Book: Mental Health in a Multi-Ethnic Society

Book Title:

Mental Health in a Multi-Ethnic Society: A Multidisciplinary Handbook.

Author(s): Suman Fernando and Frank Keating (Editors).

Year: 2008.

Edition: Second (2nd).

Publisher: Routledge.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

This new edition of Mental Health in a Multi-Ethnic Society is an authoritative, comprehensive guide on issues around race, culture and mental health service provision. It has been updated to reflect the changes in the UK over the last ten years and features entirely new chapters by over twenty authors, expanding the range of topics by including issues of particular concern for women, family therapy, and mental health of refugees and asylum seekers.

Divided into four sections the book covers:

  • Issues around mental health service provision for black and minority ethnic (BME) communities including refugees and asylum seekers.
  • Critical accounts of how these issues may be confronted, with examples of projects that attempt to do just that.
  • Programmes and innovative services that appear to meet some of the needs of BME communities.
  • A critical but constructive account of lessons to be drawn from earlier sections and discussion of the way ahead.

With chapters on training, service user involvement, policy development and service provision Mental Health in a Multi-Ethnic Society will appeal to academics, professionals, trainers and managers, as well as providing up-to-date information for a general readership.

What is Helper Theory?

Introduction

Helper theory or the helper therapy principle was first described by Frank Riessman (1965) in an article published in the journal Social Work. The principle suggests that when an individual (the “helper”) provides assistance to another person, the helper may benefit.

Riessman’s model has inspired subsequent research and practice by scholars, clinicians, and indigenous populations to address a variety of social and health-related issues plaguing individuals and communities around the world.

Refer to Peer Support and Skills and Abilities Required for Peer Support.

Riessman’s Formulation

Riessman’s seminal article explored how non-professionals supported one another in self-help/mutual-aid support groups based on Riessman’s observations of a sample of these groups, as well as his summary of the findings of research in the areas of social work, education, and leadership. This article suggested that although the “use of people with a problem to help other people who have the same problem in [a] more severe form” is “an age-old therapeutic approach,” the traditional focus on outcomes for those receiving help to the exclusion of considering outcomes for those providing help is too narrow; instead, Riessman (1965, p.27) advocated for increased consideration of the experience of “the individual that needs the help less, that is, the person who is providing the assistance” because “frequently it is he who improves!”

Although Riessman expressed doubt that individuals receiving help always benefit from the assistance provided to them, he felt more sure that individuals providing help are likely experiencing important gains; thus, according to Riessman, the helping interaction at least has the potential to be mutually beneficial for both parties involved (i.e. for both the individual giving and for the individual receiving aid), but it is not absolutely necessary for the “helpee” to benefit in order for the “helper” to enjoy the benefits of helping. In instances where true mutual benefit occurs, the helper and helpee benefit in different ways, such that the person receiving help benefits by way of receiving whatever specific form of assistance is offered to them (e.g. emotional support, information, etc.) while the person providing help benefits by the very act of providing help, regardless of the type of aid they provide.

Riessman posited several different mechanisms which may facilitate the benefits experienced by an individual engaged in a helping role:

  • Gaining an improved self-image;
  • Becoming more committed to a position through the process of advocating it (i.e. “self-persuasion through persuading others”);
  • Experiencing meaningful development of abilities after having been given a stake in a system and learning through teaching others;
  • Gaining access to a socially-valued role and the resultant sense of social status and importance;
  • Enjoying opportunities to affirm one’s own wellness following placement in a system as a role model; and
  • Shifting one’s focus from self-concerns and problems to assisting others (and thus distracting oneself from ongoing difficulties).

Health Care

Lepore, Buzaglo, Liberman, Golant, Greener, and Davey (2014) investigated the helper-therapy principle in a randomised control trial of a “prosocial”, other-focused Internet Support Group (P-ISG) designed to elicit peer-instigated, supportive interactions online among female breast cancer survivors. When compared to female breast cancer survivors who participated in a standard, self-focused Internet Support Group (S-ISG), which was not designed to explicitly provide opportunities for helping interactions to take place, analyses found that individuals in the P-ISG condition did provide more support to others yet P-ISG participants experienced a higher level of depression and anxiety following the intervention than those in S-ISG. These results fail to provide support for the helper-therapy principle which posits that “helping others is effective at promoting mental health” (Lepore et al., 2014, p.4085). In accounting for these results, Lepore et al. (2014) suggest that it is possible that women in the P-ISG condition felt hesitant to express their negative feelings out of fear that doing so might impact others adversely, whereas women in the S-ISG felt more able to unburden themselves of emotional pain and thus enjoyed better mental health outcomes.

Arnold, Calhoun, Tedeschi, and Cann (2005) explored both the positive and negative sequelae of providing psychotherapy to clients who had experienced trauma and subsequent posttraumatic growth by conducting naturalistic interviews with a small sample of clinicians (N = 21). Although all interviewees indicated experiencing some degree of negative experience as a result of engaging in trauma-focused psychotherapy (such as intrusive thoughts, negative emotional responses, negative physical responses, and doubts about clinical competence), all participants also indicated some sort of positive personal outcome occurred as a result of assisting psychotherapy clients with these types of experiences. The positive reactions experienced by clinicians engaged in trauma work included: enjoying the gratification that comes through watching others grow and triumph following difficult times; increasing recognition of one’s own personal growth and development; expanding ability to connect emotionally with others; impacting one’s own sense of spirituality; increased awareness of one’s own good fortune in life; and increasing appreciation for the strength and resiliency of human beings. This finding suggests that the helper-therapy principle may operate in a clinical context whereby therapists (i.e. the helpers) benefit from engaging in the process of providing treatment to psychotherapy clients who have survived traumatic experiences.

Pagano, Post, and Johnson (2011) reviewed recent evidence examining “helper health benefits” among populations experiencing problematic involvement with alcohol, other mental health conditions, and/or general medical problems. In brief, their review suggests that when individuals with chronic health conditions (e.g. alcohol use disorder, body dysmorphic disorder with comorbid alcohol dependence, multiple sclerosis, chronic pain) help others living with the same chronic condition, the individual helper benefits (e.g. longer time-to-relapse, remission, reduced depression and other problematic symptoms, and increased self-confidence, self-esteem, and role functioning).

Additionally, Post’s (2005, p.73) review of the literature on altruism, happiness, and health indicates that “a strong correlation exists between the well-being, happiness, health, and longevity of people who are emotionally kind and compassionate in their charitable helping activities”. However, Post also notes that individual helpers may become overwhelmed by over-involvement in the lives of others, and that giving assistance beyond a certain variable threshold may lead to deleterious rather than beneficial outcomes for helpers.

Social Work

Melkman, Mor-Salwo, Mangold, Zeller, & Benbenishty (2015) used a grounded theory approach to understand:

  1. The motivations and experiences which led young adult “careleavers” (N = 28, aged 18-26) in Israel and Germany to assume a helper role; and
  2. The benefits they report enjoying as a result of helping others through volunteerism and/or human-service focused careers.

