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This chapter sheds light on some of the barriers to integrating peer support workers in health and welfare services.

Lack of recognition of experiential knowledge, user and family perspectives, unclear roles, stigma, working conditions, organizational culture, and training are among the barriers frequently mentioned in international literature (Ibrahim et al., 2020; Vandewalle, 2016).

The following pages are my attempt to reflect on some of these barriers and describe how they manifest in the Norwegian context.

I do this based on my role in building Erfaringssentrum – the national advocacy and user organization for peer support workers in Norway (www.erfaringssentrum.no). Therefore, it is natural that I draw on concrete, practice-based experiences from conversations with peer support workers and professionals, as well as from my own experiences in the role.

In recent years, Erfaringssentrum has conducted annual membership surveys among the peer support workers affiliated with the organization, known as the “Peer Support Worker Survey.” In some parts of this chapter, I refer to data from the 2022 survey (n=168).

Towards the end of the chapter, I will highlight actions that leaders, professionals, authorities, and peer support workers themselves can take to break down barriers and create effective processes when hiring peer support workers or further developing existing positions.

Before I begin, I would like to briefly clarify the difference between personal lived experience and experiential expertise by illustrating the distinction with a somewhat caricatured narrative based on real events.

The Difference Between Lived Experience and Experiential Expertise

A lecturer is preparing to facilitate a teaching session. The goal of the session is to help students learn from the perspectives of service users. For pedagogical reasons, she brings two people with experience of substance use. One is an active service user who is still using and receiving help. The other has been drug-free for a long time and works as a peer support worker in specialist health services. He has extensive experience in giving talks.

The two were invited to illustrate the difference between lived experience and experiential expertise.

First, a man walks in wearing dirty jeans and a worn wool sweater. He talks about life on the streets, as it is today. He is visibly nervous and stutters a little. At the same time, he speaks with courage and honesty about still using heroin. “I guess it might be okay to quit, but everything swings between heaven and hell – and I don’t really feel there’s any real help out there. The care for people like us on the outside isn’t good enough. People on the outside – that’s where I feel at home. Always have, since first grade.” He says he’s “having a damn bad day,” and adds that the 750 kroner he’s getting for “rambling on” makes “a small difference, at least.”

He then shares that his mother died three months ago from cancer, and that he’s angry at the hospital for not letting him stay with her long enough. “There’s no point trying to be of help as a next of kin when you’ve got a drug problem. That’s something you future professionals should write down in your notebooks. Because it’s damn hard for us with addiction problems to be taken seriously by surgeons and nurses in somatic care – no one really listens to us. To me, it felt like I was just in the way, a problem. Maybe even a little dumb.”

After the break, the peer support worker enters the auditorium. He’s well-built, has tattoos on both arms and his neck, and wears branded clothes. It’s clear that this man has seen his share of rough times. He opens his PowerPoint presentation with confidence. The first image shows him as a child – sad and disheveled. The next image shows him with a distant look and a fragile appearance. The same scenario plays out in another photo of him, now a little older. He continues, showing another picture: “This is me, just days before I realized I was going to die if I didn’t change my life.” He is thin, visibly worn, and his eyes are vacant. He continues: it wasn’t easy going in and out of prison either. The next image is of a hospital bed. “I nearly died here.” He pauses and makes deliberate eye contact with someone in the front row. The next image shows him standing on a grassy field outside a large yellow and white building. He looks thin and tired. “This place saved my life,” he says, gazing into the air, and pauses for just the right number of seconds. The next image shows the same man with icicles in his unkempt beard, smiling at the camera. He explains that it’s a selfie he took just before reaching the top of the Himalayas. “I found myself through physical activity and accepting that I was good enough as I am.” His message to the audience is clear: “My aim with this talk is to tell you, as health professionals, that you play a crucial role in bringing hope and changing the mindset of the patients you meet – whether in somatic care or addiction services. You’ve got what it takes.”

