What is Weathering Hypothesis?

Introduction

The weathering hypothesis was proposed to account for early health deterioration as a result of cumulative exposure to experiences of social, economic and political adversity.

It is well documented that minority groups and marginalised communities suffer from poorer health outcomes. This may be due to a multitude of stressors including prejudice, social alienation, institutional bias, political oppression, economic exclusion and racial discrimination. The weathering hypothesis proposes that the cumulative burden of these stressors as individuals age is “weathering,” and the increased weathering experienced by minority groups compared to others can account for differences in health outcomes. In recent years, the biological plausibility of the weathering hypothesis has been investigated in studies evaluating the physiological effects of social, environmental and political stressors among marginalised communities. This has led to more widespread use of the weathering hypothesis as a framework for explaining health disparities on the basis of differential exposure to racially based stressors. Researchers have also identified patterns connecting weathering to biological phenomena associated with stress and aging, such as allostatic load, epigenetics, and telomere shortening.

Origins

The weathering hypothesis was initially formulated by Dr. Arline T. Geronimus to explain the poor maternal health and birth outcomes of African American women that she observed in correspondence with increased age. While working part-time at a school for pregnant teenagers in Trenton, New Jersey, Geronimus first noticed that the teens who came to the school tended to have far more health problems than her classmates at Princeton University. She thus began to wonder whether the health conditions of the teens at that clinic may have been caused by their environment. Subsequent research on the disparity in maternal health between African American and white women led Geronimus to propose the weathering hypothesis. She proposed that the accumulation of cultural, social and economic disadvantages may lead to earlier deterioration of health among African American women compared to their non-Hispanic, white counterparts. Geronimus specifically chose the term weathering as a metaphor for the effects she perceived that exposure to stress was having on the health of marginalised people. While the weathering hypothesis was initially proposed based on observations of patterns in maternal health, academics have expanded its application as a framework to examine other health disparities as well.

Geronimus’ Research

While conducting research in the Department of Public Health Policy and Administration as a graduate student at the University of Michigan in 1992, Geronimus noticed a trend in disparities between the fertility of African American women versus their white counterparts. She noted that while the average white woman experiences her point of highest fertility and lowest risk of pregnancy complications or neonatal mortality between her 20’s and 30’s, this generalisation did not apply to African American women. Instead, among African American women, teen mothers are most likely to have healthy pregnancies and offspring. The data indicated a widening disparity in black-white infant mortality as maternal ages increase. Subsequently, Geronimus proposed the “weathering hypothesis,” which she initially conceived as a potential explanation for the patterns of racial variation in infant mortality with increasing maternal age.

Health Disparities

In the context of the weathering hypothesis, individual health is dynamic and shaped over time by social, economic, and environmental influences. These social determinants dictate what different demographics are exposed to as they develop and age. Racism and discrimination are two specific social determinants that lay the foundation for systemic inequality in access and upward mobility. This entrenchment of social inequities disproportionately impacts minorities and communities of colour, who remain in environments of poverty that have significantly more stressors than those of wealthier, predominantly white communities. These stressors – and the associated burden of coping with them – manifest as physiological responses that have detrimental effects on individual health, often leading to a disproportionately high occurrence of chronic illness and shorter life expectancy in minority communities. Multi-ethnic studies have yielded significant data demonstrating that weathering – accumulated health risk due to social, economic and environmental stressors – is a manifestation of social stratification that systemically influences disparities in health and mortality between dominant and minority communities.

Maternal Health

Maternal mortality is three to four times higher for Black mothers than white mothers in the United States. Infant mortality is also twice as high for infants born to non-Hispanic Black mothers compared to infants born to non-Hispanic white mothers. Additionally, there are racial disparities for negative birth outcomes like low birth weight, which has been found to influence risk of infant mortality and developmental outcomes after birth, and preterm birth. Across all women, older maternal age is associated with higher rates of these negative outcomes during pregnancy, but studies have consistently found that rates rise more rapidly for Black women than white women. The weathering hypothesis proposes that the accumulation of racial stress over Black women’s lives contributes to this observed pattern of racial disparities in maternal health and birth outcomes that increase with maternal age. Research has consistently identified an association between preterm birth and low birth weight in Black women and maternal stress caused by experiences of racism, systemic bias, socioeconomic disadvantage, segregated neighbourhoods, and high rates of violent crime. There is biological evidence of weathering, including the finding that Black women have shorter telomeres, a biological indicator of age, when compared with white women of the same chronological age. Though increased socioeconomic status serves as a protective factor against negative birth outcomes for non-Hispanic white mothers, disproportionate rates of preterm birth and low birth weight for non-Hispanic Black mothers have been found at every education and income level. The weathering hypothesis has also been used to explain this trend because upward socioeconomic mobility is associated with increased exposure to discrimination for women of colour.

