Developing peer-led recovery groups (PRIZE) for people with psychosis and their caregivers in a low resource South African setting

Aim In South Africa and other low- and middle-income countries (LMIC), personal recovery for people with a severe mental health condition (SMHC) is hampered by lack of community-based support. This paper describes the development of a non-specialist and peer-facilitated recovery intervention (PRIZE) intended as an adjunct to traditional psychiatric care. Methods Inputs into the adaptation process included evidence review, followed by 43 in-depth interviews exploring perspectives and desired recovery outcomes of people with lived experience and caregivers, and 15 interviews with service providers. These were analysed thematically and guided development of a theory of change. District stakeholder mapping, engagement and feedback was undertaken to explore potential acceptability and feasibility of recovery groups facilitated by trained peers (people with lived experience of serious mental health problems as service users or carers). Results Formative work identified the expressed recovery needs and led to a theory of change based on building self-esteem, reducing social isolation, and improving responses to financial instability, substance use and medication difficulties. For caregivers, the intervention was based on sharing of experiences and coping strategies. The intervention developed incorporated two phases of mutual support groups comprising service users with SMHC and family caregivers. An initial auxiliary social worker-led phase (9 weekly sessions) was followed by a supported peer-led phase (12 weekly sessions). The initial didactic psychosocial rehabilitation intervention evolved into an intervention designed to support individuals’ recovery journeys, grounded in recovery-focused core values of building hope, opportunity and control, and in which groups harnessed their own problem-solving strengths. This required training to realign the practice of auxiliary social workers accustomed to a traditional helping role towards a more enabling and empowering role. Particular attention was given to processes for supportive supervision and mentorship for auxiliary social workers and peer facilitators. Conclusion The involvement of district stakeholders and potential participants resulted in a tailored, context-specific intervention with potential to contribute to evidence for community-based, task-shared, peer-led and recovery-focused interventions in LMIC.