Participants reported that observing role models involved in helping roles, being exposed to prosocial values, and having opportunities to volunteer within the system in which they were simultaneously receiving care all contributed to later assumption of more stable and regular helping roles. These participants felt obliged to provide assistance to others, desired to provide this assistance to others, and felt sufficiently competent to carry out the tasks required of them in their helping role. These participants reported that helping others provided them with a sense of purpose in their lives, and also increased self-efficacy, social connectedness, and ability to cope with personal issues. Additionally, participants reported that assuming a helping role provided a sense of normalcy to their lives, as well as providing a sense of perspective on their own journey and outcomes. As one participant (a volunteer with a police department who was assigned to work with at-risk youth) shared with the researchers:

“The fact that I could bring a runaway girl back to her home and I made her trust me, the fact that I located a missing girl, the fact that I escorted a rape victim to hospital and I managed to give her strength and support her, these are the things that give me meaning, tell me that I’m in a much better situation than others” (Melkman et al., 2015, p.45).

Self-Help/Mutual-Help

Roberts, Salem, Rappaport, Toro, Luke, and Seidman (1999, p.859) found support for the helper-therapy principle among participants of GROW, a mutual-help group for individuals with serious mental illness, whereby “participants who offered help to others evidenced improvement over time in psychosocial adjustment”.

Maton (1988) reports that occupying both “helper” and “helpee” roles in a self-help/mutual-aid group (i.e. bidirectional support) was positively correlated with psychological well-being and positive perceptions regarding the benefits of group membership, and that these members with dual-roles had a greater sense of well-being and a more favourable opinion of the group than members who were helpees (i.e. recipients of assistance) only.

Olson, Jason, Ferrari, and Hutcheson (2005) reviewed the existent literature on four mutual-help organisations (Alcoholics Anonymous, Oxford House, GROW, and Schizophrenics Anonymous). They suggest that the processes of change framework found within the transtheoretical model of intentional behaviour change (Prochaska, Diclemente, and Norcross, 1992) is a useful model to conceptualise the activities of mutual-help organization members throughout their journey of mental health recovery. They explicitly link social liberation, the last of the ten processes of change articulated by the model (the others being: consciousness raising, self-re-evaluation, helping relationships, self-liberation, environmental re-evaluation, dramatic relief/emotional arousal, stimulus control, reinforcement management, and counterconditioning) to the helper-therapy principle, along with a related concept known as bidirectional support (Maton, 1988). Per Olson et al. (2005), social liberation “involves the person in recovery focusing attention away from oneself and developing a broader recognition of social issues that contributed to the targeted problem” which encourages “recovering individuals to take more helping-related attitudes toward others who face similar problems” (Olson et al., 2005, p.174). In reviewing the research conducted among members of these four self-help/mutual-help organisations, they identify three different mechanisms which might underlie the therapeutic effect of mutual-help:

  1. When an individual helps another, the helper’s social functioning improves because the act of providing help to another allows the helper to work through their own difficulties;
  2. When an individual helps another, the helper’s social functioning improves because the act of providing help to another allows the helper to reinforce their own personal learning about recovery; and/or
  3. When an individual helps another, the helper experiences an increase in their own sense of competence and usefulness to others and enables the helper to adopt a “strength-based roles that have not been fully exercised in other areas of life” (Olson et al., 2005, p.175).

In reviewing the research on GROW, specifically, 67% of members of this organisation sampled by Young and Williams (1987) who were asked how they most benefited from participation reported that involvement in GROW “taught [them they] could help others” (the most endorsed answer among all listed categories). As suggested by a study by Maton and Salem (1995), this idea is most succinctly expressed by way of an axiom of GROW which is often recited at meetings: “If you need help, help others.”

A review of empirical studies investigating the effect of mutual help group participation for individuals with mental health problems by Pistrang, Barker, and Humphreys (2008, p.110) provides “limited but promising evidence that mutual help groups benefit people with three types of problems: chronic mental illness, depression/anxiety, and bereavement”.

References

Arnold, D., Calhoun, L. G., Tedeschi, R. & Cann, A. (2005). Vicarious posttraumatic growth in psychotherapy. Journal of Humanistic Psychology. 45(2), pp.239-263.

Lepore, S.J., Buzaglo, J.S., Liberman, M.A., Golant, M., Greener, J.R. & Davey A. (2014) Comparing standard versus prosocial internet support groups for patients with breast cancer: A randomized controlled trial of the helper therapy principle. Journal of Clinical Oncology. 32(36), pp.4081-4086.

Maton, K.I. (1988). Social support, organization characteristics, psychological wellbeing and group appraisal in three self-help populations. American Journal of Community Psychology. 16(1), pp.53-77.

Maton, K.I. & Salem, D.A. (1995). Organizational characteristics of empowering community settings: A multiple case study approach. American Journal of Community Psychology. 23(5), pp631-656.

Melkman, E., Mor-Salwo, Y., Mangold, K., Zeller, M. & Benbenishty, R. (July 2015). Care leavers as helpers: Motivations for and benefits of helping others. Children and Youth Services Review. 54, pp.41-48.

Olson, B.D., Jason, L.A., Ferrari, J.R. & Hutcheson, T.D. (2005). Bridging professional and mutual-help: An application of the transtheoretical model to the mutual-help organization. Applied and Preventive Psychology. 11(3), pp.167-178.

Pagano, M.E., Post, S.G. & Johnson, S.M. (2011). Alcoholics Anonymous-Related Helping and the Helper Therapy Principle. Alcoholism Treatment Quarterly. 29(1), pp.23-34.

Pistrang, N., Barker, C. & Humphreys, K. (2008). Mutual Help Groups for Mental Health Problems: A Review of Effectiveness Studies. American Journal of Community Psychology. 42(1-2), pp.110-121.

Post, S.G. (2005). Altruism, happiness, and health: it’s good to be good. International Journal of Behavioral Medicine. 12(2), pp.66-77.

Prochaska, J.O., DiClemente, C.C. & Norcross, J.C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist. 47(9), pp.1102-1114.

Riessman, F. (1965) The ‘Helper’ Therapy Principle. Social Work. 10(2), pp.27-32.

Roberts, L., Salem, D., Rappaport, J., Toro, P.A., Luke, D.A. & Seidman, E. (1999). Giving and receiving help: Interpersonal transactions in mutual-help meetings and psychosocial adjustment of members. American Journal of Community Psychology. 27(6), pp.841-868.

Young, J. & Williams, C.L. (1987). An Evaluation of Grow, a Mutual-Help Community Mental Health Organisation. Community Health Studies. 11(1), pp.38-42.

What Skills & Abilities are Required for Peer Support?

Introduction

Peer support is an important element in an individual’s journey as they cope/manage/live with their mental health condition.

Although there is currently only a small research base on the value and effectiveness of peer support, this research is generally positive regarding its impact on the individual (Gillard et al., 2013; Gillard & Holley, 2018):

  • Receiving the peer support (helpee); and
  • Providing the peer support (helper).

Look here for an overview of Peer Support.

This article refers to peer support within the UK, and particularly Scotland (where I live).

Background

Peer support roles are still relatively new in the UK and these exciting new(ish) roles have been developed specifically for individuals who have lived experience of recovery from mental distress.