There is modest evidence supporting the effects of weathering on mothers from other minority groups, including for high birth weight outcomes among American Indian/Alaska Native women. Research has started to explore whether the weathering hypothesis could also explain racial disparities in the outcomes of assisted reproductive technologies, but so far the findings are inconsistent.

Mental Health

Research shows that mental health disparities among marginalized communities exist. Daily discrimination faced by marginalised groups have been found to be associated with increased depressive symptoms and feelings of loneliness. Low-income communities are more likely to have severe mental illnesses, which is frequently heightened by the inaccessibility to quality healthcare. Researchers found that persisting epigenetic changes lead to increased risk of postpartum depression as a result of adverse life events and cumulative life stress among Black, Latinx, and low-income women. In a study assessing African American men, experiences of racism were linked to a poorer mental health state.

Intersectionality of Systems of Oppression

Intersectionality is a term coined by Kimberlé Crenshaw to describe the interconnected nature of different systems of oppression, the layered effects of which can be seen in the healthcare system. Research indicates that lower class status and increased depressive symptoms are associated with higher levels of biological weathering among Black individuals in comparison to white individuals. In a study exploring disparities in mental health, researchers found that Black sexual minority women reported higher frequencies of discrimination and decreased levels of social and psychological well-being than their white sexual minority women counterparts. Black sexual minority women had decreased levels of social well-being and increased levels of depressive symptoms in comparison to Black sexual minority men. African American women are also more likely to contract COVID-19 than African American men and white women. The prevalence of medical racism and sexism (lack of quality healthcare, harmful experimentation, etc.) has led to negative relationships with healthcare systems and increased risk of negative sexual and reproductive health outcomes among African American women. Existing research show how systems of oppression work together to oppress marginalized groups within the healthcare system and, as a result, these groups disproportionately experience negative health effects.

Criticism and Related Theories

Arline Geronimus faced significant pushback for the weathering hypothesis, including from members of the medical community who believed there was a genetic or evolutionary explanation for racial differences in health outcomes. There was some early criticism regarding the quality of her data, though the evidence of weathering and health disparities has grown since. Others pushed back against the weathering hypothesis because its application to racial disparities in maternal health seemed to contradict what advocacy groups had been saying about the negative consequences of teen pregnancy on young mothers. A further criticism of this theory believes that Geronimus and others have not sufficiently demonstrated a link between weathering and racial and gender disparities in life expectancy.

The weathering hypothesis was initially proposed as a sociological explanation for health disparities, but it is closely related to biological theories like the allostatic load model, which proposes that an individual’s exposure to repeated or chronic stress over their lifetime has physiological consequences which can be measured through various biomarkers. Research has tended to discuss allostasis and allostatic load as the molecular mechanism behind the weathering hypothesis, and Geronimus herself went on to study racial differences in allostatic load. Another related theory is the life course approach, which emphasizes focus on cumulative life experiences rather than maternal risk factors as an explanation for birth outcome disparities. Researchers have also been interested in studying the possibility of children inheriting the epigenetic changes which result from their mother’s cumulative life stress, which could relate the weathering hypothesis with transgenerational trauma.

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Magic Medicine (2018)

Introduction

Can magic mushrooms cure depression? This documentary follows the first medical trial to explore the use of psilocybin as a treatment for clinical depression.

Outline

In 2012 a team of medical researchers asked themselves, “what would happen if we gave psilocybin (magic mushrooms) to people suffering from severe depression”? It took them three years to get the necessary permissions to find out.

Production & Filming Details

  • Director(s):
    • Monty Wales.
  • Producer(s):
    • Lizzie Gillett.
    • Monty Wales.
  • Writer(s):
    • Monty Wales.
  • Music:
    • Christopher White.
  • Cinematography:
    • Monty Wales.
  • Editor(s):
    • John Mister.
  • Production:
    • Life Cycle Films.
  • Distributor(s):
    • Dartmouth Films (2018) (UK) (theatrical).
  • Release Date: 09 November 2018 (London, UK).
  • Running Time: 79 minutes.
  • Rating: 15.
  • Country: UK.
  • Language: English.

The Psychedelic Drug Trial (2021)

Introduction

With exclusive access to a ground-breaking trial, this film asks if psychedelic drugs combined with psychological support can help tackle one of the biggest medical challenges we face – depression.

Outline

The Psychedelic Drug Trial has exclusive access to a ground-breaking new trial at Imperial College London. The trial sees, for the first time ever under controlled conditions, a psychedelic drug tested head-to-head against a standard antidepressant as a treatment for depression.

