Voices from the territory and living care networks: facilitators and barriers to implementing peer support in community mental health services in Brazil

Peer Support has increasingly been recognized as a key component of recovery-oriented mental health care, especially in low- and middle-income countries, where social participation and user-led initiatives contribute to deinstitutionalization and care in freedom. However, the recognition and funding among peers remain limited. Nevertheless, institutional recognition of peer roles and the provision of stipends or remuneration for peer supporters remain. This study aimed to identify barriers and facilitators to the implementation of Peer Support during its pre-implementation phase in community mental health services in Campinas, Brazil, using the Consolidated Framework for Implementation Research. A participatory qualitative design was adopted, combining field notes, meeting minutes, and collective discussions from twelve Research Management Committee meetings involving co-researchers and researchers with lived experience of mental health conditions, clinical mental health practice and research experience. The analysis identified contextual barriers such as over-standardization of care pathways, institutional stigma, and structural inequalities, as well as facilitators including collaborative decision-making, affective bonds, and territorial knowledge. Strategies such as continuous training, institutional partnerships, formal role recognition, and stipends/remuneration for peer supporters are essential for the sustainability of Peer Support in public community mental health services.