removal of its chatbot, Tessa, and fears over harms from ChatGPT with its stigma and sycophancy, I am wary of a culture of digital solutions which focus on competition and financial interests as opposed to public benefit and social justice.
This review offers little to reassure or to influence practice. It is the unspoken gaps that are important. We don’t know what type of peer support, formal or informal, digital or in person, might work for different circumstances, countries, health conditions and demographic characteristics. There is unlikely to be one solution for all, and there are many gaps to interest researchers.
But first, perhaps we need to “ask what kind of future we want to create, together” (Bender & Hanna, 2025, p. 196). Peer support is fundamentally not about bricks or clicks, but about people, specifically people with lived expertise. We might want to use digital platforms, or we might not. But we should certainly be involved in questioning and creating our future choices.
What kind of future are we creating, together?
Statement of interests
I am a co-director of both With-you Consultancy Ltd, which provides training and consultancy related to peer support, and the Survivor Researcher Network CIC, which provides support for researchers working from a lived experience perspective. I also work freelance for various Universities and organisations. The views expressed in this blog are personal and do not represent the views of any organisation I am linked with.
I was a co-author on two papers which I have cited: those led by Cooper and by Colder Carras.
My PhD thesis is titled ‘Navigating the digital world: a grounded theory study of the use of digital technologies by peer supporters’.
Links
Primary paper
Yeo, G., Fortuna, K. L., Lansford, J. E., & Rudolph, K. D. (2025). The effects of digital peer support interventions on physical and mental health: A review and meta-analysis. Epidemiology and Psychiatric Sciences, 34, e9.
Other references
Baidawi, S., Avery, S., Ball, R., & Newitt, R. (2025). Living with Experience in the Academy: Pressures to Disclose in Routine Research Activities. Australian Social Work, 78(2), 226–235. https://doi.org/10.1080/0312407X.2023.2237490
Bender, E.M. & Hanna, A. (2025) The AI Con. Penguin Random House
Colder Carras, M., Machin, K., Brown, M., Marttinen, T.-L., Maxwell, C., Frampton, B., Jackman, M., & Jones, N. (2022). Strengthening Review and Publication of Participatory Mental Health Research to Promote Empowerment and Prevent Co-optation. Psychiatric Services, appi.ps.20220085. https://doi.org/10.1176/appi.ps.20220085
Cooper, R. E., Saunders, K. R. K., Greenburgh, A., Shah, P., Appleton, R., Machin, K., Jeynes, T., Barnett, P., Allan, S. M., Griffiths, J., Stuart, R., Mitchell, L., Chipp, B., Jeffreys, S., Lloyd-Evans, B., Simpson, A., & Johnson, S. (2024). The effectiveness, implementation, and experiences of peer support approaches for mental health: A systematic umbrella review. BMC Medicine, 22(1), 72. https://doi.org/10.1186/s12916-024-03260-y
Gillard, S. (2019). Peer support in mental health services: Where is the research taking us, and do we want to go there? Journal of Mental Health, 28(4), 341–344. https://doi.org/10.1080/09638237.2019.1608935
Gillard, S., Bremner, S., Patel, A., Goldsmith, L., Marks, J., Foster, R., Morshead, R., White, S., Gibson, S. L., Healey, A., Lucock, M., Patel, S., Repper, J., Rinaldi, M., Simpson, A., Ussher, M., Worner, J., & Priebe, S. (2022). Peer support for discharge from inpatient mental health care versus care as usual in England (ENRICH): A parallel, two-group, individually randomised controlled trial. The Lancet Psychiatry, 9(2), 125–136. https://doi.org/10.1016/S2215-0366(21)00398-9
Ma, Z. (2025). Survivors, users, or peers? Translating identities and decolonizing mental health in China. Transcultural Psychiatry. https://doi.org/10.1177/13634615251359756
Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical perspective. Psychiatric Rehabilitation Journal, 25(2), 134–141.
NHS. (2025). Fit for the future: 10 year health plan for England. https://www.england.nhs.uk/long-term-plan/
NHSE. (2020) Workforce, training and education: Peer support workers. https://www.hee.nhs.uk/our-work/mental-health/new-roles-mental-health/peer-support-workers
O’Dea, B., Han, J., Batterham, P. J., Achilles, M. R., Calear, A. L., Werner-Seidler, A., Parker, B., Shand, F., & Christensen, H. (2020). A randomised controlled trial of a relationship-focussed mobile phone application for improving adolescents’ mental health. Journal of Child Psychology and Psychiatry, 61(8), 899–913. https://doi.org/10.1111/jcpp.13294
Pavarini, G., Reardon, T., Hollowell, A., Bennett, V., Lawrance, E., Brooks-Hall, E., Foster-Estwick, A., Juma, D. O., Lewis, P., Power, L., Rogers, M., Pinfold, V., Singh, I., & Peer Support Young People’s Advisory Group. (2023). Online peer support training to promote adolescents’ emotional support skills, mental health and agency during COVID-19: Randomised controlled trial and qualitative evaluation. European Child & Adolescent Psychiatry, 32(6), 1119–1130. https://doi.org/10.1007/s00787-021-01933-0