The film follows a pioneering team of scientists and psychotherapists, led by Professor David Nutt, Dr Robin Carhart-Harris and Dr Rosalind Watts, as they compare the effects of psilocybin (the active ingredient of magic mushrooms) with an antidepressant (an SSRI called escitalopram) on a small group of participants with clinical depression. This is scientific research at its most cutting edge. With over seven million people being prescribed antidepressants each year in England alone, this drug trial is an important milestone in understanding a completely different treatment for depression.

Filmed over 16 months, this film explores both the immediate and long-term impacts of the trial on the lives of participants. It investigates whether psychedelic drugs combined with psychological support could help tackle one of the biggest medical challenges faced today and what it takes to conduct research in uncharted scientific territory.

How do psychedelic drugs measure up against the industry-standard antidepressants that have been popular since the 1990s? The empirical results of the trial are explored alongside the participants’ powerful lived experience.

About the Trial

All psychedelic drug use shown in this programme was part of a carefully controlled clinical trial under the supervision of specially trained psychotherapists.

The trial was run by Professor Nutt, Dr Carhart-Harris and Dr Watts and their team at Imperial College from 2019 to 2020. Fifty-nine participants took part, the trial is now finished.

The psychedelic drugs used in the trial are illegal in the UK and not available for medical treatment. You should always consult your doctor before you stop, change or start any new treatment.

Production & Filming Details

  • Director(s):
    • Sam Eastall.
  • Producer(s):
    • Caroline Lai … line producer.
    • Alice Martineau … producer.
    • Anna Murphy … executive producer.
    • Sabine Pusch … edit producer.
    • Caroline Willis … line producer.
  • Writer(s):
  • Music:
  • Cinematography:
    • Richard Jephcote … director of photography.
  • Editor(s):
    • Zoe Davis … editor.
    • Alex Spence … assistant editor.
  • Production:
    • Grain Media.
  • Distributor(s):
    • BBC Two (2021) (UK) (TV).
    • British Broadcasting Corporation (BBC) (2021) (UK) (all media).
  • Release Date: 19 May 2021 (UK).
  • Running Time: 59 minutes.
  • Rating: Unknown.
  • Country: UK.
  • Language: English.

The Responder (2022): S01E05

Introduction

The Responder is a British police procedural series set in Liverpool, written by former Merseyside Police officer Tony Schumacher and starring Martin Freeman, Adelayo Adedayo, Ian Hart, and MyAnna Buring.

A crisis-stricken, morally compromised first-responder tackles a series of night shifts on the beat in Liverpool, while trying to keep his head above water personally and professionally.

Outline

Chris is forced to work for a major drug dealer to return the drugs stolen by Casey. When Rachel needs his help urgently, Chris must decide where his loyalties truly lie.

The Responder Series

You can find a full index and overview of The Responder here.

Production & Filming Details

  • Release Date: 24 January 2022.
  • Running Time: 60 minutes (per episode).
  • Rating: 15.
  • Country: UK.
  • Language: English.

The Responder (2022): S01E04

Introduction

The Responder is a British police procedural series set in Liverpool, written by former Merseyside Police officer Tony Schumacher and starring Martin Freeman, Adelayo Adedayo, Ian Hart, and MyAnna Buring.

A crisis-stricken, morally compromised first-responder tackles a series of night shifts on the beat in Liverpool, while trying to keep his head above water personally and professionally.

Outline

Chris hits rock bottom. Rachel begins to suspect Mullen may not be all he appears, and Casey teams up with Marco to find a buyer.

The Responder Series

You can find a full index and overview of The Responder here.

Production & Filming Details

  • Release Date: 24 January 2022.
  • Running Time: 60 minutes (per episode).
  • Rating: 15.
  • Country: UK.
  • Language: English.

The Responder (2022): S01E03

Introduction

The Responder is a British police procedural series set in Liverpool, written by former Merseyside Police officer Tony Schumacher and starring Martin Freeman, Adelayo Adedayo, Ian Hart, and MyAnna Buring.

A crisis-stricken, morally compromised first-responder tackles a series of night shifts on the beat in Liverpool, while trying to keep his head above water personally and professionally.

Outline

Chris plans to hand the drugs in, until Carl makes him an offer that he cannot refuse. Rachel strikes a deal with Mullen, but Chris’ behaviour makes her feel conflicted.

The Responder Series

You can find a full index and overview of The Responder here.

Production & Filming Details

  • Release Date: 24 January 2022.
  • Running Time: 60 minutes (per episode).
  • Rating: 15.
  • Country: UK.
  • Language: English.

The Responder (2022): S01E02

Introduction

The Responder is a British police procedural series set in Liverpool, written by former Merseyside Police officer Tony Schumacher and starring Martin Freeman, Adelayo Adedayo, Ian Hart, and MyAnna Buring.