“An increasing number of organisations and services are developing peer support roles. There are now around 80 paid posts in mental health services and a far higher number of unpaid roles.” (Christie, 2016, p.3).

Within the public sector (i.e. NHS), peer support is a paid role and within the third (charity) sector the role may be paid (i.e. member of staff) or unpaid (i.e. volunteer).

Titles vary also, for example peer worker, peer support worker, peer support specialist, and community support worker.

For administrative purposes, individuals are referred to as Service Users by charities and as Patients by the NHS.

The Role of Peer Support

The overarching purpose of the role is to provide support and assistance to individuals to promote independence and self responsibility. And, as such, you will work alongside existing mental health services to promote and deliver support which facilitates recovery for the individual (it is important to note that recovery means different things to different individuals, i.e. it is a unique process).

Within the role you may be expected to:

  • Use the knowledge gained through your own lived experience to inspire hope and belief that recovery is possible in others.
  • Work with a Community Mental Health Team alongside a clinical team to help patients/service users achieve their recovery goals.
    • To assist individuals to create their own outcomes focused recovery plans.
  • Work with people with complex psychological needs, meaning you will need to be emotionally and mentally resilient.
  • Provide 1:1 and/or group support, exploring the individual’s hopes for moving out of social isolation and towards meaningful opportunities, relationships and community engagement.
  • Draw upon your experiences of recovery and attend training on the most effective way to so this.
  • Be involved in contributing to the development of the peer support role, within mental health services.
  • Develop (and within) a relationship of mutuality and information sharing, promote recovery, self-management and opportunities for improved health and wellbeing.
    • Develop relationships with people based on the principals of peer support.
  • To share ideas about ways of achieving recovery goals, drawing on personal experiences and a range of coping, self help and self-management techniques.
  • Make a positive contribution to the reduction in stigma associated with mental health issues.
  • To model personal responsibility, self-awareness, self-belief, self advocacy and hopefulness.
  • Maintain a working knowledge of current trends in mental health, recovery and peer support through a variety of sources.
    • For example, by reading books, journals and accessing peer support networks.
  • Deal with sensitive and confidential information, and take account of safeguarding and child safety issues.
    • The peer supported should be wary of issues that may bring them into conflict with the patient/service user.
    • Maintain a positive therapeutic relationship and maintain child protection standards.
  • Work in partnership with other organisations.

Purpose of the Role

The exact provision of support will vary between organisations, and the following examples are for illustration only.

Example 01

  • Building supportive and respectful relationships with patients on the ward/service users in the charity.
  • Supporting others using the personal experience and confidence you have gained having overcome similar challenges.
  • Assisting clinical/charity staff to help people identify their own recovery goals.
  • Providing information and support to family and friends of patients/service users.
  • Developing the peer support worker programme and role within organisation.
  • Modelling personal responsibility, self-awareness, self-belief, self-advocacy and hopefulness.

Example 02

  • Wellbeing mentors will take a lead in delivering all one to one therapeutic and group work activity. They will also provide one to one support and key-working interventions using Wellness Recovery Action Plans.
  • Building and developing service users’ personal strengths, social networks and recovery capital (social, physical, human and cultural).
  • Provide practical support and supervision to volunteers/ Peer Workers as required.
  • Develop effective relationships with other groups and agencies in our area and take opportunities to promote mental health awareness in the wider community.
  • Effectively and proactively connecting service users into a range of health and social care services that support their recovery.
  • To assist the Lead Practitioner in addressing clients support needs and to review progress with clients at regular intervals.
  • To participate in effective team work and establish good channels of communication to all local organisations.
  • To promote peer and volunteering opportunities within the service.
  • To provide an efficient and welcoming reception service to visitors to the unit.

From the above two examples, we can see that peer support may offer a range of services that provide practical, emotional and social support. And, these services should be focused on improving health and wellbeing and aim to ensure that all the services are flexible, personalised and recovery focused.

What Attitude/Skills/Knowledge Do You Need for the Role of Peer Support?

  • A background of personally recovering from mental health issues.
  • Past and lived experience of using mental health services or awareness of mental health issues.
  • An understanding of the impact of mental health issues on individuals, families, and communities.
  • Resilience and to be able to know when to ask for help.
  • Demonstrate an awareness of mental health interventions and commitment to supporting recovery.
  • An understanding of factors which can affect recovery in mental health.
  • IT literacy including Microsoft Office and Internet or a willingness to learn.
  • Strong verbal and written communication skills.
  • The ability to work well in a multi-disciplinary team.
  • Empathy, good listening skills, approach-ability and common sense.
  • Enthusiastic, motivated, and positive in outlook.

Support for the Peer Support Role

For those in the NHS, they will receive formal/structured induction, training and on-going supervision, including a network of other peer support workers employed within the NHS.

Within the charity sector, induction, training, and ongoing supervision varies between organisations.

What is the Most Challenging/Difficult Part of the Role

Experience of what is challenging or difficult will depend on the background of the peer supporter, and below are some examples.

  • Aspects of the role can prove to be mentally demanding and stressful.
  • The peer supporter is required to provide mental effort and concentration due to confidentiality and the sensitivity of information, which is being given and sought.
  • There are emotional demands when communicating with distressed, anxious, worried individuals or relatives.
    • It is necessary to maintain a non-judgemental approach when discussing sensitive issues.
  • The peer supporter will have lived experience of mental health issues.
    • It is necessary for the peer supporter to demonstrate the ability to take personal responsibility with regards to their own personal recovery needs, limitations and support needs.
  • To assist members of staff/volunteers in providing comprehensive recovery focussed support to individuals who have a range of physical, mental and emotional issues and who may display verbal and/or physical aggression.
  • To work with individuals who may have negative preconceptions of health and social care, having had experience of discrimination from other services/organisations/people due to their mental health issue(s).
  • Responding to acute symptoms of relapse and challenging behaviour of individuals in isolated or public locations while unsupervised in the community.
  • Using initiative when alone with individuals in crisis and instigating emergency procedures in conjunction with trained staff.

Useful Courses

There are a number of optional/mandatory courses which a potential peer supporter can attend.

  • Individual Recovery Outcomes Counter (I.ROC).
  • Recovery in Practice.
  • Wellness Recovery Action Planning (WRAP).
  • Recovery & WRAP.
  • Coaching.
  • Personal Planning.
  • Managing Risk.
  • Managing Actual and Potential Aggression.
  • Scottish Mental Health First Aid.
  • Applied Suicide Intervention Skills Training.
  • Mental Health Awareness.
  • Self Harm Awareness.
  • HOPE Toolkit (Home, Opportunity, People, and Empowerment).
  • SVQ 3 in Healthcare (superseded by SVQ 3 Social Services and Healthcare at SCQF Level 7).
    • To work in the NHS you must have a recognised healthcare qualification.
    • This is a work-based course.
    • Can have an equivalent as defined by the Scottish Social Services Council (SSSC).
    • Mandatory to apply for role in some organisations, others state willingness to work towards, and some state relevant previous experience working with individuals who have mental health issues.
  • PDA in Mental Health Peer Support or a relevant course in peer support.
    • Mandatory to apply for role in some organisations, others state willingness to work towards.

