Lived Experience and Clinician Perspectives on the Priorities and Challenges of Integrating Peer Support in Acute Psychiatric Services for People With <scp>BPD</scp>

People with borderline personality disorder (BPD) are high utilisers of acute psychiatric services (i.e., psychiatric emergency and inpatient services). Yet, people with BPD often encounter significant stigma in these settings, which can result in demoralisation and reluctance to seek further care. Peer support services are increasingly adopted to align mental health services with recovery-oriented principles. This study aimed to understand the perceived acceptability, opportunities and challenges of integrating peer support for people with BPD in acute psychiatric services. We invited people with lived experience (i.e., people with symptoms of BPD and their loved ones) and mental health professionals who provide care for people with BPD to participate in an online survey. We received 41 quantitative responses and 25 responses to open-ended questions. Peer support was rated as important by people with lived experience and providers. Themes extracted via thematic analysis from the open-text responses considered how peer support would (or would not) meet patients' needs, including: feeling seen, heard and understood; fostering a sense of connection and belonging; reducing negative or stigmatising experiences; accessing instrumental and informational support; experiencing a sense of psychological safety; and enhancing a sense of hope. Most responses saw peer support as well matched to these needs; however, some expressed possible implementation challenges, including staffing consistency, role confusion and incompatibility of crisis stabilisation versus recovery goals. Overall, results underscored the potential of peer support to enhance alignment with recovery-oriented practice, which is an organisational priority for many mental health services.