Academic journal article Health Sociology Review

Involvement in Mental Health Self-Help Groups and Recovery

Academic journal article Health Sociology Review

Involvement in Mental Health Self-Help Groups and Recovery

Article excerpt

Introduction

Self-help groups for people with mental health problems are the most prevalent form of self-help. There are several thousand groups in Australia, the UK, and the US. In the US, they are utilized by over two million adults annually (Goldstrom et al., 2006; Substance Abuse and Mental Health Services Administration, 2009).1 While qualitative research points to beneficial effects, quantitative studies examining psychiatric outcomes show mixed effects, with about half the studies showing favourable effects on symptoms and social functioning (Pistrang, Baker, & Humphreys, 2008, 2010). However, the processes by which involvement in self-help impacts recovery are not fully understood, in part due to the atheoretical nature of research (Brown & Lucksted, 2010; Lloyd-Evans et al., 2014; Pistrang, Baker, & Humphreys, 2010). Studies that examine factors that mediate the effects of involvement on outcomes are limited to cross-sectional designs, precluding firm inferences about causal direction. Moreover, studies examine outcomes in isolation, without considering processes that link them together. By theoretically organizing recoveryoriented processes, the potential effects of involvement in self-help can be better understood.

In this study, we first review how recovery is believed to be facilitated by self-help groups for persons with severe mental illness, emphasizing relationships among key components. Next, we discuss qualitative and quantitative research on self-help and its limitations. Applying empowerment, stigma, and social selection perspectives, we formulate and test a model of the relationships between involvement in self-help (level of participation and interaction with other members), empowerment (self-esteem, mental health confidence, and stigma reduction), symptoms, and quality of life. Then, we examine the reciprocal relationships between beliefs in the efficacy of self-help and involvement. Finally, we report results regarding why some respondents never attended self-help group meetings, why those who continue to attend do so, and why others stop attending.

Self-help and recovery

Over the last few decades, mental health consumer advocates, service researchers, and providers have argued for an approach to recovery from mental illness that places emphasis not only on the symptoms of a disorder, but on the 'life context' of persons with mental illness (Anthony, 1993; Ralph & Corrigan, 2005). They maintain that, in addition to medication-based symptom management, 'empowerment', increased self-esteem and self-efficacy, along with meaningful relationships, work and improved quality of life, are key interrelated components of recovery. Recovery is therefore conceptualized not as some endpoint, but rather, as an ongoing, eminently social-psychological process in which these elements covary over time (Markowitz, 2005).

Self-help organizations (e.g., Recovery, Inc.; Schizophrenics Anonymous) have proliferated over the past several decades, as advocacy groups, alternatives, and supplements to conventional services, often in the spirit of helping foster empowerment and recovery (Goldstrom et al. 2006; Katz, 1993). One advantage of self-help groups is thought to be cost-effectiveness, particularly in the climate of fiscal constraints on therapy (Brown, 2009). Although mental health self-help groups vary in their focus and dynamics, they are member-governed, and emphasize self-advocacy and taking an active role in treatment decisions. These groups are believed to provide support, acceptance, and knowledge gained by interaction with 'peers', those who also have a diagnosis of mental illness - in Goffman's(1963) term, the 'own' (a group of individuals who share a particular stigma), a vital step in making cognitive changes that lead to improved functioning and quality of life (Jacobs & Goodman, 1989). This is consistent with self-attribution theories that indicate when persons with mental illness are embedded in meaningful groups and engaged in productive activity, their sense of self is enhanced (Markowitz, 2001). …

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