Co-Workers

In peer support you will work with a variety of volunteers and professionals in a mix of roles, including:

  • Clinical staff (psychiatrists, psychologists, nurses etc.).
  • Recovery Worker.
  • Recovery Practitioner.
  • Peer Worker.
  • Community Addiction Worker.

Further Reading

References

Christie, L. (2016) Peer Support Roles in Mental Health Services. Available from World Wide Web: https://www.iriss.org.uk/sites/default/files/2016-06/insights-31.pdf. [Accessed: 21 January, 2021].

What is Peer Mentoring?

Introduction

Peer mentoring is a form of mentorship that usually takes place between a person who has lived through a specific experience (peer mentor) and a person who is new to that experience (the peer mentee). An example would be an experienced student being a peer mentor to a new student, the peer mentee, in a particular subject, or in a new school. Peer mentors are also used for health and lifestyle changes. For example, clients, or patients, with support from peers, may have one-on-one sessions that meet regularly to help them recover or rehabilitate.

Peer mentoring provides individuals who have suffered from a specific life experience the chance to learn from those who have recovered, or rehabilitated, following such an experience. Peer mentors provide education, recreation and support opportunities to individuals. The peer mentor may challenge the mentee with new ideas, and encourage the mentee to move beyond the things that are most comfortable. Most peer mentors are picked for their sensibility, confidence, social skills and reliability.

Critics of peer mentoring insist that little is known of the nature of peer mentoring relationships and that there are few consistent studies indicating the outcomes of peer mentoring beyond good feelings among peers and the development of friendships. Peer mentoring led by senior students may discourage diversity and prevent critical analysis of the higher education system.

Refer to Peer Support, Peer Support Specialist, and Support Group.

Programme Design Characteristics

The frequency with which peer mentors and mentees meet varies according to the particular mentoring programme. Some pairs may make contact once a month, while others may meet 3-4 times per month or more. It is usually advised that mentors and mentees meet more often in the beginning of the relationship in order to establish a good foundation. Mentors and mentees may maintain contact through email, telephone or in-person meetings. Peer mentoring organisations may also set up social events for those participating in the programme. These events provide good opportunities for increased social interaction between mentors and mentees.

The compatibility of mentor and mentee is a factor that should be taken into consideration when choosing pairs. Mentors and mentees may benefit from having similar backgrounds, interests and life experiences. Age, gender, ethnicity, language preferences, and education may be taken into consideration when pairing mentors with mentees.

The quality of the peer mentoring relationship is important for mentees to experience positive results. A mentor relationship is more successful when the mentor cares for the whole person and not just the academic or career side of a person. Successful mentors tend to be available, knowledgeable, educated in diversity issues, empathic, personable, encouraging, supportive, and passionate. Although this is not an exhaustive list of qualities, they have been shown to be important for successful mentoring relationships. It is important to keep qualities like this in mind when recruiting and training mentors.

The objectives of a peer mentoring programme should be well-defined and measurable. The effectiveness of the program should be monitored to ensure that the objectives are being met. One way to monitor the effectiveness of a programme is to administer evaluations to the mentors and mentees.

In Education

Peer mentoring in education was promoted during the 1960s by educator and theorist Paulo Freire:

“The fundamental task of the mentor is a liberatory task. It is not to encourage the mentor’s goals and aspirations and dreams to be reproduced in the mentees, the students, but to give rise to the possibility that the students become the owners of their own history. This is how I understand the need that teachers have to transcend their merely instructive task and to assume the ethical posture of a mentor who truly believes in the total autonomy, freedom, and development of those he or she mentors.”

Peer mentors appear mainly in secondary schools where students moving up from primary schools may need assistance in settling into the new schedule and lifestyle of secondary school life. However peer mentoring can occur at the grade school level, the undergraduate level, and the graduate school level. The goals of the programme may vary according to the level, the educational institution or the discipline.

Peer mentors in secondary schools aid in the transition of younger students from primary school to secondary school. They may assist mentees with their school work and study skills, peer pressure (such as pressure to use drugs or have sex), issues with attendance and behaviour, and typical family problems. Youth mentors are persons for children or adolescents to spend time with, often to compensate for absent family members or an inadequate home environment. Mentoring programmes for youth can be especially useful for students who are suffering from a lack of social support, and who therefore may be susceptible to delinquency.

Peer mentors for undergraduates may assist newly admitted students with time management, study skills, organisational skills, curriculum planning, administrative issues, test preparation, term paper preparation, goal setting, and grade monitoring. Additionally, such mentors may provide other forms of social support for the student, such as friendship, networking, and aiding the student’s adjustment to college life.

A peer mentor at the graduate school level may assist new students in selecting an advisor, negotiating the advisor/advisee relationship, preparation for major examinations, publishing articles, searching for jobs, and adjusting to the rigors of graduate school life.

In Higher Education

Peer mentoring in higher education has enjoyed a good name and is seen favourably by both educational administrators and students. During the last decade, peer mentoring has expanded and is found in most colleges and universities, frequently as a means to outreach, retain, and recruit minority students. Peer mentoring is used extensively in higher education for several reasons:

  • Benefits attributed to classical mentoring (when an older adult mentors a younger person) can translate to peer mentoring relationships, mainly when the peer mentor and the mentee have similar backgrounds.
    • Some colleges and university campuses have encouraged peer mentorship programs to aid retention of under-represented populations, such as women in economics.
  • The lack of role models or volunteers forces administrators and student leaders to use students as peer mentors of other students – usually first year students, ethnic minorities, and women – in order to guide, support, and instruct junior students;
  • Because peer mentoring programmes require a low budget for administration and/or development, they become a cheap alternative to support students perceived as likely to fail.

Advantages in Education

Peer mentoring may help new students adapt to a new academic environment faster. The relationship between the mentor and mentee gives the mentee a sense of being connected to the larger community where they may otherwise feel lost. Mentors are chosen because they are academically successful and because they possess good communication, social and leadership skills. As a consequence, mentors serve as positive role models for the students, guiding them towards academic and social success. Mentors provide support, advice, encouragement, and even friendship to students. Peer mentoring may improve student retention rates.

Mentors also stand to benefit from the mentor/mentee relationship. Mentors develop friendships through their participation in mentoring programmes and usually derive satisfaction from helping a younger student, and possibly shaping his or her life in a positive way. Mentors may also be paid, and they may receive other benefits such as prioritised registration, course credit, and references.

In higher education tutorial settings, the benefits of peer mentoring programmes also extend to class tutors. Using grounded theory techniques, Outhred and Chester found that five themes underlie their experiences:

  1. Role exploration;
  2. Sharing responsibility;
  3. Regulation of the peer-tutored groups;
  4. Harnessing the peer tutors’ role; and
  5. Community.

