Vocational peer support for people with serious mental illness: a scoping review on mechanisms, structures, lived experience and perceived impacts

Abstract

Abstract People with serious mental illness face multiple barriers to (re-)entering the workforce, including early exclusion from the labor market, stigmatization, mental health instability, and fragmented support systems. Peer support, understood as social, emotional, and practical support provided by people with lived experience of mental illness, has emerged as a promising approach to enhancing psychosocial resources and promoting recovery, yet its specific role in vocational contexts remains under-researched. This review examines peer support as part of vocational rehabilitation services, where peers support others in their vocational reintegration. This scoping review systematically examines existing empirical evidence on vocational peer support for people with serious mental illness, focusing on user perspectives regarding structural conditions, mechanisms of action, and perceived outcomes. Five databases were used for the search (PubMed, PsycArticles, PsycInfo, Web of Science, and CINAHL). Eleven empirical studies (qualitative, quantitative, and mixed methods) were analyzed following the PRISMA-ScR guidelines. A thematic analysis based on Braun and Clarke’s framework was used to identify key patterns. Three thematic clusters emerged: (1) conceptualizations and structural embedding of vocational peer support, ranging from less to highly structured interventions; (2) organizational, and relational conditions of implementation, including role clarity and professionalization; and (3) user-reported effects, such as enhanced agency, stigma reduction, and vocational orientation. Peer support was experienced as emotionally empowering and socially validating, its sustainable impact on employment remains mixed and context-dependent and appears to be challenged by systemic barriers and institutional fragmentation. Peer support can complement traditional vocational services by fostering hope, identity reconstruction, and practical engagement. Sustainable effects, however, depend on its institutional embedding, role integration, and continuity across service transitions. Further research should clarify the mechanisms and contextual conditions that enable effective vocational outcomes.