Le rétablissement, ou recovery, décrit un processus qui permet aux personnes souffrant de troubles psychiques de vivre dignement avec leur maladie, sans égard à la sévérité ou persistence éventuelle des symptômes de celle-ci, et de retrouver une place de citoyen à part entière dans la société. Dans le droit de fil de ce concept, le soutien par les pairs s’est développé rapidement dans le monde, au départ dans un contexte de bénévolat. Depuis quelques années, ce phénomène tend vers une plus grande formalisation, et des expérimentations en faveur de l’intégration de pairs aidants professionnels rémunérés dans des équipes de soins traditionnelles ouvertes à cette approche ont eu lieu dans de nombreux pays. Dans ce contexte, l’objectif de notre étude est de faire une synthèse des programmes de pairs aidants professionnels et rémunérés en France, et de tenter d’identifier les difficultés que rencontrent ces projets.

Notre travail est une revue de littérature nationale et internationale en français et anglais, effectuée à partir de bases de données médicales et psychologiques, sur une période récente : 2005–2016.

En France, l’émergence de telles politiques est récente mais réelle, à travers des projets expérimentaux pour la plupart toujours en cours. Ces programmes ont suscité un vif intérêt de la part des associations d’usagers et de familles, mais également de vives tensions au sein du système de soins.

Nous terminerons notre article par des recommandations issues de l’expérience internationale mais également du contexte français.

Recovery is a process through which people experiencing mental illness learn to live with their disorder and reach social insertion and citizenship. This positive approach focuses on a person's competencies and strengths rather than on the symptoms. Within this philosophy, peer support has been unevenly developing in mental health services worldwide with roots in the South-American social programs for homeless people and in the American recovery circles in the field of addiction. Therapeutic efficiency of peer support has been proven by several studies including a control group, as being at least as good as traditional services and even better in some specific areas such as reduction of need for emergency services and ability to reach “difficult” patients. The integration of former psychiatric services users in mental health services can take several forms, from the participation to scientific research studies to the direct involvement in a professional team at mental health facilities. In this context, our research aims to sum up the situation in France in comparison with other countries.

We conducted a worldwide literature review in English and in French on peer support experiences and policies in mental health services, using medical and psychological databases (PsycInfo, PsycArticles, SantéPsy, Cairn, Medline, Wiley Interscience and PubPsych) on a recent period: 2005–2016. In total, 32 relevant scientific papers have been included in our research. In some cases, we have also used official reports, blogs, Internet sites, and mass media articles when they were relevant.

Our results show that this movement has been long to develop in France, with controversies having been raised since the beginning on the role that peers should play and confusion with existing social integration programs in the associative sector. Drawing inspiration from the Canadian model, a recent “peer mentor” initiative has been analyzed after 2 years of existence: many benefits for services users such as the optional aspect of this care process, a more authentic therapeutic relationship, a less normative frame, an active partnership, and a more optimistic philosophy aiming to make “small steps” towards improvement have been reported. Health professionals and peer mentors themselves have found benefits during the process. However, several limits such as difficulties to find a place with regards to the psychiatric team and difficulties to take advantage of the peer specificity, resulting in a significant attrition of the number of peer mentors, could be observed. A few other important initiatives focused on social insertion and using the help of professional peer support have been developed in recent years, but they seem to have encountered the same issues about positioning themselves both in terms of day-to-day integration in the professional environment and in the job title given by institutions which rarely corresponds to their experience and specificity. In addition, it remains difficult to obtain reliable information, as only a few papers have been published on this matter. Also, while some evaluation studies are currently being carried out, independent quantitative studies of the few running programs seem to lack in this field.

In our presentation, taking into account the difficulties that were raised in French programs and the lessons of practical experiences at work in other countries, we propose recommendations for larger and more effective implementations of peer support programs in France. As this new kind of care is emerging and seems promising in terms of benefits for not only the users but also the peer supporters and the teams of health professionals, we also insist on the need for a systematic scientific and objective evaluation of the programs.