Criticisms

Peer mentoring programmes usually target ethnic minorities, people with disabilities and women. This approach tends to be conceived out of the “deficiency model” where multi-ethnic students, women and students with disabilities are perceived as being in need of help and unlikely to succeed unless senior students or successful adults help them. One of the main criticisms of peer mentoring is the lack of research to show how peer mentoring relationships work, how they develop, and what their outcomes are. Also, the nature of being either a mentor or mentee and at the same time a peer can make the relationship a dual one where other identities also converge. Some peer mentoring programmes promote assimilation among ethnic minority students because of the use of student role models who are perceived as successful in social and educational environments characterised by majority students. These role models then become the people that peer mentees strive to imitate or emulate. A more subtle criticism of peer mentoring refers to their lack of supervision and structure: most peer mentoring programmes led by undergraduate students rarely have direct supervision of full-time university staff.

Given the fact that students are led by other students who serve as peer mentors, critics say that university staff may free themselves from their responsibility to listen and help first year students classified as peer mentees, the group with the largest attrition rate in higher education. Without extensive training and supervision, senior students who serve as mentors may offer unreliable guidance to peer mentees. There is little research on what happens within peer mentoring relationships. Maryann Jacobi, in an extensive meta-analysis of mentoring research, concludes by asking, “Does mentoring help students succeed in college? If so, how? Both theoretical and empirical answers to these questions are lacking.” Stephanie Budge states:

“The concept of mentoring has become increasingly popular over the past few decades. Mentoring has been advertised as necessary in order for students and employees to flourish in their environment. However, the lack of research concerning peer mentoring programmes in particular is surprising. While there is an abundance of articles on the topic of mentoring in the educational setting, authors must be held to more stringent research standards and more definitional consistency. In addition to higher quality research, the fundamental flaws within peer mentoring programs need to be corrected before these programs can reach their full potential on college campuses.”

Peer mentoring in higher education usually focuses on social, academic, and cultural skills that can help students graduate from colleges and universities, and how the educational system works (e.g. how to apply for financial aid, how to register for classes, how to write papers, how to choose a major, etc.). The knowledge students receive usually comes from senior students who serve as peer mentors.

Although peer mentoring programmes are appealing to most people and seem easy to implement and develop, there is little research to suggest that peer mentoring gives the same results as classical mentoring.

Versus Classical Mentoring

Morton-Cooper and Palmer distinguish between classical mentoring (also known as primary mentoring) and contract or facilitated mentoring. Classical mentoring is characterized as an informal, often spontaneous enabling relationship between an older mentor and a younger mentee, based on a shared wish to work together, usually for a long period, without financial compensation for the mentor.

Peer mentoring differs from classical mentoring in two aspects. First, in peer mentoring mentors and mentees are close in age, experience, educational level, and they may also overlap in their personal identities, which are usually the criteria for matching, but this may leave junior students vulnerable to peer pressure and unsupervised rivalry. Second, peer mentoring programmes are semi-structured planned programmes with specific guidelines and frequently with a set number of meetings and activities within a predetermined amount of time. Students who enrol in peer mentoring programmes tend to be matched mostly according to major course of study, gender, language of preference, and ethnic background, and those students who share the largest number of similarities tend to become peers in the peer mentoring relationship. Little research is available to know what happens between peer mentors and peer mentees who have different characteristics.

Cross-Age

The Handbook of Youth Mentoring provides the following definition of cross-age peer mentoring:

“Peer mentoring involves an interpersonal relationship between two youths of different ages that reflects a greater degree of hierarchical power imbalance than is typical of a friendship and in which the goal is for the older youth to promote one or more aspects of the younger youth’s development. Peer mentoring refers to a sustained (long-term), usually formalized (i.e. program-based), developmental relationship. The relationship is “developmental” in that the older peer’s goal is to help guide the younger mentee’s development in domains such as interpersonal skills, self-esteem and conventional connectedness and attitudes (e.g. future motivation, hopefulness).”

Cross-age mentoring can be distinguished from peer mentoring by the fact that the mentor is in a higher grade level and/or is older than the mentee. Whereas in peer mentoring students of the same age are paired together based on varying levels of achievement. Karcher (2007) also notes:

“Cross-age peer mentoring programs utilize structure, meet for more than ten meetings, do not focus primarily on deficit or problem reduction, and require an age span of at least two years.”

Advantages of Cross Age Mentoring

In general, cross-age mentoring programmes can involve a tutoring or teaching component, personal mentorship and guidance, or both, and they incorporate many of the advantages of other forms of peer mentorship. Because student mentors are closer in age, knowledge, authority and cognitive development than adult mentors, mentees often feel freer to express ideas, ask questions, and take risks. These similarities also make it easier for mentors to understand personal and academic problems that the mentee may be experiencing, and present solutions in a more understandable and relevant way. Furthermore, unlike same-age peer mentoring, cross-age programmes can prevent feelings of inferiority on the part of the mentee when they are mentored or tutored by a student of the same age or status. Thus, mentors who are slightly older than their mentees can take advantage of the higher status provided by their age difference while enjoying increased compatibility with their students. The specific benefits of cross-age mentoring/tutoring are numerous, and are briefly described here in three main categories:

  • Increased academic achievement;
  • Improved interpersonal skills; and
  • Personal development.

Cross-age mentorship, and tutoring programmes in particular, support the academic achievement and learning process of both the mentor and the mentee. Mentees benefit from increased personalised attention in a one-on-one setting and can work at their own pace. Sessions are customised for the mentee’s individual questions, needs, and learning styles, and mentees gain a greater mastery of the material and concepts, while developing creativity and critical thinking skills. The mentor may also gain a deeper understanding of the material or subject that they are teaching, as this relationship often encourages a deeper dedication to their own studies so that they may more effectively communicate what they have learned. The mentor gains a deeper sense of responsibility, dedication, and pride in being able to help a peer, while both students take pride in mutual accomplishments and successes. Ultimately, cross-age mentorship programmes may increase retention and graduation rates, especially among minority students.

In addition to improved learning and transmission of information, the mentorship process allows both students to develop more effective interpersonal communication skills. Mentees learn how to effectively form and pose questions, seek advice, and practice active listening and concentration. Similarly, the mentors gain valuable practice in effective teaching strategies. This format fosters increased self-esteem, empathy and patience in both participants, potentially creating new friendships and breaking down social barriers for students struggling to adjust to a new academic setting. Often the mentor will serve as an important role-model, and can model academic skills and work habits as well as personal values (e.g. dedication to service, empathy, and internal motivation). This relationship can be pivotal for the success of new or underserved students in academia by providing an opportunity for peers to discuss academic issues, career choices, research ideas, and personal matters.

Monitoring and Evaluation

Cross-age mentoring programmes require careful consideration of the goals, objectives and the available human, physical and financial resources in order to ultimately assess the progress made by the participants and the overall usefulness of the programme. Frequent assessment is important as it gives valuable insight into how well the cross-age mentoring curriculum is organised and implemented, and provides positive reinforcement for both the mentor and mentee. Mentors should be pre-screened according to their academic proficiency and attitudes to ensure that they will be able to meet the needs of a mentee. Moreover, mentors will also benefit from ongoing training, supervision and psychological support by teachers, administrators, parents and other members of the community.