At this point, several students have tears in their eyes. The peer support worker continues. The rest of the lecture focuses on how nurses should treat people with addiction with more empathy, the importance of listening to the patient when choosing treatment approaches, and the value of encouraging physical activity.

This, perhaps exaggerated, illustration helps show the difference between lived experience – something raw, personal, and unprocessed – a "here and now" description of difficult living conditions.

When someone has developed experiential expertise, their narrative about a troubled past has been reflected upon and refined. The person has usually chosen what to share and what to withhold. In that way, the story becomes a narrative where the storyteller describes their personal journey of confronting their inner demons. It is a story of change and transformation. Experiential expertise is not static. Participants in the study by Klevan et al. (2018) describe experiential knowledge (i.e., experiential expertise) as knowledge that does not simply exist – but rather becomes, through reflection and through encounters with others and with oneself. Like the man who has given many talks and has developed ways of being and a language that moves people. Pinpointing the exact moment when lived experience becomes expertise is difficult – but the difference is nevertheless clear.

In relationships with service users, the central element should not be the peer support worker’s personal story, but rather how it is conveyed, what is conveyed, and where and when it is shared. The art of storytelling – “show, don’t tell” – always applies, here too. In interactions with service users, especially those of high quality, it is often more about what cannot be said or put into words. There is little that needs to be said when the wrinkles or the tattoos on a face tell where someone has been. It’s the implicit. The unspoken and tacit knowledge that gives depth and meaning.

Having experiential expertise can be summarized as having developed the ability to consciously use all of these implicit and explicit forms of communication when meeting those in need – while also having ethical awareness, knowledge of legislation, and an understanding of the service system. It is about cultivating the sensitivity to mirror those they aim to support, and the willingness to go the extra mile by being open about one’s own experiences and baggage.

Meeting someone with similar experiences helps build a bridge into the service system. When it works, it can foster trust and inspire hope. When it fails, it is usually because the relationship lacks authenticity – and “experiential expertise” has become a new form of power structure, with honesty about the purpose of the relationship shaped on the peer support worker’s terms.

Recognition and Validation of Lived Experience, Family Perspectives, and Experiential Expertise

Gaining recognition for user and family experiences is challenging. It is even more difficult to have these experiences acknowledged as expertise in societies that place a high value on formal education. This applies both in terms of salary and as a legitimate form of knowledge. Achieving full equality between user and family experiences, experiential expertise, and professional or evidence-based knowledge is likely neither possible nor necessarily desirable. Professional knowledge within health and care professions has the weight of numerous professorships. The volume of research articles on the mechanisms behind mental illness and the causes of substance use disorders is extensive.

Professional disciplines and research traditions have long histories. The formal organization of user and family rights movements did not emerge in Norway until the late 1970s. In the Norwegian context, the first user organization in the field of mental health, Mental Helse (Mental Health), was founded in September 1978. In the substance use field, A-larmwas the first organization, established in 1995 (Arctander, 2021). People with substance use disorders only secured patient rights in 2004. It was only after a prolonged struggle that the Family Alliance (Pårørendealliansen) helped shape the concept of “family involvement” as something distinct. This was formally introduced with the launch of the National Family Involvement Strategy 2021–2025 (Regjeringen, 2021, p. 56).

In their book The Many Faces of User Involvement, Askheim and Andersen describe user involvement as “a concept that scores high on the list of welfare buzzwords” (Askheim & Andersen, 2023, p. 11). User perspectives are increasingly emphasized in strategic documents and guidelines from directorates and ministries. Nevertheless, from the point of view of user organizations, gaining recognition and being heard at the system level remains a significant challenge. In a 2020 consultation response regarding amendments to the Health and Care Services Act, Mental Helse wrote:

“Mental Helse experiences that real influence at the system level is difficult to achieve, as the user side, almost without exception, participates as a minority, often enters the process late, and most often only takes part in advisory roles. Employed peer support workers or individuals with user experience provide an opportunity for limited experiential contributions within services. However, the practice in these positions varies greatly in terms of content, role, and participation in service systems. Peer support workers should never replace user representatives from organizations. Therefore, user representatives must be involved at all levels of service planning and service development.” (Mental Helse, 2020, p. 2)

The emphasis on employing peer support workers can be seen as a result of demands from organized service users for increased involvement, even though there are still challenges related to how user organizations perceive the role of peer support workers—and an apparent concern that peer support workers might “take” the jobs of user representatives.

