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Exploring the Utility of Self-Help Groups: Does Self-Help Group Membership Enhance Mental Health?

I Introduction

II Self-Help Groups and Mental Health

III Summary and Discussion

IV Conclusion

-- submitted by Irene Boldt, a 3rd year nursing student at Ryerson, through Spencer Brennan, Coordinator, Ontario Self-Help Network Program, Self-Help Resource Centre

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I Introduction

The intention of this paper is to demonstrate to healthcare professionals (HCP) that self-help groups have the potential to positively influence the mental health of their members. After defining self-help and mental health, discussing methodological issues related to studying self-help and reviewing current, relevant self-help studies, this paper concludes that HCP can confidently recommend self-help groups to their clients, particularly those clients with, or with the potential for, mental health issues, as a way to promote and improve mental health.

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II Self-Help Groups and Mental Health

Self-help groups, also referred to as mutual-aid, mutual support, peer-support or support groups, are “informal networks of individuals who share a common experience or issue.” [1] Self-help groups may have varying degrees of professional organization or involvement: some groups are operated entirely, and independently, by group members, while other groups are attended, organized, or minimally-guided by caring HCP. Yet, irrespective of the level of professional involvement, what defines and is unique to self-help groups is that they are run for and controlled by group members, and they focus on making use of the “‘experiential knowledge’” possessed by each group member. [2] And all self-help groups, regardless of their common experience or issue, intend to assist members by providing emotional and practical support and by facilitating the exchange of information. [1]

The question is: do self-help groups promote the positive mental health of their members, and if so, how and to what extent? This paper will thus consider the most relevant self-help group research to determine if self-help groups positively enhance the mental health of their members.

  1. According to the Canadian Mental Health Association (CMHA), mental health is not simply the absence of mental illness, but is a holistic conception of mental wellness and fitness. [3] People can be more or less mentally healthy, and mental health is attainable even in the presence of a clinical diagnosis. The CMHA lists five key characteristics of mental health: the ability to enjoy life, resiliency, balance, self-actualization and flexibility. The ability to enjoy life is the capacity to live in and enjoy the present moment without dwelling on negative thoughts of the past or future. Resiliency is the ability to deal successfully with difficult times while maintaining a sense of optimism. Balance is attained when all aspects of life are given the attention they require, and no one element receives too much or too little attention. Self-actualization is achieved by acknowledging and realizing one’s full potential, and flexibility is the ability to deal effectively with changes in emotions and expectations. These five characteristics will be considered when looking at the findings from current self-help group research, as a way to assess whether or not self-help groups impart mental health benefits to their group members.    

Studying Self-Help Groups: Methodological Issues

Historically research focusing on self-helps groups has been inconclusive, leaving many HCP feeling confused about the benefits of self-help groups and thus reluctant to recommend the use of such groups to their patients. The available evidence is riddled with various, often incongruent definitions of self-help, and the range of study methods used have created a literature base that may appear confusing and contradictory. [4] The purpose of this section is to clarify some of the issues researchers face when studying self-help groups.

Broadly, self-help groups have been studied using one of the two dominant research traditions. Qualitative research studies articulate the subjective experiences of self-help group members and their findings describe the benefits members attribute to self-help group membership. Quantitative research studies, experiments and quasi-experiments, use systematic and structured methods to gather information, focusing on objective assessments and exercising control over the research situation. These studies investigate self-help group member outcomes, not experiences, using standardized psychological and psychosocial assessment tools. These studies yield empirical information that enables researchers to establish casual links between outcomes and self-help group membership.

These research methods are not unique to the study of self-help groups, however self-help groups themselves are distinct from other studied phenomena. [4] On the one hand, quantitative studies can provide concrete evidence that self-help groups impart unique benefits to their members, as these rigorous study conditions limit spurious influences. Yet, the artificial nature of these controlled experimental conditions may distort the self-help group phenomenon as it exists “in the field.” One of the central tenants of self-help group membership is that it is voluntary: people may join or leave the group when they chose. Therefore, to have a researcher assign people to a treatment condition (a self-help group), and require them to stay in the group for the duration of the study, seems to violate the voluntary nature of and the flexibility inherent to self-help group participation.