A crisis-stricken, morally compromised first-responder tackles a series of night shifts on the beat in Liverpool, while trying to keep his head above water personally and professionally.

Outline

Chris must juggle handling rookie police officer Rachel while also tracking down Casey, after Chris threatens his family. Casey puts her trust in a friend to hide her from Carl.

The Responder Series

You can find a full index and overview of The Responder here.

Production & Filming Details

  • Release Date: 24 January 2022.
  • Running Time: 60 minutes (per episode).
  • Rating: 15.
  • Country: UK.
  • Language: English.

The Responder (2022): S01E01

Introduction

The Responder is a British police procedural series set in Liverpool, written by former Merseyside Police officer Tony Schumacher and starring Martin Freeman, Adelayo Adedayo, Ian Hart, and MyAnna Buring.

A crisis-stricken, morally compromised first-responder tackles a series of night shifts on the beat in Liverpool, while trying to keep his head above water personally and professionally.

Outline

Police response officer Chris is struggling to keep a grip on his mental health and marriage when he is offered a path to redemption in the form of a young heroin addict.

The Responder Series

You can find a full index and overview of The Responder here.

Production & Filming Details

  • Release Date: 24 January 2022.
  • Running Time: 60 minutes (per episode).
  • Rating: 15.
  • Country: UK.
  • Language: English.

The Responder TV Series Overview (2022)

Introduction

The Responder is a British police procedural series set in Liverpool, written by former Merseyside Police officer Tony Schumacher and starring Martin Freeman, Adelayo Adedayo, Ian Hart, and MyAnna Buring.

A crisis-stricken, morally compromised first-responder tackles a series of night shifts on the beat in Liverpool, while trying to keep his head above water personally and professionally.

Outline

Chris Carson is a police officer, in a fictional constabulary covering Liverpool, who has been demoted from his position as a sergeant and undertakes a series of night shifts in central Liverpool. His work scenes are interspersed with scenes of him at therapy, at home, and with his mother in a nursing home. He is partnered with Rachel Hargreaves, an inexperienced and still idealistic officer who wants to play by the rules. Carl Sweeney is a mid-level drug dealer whose stash of cocaine has been purloined by Casey, a local “baghead”. Chris is trying to help Casey and, in doing so, crosses Carl. Other major characters include the naïve local scally Marco, who finds himself out of his depth.

Carson is a conflicted and compromised man, with somewhat divided loyalties, a desire to do good but violent aggressive streak brought on by childhood trauma exacerbated by his experience in the police. He has been demoted from sergeant and is pursued by the officer responsible as part of a corruption probe, whose motives may not be entirely honest. The effects of the jobs and Chris’ mental state take a toll on his family.

Cast

  • Martin Freeman as Chris Carson.
  • Adelayo Adedayo as Rachel Hargreaves, a probationary police officer.
  • Warren Brown as Raymond Mullen, a demoted officer with an axe to grind.
  • MyAnna Buring as Kate Carson, Chris’ wife.
  • Emily Fairn as Casey, a drug addict.
  • Josh Finan as Marco, Casey’s friend.
  • Philip S. McGuinness as Ian, Carl’s henchman.
  • Mark Womack as Barry, Carl’s henchman.
  • Ian Hart as Carl Sweeney, a drug dealer.
  • Rita Tushingham as June Carson, Chris’ mother.
  • Philip Barantini as Steve, Rachel’s boyfriend.
  • David Bradley as Davey, a local homeless man.
  • Kerrie Hayes as Ellie Mullen, Raymond’s wife and Kate’s best friend.
  • Faye McKeever as Jodie Sweeney, Carl’s wife.
  • Philip Whitchurch as Joe, Casey’s grandfather.
  • Christine Tremarco as Dr. Diane Gallagher, Greg’s sister.
  • Amaka Okafor as Detective Inspector Deborah Barnes, Chris’ boss.
  • James Nelson-Joyce as Greg Gallagher, a drug lord.
  • Elizabeth Berrington as Lynne Renfrew, Chris’ therapist.
  • Victor McGuire as Trevor.
  • Dominic Carter as Sergeant Bernie Wilson.
  • Matthew Cottle as Father Liam Neeson.
  • Dave Hill as Billy.
  • Sylvie Gatrill as Mary.
  • Sonny Walker as Stevo Marsh.
  • James Ledsham as Enno.
  • Connor Dempsey as Kyle.
  • David Ayres as Andy.
  • Kieron Urquhart as Paul.
  • Harry Burke as Liam.

