Abstract
Traditional mental health acute inpatient treatment has been described as harmful and traumatic. Peer-led community-based treatment is a new alternative model of care in New Zealand, whereby acute mental health treatment is provided in a home-like environment delivered by peer specialists with lived experience. A mixed-methods process evaluation compared socio-demographic and admission data from a peer-led acute service with those of a local public acute mental health hospital. Qualitative interviews were also conducted with guests (n = 10), peer specialists (n = 3), and clinical staff (n = 10), and analysed using inductive thematic analysis. The most common diagnoses of guests were major depressive disorder (28.7%) and psychotic disorder (20.6%). Compared with the traditional hospital, the peer-led service admitted fewer Indigenous Māori guests (14.8% vs. 18.9%), more women (64.6% vs. 44.7%), and fewer people from socioeconomically deprived areas. Risk was qualitatively identified as the main factor impacting referral patterns. Very few adverse events were recorded. Guests described positive experiences of interpersonal and environmental safety. Clinician and peer interviews highlighted issues with the alliance between the service and clinical outpatient teams. This evaluation indicated that peer-led acute community mental health services can foster recovery by offering safe, calm, and relationally supportive environments. However, the demographic profile of guests, often women from less deprived backgrounds, indicates the model may inadequately serve high-need groups. Future challenges include adopting a greater tolerance for risk through clear articulation of the services interpersonal and environmental safety approaches, enhancing equitable access, and improving clinicians' knowledge of recovery-oriented and peer-led treatment philosophies.