In recent years, mental health services around the world have begun to recognize the invaluable role that peer support workers (PSWs) can play in the rehabilitation process for individuals with severe mental illness (SMI). Peer support offers a unique form of assistance, where individuals who have experienced mental health challenges themselves provide guidance, empathy, and practical help to peers undergoing similar struggles. This approach not only fosters social inclusion but also promises to improve psychological and employment outcomes, yet robust data from non-Western regions have been sparse. A groundbreaking study conducted in Taiwan offers new insight into how structured peer support training and individualized sessions can influence internalized stigma, self-efficacy, occupational competence, and employment for persons with SMI.
The research, undertaken at a community rehabilitation center in eastern Taiwan during 2018 and 2019, implemented a rigorous 28-hour training curriculum for PSWs before they engaged with service users. These peer workers, who themselves faced challenges from mental illness, underwent comprehensive preparation to equip them with skills necessary to deliver effective one-on-one support. The practical aspect consisted of eight internship sessions, where each PSW provided individualized support to two or three service users for approximately one to one and a half hours weekly. This structured approach ensured an intimate, sustained engagement designed to maximize therapeutic benefits.
One pivotal aspect of the study was the meticulous assessment of key psychological domains using validated measurement scales adapted for the Taiwanese context. Internalized stigma, a pernicious factor known to undermine recovery, was evaluated with the Internalized Stigma of Mental Illness Scale–Chinese version (ISMI–C). Self-efficacy, which reflects a person’s belief in their capacity to enact change, was measured through the General Self-Efficacy Scale–Chinese (GSS–C). Additionally, occupational competence, a determinant of one’s ability to function productively within social and work environments, was gauged using the Traditional Chinese–Occupational Self-Assessment Scale (TC–OSA). By integrating these psychometric tools, the researchers sought to unravel the nuanced psychological shifts elicited by peer support interventions.
The participant profile revealed a predominantly middle-aged cohort, averaging 48.9 years, with a slight majority of women comprising 58.1% of the sample. The bulk of participants resided in halfway houses, supportive communal living environments designed to aid individuals transitioning from institutional care to community integration. Most diagnoses among participants were schizophrenia, underlining the severity and chronic nature of illnesses involved. These demographic insights underscore the targeted population’s vulnerability and the critical need for interventions tailored to their complex psychosocial realities.
Upon completion of the program, one notable finding was the statistically significant enhancement in peer support workers’ capability to navigate their environment, as indicated by improvement in the TC–OSA “my environment” subscale scores. This suggests that undergoing structured training and delivering peer support fostered tangible growth in occupational competence among PSWs themselves, equipping them to better manage the environmental challenges inherent in daily living and employment contexts. Enhancing environmental mastery is crucial for sustainable community participation and quality of life for individuals with mental illness.
For the service users receiving the support, a critical positive outcome emerged in the form of meaningful financial gains. The study documented a significant increase in weekly income following the peer support intervention, from an average of USD 25.7 to USD 47.9. This almost doubling of income highlights the potential for peer support programs to facilitate not only psychological but also tangible economic empowerment for persons with severe mental illness. Increased earning capacity is a vital step toward self-sufficiency and social integration, marking a transformative leap in rehabilitation outcomes.
Despite these encouraging results, the study did not observe significant changes in other psychological parameters such as internalized stigma or global self-efficacy within the duration assessed. These findings illuminate the complex and multifaceted nature of mental health recovery processes, where shifts in deeply ingrained self-perceptions may require longer interventions or adjunctive therapeutic modalities to manifest reliably. Nonetheless, the improvements in occupational skills and income represent meaningful progress that supports ongoing refinement and scaling of peer-led models.