Trivia

  • Tony Schumacher (creator and writer) has said that the character has “a lot to do” with him and the struggles he faced as a police officer, but that the storyline is fictional.
  • In late March 2022 the series was officially renewed for a second season.
  • The series was be shown by Canal plus in France and on SBS TV and SBS On Demand in Australia, as well as various other deals seeing the series being shown around the world.
  • Martin Freeman spent 18 months before he filmed the series talking to himself in a Scouse accent so he could perfect it.
  • Elizabeth Berrington and Martin Freeman previously worked together in The Office Christmas Special (2003).
  • The first season is broadcast in some countries in a six-episode edit.

The Responder Series

  • Series 02 (?2023):
    • Renewed in March 2022.

Production & Filming Details

  • Director(s):
    • Tim Mielants.
    • Fien Troch.
    • Philip Barantini.
  • Producer(s):
    • Laurence Bowen … executive producer (5 episodes, 2022).
    • Toby Bruce … story producer (5 episodes, 2022).
    • Chris Carey … executive producer (5 episodes, 2022).
    • Susan Dunn … line producer (5 episodes, 2022).
    • Nawfal Faizullah … commissioning executive / commissioning executive: BBC (5 episodes, 2022).
    • Rebecca Ferguson … series produced by (5 episodes, 2022).
    • Martin Freeman … executive producer (5 episodes, 2022).
    • Mona Qureshi … executive producer (5 episodes, 2022).
    • Barrington Paul Robinson … co-producer (5 episodes, 2022).
    • Phill Reeves … assistant line producer (3 episodes, 2022).
    • Charlie Greenstein … line producer (1 episode, 2022).
  • Writer(s):
    • Tony Schumacher.
  • Music:
    • Matthew Herbert … (5 episodes, 2022).
  • Cinematography:
    • Johan Heurlin Aidt … (4 episodes, 2022).
    • Matthew Lewis … (1 episode, 2022).
  • Editor(s):
    • Danielle Palmer … (2 episodes, 2022).
    • Alex Fountain … (1 episode, 2022).
    • Donovan Jones … (1 episode, 2022).
  • Production:
    • Dancing Ledge Productions.
    • British Broadcasting Corporation (BBC) (for).
    • Liverpool Film Office (funding).
  • Distributor(s):
    • BBC One (2022) (UK) (TV).
    • British Broadcasting Corporation (BBC) (2022) (UK) (all media).
    • BBC iPlayer (2022) (UK) (video) (VOD).
    • BritBox (UK) (video) (VOD).
    • Fremantle (2022) (World-wide) (all media).
  • Release Date: 24 January 2022.
  • Running Time: 60 minutes (per episode).
  • Rating: 15.
  • Country: UK.
  • Language: English.

What are Self-Help Groups for Mental Health?

Introduction

Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing.

This article focuses on groups for which members do not need to share a common diagnosis or aetiology of their mental illness. Improving mental health and wellbeing is also a desired outcome of groups like, for example, Alcoholics Anonymous and Survivors Network of those Abused by Priests. In those cases, for example, members share the trait of alcoholism or traumatic experiences of abuse by priests and those groups focus on improving the mental health and wellbeing of members while acknowledging their shared circumstances.

Despite the different approaches, many of the psychosocial processes in the groups are the same. Self-help groups have had varying relationships with mental health professionals. Due to the nature of these groups, self-help groups can help defray the costs of mental health treatment and implementation into the existing mental health system could help provide treatment to a greater number of the mentally ill population.

Types

Mutual Support and Self-Help

Mutual support or peer support is a process by which people voluntarily come together to help each other address common problems. Mutual support is social, emotional or instrumental support that is mutually offered or provided by persons with similar mental health conditions where there is some mutual agreement on what is helpful.

Mutual support may include many other mental health consumer non-profits and social groups. Such groups are further distinguished as either Individual Therapy (inner-focused) or Social Reform (outer-focused) groups. The former is where members seek to improve themselves, where as the latter set encompasses advocacy organisations such as the National Alliance on Mental Illness and Psychiatric Rehabilitation Association.

Self-help groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. Self-help groups are less bureaucratic and work on a more grassroots level. Self-help Organisations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favour of those affected.

Behaviour Control or Stress Coping Groups

Of individual therapy groups, researchers distinguish between Behaviour Control groups (such as Alcoholics Anonymous and TOPS) and Stress Coping groups (such as mental health support groups, cancer patient support groups, and groups of single parents). German researchers refer to Stress Coping groups as Conversation Circles.

Significant differences exist between Behavioural Control groups and Stress Coping groups. Meetings of Behaviour Control groups tend to be significantly larger than Stress Coping counterparts (by more than a factor of two). Behaviour Control group members have a longer average group tenure than members of Stress Coping groups (45 months compared to 11 months) and are less likely to consider their membership as temporary. While very few members of either set saw professionals concurrently while being active in their group, Stress Coping members were more likely to have previously seen professionals than Behaviour Control group members. Similarly, Stress Coping groups worked closer with mental health professionals.

