Peer support plays an essential role in patient recovery by encouraging a supportive approach based on experiential knowledge. It helps to create individualised care centred on life projects and individual strengths. Within the teams, the knowledge of the peer health mediator and the carers is shared. This approach helps to improve care by drawing on the depth of people\'s experiences and feelings, and their resilience in the face of illness.

As peer support becomes more professional, it is becoming increasingly recognised and diversified. When a mental health patient-trainer works with psychiatric carers, the latter gain a better understanding of the patient\'s point of view. In addition, valuing their experiential knowledge can support peer helpers in their recovery. However, we mustn\'t forget that these are fragile people and that their past can come back to haunt them if they are not careful. Testimonial.

Peer support is based on the mirror effect between the peer carer and the person being supported, which is a powerful lever for recovery. Through their work, peer helpers also hold up a mirror to \"non-peer\" carers. The reflection they see is a litmus test that can lead to changes in care practices, but it can also generate defensive reactions.

The concept of peer support is now firmly established in the psychiatric landscape. While taking into account the benefits that this approach brings to patients and teams, it is essential to consider the need to define a framework for the practice of peer support. This framework, which is essential for the development of the practice, will help to avoid overly fragile exposure, which is synonymous with difficulties for peer helpers and their teams.

Over the last fifteen years or so in France, the deployment of peer professionals in mental health seems to have accelerated. The benefits of peer support have been widely demonstrated. It is based on the experiential knowledge acquired by certain patients who have recovered during their course of treatment, which can be passed on by positive identification, stimulating hope and motivation. These unique skills are then complemented by more theoretical knowledge sanctioned by a diploma that legitimises the future professionals and gives them access to undisputed recognition to work alongside pre-existing systems. However, it is not always easy to integrate them into health and social teams.

Introducing patient partnership in mental health and psychiatry to initial training is an innovative way of promoting recovery, while at the same time highlighting the undeniable contribution of peer support within healthcare teams, in order to accompany the people concerned. This is why Croix-Rouge Compétence Auvergne-Rhône-Alpes is developing a specific training program for trainees.

Compared to the general population and to males with mental health disorders, women with these disorders face more obstacles in psychiatric and mental health care settings. This strongly encourages mental health policies and psychiatric care to consider specific strategies that prevent gender bias in treatment among women with mental health issues. A growing body of research demonstrates the benefits of having peer workers-professionals with a lived experience of mental health issues who use their own experiences of mental distress to support others with comparable experiences-in mental health services. We postulate that peer support can become an important and integrated aspect of preventing and addressing discrimination against women in psychiatry and mental health care. First, women peer workers may combine their lived experiences as service users and as women to provide unique, experience- and gender-based support to women users who experience discrimination. Non-women or women peer workers who did not experience gender discrimination in psychiatric settings may nevertheless benefit from the integration of gender education in their curriculum and, in turn, bring a feminist lens to their work to achieve this mission. Second, using their experience as service users, peer workers have the credible ability to communicate and translate women patients\' needs to the medical staff, and thus facilitate concrete, need-based adjustments of services. Third, peer workers\' involvement as instructors in medical schools could provide early awareness of injustices experienced by women in psychiatry and mental health care. Further research is required to test the effectiveness of peer workers in addressing discrimination against women in real-world clinical settings. More broadly, from a diversity perspective, we believe that peer workers are one of the critical elements in the fight against discrimination in psychiatry and mental health.

OBJECTIVE: The effectiveness of programs integrating trained and paid peer helpers on symptoms, quality of life and recovery of persons with bipolar disorder or schizophrenia is still poorly understood. The factors influencing the integration of peer helpers into healthcare teams are also poorly understood.
METHODS: A systematic review of the literature was performed. We systematically searched multiple electronic databases for articles: (i) exploring the effectiveness of the intervention of trained and paid peer helpers in bipolar disorder and schizophrenia (ii) reporting barriers and facilitators to the integration of peer helpers.
RESULTS: Forty-eight articles were included, 24 on the effectiveness of the intervention of peer helpers, 18 on barriers and 13 on facilitators to the integration of peer helpers in health teams. Of them, 25 were based upon qualitative methods (7 concerning the effectiveness of the intervention of peer helpers, 14 the barriers and 7 the facilitators to their integration); 23 were based upon quantitative methods (9 studies focused on the effectiveness of peer helper intervention, 2 on barriers and 6 on integration facilitators). The 23 quantitative studies included 8 randomized controlled trials.
CONCLUSIONS: In spite of their heterogeneity, the results suggest that that interventions of peer helpers have a positive impact on the recovery, quality of life, social functioning, physical health and clinical outcome of persons with bipolar disorder or schizophrenia. The results also showed that the integration of peer helpers is favored by caregivers\' awareness about the role of peer helpers and knowledge about the recovery model. The results highlight the need for peer helpers to have a well-defined role and to be supervised, preferably by another peer helper.