The gradual democratization of society and a political aim to give “vulnerable groups” greater influence (Askheim, 2023) can also be understood as part of the rationale behind the employment of peer support workers. These positions can be seen as tools used by public authorities to move individuals from welfare benefits into “ordinary” employment. At the same time, they serve as a means to strengthen the user perspective within services.

The use of peer support workers has an impact both at the service level and the individual level (Gillard et al., 2022) (see also Chapter 3). Hiring peer support workers can therefore serve as a valuable tool to reinforce the user perspective within services, while also supporting other welfare policy objectives.

Over time, through policy documents, legislative reforms, and national guidelines, it has become an explicit goal that service users should have influence at the individual, service, and system levels (Norwegian Directorate of Health, 2014; Meld. St. 11, 2015–2016; Meld. St. 7, 2019–2020). The impact of the user movement in Norway (Council for Mental Health, 2008), along with international trends (WHO, 2022), has made it possible to argue for a systematic implementation of peer support workers in Norway. This was also a political ambition expressed in the National Health and Hospital Plan 2016–2019 (Meld. St. 11, 2015–2016, p. 30). The outcomes of this effort showed that hiring peer support workers led to more user-oriented cultures within services, though challenges related to wages and supervision remain (Meld. St. 7, 2019–2020, p. 63). In that plan, the government states that it is the employer’s responsibility to address these issues. This is fair and appropriate—but at the same time, the implementation also highlighted the need for an organization that looks after the interests of peer support workers.

Having “change agents” embedded within services arguably has a greater impact than inviting user representatives to provide input sporadically. This is partly because service users may encounter someone who can offer them hope and a different kind of understanding than traditional professionals, and partly because peer support workers are often more willing to incorporate user perspectives into the daily work of development and service improvement. Today, 49 percent of peer support workers in the services also serve as user representatives—either in paid or voluntary roles—alongside their jobs (Mohn-Haugen & Mørk, 2023).

Peer support workers in Norwegian welfare services can thus help ensure that experiential expertise and lived experience are valued more equally. This can occur when peer support workers supplement, challenge, and expand the existing knowledge base within services (Askheim, 2023).

However, this requires that experiential expertise and user perspectives are understood, validated, and recognized within services. In the report Integration of Experiential Knowledge: How Do Peer Support Workers with Substance Use Experience Perceive Their Work Situation?, Åkerblom, Agdal, and Haakset (2020) write:

“Validation of experiential expertise is essential to ensure the successful integration of peer support workers. Based on our insights, the integration of peer support workers in services depends on whether mental health and substance use services provide the structures and frameworks in which experiential knowledge can develop.”

In the report “It’s Kind of Like Its Own Language – Peer Workers’ Understandings and Use of Experience-Based Knowledge in Collaboration with Users in Mental Health Services” (Klevan et al., 2018), participants in the study (N=36) expressed that “in many areas they feel heard and included” (p. 8). At the same time, Klevan and colleagues point out that “experiential knowledge does not necessarily change the overall understanding of knowledge within services.” Expecting peer support workers to achieve this alone is unrealistic, given that there are often only one or two of them employed within a single service. However, the long-term presence of peer support workers in services can contribute to this new knowledge domain gradually becoming a natural part of the system (see also Chapter 4). There are growing indications that services are recognizing the value of experiential expertise, as reflected in the increasing number of municipalities that have hired peer support workers and the number that report working in a recovery-oriented manner (SINTEF, 2019; 2020; 2021; 2022).

