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Self-Help/Mutual Aid: Take Another Look



A. SELF-HELP/MUTUAL AID: DEFINING THE TERMS



It's nothing to do with a certain section of the bookstore. It's frequently confused with self-care, and it's often overlooked as a viable health promotion tool.



It's called self-help/mutual aid and in more than 50 countries around the word, it's used to describe a process of voluntarily sharing mutual support and information around a common concern such as living with breast cancer or surviving a stroke. In Ontario, there are more than 3000 self-help/mutual aid initiatives, all organized, directed and sustained by participants in almost every community across the province.



These initiatives include:



- independent face-to-face self-help groups (Alcoholics Anonymous)

- on-line self-help groups (Irritable Bowel Syndrome Group)

- telephone and pen pal networks

- independent groups with in-kind support from an organization

- groups transitioning from professional to peer leadership

- self-help information and referral centres (Self-Help Resource Centre of Greater Toronto)

- self-help organizations (Bereaved Families of Ontario)


B. WHERE DOES SELF-HELP/MUTUAL AID FIT IN HEALTH PROMOTION WORK?



In 1986, Health Canada released, Achieving Health for All, presenting three mechanisms intrinsic to health promotion. These mechanisms were self-care, healthy environments, and "mutual aid, or the actions people take to help each other cope"..



More importantly, the Ottawa Charter insisted that health promotion action not only include healthy public policy and strong community action, but also the creation of supportive environments. "The

overall guiding principle for the world, nations, regions and communities alike is the need to encourage reciprocal maintenance-to take care of each other.." (http://www.who.dk/policy/ottawa.html, pg2)



Then more than ten years later at Jakarta, we agreed once more that "health promotion is carried out by and with people, not on or to people." (http://www.ki.se/phs/wcc-she/declarations/jakarta.html)



The self-help/mutual aid process is about building supportive environments for people. Self-help/mutual aid is based on reciprocal maintenance, and it's success rests on whether it is carried out by and with people, not on or to people. It can be an effective, complementary, community capacity building tool, but it is commonly ignored or dismissed by many in health promotion.



Priority Populations and Issues

Gone are the days when self-help was synonymous with Alcoholics Anonymous. Self-help/mutual aid is now being used by many populations including seniors, women, the disabled and youth as a strategy to cope with: abuse, addictions, bereavement, caregiving, aging, disability, eating disorders, (un)employment, heart health, mental health and many hundreds of health conditions such as arthritis, cancer and HIV/AIDS.



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C. KEY DIFFERENCES BETWEEN SELF-HELP AND PROFESSIONALLY-LED INITIATIVES



Because self-help groups and networks are led by the participants themselves, the process is very different to professionally-led program delivery.



Compare an open, ongoing self-help group for people living with heart disease to a 6 week educational 'heart health' program.



Strategy Self-help group Professional program



Structure: informal formal



Decision Making: participative hierarchical



Main Concern: mutual support and info provision of services, education



Source of knowledge: personal experience facilitator expertise



Duration: ongoing dependent on funding



Fee: low/no fee for members depends on funding, materials



Resources: in-kind supports paid staff, organizational funding



Language: everyday jargon/ everyday



Evaluation: decided by group required by funder/organization



varied type/frequency formal



Although all these differences may not always apply, the key contrast between these two models is leadership. Self-help initiatives are developed by individuals seeking others in the same situation.

Leaders are also members, primarily there to give and receive support, rather than to facilitate the group whether it is in person or on-line. Structure, location, duration and content are also dependent on what the group wants, rather than the strategic goals of an organization and its funders.



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D. DOES SELF-HELP HELP?



Despite the difference to the accepted norm of program delivery, at last count, more than 6.25 million Americans and 2.1 million Canadians now participate in self-help/mutual aid activity for complementary

support and health information (1990).



The benefits of self-help participation are varied and always depend in the individual. For a member, participation (in a group, network or organization) may reduce isolation, create a sense of community,

serve an advocacy function as well as enhance self-care, problem-solving, facilitation and planning skills.



Research Findings

In 1997, Bryan Hyndman at Centre for Health Promotion, University of Toronto and president of the Ontario Public Health Association produced Does Self-Help Help? a review of the literature on the effectiveness of self-help programs. Among other findings, Hyndman suggested that members may enjoy many of the benefits listed above if they join and then continue to attend self-help programs on a regular basis.



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E. LIMITATIONS OF SELF-HELP

Self-help has its limitations however. Many individuals may not be comfortable in a peer group setting, preferring either individual counselling or professionally-led/eduational programs. Also, for self-help to take place, the impetus to participate must be voluntary, starting with an individual rather than a helping professional. Individuals cannot therefore be mandated to attend self-help groups, nor can they be recruited to lead groups initiated by a helping professional to meet pre-existing program goals.

Self-help, like health promotion in general, is also difficult to evaluate, especially over short periods of time.



For all of these reasons, it is imperative that funders and policy makers understand that self-help initiatives are not a replacement for existing services. Although self-help initiatives may be cost-effective, relying on in-kind, member support rather than external funding, they are a complement not an alternative to other health promotion programs.



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F. THE SELF-HELP RESOURCE CENTRE/ ONTARIO SELF-HELP NETWORK



Supporting the growth and development of complementary self-help initiatives, the Self-Help Resource Centre of Greater Toronto/Ontario Self-Help Network (SHRC/OSHNET) is the fastest growing self-help

centre in North America. Founded in 1987, SHRC/OSHNET is supported by the Ontario Ministry of Health, Health Promotion Branch, Trillium, the United Way and other public and private funders. It continues to produce the only directory of self-help initiatives in the Toronto area, as well self-help centres and organizations across the province/nation. Other services include: information and referral,

training, research and skill development opportunities for more than 25,000 professionals, students, visiting scholars and self-helpers annually. Affiliated with the Centre for Health Promotion at the

University of Toronto, SHRC also provides consultation to policy makers, planners and organizations on self-help and the planning, development and maintenance of self-help initiatives.



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G. SELF-HELP/MUTUAL AID AT WORK



At the heart of self-help/mutual aid work is personal experience, so it seems fitting to end with an illustrative story of self-help as a health promotion tool in Ontario.



Not long ago, I was asked by to fly to Algoma and give a workshop on how to start and maintain your own self-help support group. Attendance was excellent with helping professionals, youth, parents, seniors, men and women all sitting together in the audience. Over the course of the day, I learned the story of one group of older women, quietly sitting together around a table. The were all going through menopause, they were all aging, they were all trying to quit smoking, and they were all trying to exercise and keep fit. They had met through a short term educational program and because it had come to an end, had come to the workshop to find out how to start their own group. Their main goal

was to meet others also trying to improve their overall health, rather than smoking cessation or menopause education. The group didn't need any funding, just somewhere to meet and a little consultation every now and then. In effect, they were building their own supportive environment where one did not exist, based on reciprocal maintenance, for and with each other. They were bringing together all the issues; smoking cessation, aging and heart health and showing me real health

promotion in action, from the Ottawa Charter to Jakarta and everything in between.


References



Health Canada. 1986. Achieving health for all: A framework for health promotion 1986.



Ottawa Charter for Health Promotion: First International Conference on Health Promotion-Ottawa, Canada, 17-21 November 1986. http://www.who.int/hpr/NPH/docs/OttawaCharterforHealthPromotion.pdf



The Jakarta Declaration on Leading Health Promotion. The Fourth International Conference on Health Promotion: New Players for a New 21st Century, 21-25 July 1997, Jakarta, Indonesia.

http://www.who.int/hpr/archive/docs/jakarta/english.html