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Suicidality is a significant and persistent public health concern, and people who are suicidal report negative experiences with clinical services. Peer-based interventions are a rapidly growing component of mental health care and suicide prevention. This scoping review's aim is to identify, summarise and synthesise the design, features and evidence for peer-led models and interventions for people experiencing emotional distress or suicidal crisis. This study followed the Joanna Briggs Institute scoping review guidelines. Online databases were searched in May 2022 and in October 2024. A total of 59 papers were identified. The scoping review provides an overview of key components of service models and interventions. In general, peer-led programs were widely accepted, with participants reporting positive improvements to mood, social connectedness, communication and coping skills. Despite the importance of training and supervision, a review of training content revealed a discordance between training and peer work principles in some cases. A concentration on facilitation of the service model or intervention rather than on the peer model itself meant there was limited information on the empirical and ethical arguments that supported the model of care. Future research is needed on peer-led models and how involvement and engagement of peers, consumers and carers can positively influence the planning, design, implementation and evaluation of new service models and interventions.