Preserving the Heart of Peer Support: The 8 Interrelated Challenges

Grounded in shared experience and mutual understanding, peer support fosters genuine connections that inspire hope and empowerment. This model can help improve individual recovery outcomes by enhancing a person’s sense of belonging, autonomy and self-efficacy. For systems of care, peer support has proven effective in reducing hospitalizations and emergency department visits while improving patient retention and engagement.

Yet, as peer specialists integrate further into formal systems, the peer support workforce faces numerous challenges that require attention to sustain its transformative power. How can we ensure that peer support specialists continue to thrive in systems that desperately need their voice, yet sometimes struggle to understand it? The following explores eight key challenges and how organizations can preserve the heart of peer support and ensure its potential is fully realized.

Challenge 1: Dispersion of Peer Support

As more settings integrate peer support, there is a risk of losing sight of what makes it valuable — its foundational roots in relationality, human rights, social justice and equity. The unique approach that defines peer support becomes diluted, with the focus reduced to merely services rather than the authentic human connection that makes it so impactful.

Another consequence of this dispersion is a focus on clinical and systems outcomes rather than recovery outcomes. The emphasis should remain on peer support’s purpose and ability to foster hope, empowerment and social connectedness — not just on improving health care metrics.

Challenge 2: Lack of Organizational Readiness

Many organizations are eager to integrate peer support but often lack the infrastructure — or the understanding of its value and scope — to do so effectively. This can result in role ambiguity, lack of support and misaligned expectations. Introducing peers into any organization requires adaptation.

Challenge 3: Inadequate or Inappropriate Supervision

Supervision is crucial to peer support specialists’ professional development and emotional wellbeing, but too often supervisors lack a deep understanding of the peer role, its principles and challenges, and the value of lived experience. This can lead to confusion about expectations and failure to provide the appropriate support for recovery peer specialists’ unique challenges, such as managing grief or navigating complex client relationships.

Challenge 4: Role Drift With Professionalization and Formalization

More integration brings increased role drift where peer specialists are seen as support staff and asked to perform more clinical or administrative tasks outside their intended scope (e.g., acting as de facto “junior” therapists, care coordinators or crisis managers). Peer specialists’ distinct set of skills, knowledge and empathy should be empowering individuals on their self-defined recovery journeys rather than filling gaps.

Additionally, the growing trend to medicalize peer support, especially in settings that rely on Medicaid billing, can undermine the core of peer work, reducing it to a set of tasks focused on assessments, documentation and standardized interventions.

Challenge 5: Push for Standardization

While standardization in care is important for consistency and quality, there is growing concern that formalizing the peer specialist role diminishes the authenticity of individual lived experience and autonomy of building genuine relationships with people seeking recovery. Standardized practices often ignore the local context of recovery.

An overly rigid or excessive approach to standardization and credentialing can impact the flexibility that makes peer support so effective, reducing its relational work to a procedural task. Peer support thrives on adaptability, with each interaction shaped by an individual’s unique needs.

Challenge 6: Low Wages and Demanding Work

Despite their critical contributions, peer specialists are often underpaid and face heavy workloads — on top of the emotional labor — leading to burnout and high turnover. Low wages averaging around $19 per hour, per current data from ZipRecruiter, place many peers in financially unstable positions, making it difficult for them to support their own and others’ recovery.

Challenge 7: Limited Career Progression

Often viewed as an entry-level role, peer work lacks structured career advancement opportunities, which also results in high turnover and many skilled individuals opting to pursue further education and different professions as counselors, therapists or case managers.

Challenge 8: Unanswered Questions

To preserve the integrity of peer support, more research is critical, particularly on the influence of lived experience (e.g., how closely a peer’s lived experience needs to align with the person they support, what balance of personal experience and trained skills produces the best outcomes). Additionally, research must shift focus from clinical outcomes to recovery-oriented metrics — such as hope, empowerment and belonging — to fully capture peer support’s long-term impact.

Moving Forward: Embracing the Heart of Peer Support

The challenges facing the peer recovery workforce are significant, but they also present opportunities for growth and transformation. Preserving the heart of peer support means valuing lived experience and respecting the peer worker role and its distinct contributions from traditional clinical practices. To do this, organizations must commit to cultivating a culture that is supportive of peer roles, providing appropriate supervision, and offering fair compensation and career opportunities.

When we address these challenges, we strengthen not only the peer workforce but the broader systems of care that rely on it to make recovery-oriented services truly effective. It is crucial that peer workers’ voices remain central to the development of these systems, ensuring that peer support continues to be a source of hope, empowerment and positive change for individuals and communities.

First Author

Elizabeth Burden
Senior Advisor, Practice and Improvement, National Council for Mental Wellbeing