Clearly, quantitative and qualitative research paradigms differ in what they offer to our understanding of the usefulness of self-help groups. Qualitative research is able to investigate self-help groups as they exist, and can contribute vivid descriptions of the reality self-help group members’ experience. Quantitative studies reflect an approach to information gathering that appeals to those who want to know that self-help groups provide benefits that are objectively evident, regardless of subjective experiences and personal opinions. Since it is the intention of this paper to determine if self-help groups benefit their members’ mental health, findings from each research discipline will be investigated. As Humphreys & Rappaport note, “multiple methods and approaches… must be used to fully map the phenomenon.”  [4]

A Review of the Relevant Self-Help Literature

Studies included in this review are from both research traditions, speak to a variety of problems and issues addressed by self-help groups, and are from a number of different countries.  What every study shares is a conception of self-help: regardless of the presence, absence, or level of professional involvement, groups are run by and for the participants.

Qualitative research

Three qualitative studies were reviewed for the purposes of this paper. [5, 6, 7] The findings of these studies reveal a variety of common experiences. Group members describe a sense of belonging, of being understood and of feeling normal, which they attributed to the experience of group sharing and reciprocity. [5, 6, 7] Practically, group members describe an increase in knowledge related to their particular issue or problem, an increase in their ability to cope effectively and an increased sense of control and personal agency. [5, 6, 7] Self-help group members also derived satisfaction from both giving and receiving help. [5, 6, 7] Other ascribed benefits of self-help group membership include enhanced self-perception, an increase in self-confidence and an improvement in the strength and functioning of personal and familial relationships.  [5, 7]

Considering these findings in the context of the CMHA conception of mental health, belonging, being understood, feeling normal and greater self-confidence reflect an increase in the ability to enjoy life, create balance, be resilient and to self-actualize. An increase in practical knowledge, coping, self-control and personal agency allow for greater flexibility and facilitate self-actualization. Finally, improved personal and familial relationships will impact mental health positively in all of the above mentioned areas.

Quantitative research      

Two types of quantitative studies are included for the purposes of this review: two experimental studies and five quasi-experimental studies. The two experimental studies are included as evidence that rigorous experiments can validate the utility of self-help groups. The five quasi-experimental studies included make use of pre-existing self-help groups capturing authentic self-help group outcomes.       

Experimental studies.

The two experimental studies investigate the utility of self-help group membership for the family caregivers of patients with schizophrenia, and make use of randomized, controlled trials. [8, 9]  Results from these studies indicate that self-help group participants showed a decrease in family burden and an increase in family functioning and social support. [8, 9] Like the findings from the qualitative studies, this increase in social support and family functioning, with the corresponding decrease in family burden, will enhance group members’ mental health by improving their ability to enjoy life, achieve balance, be resilient and flexible and self-actualize.   

Quasi-experimental studies.

The five quasi-experimental studies included in this review look at a variety of problems and issues addressed by self-help groups. [10, 11, 2, 12, 13] All five studies made use of pre-existing self-help groups, examined the outcomes of self-help group members and used standardized measures to do so.

Three studies located participants already involved in self-help groups. [10, 11, 7] Two of these studies looked at self-help groups for families of ill persons. [10, 7] These studies found that self-help group members were helped by and satisfied with their self-help group [2, 7] and that the benefits of self-help group membership included increases in practical, relevant information, an increase in coping abilities and a strengthening of family relationships. [10] The third study looked at the experiences of recovering addicts with a co-morbid mental illness, and the results of this study show a positive correlation between self-group attendance and medication adherence. [11]

One study looked at newly-recruited self-help members, recently hospitalized for a mood disorder episode. [12] The study found that an increase in self-help group involvement was associated with an increase in effective illness management. [12]

The fifth and final study examined patient outcomes of veterans with severe mental illnesses before and after the implementation of a long-term self-help group initiative (the Vet-to-Vet program). [13] Findings suggest that veterans who attended more than ten self-help group meetings had an increase in confidence, empowerment and overall functioning and a decrease in alcohol use. [13]