In the Workplace

Peer mentoring can offer employees a valuable source of support and information in the workplace. Peer mentoring offers a low cost way to train new employees or to upgrade the skills of less experienced workers. Mentees may feel more comfortable learning from a peer than in a hierarchical setting. Mentors as well as mentees may also benefit from the bonds they form with colleagues. In 1978 Edgar Schein described multiple roles for successful mentors in the work setting. New employees who are paired with a mentor are twice as likely to remain in their job than those who do not receive mentorship.

In Health Care

Peer mentoring has been shown to increase resistance to stress-related anxiety and depression in patients, or clients, affected by chronic illness or mental health issues. Mental health peer mentors and peer support groups help clients change their lifestyle and adhere to a more productive healthy lifestyle by adjusting habits and helping them realise helpful ways of coping and taking on personal responsibility. Peer mentors can also help patients prepare for medical and surgical procedures and adhere to treatment regimes. Peer mentoring has been implemented in programmes to support survivors of traumatic brain injury, cancer patients, dialysis patients, diabetics persons with spinal cord injuries, and to reduce HIV transmission and increase adherence to treatment in HIV-positive IV drug users. Peer mentoring is also used in training health care workers.

Other Applications

Peer mentoring has also been used to prevent gang violence in schoolchildren and teens, to support young people who have been sexually exploited, to improve the quality of child care among economically disadvantaged first-time mothers, and to improve performance in military recruits.

What is a Support Group?

Introduction

In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic. Members with the same issues can come together for sharing coping strategies, to feel more empowered and for a sense of community.

Help may take the form of providing and evaluating relevant information, relating personal experiences, listening to and accepting others’ experiences, providing sympathetic understanding and establishing social networks.

A support group may also work to inform the public or engage in advocacy.

Refer to Peer Support and Peer Support Specialist.

Background

Formal support groups may appear to be a modern phenomenon, but they supplement traditional fraternal organisations such as Freemasonry in some respects, and may build on certain supportive functions (formerly) carried out in (extended) families.

Other types of groups formed to support causes, including causes outside of themselves, are more often called advocacy groups, interest groups, lobby groups, pressure groups or promotional groups. Trade unions and many environmental groups, for example, are interest groups.

The term support group in this article refers to peer-to-peer support.

Maintaining Contact

Support groups maintain interpersonal contact among their members in a variety of ways. Traditionally, groups meet in person in sizes that allow conversational interaction. Support groups also maintain contact through printed newsletters, telephone chains, internet forums, and mailing lists. Some support groups are exclusively online (see below).

Membership in some support groups is formally controlled, with admission requirements and membership fees. Other groups are “open” and allow anyone to attend an advertised meeting, for example, or to participate in an online forum.

Management by Peers or Professionals

A self-help support group is fully organised and managed by its members, who are commonly volunteers and have personal experience in the subject of the group’s focus. These groups may also be referred to as fellowships, peer support groups, lay organisations, mutual help groups, or mutual aid self-help groups. Most common are 12-step groups such as Alcoholics Anonymous and self-help groups for mental health.

Professionally operated support groups are facilitated by professionals who most often do not share the problem of the members, such as social workers, psychologists, or members of the clergy. The facilitator controls discussions and provides other managerial service. Such professionally operated groups are often found in institutional settings, including hospitals, drug-treatment centres and correctional facilities. These types of support group may run for a specified period of time, and an attendance fee is sometimes charged.

Types of Support Group

In the case of a disease, an identity or a pre-disposition, for example, a support group will provide information, act as a clearing-house for experiences, and may serve as a public relations voice for sufferers, other members, and their families. Groups for high IQ or LGBTQIA+ individuals, for example, differ in their inclusivity, but both connect people on the basis of identity or pre-disposition.

For more temporary concerns, such as bereavement or episodic medical conditions, a support group may veer more towards helping those involved to overcome or push through their condition/experience.

Some support groups and conditions for which such groups may be formed are:

  • Addiction.
  • Alcoholics Anonymous.
  • Anxiety disorders.
  • Bereavement.
  • Cancer.
  • Diabetes.
  • Debtors Anonymous.
  • Domestic violence.
  • Eating disorders.
  • Gamblers Anonymous.
  • Grief.
  • Infertility.
  • Mental Health.
  • Sexual abuse survivors.
  • Stuttering.
  • Suicide prevention.

Online Support Groups

Since at least 1982, the Internet has provided a venue for support groups. Discussing online self-help support groups as the precursor to e-therapy, Martha Ainsworth notes that “the enduring success of these groups has firmly established the potential of computer-mediated communication to enable discussion of sensitive personal issues.”

In one study of the effectiveness of online support groups among patients with head and neck cancer, longer participation in online support groups were found to result in a better health-related quality of life.

Appropriate Groups Still Difficult to Find

A researcher from University College London says the lack of qualitative directories, and the fact that many support groups are not listed by search engines can make finding an appropriate group difficult. Even so, he does say that the medical community needs “to understand the use of personal experiences rather than an evidence-based approach… these groups also impact on how individuals use information. They can help people learn how to find and use information: for example, users swap Web sites and discuss Web sites.”

It is not difficult to find an online support group, but it is hard to find a good one. In the article What to Look for in Quality Online Support Groups, John M. Grohol gives tips for evaluating online groups and states: “In good online support groups, members stick around long after they’ve received the support they were seeking. They stay because they want to give others what they themselves found in the group. Psychologists call this high group cohesion, and it is the pinnacle of group achievement.”

Benefits and Pitfalls

Several studies have shown the importance of the Internet in providing social support, particularly to groups with chronic health problems. Especially in cases of uncommon ailments, a sense of community and understanding in spite of great geographical distances can be important, in addition to sharing of knowledge.

Online support groups, online communities for those affected by a common problem, give mutual support and provide information, two often inseparable features. They are, according to Henry Potts of University College London, “an overlooked resource for patients.” Many studies have looked at the content of messages, while what matters is the effect that participation in the group has on the individual. Potts complains that research on these groups has lagged behind, particularly on the groups which are set up by the people with the problems, rather than by researchers and healthcare professionals. User-defined groups can share the sort of practical knowledge that healthcare professionals can overlook, and they also impact on how individuals find, interpret and use information.

There are many benefits to online support groups that have been found through research studies. Although online support group users are not required to be anonymous, a study conducted by Baym (2010) finds that anonymity is beneficial to those who are lonely or anxious. This does not pertain to some people seeking support groups, because not all are lonely and/or anxious, but for those who are, online support groups are a great outlet where one can feel comfortable honestly expressing themselves because the other users do not know who they are.

A study was conducted by Walther and Boyd (2000) and they found a common trend to why people find online support groups appealing. First, the social distance between members online reduced embarrassment and they appreciated the greater range of expertise offered in the larger online social network. Next, they found that anonymity increased one’s confidence in providing support to others and decreased embarrassment. The users of the social support websites were more comfortable being able to reread and edit their comments and discussion forum entries before sending them, and they have access to the website any time during the day. Each of these characteristics of online support groups are not offered when going to an in-person support group.

In a study conducted by Gunther Eysenbach, John Powell, Marina Englesakis, Carlos Rizo, and Anita Stern (2004), the researchers found it difficult to draw conclusions on the effectiveness of online peer-to-peer support groups. In online support groups, people must have the desire to support and help each other, and many times participants go on the sites in order to get help themselves or are limited to a certain subgroup.

