Global Study Reveals Peer Support Training Gaps and Compensation Barriers Worldwide

Peer supporters—people with their own lived experience of mental illness who help others navigate recovery—have proven remarkably effective at improving outcomes for those struggling with serious mental health challenges. Yet almost no one has bothered to ask them what their work is actually like. A new global study of 101 peer supporters, along with interviews and focus groups across multiple countries, reveals a workforce that is deeply motivated but systematically undervalued, undertrained, and underpaid.

The research, conducted by Harvard Medical School and the global mental health organization Aves Mental Health, found that peer supporters are using their core skills at high rates. Nearly 90 percent regularly draw on their own recovery story to inspire hope in others. More than 81 percent emphasize collaboration and genuine care rather than directing people toward predetermined outcomes. About 78 percent prioritize clear, accessible communication. These are the things that make peer support work. The competencies are consistent across countries and contexts. Yet the infrastructure supporting these workers is fragmented, inconsistent, and often inadequate.

The barriers emerge everywhere, even in countries like the United States where peer support has been formally integrated into the mental health system for over a decade. Peer supporters report insufficient training, unclear role definitions, and a pervasive sense that they are not truly valued by the organizations that employ them. Stigma persists—both from the broader public and from clinical colleagues who view peer supporters as less credible than licensed providers. The compensation is inequitable. Career pathways are limited or nonexistent. Many peer supporters described moments of "role drift," where they found themselves pulled into clinical or administrative work that fell outside their actual role, often without additional training or pay. Perhaps most troubling, nearly half of survey respondents had experience supervising other peer supporters, yet only 62.5 percent of those supervisors had received any training in how to do so.

The emotional toll is real. Peer supporters carry the weight of their own mental health challenges while supporting others through theirs. Without adequate peer supervision—ideally from someone with lived experience who understands the specific triggers and vulnerabilities that come with the work—burnout becomes inevitable. Many participants expressed frustration with being supervised by clinicians who, despite their clinical expertise, lacked the lived experience necessary to truly understand what peer supporters face. The preference across the study was clear: peer supporters wanted to be supervised by more experienced peers, either instead of or in addition to clinical supervisors.

The study also revealed important differences between formal and informal peer support systems. In the United States, Canada, Denmark, and Australia, peer support has become increasingly standardized and regulated. But in much of the rest of the world, peer support exists in ad-hoc or voluntary forms, often delivered through grassroots organizations, faith communities, and informal networks. These informal systems fill critical gaps in mental health care access, yet they operate without standardized training, consistent compensation, or formal recognition. This creates both opportunity and risk: grassroots organizations can build trust and reduce stigma in ways that formal systems sometimes cannot, but the lack of standards also increases the likelihood of inadequate training, role confusion, and exploitation of peer supporters.

The researchers recommend several concrete steps. First, countries should develop standardized sets of core competencies for peer support work—not to rigidly control how peer supporters operate, but to create clarity about what distinguishes their role from clinical roles and to ensure quality across different settings. Second, training should be carefully designed, drawing on case-based learning and role plays, and tailored to the specific context in which peer supporters will work. Third, peer supervision should be expanded and formalized, with dedicated training for experienced peer supporters who take on supervisory roles. Fourth, compensation must be equitable and sustainable. And finally, implementation models should be adapted to local contexts rather than imposed from above—which means partnering with grassroots and faith-based organizations that already have trust and relationships within their communities.

The study's limitations are worth noting. The sample was small, recruited largely through professional networks, and skewed toward well-connected peer supporters in high-income countries and the United States. No Spanish-language survey respondents participated, despite translation efforts. The findings therefore may not fully represent the experiences of peer supporters in the Global South or those working in truly informal settings. Still, the consistency of the barriers reported across diverse contexts—stigma, inadequate compensation, training gaps, lack of career pathways—suggests these are not isolated problems but systemic issues that demand attention. As mental health systems worldwide struggle with provider shortages and care gaps, peer support represents a proven, cost-effective strategy for reaching people who might otherwise go unsupported. But that strategy will only work if the peer supporters themselves are properly trained, fairly compensated, and genuinely valued as the specialists they are.