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III Summary and Discussion

In summation, research studies indicate that self-help group members experience an increased sense of belonging, of being understood, and of normalcy. Groups impart practical knowledge and skills for dealing with the relevant problem, facilitate increased coping and provide a sense of control and personal agency. Members have increased self-confidence, self-perception and feelings of empowerment. Self-help group membership also improves personal and familial relationships, increases social support and decreases family burden. Each of these benefits has the potential to enhance at least one, if not more than one, of the mental health characteristics articulated by the CMHA. Thus, it is the position of this paper that self-help group membership, at a minimum, has the potential to improve the mental health of every self-help group member. Finally, one limitation of this paper is that it did not consider studies in which no positive outcomes were found. For examples of these studies, please refer to Pistrang, Baker and Humphreys.  [2]

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IV Conclusion

In conclusion, research evidence suggests that self-help groups can have a positive impact on members’ mental health. All the reviewed studies, in one way or another, confirm the intentions of self-help groups, providing members with emotional and practical support and facilitating information exchange. Additionally, each ascribed benefit, in one way or another, enhances the mental health of self-help group members by improving their ability to enjoy life, be resilient, achieve balance, be flexible and self-actualize. The intention of this paper has been to demonstrate to HCP that self-help groups positively influence the mental health of their members. Having accomplished this, HCP can feel confident recommending the use of self-help groups as a way to promote and improve the positive mental health of their clients.

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References

1. Self-Help Resource Centre. (n.d.). What is self-help? Retrieved February 10, 2009 from http://www.selfhelp.on.ca/whatis.html

2. Pistrang, N., Barker, C. & Humphreys, K. (2008). Mutual help groups for mental health problems: A review of effectiveness studies. American Journal of Community Psychology, 40, 110-21

3. Canadian Mental Health Association. (2009). Meaning of mental health. Retrieved February 24, 2009, from http://www.cmha.ca/bins/content_page.asp?cid=2-267-1319&lang=1

4. Humphreys, K & Rappaport, J. (1994). Researching self-help/mutual aid groups and organizations: Many roads, one journey. Applied and Preventative Psychology, 3, 217-31

5. Adamsen, L. (2002). ‘From victim to agent’: the clinical and social significance of self-help group participation for people with life-threatening diseases. Scandinavian Journal of Caring Science, 16, 224-31  

6. Munn-Giddings, C. & McVicar, A. (2006). Self-help groups as mutual support: What do carers value? Health & Social Care in the Community, 15(1), 26-34

7. Solomon, M., Pistrang, N. & Baker, C. (2001). The benefits of mutual support groups for parents of children with disabilities. American Journal of Community Psychology, 29(1), 113-32

8. Chien, W., Norman, I. & Thompson, D. R. (2004). A randomized controlled trial of a mutual support group for family caregivers of patients with schizophrenia. International Journal of Nursing Studies, 41, 637-49)

9. Chien, W., Thompson, D. R. & Norman, I. (2008). Evaluation of a peer-led mutual support group for Chinese families of people with schizophrenia. American Journal of Community Psychology, 42, 122-34

10. Heller, T., Roccoforte, J. A., Hsieh, K., Cook, J. A. & Pickett, S. A. (1997). Benefits of support groups for families of adults with severe mental illness. American Journal of Orthopsychiatry, 67(2), 187-98 

11. Magura, S., Laudet, A. B., Mahmood, D., Rosenblum, A. & Knight, E. (2002). Adherence to medication regimens and participation in dual-focused self-help groups. Psychiatric Services, 53(3), 310-16

12. Powell, T. J., Yeaton, W., Hill, E. M. & Silk, K. R. (2001). Predictors of psychosocial

outcomes for patients with mood disorders: The effects of self-help group participation. Psychiatric Rehabilitation Journal, 25(1), 3-11

13. Resnick, S. G. & Rosenheck, R. A. (2008). Intergrating peer-provided services: A quasi-experimental study of recovery orientation, confidence and empowerment. Psychiatric Services, 59(11), 1307-14