Member vs Professional Leadership

Member Leadership

In Germany, a specific subset of Conversation Circles are categorised as Talking Groups (Gesprächsselbsthilfegruppen). In Talking Groups all members of the group have the same rights, each member is responsible only for themselves (group members do not make decisions for other group members), each group is autonomous, everyone attends the group on account of their own problems, whatever is discussed in the group remains confidential, and participation is free of charge.

Professionally Led Group Psychotherapy

Self-help groups are not intended to provide “deep” psychotherapy. Nevertheless, their emphasis on psychosocial processes and the understanding shared by those with the same or similar mental illnesses does achieve constructive treatment goals.

Interpersonal learning, which is done through processes such as feedback and confrontation, is generally deemphasized in self-help groups. This is largely because it can be threatening, and requires training and understanding of small group processes. Similarly, reality testing is also deemphasized. Reality testing relies on consensual validation, offering feedback, seeking feedback and confrontation. These processes seldom occur in self-help groups, though they frequently occur in professionally directed groups.

Professional Affiliation and Group Lifespan

If self-help groups are not affiliated with a national organisation, professional involvement increases their life expectancy. Conversely, if particular groups are affiliated with a national organisation professional involvement decreases their life expectancy. Rules enforcing self-regulation in Talking Groups are essential for the group’s effectiveness.

Typology of Self-Help Groups

In 1991 researchers Marsha A. Schubert and Thomasina Borkman created five conceptual categorizations for self-help groups.

Unaffiliated Groups

Unaffiliated groups are defined as self-help groups that function independently from any control at state or national levels, and from any other group or professionals. These groups accept all potential members, and everyone has an equal opportunity to volunteer or be elected. Leaders serve to help the groups function by collecting donations not through controlling the members. Experiential knowledge is mostly found, and there is a high emphasis on sharing. An example of an unaffiliated group includes Wildflowers’ Movement in Los Angeles.

Federated Groups

Federated groups have superordinate levels of their own self-help organisation at state or national levels which makes publicity and literature available. The local unit of the federated self-help group retains full control of its decisions. These groups tend to rely on experiential knowledge, and professionals rarely directly interact. The leaders of these groups would be any members comfortable with the format and willing to accept responsibilities. Leaders do not need to have formal training to gain their title. Examples of a federated self-help group would be Depression and Bipolar Support Alliance (DBSA) and Recovery International.

Affiliated Groups

Affiliated groups are subordinate to another group, a regional or national level of their own organisation. Local groups conform to the guidelines of the regional/national groups. Leaders are self-helpers not professional caregivers, and meetings included educational activities and sharing, supplemented by research and professionals. Examples of an affiliated self-help group would be the National Alliance on Mental Illness (NAMI).

Managed Groups

Managed groups are based on a combination of self-help and professional techniques. These groups are populated generally through referrals and group activities are led by group members. Managed groups do not meet all the criteria for self-help groups, and so should be designated professionally controlled support groups. Examples of managed groups are common with support groups in hospitals, such as those with breast cancer survivors and patients that may be managed by a nurse or therapist in some professional fashion.

Hybrid Groups

The hybrid group has characteristics of the affiliated and managed groups. Like affiliated groups, hybrid groups are organised by another level of their own organisation. To participate in specialised roles, training is developed by a higher level and enforced through trained leaders or facilitators. Like a managed group, a hybrid group cooperates and interacts with professionals, and that knowledge is highly valued alongside experiential knowledge.

Group Processes

No two self-help group are exactly alike, the make-up and attitudes are influenced by the group ideology and environment. In most cases, the group becomes a miniature society that can function like a buffer between the members and the rest of the world. The most essential processes are those that meet personal and social needs in an environment of safety and simplicity. Elegant theoretical formulations, systematic behavioural techniques, and complicated cognitive-restructuring methods are not necessary.

Despite the differences, researchers have identified many psychosocial processes occurring in self-help groups related to their effectiveness. This list includes, but is not limited to: acceptance, behavioural rehearsal, changing member’s perspectives of themselves, changing member’s perspectives of the world, catharsis, extinction, role modelling, learning new coping strategies, mutual affirmation, personal goal setting, instilling hope, justification, normalisation, positive reinforcement, reducing social isolation, reducing stigma, self-disclosure, sharing (or “opening up”), and showing empathy.

Five theoretical frameworks have been used in attempts to explain the effectiveness of self-help groups.