When given sufficient trust and responsibility, peer support workers are able to engage with users and patients through more authentic relationships. This is likely because they are themselves closer to these processes—both emotionally and physically. At the same time, such relationships are not automatically effective or beneficial, especially in contexts where peer support workers do not receive adequate training, have unclear roles, or lack proper support. This is also evident in the literature review by Ibrahim et al. (2020).

The integration of peer support workers is a process that takes time and will likely remain pioneering work for years to come. In a complex society, many factors influence this development—and the creation of a new role within services to represent users’ perspectives is also shaped by broader societal barriers. There are several key obstacles to the genuine validation of experiential knowledge and user and family experience as a distinct form of expertise.

These include:

1. deeply rooted professional traditions and epistemologies within services,
2. unclear roles and mandates for peer support workers, and
3. persistent stigma.

Established Professions and Epistemologies in Health and Welfare Services

There are already professional tensions and internal challenges within the services—challenges that are not necessarily compatible with the validation of lived experience and experiential expertise. Many services still rely heavily on traditional clinical practices and lack the necessary conditions to operate in a recovery-oriented way. There is limited recognition of the knowledge held by service users and their families. Treatment pathways are standardized, and traditional hierarchies persist. The biomedical understanding of the human mind remains dominant: “Something is broken, and the goal is to restore functionality.” This is the most frequently cited barrier in the relevant research literature reviewed by Ibrahim et al. (2020). Klevan et al. (2018) also highlight that experiential expertise requires a very different framework than the evidence-based practices that currently dominate the mental health and substance use fields (Åkerblom et al., 2020).

When evidence-based practice is the prevailing standard, it becomes difficult to achieve genuine recognition of lived experience and experiential expertise as valid forms of knowledge. Moreover, not all professionals are necessarily supportive of involving people with lived experience in service provision. In the report “Nursing in Municipal Mental Health and Substance Use Services – A Study of Nurses’ Roles, Functions, and Professionalism” (Karlsson & Kim, 2015), the majority of participating nurses expressed skepticism about involving individuals with lived experience in patient care (p. 8).

Experiential knowledge and user perspectives are being introduced into well-established service systems populated by long-standing, highly influential professions. This shift is taking place at a time of concern about whether there will be enough healthcare personnel in the future. The Norwegian Health Personnel Commission describes the situation as follows:

"A prerequisite for developing a sustainable health and care service is that all involved parties – the workforce, the population, and politicians – possess an understanding of the limitations and realities that challenge the publicly funded health and care services for the entire population. There must be a shared recognition of the realistic scope and quality of services. All affected stakeholders must participate in this effort: Parliament, the government, politicians in general, supervisory authorities, health enterprises and municipalities, labor organizations, personnel, patients, users, and family members. Everyone has an important contribution to make and must help reduce the gap between expectations and reality."(Meld. St. 4, 2015–2016, p. 15)

Large professional organizations such as the Norwegian Nurses Organization (Norsk Sykepleierforbund) and the Norwegian Psychological Association (Psykologforeningen) have worked actively for decades to gain recognition for their professions. The Norwegian Nurses Organization was founded in 1912, and the Norwegian Psychological Association in 1934. By contrast, the national user and advocacy organization for peer support workers, Erfaringssentrum, was founded as recently as 2017. The struggle for recognition among nurses is still ongoing—both in terms of professional status and wages. Psychologists, too, continue to face professional challenges, and they remain committed to the use of evidence-based practice.

Like nurses, support staff, and social workers, peer support workers are employed in services marked by demanding working conditions, lack of supervision, pressure to increase efficiency, and constant restructuring.

At the same time, the message from the Health Personnel Commission is clear: everyone must lower their expectations, and strict prioritization is required—this includes professionals, politicians, patients, families, and service users alike. This makes the systemic barriers to recognizing a new knowledge paradigm and a new form of competence within the services particularly challenging. As of 2023, peer support workers are still officially regarded as a group with the “potential to become a professional group” (Meld. St. 4, 2023–2024, p. 137).

