Recognizing peer support initiatives organized outside of the clinical setting: insights from a Belgian Delphi method with peer supporters, patients, and mental health professionals

Peer support is provided in Belgium as a recovery-oriented and rights-based practice that is typically grounded in lived experience. Peer-led initiatives for peer support have expanded, but their recognition and positioning in the mental healthcare landscape remain inadequate. This study examined how intentional asymmetric peer support outside clinical settings can function optimally and complement formal care. A three-round Delphi study was conducted with Belgian peer supporters, mental health professionals, and patient representatives. In Round 1, participants completed an open-ended qualitative survey. Responses were inductively analyzed into statements, which were subsequently refined and rated across two iterative rounds to establish consensus and identify areas of divergence. Of the 441 participants in Round 1, 376 met inclusion criteria; 277 agreed to continue, with 169 and 115 participants completing Rounds 2 and 3, respectively. From 53 statements, 38 reached consensus. Participants consistently emphasized the complementary value of peer support alongside clinical care, highlighting benefits such as hope, empowerment, social connection, and recovery for both recipients and peer supporters. Consensus further underscored the importance of role clarity, training, supervision, and adequate organizational, logistical, and financial support. However, persistent divergences emerged regarding role boundaries, remuneration, and the degree of formalization (not aligned with specific stakeholder groups but observed within each group). These tensions reflect the dual nature of peer support, positioned between informal, experiential practice, and formalized healthcare roles. Peer-led, non-clinical peer support represents a valuable complement to the recovery-oriented mental health landscape in Belgium. However, its sustainable integration requires strengthening recognition and support structures while preserving the core values of mutuality, authenticity, and lived experience. The findings highlight a central challenge for the field: balancing professionalization with the preservation of the relational and experiential foundations that underpin peer support.