TheoryOutline
Social SupportHaving a community of people to give physical and emotional comfort, people who love and care, is a moderating factor in the development of psychological and physical disease.
Experiential KnowledgeMembers obtain specialised information and perspectives that other members have obtained through living with severe mental illness. Validation of their approaches to problems increases their confidence.
Social Learning TheoryMembers with experience become credible role models.
Social Comparison TheoryIndividuals with similar mental illness are attracted to each other in order to establish a sense of normalcy for themselves. Comparing one another to each other is considered to provide other peers with an incentive to change for the better either through upward comparison (looking up to someone as a role model) or downward comparison (seeing an example of how debilitating mental illness can be).
Helper TheoryThose helping each other feel greater interpersonal competence from changing other’s lives for the better. The helpers feel they have gained as much as they have given to others. The helpers receive “personalized learning” from working with helpees. The helpers’ self-esteem improves with the social approval received from those they have helped, putting them in a more advantageous position to help others.

A framework derived from common themes in empirical data describes recovery as a contextual nonlinear process, a trend of general improvement with unavoidable paroxysms while negotiating environmental, socioeconomic and internal forces, motivated by a drive to move forward in one’s life. The framework identified several negotiation strategies, some designed to accommodate illnesses and others designed to change thinking and behaviour. The former category includes strategies such as acceptance and balancing activities. The latter includes positive thinking, increasing one’s own personal agency/control and activism within the mental health system.

Relationship with Mental Health Professionals

A 1978 survey of mental health professionals in the United States found they had a relatively favourable opinion of self-help groups and there was a hospitable climate for integration and cooperation with self-help groups in the mental health delivery system. The role of self-help groups in instilling hope, facilitating coping, and improving the quality of life of their members is now widely accepted in many areas both inside and outside of the general medical community.

The 1987 Surgeon’s General Workshop marked a publicised call for egalitarian relationships with self-help groups. Surgeon General C. Everett Koop presented at this workshop, advocating for relationships that are not superordinate-subordinate, but rather emphasizing respectful, equal relations.

A survey of psychotherapists in Germany found that 50% of the respondents reported a high or very high acceptance of self-help groups and 43.2% rated their acceptance of self-help groups as moderate. Only 6.8% of respondents rated their acceptance of self-help groups as low or very low.

Surveys of self-help groups have shown very little evidence of antagonism towards mental health professionals. The maxim of self-help groups in the United States is “Doctors know better than we do how sickness can be treated. We know better than doctors how sick people can be treated as humans.”

Referrals

A large majority of self-help users use professional services as a gateway to self-help services, or concurrently with professional service or the aftercare following professional service. Professional referrals to self-help groups thus can be a cost-effective method of continuing mental health services and the two can co-exist within their own fields. While twelve-step groups, such as Alcoholics Anonymous, make an indispensable contribution to the mental and/or substance use (M/SU) professional services system, a vast number of non-twelve-step groups remain underutilised within that system.

Professional referrals to self-help groups for mental health are less effective than arranging for prospective self-help members to meet with veterans of the self-help group. This is true even when compared to referrals from professionals familiar with the self-help group when referring clients to it. Referrals mostly come from informal sources (e.g. family, friends, word of mouth, self). Those attending groups as a result of professional referrals account for only one fifth to one-third of the population. One survey found 54% of members learned about their self-help group from the media, 40% learned about their group from friends and relatives, and relatively few learned about them from professional referrals.

Effectiveness

Self-help groups are effective for helping people cope with, and recover from, a wide variety of problems. German Talking Groups have been shown to be as effective as psychoanalytically oriented group therapy. Participation in self-help groups for mental health is correlated with reductions in psychiatric hospitalisations, and shorter hospitalisations if they occur. Members demonstrate improved coping skills, greater acceptance of their illness, improved medication adherence, decreased levels of worry, higher satisfaction with their health, improved daily functioning and improved illness management. Participation in self-help groups for mental health encourages more appropriate use of professional services, making the time spent in care more efficient. The amount of time spent in the programmes, and how proactive the members are in them, has also been correlated with increased benefits. Decreased hospitalisation and shorter durations of hospitalisation indicate that self-help groups result in financial savings for the health care system, as hospitalisation is one of the most expensive mental health services. Similarly, reduced utilisation of other mental health services may translate into additional savings for the system.

While self-help groups for mental health increase self-esteem, reduce stigma, accelerate rehabilitation, improve decision-making, decrease tendency to decompensate under stress, and improve social functioning, they are not always shown to reduce psychiatric symptomatology. The therapeutic effects are attributed to the increased social support, sense of community, education and personal empowerment.

Members of self-help groups for mental health rated their perception of the group’s effectiveness on average at 4.3 on a 5-point Likert scale.

Social support, in general, can lead to added benefits in managing stress, a factor that can exacerbate mental illness.

Select List of Organisations

Depressed Anonymous

Depressed Anonymous (DA) is based on the model pioneered by Alcoholics Anonymous and open to anyone who wants to stop saddening themselves.