There are, however, promising examples of peer support workers having a positive impact on the development of mental health and substance use services, and a growing number of service providers seem to recognize the value of employing individuals with lived experience. Several managers report that they see the value of peer support workers and use them in a variety of roles (Åkerblom & Mohn-Haugen, 2022). This is further supported by SINTEF’s annual IS 24/8 surveys, in which municipal services are asked what kinds of tasks peer support workers are assigned (SINTEF, 2019; 2020; 2021; 2022).

The increase in the number of peer support workers during the national escalation plan for the substance use field (2016–2021) also suggests growing interest in these roles across the health, social, and welfare sectors. What the growth in numbers does not reflect, however, is quality. Both Erfaringssentrum and the Norwegian Nurses Organization have therefore emphasized the need for an eligibility or suitability committee for peer support workers (Karlsen, 2022).

The national peer support worker surveys conducted annually by Erfaringssentrum also show that many peer support workers enjoy their roles and experience a strong sense of mastery (Holst & Mohn-Haugen, 2021; 2022; Mohn-Haugen & Mørk, 2023). This is echoed by nearly all the interview participants in the report by Åkerblom et al. (2020).

A gradual professionalization of lived experience is underway, and slowly but surely, cultural change is occurring within services—moving toward a more resource-focused mindset. Through their daily pioneering work, peer support workers may, in the long term, contribute to the validation of user and family experiences and experiential expertise as legitimate forms of knowledge. At the same time, the systemic challenges within services make this work particularly difficult—at least in the short term.

Unclear Roles and Role Confusion

Government policy documents, such as the National Health and Hospital Plan 2016–2019 (Meld. St. 11, 2015–2016, p. 30), clearly expressed the intention to conduct a “systematic trial” of peer support workers. These signals resulted in financial frameworks being established to support the hiring of peer support workers, and such hires have taken place over time.

However, the preparatory work and structural conditions for these hires have not been adequate. Since the initiative to test the use of peer support workers has been government-driven, but without clear direction regarding their intended function, professional development has largely occurred after the implementation process began. This has, unfortunately, led to harm for some peer support workers in the field.

Many peer support workers have found themselves in situations where they feel unable to succeed, simply because it has been unclear what tasks they are expected to perform.

An example from one service that Erfaringssentrum has been in contact with illustrates this point:

A young woman applies for a peer support position in a large Norwegian municipality. During the interview, she is asked about her personal experience, how she functions as part of a team, what triggers her, and how she handles challenges. She finds the interview meaningful, and a few days later, she receives a phone call informing her that she got the job. She is excited to begin.

On her first day, a team member asks what her role will be and what substances she used in the past. She cannot answer the first question, and finds the second one rather intrusive. As the months pass, she continues to feel unsure about her role in the team—how to use her experience when interacting with professionals and the service users she follows up. This uncertainty leads her colleagues to begin questioning what she can actually contribute. Her manager continues assigning her tasks, but she is unsure whether she is truly making use of her experiential knowledge.

She also finds it difficult to say no or to set boundaries, since her contract is only temporary. The peer support worker tries to bring this up with her manager and asks how he intends to utilize her competence. He replies that they will sit down and develop a job description at some point. When she requests guidance from someone else with lived experience, she receives the same vague answer—that they will “look into it later.”

In her interactions with other professionals, it becomes difficult for her to find her place—and to explain her role. She feels that she is not fully accepted by her colleagues and that they do not entirely take her seriously. What was supposed to be a meaningful job turns into something demotivating, and she finds herself repeatedly compromising her own boundaries and values.

This peer support worker is not in a unique situation—many others have experienced, and continue to experience, similar challenges. Erfaringssentrum regularly receives inquiries related to this issue. In this specific case, the manager who hired the peer support worker had no clear plan for the role, and the position was poorly anchored within both the leadership and among the professionals. This makes it very difficult for the peer support worker to articulate what kind of expertise she can contribute—especially when neither she nor the manager has a clear understanding of what is expected, or what the manager envisioned when making the hire. When the professionals then begin to express skepticism, it creates a highly challenging situation.

