Peer-Led Psychotherapy

review outlining the effectiveness of peer-delivered psychotherapy.However, we challenge the conclusion by Dr O'Hara that it is "not yet" time for peer-delivered psychotherapy for postpartum depression.Safe interaction with the health care system is a privilege that numerous people do not receive.There are accessibility barriers to perinatal mental health care, which are exacerbated among many equity-deserving communities.3 For many individuals from marginalized groups, seeking mental health care has led to more harm than benefit (for example, infant/child apprehension). 4 For people who have a deep distrust of health systems, due to historical and ongoing trauma, peer support may be the safest and most culturally appropriate way to receive evidence-based services.We strongly disagree with O'Hara's "not yet" conclusion and instead advocate that the time is now to face the growing treatment gap for perinatal populations.Dr O'Hara asks, "But do women really want minimally trained former sufferers delivering psychotherapy-is it ethical?Is it sustainable?"We respond by asking, "Is it ethical to deny perinatal women effective interventions?"There will never be enough specialist providers to address the treatment gap for perinatal depression, and, as O'Hara points out, there is evidence worldwide in support of peer-delivered psychotherapy.5,6 As clinicians and researchers, it is our ethical and moral responsibility to provide perinatal women with effective interventions, and peer-delivered psychotherapy offers one patient-centered and cost-effective solution.In our patient-oriented research, participants with perinatal depression have indicated overwhelming support for this modality of therapy (Singla et al 7 and K. Chaput, PhD; M. Vekved, BSc; S. McDonald, PhD, et al, manuscript submitted).Further, because mental health clinicians and researchers are often in places of privilege, we should endeavor to collaborate with women with lived experience and their communities to ensure that their voices are the primary drivers of new directions in evidencebased practice.8 With burgeoning health care costs and rates of mental health problems, is keeping evidence-based intervention in the hands of doctoral-level psychologists sustainable when much lesser trained individuals can deliver them with therapeutic impact?Acting as a peer could be protective with respect to both clients' and peers' well-being and a form of empowerment, 9 making such a model particularly sustainable.Second, O'Hara asks, "It is the case that there is a significant shortage of trained mental health professionals.But should peers be the ones to fill the gap?" Sustainable models of peer-led supervision among multiple cadres of nonspecialist providers have been shown to be acceptable and feasible in low-resource settings.5,7 We believe that peers should be paid for their work, in the same way that any other health care provider is compensated, and that peer support can be embedded into systems of support that can help to manage and mitigate crises as they arise.Rather than questioning the growing evidence of whether peers can deliver psychotherapy, the key question is how to overcome professional guilds and build a collaborative, stepped-care system that incorporates these patientcentered models.We acknowledge that the authorship team and our views are influenced by a feminist lens and expertise in perinatal mental health and peer support, grounded in lived experience, and guided by a deep respect for social justice and Indigenous ways of knowing.

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