Tending the chair
Tending the chair
Peer support is one of the oldest ways people get through hard things, and one of the least explained. This guide covers what it is, the main types, what the research does and does not show, how it differs from therapy, and where to find it in the US, Canada and the UK, including the free options.
If you are in crisis, peer support is not the first call. In the US and Canada call or text 988. In the UK and Ireland, call Samaritans on 116 123. In an emergency, call 911 or 999. More numbers on our crisis page.
Peer support is help from someone who has been through something similar to what you are facing. Instead of a professional treating a problem, a peer offers understanding, practical knowledge and company, drawn from their own experience. It happens one-to-one, in groups, by phone and online, and it works alongside therapy rather than replacing it.
One of the most quoted definitions comes from Shery Mead and colleagues, who describe peer support as “a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful” (Mead, Hilton and Curtis, 2001). The important word is mutual. A peer is not above you. They sit beside you.
A peer is someone whose experience overlaps with yours in a way that matters. In mental health services the word usually means a person with lived experience of mental health difficulties who has been trained to use that experience to support others. In everyday life it is wider: another bereaved parent, another carer, another person who moved countries at thirty and had to start again.
The overlap does not have to be exact. What matters is that you do not have to explain the basics, and that the person is not there to assess you. Patricia Solomon’s review of peer-provided services names experiential knowledge, the expertise that comes from having lived something, as one of peer support’s core ingredients (Solomon, 2004). It is what makes the help credible, and it is why the relationship feels more equal than a clinical one.
There is no single format. Peer support is defined by who is helping and how, not by the setting. These are the main places you will find it.
Read more: one-to-one peer support, and how it differs from groups.
SAMHSA, the US federal agency for mental health and substance use, groups the help that peers give into four kinds of support (SAMHSA, 2017). Most good peer support mixes all four.
The formats those kinds of support come in look like this.
| Type | What it is | Common examples |
|---|---|---|
| Mutual-support groups | People with a shared experience meet regularly to support each other | NAMI Connection groups, DBSA groups, 12-step groups, grief groups |
| Peer specialists and peer workers | Trained, often certified, people with lived experience, employed inside services | Certified peer specialists in US clinics; peer support workers in NHS teams |
| Recovery coaches | Peer supporters focused on recovery from alcohol or drug use | Recovery community organisations, addiction services |
| Family and carer peer support | Parents and carers supporting others in the same role | NAMI Family-to-Family, local carer groups |
| Online peer communities | Moderated forums and text chat, often anonymous | Togetherall, 7 Cups |
| Paired one-to-one peer support | One trained peer, the same person over months or years | Peer mentoring programmes, Hearth |
| Workplace peer support | Colleagues trained to support colleagues | Programmes in emergency services and healthcare |
SAMHSA’s core competencies for peer workers rest on five principles, and Mental Health America uses the same list to explain what makes peer support work. Peer support is:
Abstract definitions only go so far. Here is what peer support looks like in ordinary life.
The honest summary: peer support reliably helps people feel less alone, more hopeful and more in charge of their own recovery. Its effect on clinical symptoms is smaller and less consistent, and much of the research is of low to moderate quality. That is not a weakness so much as a description of what peer support is for.