Emotions Anonymous

Emotions Anonymous (EA) is a derivative programme of Neurotics Anonymous and open to anyone who wants to achieve emotional well-being. Following the Twelve Traditions, EA groups cannot accept outside contributions.

GROW

GROW was founded in Sydney, Australia, in 1957 by a Roman Catholic priest, Father Cornelius Keogh, and people who had sought help with their mental illness at Alcoholics Anonymous (AA) meetings. After its inception, GROW members learned of Recovery, Inc. (the organisation now known as Recovery International, see below) and integrated its processes into their programme. GROW’s original literature includes the Twelve Stages of Decline, which state that emotional illness begins with self-centeredness, and the Twelve Steps of Recovery and Personal Growth, a blend of AA’s Twelve Steps and will-training methods from Recovery International. GROW groups are open to anyone who would like to join, though they specifically recruit people who have been in psychiatric hospitals or are socioeconomically disadvantaged. GROW does not operate with funding restrictions and have received state and outside funding in the past.

Neurotics Anonymous

Neurotics Anonymous is a twelve-step programme open to anyone with a desire to become emotionally well. According to the Twelve Traditions followed in the programme, Neurotics Anonymous is unable to accept outside contributions. The term “neurotics” or “neuroses” has since fallen out of favour with mental health professionals, with the movement away from the psychoanalytic principles of a DSM-II. Branches of Neurotics Anonymous have since changed their name to Emotions Anonymous, which is currently the name in favour with the Minnesota Groups. Groups in Mexico, however, called Neuróticos Anónimos still are referred to by the same name, due to the term “neuroticos” having a less pejorative connotation in Spanish. This branch continues to flourish in Mexico City as well as largely Spanish-speaking cities in the United States, such as Los Angeles.

Recovery International

Recovery, Inc. was founded in Chicago, Illinois, in 1937 by psychiatrist Abraham Low using principles in contrast to those popularised by psychoanalysis. During the organisation’s annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. Recovery International is open to anyone identifying as “nervous” (a compromise between the loaded term neurotic and the colloquial phrase “nervous breakdown”); strictly encourages members to follow their physician’s, social worker’s, psychologist’s or psychiatrist’s orders; and does not operate with funding restrictions.

Fundamentally, Low believes “Adult life is not driven by instincts but guided by Will,” using a definition of will opposite of Arthur Schopenhauer’s. Low’s programme is based on increasing determination to act, self-control, and self-confidence. Edward Sagarin compared it to a modern, reasonable, and rational implementation of Émile Coué’s psychotherapy. Recovery International is “twelve-step friendly.” Members of any twelve-step group are encouraged to attend Recovery International meetings in addition to their twelve-step group participation.

Criticism

There are several limitations of self-help groups for mental health, including but not limited to their inability to keep detailed records, lack of formal procedures to follow up with members, absence of formal screening procedures for new members, lack formal leadership training, and likely inability of members to recognise a “newcomer” presenting with a serious illness requiring immediate treatment. Additionally, there is a lack of professional or legal regulatory constraints determining how such groups can operate, there is a danger that members may disregard the advice of mental health professionals, and there can be an anti-therapeutic suppression of ambivalence and hostility. Researchers have also elaborated specific criticisms regarding self-help groups’ formulaic approach, attrition rates, over-generalisation, and “panacea complex”.

Formulaic Approach

Researchers have questioned whether formulaic approaches to self-help group therapy, like the Twelve Steps, could stifle creativity or if adherence to them may prevent the group from making useful or necessary changes. Similarly others have criticised self-help group structure as being too rigid.

High Attrition Rates

There is not a universal appeal of self-help groups; as few as 17% of people invited to attend a self-help group will do so. Of those, only one third will stay for longer than four months. Those who continue are people who value the meetings and the self-help group experience.

Overgeneralisation

Since these groups are not specifically diagnosis-related, but rather for anyone seeking mental and emotional health, they may not provide the necessary sense of community to evoke feelings of oneness required for recovery in self-help groups. Referent power is only one factor contributing to group effectiveness. A study of Schizophrenics Anonymous found expert power to be more influential in measurements of perceived group helpfulness.

Panacea Complex

There is a risk that self-help group members may come to believe that group participation is a panacea – that the group’s processes can remedy any problem.

Sexual Predation and Opportunism

Often membership of non-associated self-help groups is run by volunteers. Monitoring of relationships and standards of conduct are seldom formalised within a group and are done on a self-regulating basis. This can mean undesirable and unethical initiation of sexual and intimate encounters are facilitated in these settings. Predatory and opportunistic behaviour in these environments which by association involve divulging volatile mental states, medication changes and life circumstances mean opportunities by those willing to leverage information that is often normally guarded and deeply personal, is a risk more-so than in other social meetup settings or professionally governed bodies.