Following the 2025 PeerWorks and Peer Support Canada conference in May, I have been reflecting on what I understand to be some key emerging issues and trends for the peer support sector in Ontario and beyond — early indicators of change with the potential to dramatically shape what the sector will look like in the years and decades to come. Many of these are topics that folks within the peer work sector have already starting thinking and talking about.

Exploring the potential impacts of emerging issues allows us to proactively respond to issues before they fully emerge, as well as identify new opportunities that can be leveraged for the benefit of the sector.¹ In other words, emerging issues analysis enables us to identify and prepare for possibilities and challenges on the horizon, that have yet to be fully realized.

Many of these emerging issues intersect with pre-existing challenges and shifts within the peer support sector, as well as the broader world:

• loss of independence and autonomy within the peer sector
• increasing recognition of peer support drift
• professionalization of peer support
• privatization of healthcare
• austerity funding regimes

Artificial Intelligence (AI)

Over the past few years, the interest and use of artificial intelligence (AI) has been rapidly expanding, including within the healthcare system. Studies are already beginning to emerge focused on peer support delivered via AI chatbots,^2,3 as well AI-supported peer support⁴ — although many of these articles appear to have little to no grounding in psychiatric consumer/survivor (c/s) movement histories, models of support, or literature.

Further, LinkedIn’s AI-assisted “Collaborative Articles” (now discontinued) provides information about professional skills, including within the realm of peer support.⁵ However, these articles often fail to ground their recommendations within the unique history of the peer support sector, thus raising the potential of peer support drift. For example, one article (no longer accessible) on peer support documentation mirrored clinical practices, rather than providing guidance grounded in peer support values.

How will the sector be shaped by a world with an increasing reliance on AI? What role will AI play in the future of the peer support sector, as well as the healthcare sector more broadly?How might this impact our education, workforce, and work experiences (e.g. unemployment, burnout, hours, wages), as well as quality of care provided? Are there ways to leverage AI as a tool that works for us and our interests, rather than against us?

Education & Credentialism

In recent years, there has been increasing interest in exploring further education for the peer support sector. This has been proposed as a strategy to both demonstrate the legitimacy of peer support, as well as justify higher wages for peer support workers.

In the future, will peer support require post-secondary credentials? If so, who will be responsible for curriculum development? Will the peer support sector be able to leverage educational development as a strategy for reclaiming our independence? Or will educational requirements further contribute to peer drift — for example, if the curriculum is directed and taught by those working in other mental health disciplines? What are the key learning outcomes for further education? How might educational requirements increase barriers to entering the field, reinforce pre-existing inequities, and influence the availability of culturally-grounded support?

Regulation

In recent years, the increased awareness of peer support within the public sphere has resulted in external pressures for regulation and certification. In May of 2023, MPP Stephen Crawford presented a private members bill to the Ontario legislature, calling for the government to consider “a process for the certification of addiction peer support specialists” (p. 4362).⁶ Although this motion was later withdrawn, it represents growing external pressure for the regulation of peer support.

Will the peer support sector adopt regulation as a form of gaining legitimacy within the broader healthcare system? If so, who will be responsible for our regulation? Will the sector proactively implement our own regulatory standards, or will these be imposed on us externally?

Unionization

There has also been discussion within the peer support sector about exploring unionization as a strategy for improving our work experiences, pay, and preventing peer support drift. There is a precedent for this, with some harm reduction peer workers in Vancouver voting to unionize in 2021 — albeit not without its challenges and shotcomings.⁷ However, the relative isolation of peer support workers across Ontario would make it challenging to develop a peer support specific union, while more general unions may not be equipped to best advocate for the unique needs of peer support workers.

Will peer supporters unionize — if so, how? Will we attempt to create our own union specific to peer supporters, or join a larger union that may not fully understand the unique work we do? What would unionization accomplish — and what unintended consequences might arise? Could unionization within a broader healthcare union inadvertently contribute to peer support drift?

Involuntary Care

Both within and beyond Ontario, there have been trends toward the expansion of involuntary mental health care. In October of 2024, citing the increasing rate of homelessness, mental health, and addictions, Ontario’s Big City Mayors passed a motion calling upon the province to explore the possibility of “expand[ing] the scope of … mandatory community-based and residential mental health and addictions care and treatment” (p. 3).⁸ This follows recent expansions to involuntary care in British Columbia in September of 2024.⁹

It is worth noting here the history of the psychiatric consumer/survivor/ex-patient movement in advocating against coercive care, leading to many of the restrictions in place today. More recently, many organizations involved in the Mental Health & Addictions (MAPS) program for people navigating the criminal justice system have successfully advocated for the requirement that peer support must always be voluntary — never mandated.¹⁰

With peer support’s emphasis on self-determination and historical opposition to coercive care, how might peer support engage with these models, as well as people coerced into “care” — as accomplices, advocates, or alternatives?

Conclusion

Exploring emerging issues and trends — as well as their possible impacts — will enable the peer discipline to better anticipate and adapt to the world to come. They can help us avoid “worst-case scenarios” and identify opportunities for working towards our own interests. Proactively preparing for tomorrow today will support the peer support sector in self-determining our future on our own terms — rather than getting trapped in cycles of reaction, and someone else’s vision of our future is forced upon us.

References

1. Inayatullah, S. (2008). Six pillars: Futures thinking for transforming. foresight, 10(1), p. 4-21. https://doi.org/10.1108/14636680810855991
   [open-access PDF] ↩︎
2. Fortuna, K.L., Venegas, M., Umucu, E., Mois, G., Walker, R., & Brooks, J.M. (2019).  The Future of Peer Support in Digital Psychiatry: Promise, Progress, and Opportunities. Current Treatment Options in Psychiatry, 6, 221–231. https://doi.org/10.1007/s40501-019-00179-7 ↩︎
3. Young, J., Jawara, L. M., Nguyen, D. N., Daly, B., Huh-Yoo, J., & Razi, A. (2024, May). The role of AI in peer support for young people: A study of preferences for human-and ai-generated responses. In Proceedings of the 2024 CHI Conference on Human Factors in Computing Systems (pp. 1-18). https://doi.org/10.1145/3613904.3642574 ↩︎
4. Sharma, A., Lin, I. W., Miner, A. S., Atkins, D. C., & Althoff, T. (2023). Human–AI collaboration enables more empathic conversations in text-based peer-to-peer mental health support. Nature Machine Intelligence, 5(1), 46-57. https://doi.org/10.1038/s42256-022-00593-2
   [open-access PDF] ↩︎
5. LinkedIn (n.d.). Learn more about Collaborative Articles ↩︎
6. Legislative Assembly of Ontario (2023, May 16). Official Report of Debates (Hansard), 78B. ↩︎
7. Vescera, Z. (2023, Dec 5). Union Drive Backfires for Some PHS Peer Workers. The Tyee. ↩︎
8. Ontario’s Big City Mayors (2024, Oct 18). Motion on Chronic Homelessness, Mental Health, Safety and Addictions Crisis. ↩︎
9. Canadian Mental Health Association (2024, Sept 18). Involuntary Care Already Exists in BC, But Is It Working? ↩︎
10. e.g. the Northern Initiative for Social Action ↩︎