| Study | What it looked at | What it found |
|---|---|---|
| White et al., 2020 (BMC Psychiatry) | One-to-one peer support in mental health services: 19 trials, 3,329 people | A modest positive effect on self-reported recovery and empowerment. No effect on clinical symptoms or on use of services. |
| Smit et al., 2023 (Psychological Medicine) | 28 randomised trials of peer support for people with mental illness | Small positive effects on clinical recovery (g = 0.19) and personal recovery (g = 0.15). |
| Cooper et al., 2024 (BMC Medicine) | An umbrella review of 35 systematic reviews | Some evidence of benefit for depression, especially around pregnancy and birth, and for self-efficacy and recovery. Most of the reviews were low quality. |
| Pfeiffer et al., 2011 (General Hospital Psychiatry) | Peer support for depression, meta-analysis | Fewer depressive symptoms than usual care. In the trials that compared it with group CBT, the difference was not significant. |
| Lloyd-Evans et al., 2014 (BMC Psychiatry) | Peer support for people with severe mental illness | Little effect on hospital admission or symptoms. Some evidence of more hope, recovery and empowerment. |
| Chien et al., 2019 (Cochrane) | Peer support for schizophrenia and other serious mental illness | Not enough good-quality evidence to judge either way. |
| Kahlon et al., 2021 (JAMA Psychiatry) | A randomised trial of 240 adults: four weeks of short, regular phone calls from briefly trained lay callers | Lower loneliness, depression and anxiety than the comparison group. |
| Dale et al., 2008 (Cochrane) | Peer support by telephone for health: 7 trials, 2,492 people | Some benefits across health outcomes, from studies the authors judged to be of limited quality. |
| Bartone et al., 2019 (Omega) | Peer support for people who have been bereaved: 32 studies | Most studies found it helpful, though study designs varied widely. |
One more piece of context. A large meta-analysis linked loneliness and social isolation to a higher risk of early death (Holt-Lunstad et al., 2015). Connection is not a luxury, and peer support is one of the few kinds of help built entirely around it.
What this means for you. If you want to feel less alone, more understood and better able to steer your own life, peer support has reasonable evidence behind it. If you need a mental health condition treated, the evidence points to therapy, medication or both, with peer support alongside rather than instead.
These four get mixed up constantly. In the US, “therapy” and “counselling” are often used for the same thing; the useful line is between help that can diagnose and treat, and help that cannot.
| Peer support | Counselling | Therapy | Coaching | |
|---|---|---|---|---|
| Who gives it | Someone with relevant lived experience, trained in peer support | A trained counsellor, usually licensed or registered | A licensed clinician: psychologist, clinical social worker, psychotherapist | A coach; training varies widely |
| Main aim | Connection, hope, being understood, practical help | Working through a specific problem or life event | Assessing and treating mental health conditions | Reaching goals, usually forward-looking |
| Diagnoses or treats | No | Often, depending on licence | Yes | No |
| The relationship | Mutual, side by side | Professional | Professional and clinical | Professional, goal-focused |
| Regulation | Certification in some places, not required everywhere | Usually licensed or registered | Licensed | Largely unregulated |
| Cost | Often free in groups; paid one-to-one services exist | Varies; sometimes covered by insurance | Often the most expensive; insurance may cover it | Varies |
| Best for | Hard chapters, isolation, living with a condition, recovery | A defined problem you want to work through | Diagnosable conditions, trauma, persistent symptoms | Career and goal-directed change |
The full comparison, including when to choose which, is in peer support vs therapy: the key differences. If you are not sure which you need, start with do I need therapy, or someone to talk to?
Any guide that only lists benefits is selling something. These are the real limits.
Online peer support ranges from anonymous chat to one trained person who stays with you. The biggest difference between them is whether you talk to the same person each time, because that is what lets someone know your story instead of hearing it fresh.
| Option | Same person every time? | Format | Cost | Best for |
|---|---|---|---|---|
| HearthOur service | Yes. One Keeper (a trained peer listener), matched to you by hand within 72 hours and kept for years | A 35–60 minute video or audio call every one or two weeks, a message thread in between with replies within a day, and a written note every Friday | $39 a month (a call every two weeks) or $99 (weekly). Cancel any time | Ongoing support from one person who knows your whole story |
| NAMI Connection groups (US) | Same group, not one-to-one | Peer-led groups, in person and online | Free | Adults living with a mental health condition |
| DBSA support groups (US) | Same group, not one-to-one | Peer-led groups, many online | Free | Depression and bipolar disorder |
| Warmlines | No | Phone, sometimes text | Free | A hard evening that is not an emergency |
| 7 Cups | Rarely | Text chat with volunteer listeners | Free listener chats; paid options exist | Talking right now, anonymously |
| Togetherall | No, it is a community | Anonymous online community, monitored around the clock | Free where an employer, university or health service provides it | Staying anonymous |
Hearth is the only option above built around one person who stays. Your Keeper completes Hearth’s 120-hour training, a background check and monthly supervision, and many Keepers trained as psychologists or counsellors in their home countries. If the first match is not right, you can change Keepers after your first call at no charge. How Hearth works, or see every online peer support service compared.
