The study is timely. Family involvement in adult mental health care has long been recognised as beneficial: systematic reviews and randomised trials show that supporting and educating family members can improve outcomes for patients, reduce carer burden and even contribute to suicide prevention. Yet implementation remains patchy. Barriers documented in prior literature include confidentiality worries, professionals’ scepticism, unclear role boundaries and the persistent marginalisation of experiential knowledge compared with clinical expertise. Family peer support workers have been proposed as a practical bridge: they can reach families that clinicians cannot, model hope and coping strategies, and advocate for a more family-sensitive culture from the inside. But while peer support delivered by people with their own history of mental illness has been studied extensively, the specific variant in which the peer’s expertise is that of the family member, deployed in adult inpatient and outpatient settings, has received far less scientific attention.

To fill that gap, the Ghent University-led team recruited two psychiatric hospitals in Flanders, the Dutch-speaking northern region of Belgium, that had recently introduced family peer support workers. Using a qualitative design grounded in semi-structured interviews, the researchers spoke with four family peer support workers, six hospital policymakers and ten mental health professionals, producing a multi-stakeholder picture of the role from three distinct vantage points. The interviews were analysed thematically, following the widely used approach of Braun and Clarke, in which transcripts are coded inductively and codes are clustered into themes that capture patterns across participants. The study adhered to the COREQ reporting checklist for qualitative research, and ethical approval was obtained through the internal scientific committees of the participating institutions, in line with the Declaration of Helsinki.

The headline finding is encouraging: participants consistently perceived family peer support workers as adding real value to care. Families, they reported, engage more readily when they are met by someone who has walked a similar road. The peer worker can normalise the confusion, grief and guilt that relatives often carry, translate the bewildering language of psychiatric care, and prepare families to participate more constructively in consultations. Professionals and policymakers alike described the role as a catalyst for more family-sensitive practice, shifting the institutional default from treating the patient in isolation toward treating the patient as a person embedded in a network of relationships. In this sense the peer worker functions not only as a direct support to families but also as a cultural change agent within the organisation, gently but persistently reminding colleagues that families matter.

One family peer support worker summarised the essence of the role with a phrase that became the study’s title: “We must be the thorn in the side.” The image is telling. It captures the delicate dual position these workers occupy: close enough to the organisation to be effective, yet deliberately inconvenient enough to keep family perspectives on the agenda when routines, time pressure or professional habits would otherwise push them aside. The thorn metaphor also acknowledges that the role is inherently disruptive to established hierarchies of knowledge. Peer workers bring experiential knowledge, a form of expertise rooted in lived experience, which does not fit neatly into the evidence hierarchies of clinical practice. Negotiating that tension, between being valued as a colleague and being distinctive because of one’s lived experience, emerged as a central dynamic in the data.

But the study’s most practically useful contribution lies in its mapping of the preconditions for successful implementation. The researchers found these operating across three nested levels. At the macro level, the hospitals needed a co-created and well-considered policy vision: a strategic framework for family peer support that was developed with, not merely for, the people who would occupy the role, so that expectations were explicit from the start. At the meso level, two organisational conditions proved decisive. The first was a role description and competency profile that was clear yet flexible, giving peer workers enough definition to be understood by colleagues and families, but enough latitude to adapt to the unpredictable needs of individual families. The second was a conducive organisational culture and departmental climate, including supportive professional attitudes: where clinicians saw the peer worker as a genuine team member, collaboration flourished; where attitudes were ambivalent, the role risked isolation.

At the micro level, the study identified the mundane but critical factor of adequate time and resources. Family peer support work is relational work, built on trust that develops over repeated, unhurried contact. Understaffing, short-term funding or unrealistic caseloads can hollow out the role before it has a chance to embed. Together, the researchers argue, these interrelated preconditions form the foundation for something subtler: the everyday legitimacy of the family peer support worker. Legitimacy, in their analysis, is not conferred by a job title or an employment contract alone; it is realised in daily practice through relational trust and collaborative practice, built one interaction at a time between the peer worker, families and professional colleagues.

The researchers also stress that implementing this role remains pioneering work. Because family peer support in adult care is still novel in many health systems, there are few established templates, training pathways or career structures. The role’s boundaries must be negotiated continuously: when to join a family meeting, when to speak up, when to defer to clinical judgement, how to handle the emotional weight of working in the environment that once received their own family. Stigma, too, remains a live force, surrounding both mental illness itself and the notion that experiential knowledge counts as expertise at all. Some participants described lingering doubts among colleagues and even among families about whether a peer worker, lacking a clinical qualification, truly “belongs” in care discussions. Countering that epistemic marginalisation is, in the study’s framing, part of the job description.

For health systems watching these developments, the Belgian findings align with a growing international evidence base. A 2024 umbrella review in BMC Medicine synthesised the effectiveness, implementation and experiences of peer support across mental health and concluded that peer approaches show promise but are highly sensitive to how well the roles are designed and integrated. Meta-analytic work on family-led and individual-led peer support for serious mental illness points in the same direction: the intervention works best when it is structurally supported rather than bolted on. The new study extends this literature by focusing specifically on the family, rather than service-user, variant of peer work in adult care, a population whose own needs, from caregiver burnout to loneliness and grief, are well documented but often unaddressed within routine services.

The study is not without limitations, and the authors are appropriately careful. With four peer workers, six policymakers and ten professionals from two hospitals, the sample is deliberately small and context-specific; qualitative work of this kind aims for depth and conceptual clarity rather than statistical generalisation. The data underpinning the findings are not publicly available for confidentiality reasons, although pseudonymised data may be requested from the corresponding author. Still, the layered stakeholder design, capturing the perspectives of those who do the work, those who manage it and those who work alongside it, gives the analysis an unusual completeness.

What emerges is a practical blueprint. Health services considering family peer support workers should not simply post a vacancy and hope for cultural change to follow. They should begin with a shared, co-created vision of why families matter in adult mental health care; define a role that is clear in its purpose but flexible in its execution; invest in the organisational climate so that clinicians are prepared to collaborate rather than merely tolerate; and budget realistically for time, supervision and sustainable funding. And they should expect the role to be, at least for a while, a thorn in the side: a valued colleague whose most important contribution may be precisely the productive discomfort of insisting that families belong in the heart of mental health care, not at its periphery.