The Taiwanese context of this research introduces a culturally unique lens on peer support efficacy. Unlike Western countries where such programs have been extensively studied, societies in East Asia grapple with distinct social stigmas and systemic barriers surrounding mental illness. The research suggests that localized training curricula emphasizing peer workers’ real-life experiences in overcoming stigma could be a vital strategy in boosting self-competence and resilience among both PSWs and service users. This culturally adapted approach may enhance relatability and empowerment, critical to the acceptance and effectiveness of peer-led interventions in diverse settings.
Clinically, these findings have important implications for mental health policy and program development. Integrating PSWs into psychiatric rehabilitation teams can be an efficient means to address gaps in human resources while simultaneously enriching service delivery with unique empathic insights. The documented income improvements among service users signal that peer support can transcend psychological support alone and contribute to pragmatic outcomes that impact broader social determinants of health. Mental health services should therefore advocate for expanded training and sustainable implementation of PSW programs as complementary to traditional clinical care.
Methodologically, this study’s design of combining standardized psychometric assessments with a practical training and internship framework provides a replicable blueprint for future research. The relatively small sample size and the pilot nature of the intervention underscore the necessity for large-scale, longitudinal studies to validate these preliminary findings and further dissect the mechanisms by which peer support exerts its effects. Moreover, expanding outcome metrics to include quality of life, social connectedness, and community functioning could enrich understanding of holistic recovery trajectories.
Beyond academic and clinical realms, this research resonates with the broader narrative advancing mental health awareness and destigmatization globally. By showcasing peer support as an avenue for empowerment and economic upliftment, it challenges entrenched stereotypes that limit opportunities for individuals with severe mental illness. Personal narratives from PSWs, when harnessed in structured programs, serve as potent vehicles to dismantle stigma, foster hope, and catalyze social change toward inclusivity and dignity.
Technologically, the integration of validated scales adapted for the local language and cultural nuances exemplifies the importance of culturally sensitive tools in psychiatric research. This attention to linguistic and cultural relevance ensures that assessments more accurately capture participant realities, fostering data integrity and intervention alignment. As the field moves toward global mental health equity, such nuanced adaptations will be imperative in tailoring programs that reflect the lived experiences of diverse populations.
The Taiwanese experiment with peer support further highlights the potential role of community-based rehabilitation in bridging formal medical services and social reintegration. Halfway houses and community centers serve as pivotal nodes where peer support can be embedded within holistic care frameworks. This community-centric orientation aligns with recovery-oriented paradigms emphasizing empowerment, autonomy, and social participation as central to mental health outcomes.
Looking ahead, the trajectory for peer support services in Taiwan and similar contexts appears promising yet calls for sustained investment in training infrastructure, mentorship, and evaluation mechanisms. Health system stakeholders, policymakers, and practitioners must collaborate to institutionalize peer roles, ensuring adequate support, recognition, and integration within multidisciplinary teams. Such efforts will optimize benefits for both PSWs, who gain meaningful roles, and service users, who receive culturally resonant support conducive to recovery.
In conclusion, the pioneering study into peer support among persons with severe mental illness in Taiwan provides compelling evidence that well-designed training coupled with sustained individualized interventions can empower peer workers and improve employment outcomes for service users. While changes in internalized stigma and self-efficacy were not statistically significant in the short term, gains in occupational competence and income mark critical progress. These findings contribute significantly to the emerging global literature affirming peer support as a transformative force in mental health care and lay the groundwork for future expanded investigations and program development.
Subject of Research: The psychological and employment outcomes of peer support workers and service users with severe mental illness under one-on-one peer support services in Taiwan.
Article Title: The internalized stigma, self-efficacy, occupational competence and employment outcome among persons with severe mental illness under one-to-one peer support services in Taiwan.
Article References:
Cheng, KY., Wang, YL., Hung, WC. et al. The internalized stigma, self-efficacy, occupational competence and employment outcome among persons with severe mental illness under one-to-one peer support services in Taiwan. BMC Psychiatry 25, 412 (2025). https://doi.org/10.1186/s12888-025-06849-6
Image Credits: AI Generated