“Bringing in the user perspective” is therefore not a simple or straightforward task. It requires clear role definitions within the service and concrete assessments of how the peer support worker is expected to contribute.

It is difficult to introduce new perspectives into a service when neither the service nor the person bringing them in has a clear understanding of what experiential knowledge and lived experience truly are. It is also a significant burden to be the only person expected to represent these perspectives. That may be more than can reasonably be asked of anyone.

This makes the task particularly demanding—especially in services that are already under strain due to limited resources, weak leadership, or organizational cultures that lack a clear implementation plan (Ibrahim et al., 2020; Gillard et al., 2022).

At the same time, the annual Peer Support Worker Surveys conducted by Erfaringssentrum indicate a positive trend over the past three years. More peer support workers now have job descriptions, are involved in developing their own roles, and report being treated as equals alongside other professionals in the service (Mohn-Haugen & Holst, 2021; 2022; Mohn-Haugen & Mørk, 2023).

Integrating peer support workers into services—like recognizing user and family experiences and experiential knowledge—is a process, and it will take time.

Stigma

The third factor influencing the recognition of user knowledge and experiential expertise among individuals with mental health and substance use challenges is the stigma—and the societal discomfort with addressing painful life experiences—that persists both in the broader community and among many professionals. There is no doubt that underlying, often unspoken, prejudices exist toward people who have had or currently live with mental health and substance use problems. Examples include employers being reluctant to hire individuals with a history of mental health challenges (Bjørnshagen, 2021), people with substance use disorders being unwelcome in neighborhoods (Von Münchow, 2019), and not being viewed as full citizens on equal footing with others in society (Pettersen, 2022).

It is within this landscape of challenges related to the recognition of lived experience and experiential expertise that peer support workers must navigate as a professional group. In practice, this means that peer support workers employed in individual services often face poor working conditions, stigma, and difficulties being integrated as equal members of the workforce. At the same time, much of the Norwegian research shows that peer support workers generally enjoy their jobs and feel that they are well supported (Åkerblom et al., 2020).

Pay and Working Conditions

One recurring topic in conversations and consultations with peer support workers who contact Erfaringssentrum is the issue of pay.

Wages are a form of recognition of competence. When experiential expertise and lived experience are not fully acknowledged as a legitimate domain of knowledge, it becomes difficult to ensure sustainable wages for peer support workers at the national level. This is partly because labor unions often lack knowledge about peer support workers and their employment conditions, and partly because experience is not widely recognized as a form of expertise.

One contributing factor is that salaries in municipal services are usually not determined by the proactive manager who applied for and received funding to hire a peer support worker. Instead, salaries are often set by HR departments, where decisions are based on seniority and formal qualifications—not whether someone has “experiential expertise.”

What is the value of having experiential expertise rooted in having lived with, or recovered from, a serious mental illness or substance use disorder? How can this be measured in terms of recognition when it comes to salary? What is experiential knowledge worth—and how should it be valued when combined with formal education?

These questions remain unresolved in the Norwegian context and are difficult to address within existing systems and unions. This challenge is also present in countries with a longer history of peer support roles, such as the United States, New Zealand, the United Kingdom, and Australia (Byrne et al., 2019). One exception appears to be Switzerland, where a study found that peer support workers reported satisfaction with their wage levels (Burr et al., 2020).

Erfaringssentrum plays a dual role here: supporting peer support workers with advice and guidance on these matters, while also recognizing that this is a fight that must be taken up by labor unions. For progress to happen, more peer support workers need to engage in union activities—such as by becoming elected representatives. So far, this challenge has not been fully taken on by Norwegian peer support workers, even though 71 percent of respondents to the 2022 Peer Support Worker Survey reported being unionized (Mohn-Haugen & Mørk, 2022). This is likely due to a general lack of knowledge about working life and awareness of their rights as employees.

At the same time, there are some services that have everything in place. In other places, there are major challenges.