An additional benefit to online support groups is that participation is asynchronous. This means that it is not necessary for all participants to be logged into the forum simultaneously in order to communicate. An experience or question can be posted and others can answer questions or comment on posts whenever they are logged in and have an appropriate response. This characteristic allows for participation and mass communication without having to worry about time constraints. Additionally, there are 24-hour chat rooms and spaces for focused conversation at all times of the day or night. This allows users to get the support they need whenever they need it, while remaining comfortable and, if they so wish, anonymous.

Mental Health

Although there has been relatively little research on the effectiveness of online support groups in mental health, there is some evidence that online support groups can be beneficial. Large randomised controlled trials have both found positive effects and failed to find positive effects.

What is Peer Support?

Introduction

Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters (although it can be provided by peers without training), and can take a number of forms such as peer mentoring, reflective listening (reflecting content and/or feelings), or counselling. Peer support is also used to refer to initiatives where colleagues, members of self-help organisations and others meet, in person or online, as equals to give each other connection and support on a reciprocal basis.

Peer support is distinct from other forms of social support in that the source of support is a peer, a person who is similar in fundamental ways to the recipient of the support; their relationship is one of equality. A peer is in a position to offer support by virtue of relevant experience: they have “been there, done that” and can relate to others who are now in a similar situation. Trained peer support workers such as peer support specialists and peer counsellors receive special training and are required to obtain Continuing Education Units, like clinical staff. Some other trained peer support workers may also be law-enforcement personnel and firefighters as well as emergency medical responders.

Refer to Support Group and Peer Support Specialist.

Underlying Theory

The effectiveness of peer support is believed to derive from a variety of psychosocial processes described best by Dr. Karen Fortuna in 2019 as “social support, experiential knowledge, social learning theory, social comparison theory, the helper-therapy principle, and self-determination theory.”

  • Social support is the existence of positive psychosocial interactions with others with whom there is mutual trust and concern. Positive relationships contribute to positive adjustment and buffer against stressors and adversities by offering:
    1. Emotional support (esteem, attachment, and reassurance);
    2. Instrumental support (material goods and services);
    3. Companionship; and
    4. Information support (advice, guidance, and feedback).
  • Experiential knowledge is specialised information and perspectives that people obtain from living through a particular experience such as substance abuse, a physical disability, chronic physical or mental illness, or a traumatic event such as combat, a natural disaster, domestic violence or a violent crime, sexual abuse, or imprisonment.
    • Experiential knowledge tends to be unique and pragmatic and when shared contributes to solving problems and improving quality of life.
  • Social learning theory postulates that peers, because they have undergone and survived relevant experiences, are more credible role models for others.
    • Interactions with peers who are successfully coping with their experiences or illness are more likely to result in positive behaviour change.
  • Social comparison means that individuals are more comfortable interacting with others who share common characteristics with themselves, such as a psychiatric illness, in order to establish a sense of normalcy.
    • By interacting with others who are perceived to be better than them, peers are given a sense of optimism and something to strive toward.
  • The helper-therapy principle proposes that there are four significant benefits to those who provide peer support:
    1. Increased sense of interpersonal competence as a result of making an impact on another person’s life;
    2. Development of a sense of equality in giving and taking between himself or herself and others;
    3. Helper gains new personally-relevant knowledge while helping; and
    4. The helper receives social approval from the person they help, and others.
  • Self-determination means that individuals have the right to determine their own future – people are more likely to act on their own decisions rather than decisions made by others for them.

In Schools and Education

Peer Mentoring

Refer to Peer Mentoring.

Peer mentoring takes place in learning environments such as schools, usually between an older more experienced student and a new student. Peer mentors appear mainly in secondary schools where students moving up from primary schools may need assistance in settling into the whole new schedule and lifestyle of secondary school life. Peer mentoring is also used in the workplace as a means of orienting new employees. New employees who are paired with a peer mentor are twice as likely to remain in their job than those who do not receive mentorship.

Peer Listening

This form of peer support is widely used within schools. Peer supporters are trained, normally from within schools or universities, or sometimes by outside organisations, such as Childline’s CHIPS (Childline In Partnership With Schools) programme, to be “active listeners”. Within schools, peer supporters are normally available at break or lunch times.

Peer Mediation

Peer mediation is a means of handling incidents of bullying by bringing the victim and the bully together under mediation by one of their peers.

Peer Helper in Sports

A peer helper in sports works with young adults in sports such as football, soccer, track, volleyball, baseball, cheerleading, swimming, and basketball. They may provide help with game tactics (e.g. keeping your eye on the ball), emotional support, training support, and social support.

In Health

In Mental Health

Refer to Peer Support Specialist.

Peer support can occur within, outside or around traditional mental health services and programmes, between two people or in groups. Peer support is increasingly being offered through digital health like text messaging and smartphone apps. Peer support is a key concept in the recovery approach and in consumer-operated services programmes. Consumers/clients of mental health programmes have also formed non-profit self-help organisations, and serve to support each other and to challenge associated stigma and discrimination. The role of peer workers in mental health services was the subject of a conference in London in April 2012, jointly organised by the Centre for Mental Health and the NHS Confederation. Research has shown that peer-run self-help groups yield improvement in psychiatric symptoms resulting in decreased hospitalisation, larger social support networks and enhanced self-esteem and social functioning. There is considerable variety in the ways that peer support is defined and conceptualised as it relates to mental health services. In some cases, clinicians, psychiatrists, and other staff who do not necessarily have their own experiences of receiving psychiatric treatment are being trained, often by psychiatric survivors, in peer support as an approach to building relationships that are genuine, mutual, and non-coercive.

For Anxiety and Depression

In Canada, the LEAF (Living Effectively with Anxiety and Fear) Programme is a peer-led support group for cognitive-behavioural therapy of persons with mild to moderate panic disorders.

In a 2011 meta-analysis of seven randomised trials that compared a peer support intervention to group cognitive-behavioural therapy in patients suffering from depression, peer support interventions were found to improve depression symptoms more than usual care alone and results may be comparable to those of group cognitive behavioural therapy. These findings suggest that peer support interventions have the potential to be effective components of depression care, and they support the inclusion of peer support in recovery-oriented mental health treatment.

Several studies have shown that peer support reduces fear during stressful situations such as combat and domestic violence and may mitigate posttraumatic stress disorder. The 1982 Vietnam-Era Veterans Adjustment Survey showed that PTSD was highest in those men and women who lacked positive social support from family, friends, and society in general.

For First Responders

Peer support programmes have also been implemented to address stress and psychological trauma among law-enforcement personnel and firefighters as well as emergency medical responders. Peer support is an important component of the critical incident stress management programme used to alleviate stress and trauma among disaster first responders.

For Survivors of Trauma

Peer support has been used to help survivors of trauma, such as refugees, cope with stress and deal with difficult living conditions. Peer support is integral to the services provided by the National Centre for Trauma-Informed Care. Other programmes have been designed for female victims of domestic violence and for women in prison.