In a crisis, call or text 988 (US and Canada) or Samaritans on 116 123 (UK and Ireland). If you need diagnosis or treatment, see a licensed therapist; your Keeper can help you find one.
People have always helped each other through hard things, but modern peer support has a few clear roots. Alcoholics Anonymous, founded in 1935, turned sponsorship, one person in recovery guiding another, into a structured practice.
In the 1970s, former psychiatric patients organised self-help groups and drop-in centres, arguing that people with lived experience knew things professionals did not. From the late 1990s, US states began training and certifying peer specialists, and peer support workers became part of mental health services in the US, the UK, Canada and Australia.
Today the field includes paid professionals, volunteers, online communities and informal groups. They share one idea: someone who has been there can help in ways nobody else can.
Hearth is one-to-one online peer support. You are matched by hand with one Keeper, a trained peer listener, and you keep the same person for years. You talk in a Sit, a 35–60 minute video or audio call, and in between there is the Long Talk, a written thread with your Keeper.
Hearth is peer support, not therapy, and not a crisis service. If something needs a clinician, your Keeper says so and helps you find one, and stays with you while you do. How Hearth works · Pricing
Peer support means getting help from someone who has lived through something similar to what you are facing. It rests on shared experience and mutual respect rather than professional expertise, and it can happen one-to-one, in a group, by phone or online.
A peer support worker uses their own lived experience to support other people. They listen, share what helped them when that is useful, help people set their own goals, and connect them with services, including clinical care. They work in clinics, hospitals, crisis teams and community programmes. They do not diagnose or treat.
A bereaved parent joining a group run by other bereaved parents. A person newly diagnosed with bipolar disorder meeting a peer specialist who has lived with it for years. A carer talking each week with another carer. Each one is help from someone who has been there.
The principles in SAMHSA's core competencies for peer workers, which Mental Health America uses to explain peer support, are that it is recovery-oriented, person-centred, voluntary, relationship-focused and trauma-informed.
SAMHSA describes four kinds of support that peers give: emotional support (empathy and encouragement), informational support (practical knowledge), instrumental support (concrete help with tasks) and affiliational support (connection to other people and community).
Depending on the setting, it is also called mutual support or mutual aid, peer mentoring, lived-experience support, peer listening or peer counselling. In services, the people who provide it may be called peer specialists, peer support workers or recovery coaches.
It is not treatment, so it will not treat a mental health condition on its own. Training and quality vary widely. Boundaries can blur without good supervision. Groups can feel heavy. Confidentiality rules may differ from a clinician's. And it is not crisis care.
Partly. Reviews find modest benefits for hope, empowerment and self-reported recovery, and some benefit for depression, especially around pregnancy and birth. Effects on clinical symptoms and hospital use are small or absent, and much of the research is of low quality (White et al., 2020; Cooper et al., 2024).
Often, yes. Many support groups, warmlines and online communities are free. Peer specialists working in clinics are paid for by Medicaid or insurance in many US states. One-to-one peer support with the same trained person, such as Hearth, costs from $39 a month and gives you what free group and chat options rarely do: the same person every time.
No. Counselling is given by a trained professional, often licensed, and can include assessment and treatment. Peer support is given by someone with relevant lived experience, and it does not diagnose or treat. Many people use both at once.
7 Cups offers free text chats with volunteer listeners. NAMI and DBSA run free online support groups in the US. Togetherall is free through many employers, universities and UK health services. If you want to talk to the same trained person every time, Hearth matches you with one Keeper from $39 a month. If you are in crisis, call or text 988 in the US and Canada, or call Samaritans on 116 123 in the UK and Ireland.
Last reviewed 24 October 2026. This guide is general information, not medical advice. Hearth is peer support, not therapy and not a crisis service.