The following real-life example illustrates this:

A small Norwegian municipality is hiring peer support workers for the first time. The unit leader for the municipality’s mental health services has applied for and received grant funding from the County Governor. The peer support workers are to be employed at a local activity center. Ahead of the hiring process, wage considerations are made. After the interviews, the peer support workers are informed that they will receive full seniority and a skilled worker’s salary. They sign their contracts.

However, when the first paycheck arrives, they are paid at an assistant-level wage, without any additional compensation for their experiential expertise. They attempt to initiate dialogue with the HR department, which shows no understanding. The process drags on. During this period, I had several conversations to involve the trade union and employee representatives. Months pass, and the peer support workers grow increasingly frustrated.

“It’s incredibly frustrating—they don’t take our role seriously, even though the mayor says it’s great that the municipality now has peer support workers. It feels like HR and leadership are intentionally stalling the process, and the union doesn’t understand how to argue for wages based on experiential competence,” said one of the peer support workers.

Some time later, the same peer support worker calls back and says they have been offered a position in a neighboring municipality:

“Here, I’m suddenly being offered a skilled worker’s salary and full seniority from day one—and that’s even before including shift bonuses and such. I was surprised, but they’ve had peer support workers here for years. They seemed professional, and it was clear that the entire municipality—from top to bottom—understood the value of this kind of expertise. I’m excited to start. I’m even getting training shifts—now that’s new.”

This example illustrates the significant differences between municipalities in terms of how well they understand the value of experiential competence, and whether that competence is truly embedded as important within the organization itself.

Hiring peer support workers is not regulated by any national collective wage agreement, and there are significant differences in salary levels for peer support workers across services in Norway (Holst & Mohn-Haugen, 2021; 2022). It may not even be desirable to have a fixed national salary level for peer support workers, as this could limit flexibility. The 2022 Peer Support Worker Survey (Mohn-Haugen & Mørk, 2023) shows that large wage disparities still exist. The average annual salary was approximately NOK 450,000 in 2022.

In the municipality of Bergen, peer support workers are classified under the same wage bracket as assistants. Those who have not completed the training program “Medarbeider med brukererfaring” (a NAV initiative) receive a salary of around NOK 320,000. If they have completed the program, their salary increases to approximately NOK 360,000.

In Oslo, wage levels vary even for positions that must be assumed to have identical responsibilities. Pay depends on which district the peer support worker is employed in, as well as their other formal education. Several districts and agencies in Oslo have placed peer support workers within the salary bracket of “consultant.” This has provided greater flexibility.

In short, there are significant variations and very different wage models in place. If experiential expertise is to be fully recognized, trade unions must also play an active role. However, this in itself may not be a sufficient solution, as existing service systems may not see the value in introducing yet another profession into the health services.

Organizational Culture

As mentioned earlier in this chapter, the integration of peer support workers into services depends largely on the degree to which experiential expertise is recognized and validated—and on how well the role is anchored and defined within the service.

Therefore, the organizational culture of a given service plays a significant role in the experience of the peer support workers who are hired. Ibrahim et al. (2020) emphasize that it is particularly difficult to integrate peer support workers into organizational cultures marked by traditional hierarchies and a lack of recognition or understanding of service users’ own resources. In such services, there is little or no foundational support for the employment of peer support workers, and experiential knowledge and lived experience are not viewed as legitimate. Peer support workers in these settings are not treated as equal colleagues, and their roles are seldom acknowledged or respected.

An increasing number of municipalities in Norway report that they are working in a recovery-oriented manner. At the same time, more municipalities report having hired individuals based on their experiential expertise (Ose et al., 2019; 2020; 2021; 2022). This may indicate that many local services are actively working to develop more user-centered services that focus on the strengths of people with mental health and substance use challenges. Many peer support workers in municipal services report that they enjoy their jobs, while others describe unclear roles and insufficient conditions for using their expertise.

