Background <p>Peer support has become a cornerstone of recovery-oriented mental health systems worldwide, with increasing recognition of its value in promoting recovery, empowerment, and inclusion. In Italy, despite a long-standing tradition of community-based care, the integration of peer support services (PSSs) remains fragmented and understudied.</p> Methods <p>A national cross-sectional online survey was conducted between January and February 2025 targeting all Italian Mental Health Departments (MHDs). The survey explored the presence, organization, and perceived impact of peer support and co-production practices.</p> Results <p>A total of 61 out of 135 MHDs (45%) responded. Among them, 55.7% reported implementing peer support initiatives, primarily within community-based services. Peer support workers (PSWs) were generally perceived as effective in fostering recovery and reducing stigma. However, major barriers included lack of formal recognition, insufficient funding, and cultural resistance (e.g., reluctance among some professionals to acknowledge experiential knowledge or to integrate non-clinical roles into multidisciplinary teams). Co-production practices were reported by more than half of the MHDs, though they remained largely consultative.</p> Conclusions <p>Peer support and co-production are emerging within in Italy’s mental health system but face substantial structural and cultural barriers. National frameworks and dedicated resources are required to support sustainable implementation and the full integration of experiential knowledge into mental health services.</p>