At the time of writing, Norway is still in a development and implementation phase when it comes to peer support work, which makes the field somewhat fragile—especially since organizational cultures can shift, and such shifts may result in setbacks. Several peer support workers who have received guidance from Erfaringssentrum have reported exactly this.

It is therefore essential that experiential expertise is not only embedded within a single service or local district, but that it is also described as a guiding principle in municipal strategies and plans. Hiring people with experiential knowledge must come with a formal commitment. Oslo municipality has taken this step in its mental health strategy “En psykt bra by” (“A brilliantly mental city”), where increasing the use of peer support workers is listed as a key priority (Karlsen, 2019). Nevertheless, there are challenges even there—related to service organization, leadership and lack of leadership, as well as stigma from individual managers and professionals.

There will always be a risk that new leadership or organizational restructuring can disrupt progress—but this is precisely the point: it illustrates just how vulnerable the field still is, and how many dilemmas and competing perspectives come into play when integrating peer support workers into services.

Training

Lack of training as a barrier refers to the fact that peer support workers often lack supervision and do not have a clear understanding of their roles. This can lead to uncertainty about their own competence and confusion about their responsibilities. As a result, they may experience low confidence, unclear purpose, and a sense of exclusion or being overwhelmed.

In Norway, there are currently three one-year training programs for peer support workers. These programs combine practical placements with classroom teaching. They are considered useful because they provide participants with a foundational introduction and a theoretical framework before they enter the workforce.

One could say these are general training programs, but attending such a program is not a requirement to become a peer support worker (source: erfaringssentrum.no). At the same time, these programs have faced criticism for potentially creating an “A team” and a “B team,” where many capable individuals may be excluded from opportunities. There are also concerns that the number of training slots may exceed the number of job positions actually advertised.

In other countries, such as the U.S., training programs are shorter, and government authorities typically require certification before someone can work as a peer support worker (Cronise et al., 2016).

These training programs also help peer support workers build networks and a sense of community—even before they are employed.

At the same time, training should be seen as a preparation for employment. Equally important is that peer support workers receive workplace-specific training at the site where they are hired, and that strong onboarding routines are in place. This, of course, applies to all employees. However, it may be especially important for peer support workers, as some may have been out of the workforce for long periods. This does not mean they are lacking in resources—but it does highlight an important need.

Tools like job descriptions, performance reviews, and employee development dialogues can also be used to help both the employer and the peer support worker identify what works well and what doesn’t. Such tools also ensure that peer support workers have the opportunity to provide feedback on what aspects of the role are functioning effectively—and what areas they may need further training or support in.

Be Open and Make Mistakes

This chapter has explored well-known barriers to the employment of peer support workers. Recognition and validation of experiential knowledge—along with user and family perspectives—are key to successfully integrating peer support workers into services. This barrier is not automatically dismantled just by hiring peer support workers. It requires services to actively and collectively work toward becoming more user oriented. The peer support worker is a tool that authorities, leaders, and others can use to achieve the goal of recognition.

At the same time, this is no easy task—it is pioneering work that must be done to achieve genuine recognition. If peer support work is to succeed, it must be understood as a long-term effort. All stakeholders must be willing to learn from what works—and what does not. Professionals may need to engage in self-reflection to become less skeptical. Peer support workers themselves must be willing to accept critical scrutiny. Dilemmas must be explored. Problems must be solved.

What matters most is that leaders, professionals, and staff remain open to learning—from mistakes, from each other, and from the service users themselves.

“The first time we hired a peer support worker, we were skeptical about whether he could be trusted with a key—after all, he had committed burglaries in the past. Now, five years later, he’s the one responsible for the keys, and we’ve realized how important this type of competence is for us, our organization, and the users who come here.”

This is what a manager told me when I visited a community activity center. I would argue that this manager’s learning mindset and humble attitude can serve as an inspiration—one that helps break down barriers and enables peer support workers to take on meaningful roles. But to get there, we still have work to do. We need more knowledge, clearer role definitions, and a willingness to take some risks.