Survivor Corps defines peer support for trauma survivors as “Encouragement and assistance provided by a colleague who has overcome similar difficulties to engender self-confidence and autonomy and to enable the survivor to make his or her own decisions and implement them.” Peer support is a fundamental strategy in the rehabilitation of landmine survivors in Afghanistan, Bosnia, El Salvador and Vietnam. A study of 470 amputee survivors of war-related violence in six countries showed that nearly one hundred percent said they had benefited from peer support.

A peer support program operated by the Centre d’Encadrement et de Développement des Anciens Combattants in Burundi with support from the Centre for International Stabilization and Recovery and Action on Armed Violence has assisted survivors of war-related violence, including women with disabilities, and female ex-combatants since 2010. A similar programme in Rwanda works with survivors of the Rwandan genocide. Peer support has been recommended as a fundamental part of victim assistance programmes for survivors of war-related violence.

A 1984 study on the impact of peer support and support groups for victims of domestic violence showed that 146 battered women found women’s peer support groups the most helpful source of a range of available treatments. The women in these groups appeared to give direct advice and to act as role models. A 1986 study on 70 adolescent mothers considered to be at risk for domestic violence showed that peer support improved cognitive problem-solving skills, self-reinforcement, and parenting competence.

Pandora’s Aquarium, an online support group operating as part of Pandora’s Project, offers peer support to survivors of rape and sexual abuse and their friends and family.

In Addiction

Twelve-step programmes for overcoming substance misuse and other addiction recovery groups are often based on peer support. Since the 1930s Alcoholics Anonymous has promoted peer support between new members and their sponsors: “The process of sponsorship is this: an alcoholic who has made some progress in the recovery programme shares that experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety through AA.” Other addiction recovery programmes rely on peer support without following the twelve-step model.

In Chronic Illness

Peer support has been beneficial for many people living with diabetes. Diabetes encompasses all aspects of people’s lives, often for decades. Support from peers can offer emotional, social, and practical assistance that helps people do the things they need to do to stay healthy. Peer support groups for diabetics complement and enhance other health care services. J.F. Caro is the co-founder and Chief Scientific Officer of one of such groups named Peer for Progress.

Peer support has also been provided for people with cancer and HIV. The Breast Cancer Network of Strength trains peer counsellors to work with breast cancer survivors.

For People with Disabilities

Peer support is considered to be a key component of the independent living movement and has been widely used by organisations that work with people with disabilities, including the Amputee Coalition of America (ACA) and Survivor Corps. Since 1998 the ACA has operated a National Peer Network for survivors of limb loss. The Blinded Veterans Association has recently launched Operation Peer Support (OPS), a programme designed to support men and women returning to the US blinded or experiencing significant visual impairment in connection with their military service. Peer support has also benefited survivors of traumatic brain injury and their families. There is also FacingDisability for Families Facing Spinal Cord Injuries, which has a peer counselling programme in addition to 1,000 videos drawn from interviews of people with spinal cord injuries, their families, caregivers and experts.

For Veterans and Their Families

Several programmes exist that provide peer support for military veterans in the US and Canada. In 2010 the Military Women to Women Peer Support Group was established in Helena, Montana.

The Tragedy Assistance Programme for Survivors (TAPS) provides peer support, crisis care, casualty casework assistance, and grief and trauma resources for families of members of the US military. Operation Peer Support (OPS) is a programme for US military veterans who were blinded or have significant visual impairment.

In January 2013 Senator Patty Murray, Chairman of the United States Senate Committee on Veterans’ Affairs, sponsored an amendment of the National Defence Authorisation Act (S.3254) that would require peer counselling as part of a comprehensive suicide prevention programme for US veterans.

For Veterans with PTSD

Peer support outreach for those exposed to traumatic events refers to programmes that seek to identify and reach out to those suffering from or at risk for mental health problems following a traumatic event as a means of connecting those people to mental health services. Paraprofessional peers are defined as having a shared background as the target population and work closely with and supplement the services of the mental healthcare team. These peers are trained in certain interventions (such as Psychological/Mental Health First Aid) and are closely supervised by professional mental healthcare personnel. Peer support for recovery from PTSD refers to programmes in which someone with lived experience of PTSD, who experienced a significant reduction in symptoms, provides formal services to those who have not yet made significant steps in recovery from his or her condition. The peer support for recovery model focuses on improvement in overall health and wellness, and has long been successful in the treatment of SMI (serious mental illness) but is relatively new for PTSD.

A further review of existing literature found that carefully recruited, trained, supervised, and supported paraprofessionals can deliver mental health interventions effectively, and may be valuable in communities with fewer resources for mental healthcare.

Researchers at the Palo Alto VA National Center for PTSD also conducted focus groups at the VA Palo Alto Health Care System Trauma Recovery Programmes, a PTSD Residential Rehabilitation Programme, and a Women’s Trauma Recovery Programme to determine veteran and staff perceptions of informal peer support interventions already in place. Four themes were identified, including:

  • Peer support contributing to a feeling of social connectedness;
  • Positive role modelling by the peer support provider;
  • Peer support augmenting care offered by professional providers; and
  • Peer supporter acting as a ‘culture broker’ and orienting recipients to mental health treatment.

These findings have been put into practice through a peer support programme for veterans in the Sonora, Stockton, and Modesto VA outpatient clinics. The clinics are part of the Palo Alto Veterans Affairs Healthcare System that extend to more rural parts of northern California. The program is funded through grants in support of new treatment approaches to serve veterans in rural, traditionally underserved areas. Leadership for the program comes from the Menlo Park division of the Palo Alto VA system.

The peer support programme has been operational since 2012 with over 268 unique veterans seen between 2012 and 2015. The two peer support providers involved in the programme are veterans of the Vietnam and Iraq wars, respectively, and after having recovered from their own mental health disorders utilize their experiences to help their fellow veterans. The two providers have been responsible for leading between 5 and 7 groups each week as well as conducting telephone outreach and one-on-one engagement visits. These services have successfully helped to augment the often overburdened mental health treatment teams at the central valley outpatient VA clinics.

The peer support programme has been described in several publications. A personal story of success was featured in Stanford Medicine magazine and the collaborative nature of the programme was described in the recently published book, Partnerships for Mental Health.

For People at Work

Trauma risk management (TRiM) is a work-place based peer support for use in helping to protect the mental health of employees who have been exposed to traumatic stress. The TRiM process enables non-healthcare staff to monitor and manage colleagues. TRiM peer support training provides TRiM Practitioners with a background understanding of psychological trauma and its effects. TRiM was developed in the UK by military mental health professionals including Professor Neil Greenberg. There have been numerous scientific publications into the use of TRiM which have demonstrated it to be an acceptable and effective method of peer support. Similar to TRiM, the sustaining resilience at work (StRaW) peer support system is delivered by trained peers who are able to assist colleagues exposed to significant non-traumatic stressors, originating either at work or at home, and either support and mentor them or help them access professional support. StRaW was developed by March on Stress Ltd and early research again shows it to be a credible and effective way of supporting staff at work.

Sex Workers

Several peer based organisations exist for sex workers. The aim of these organisations is to support the health, rights and well being of sex workers and advocate on their behalf for law reform in order to make working safer. Sex work is work and there are many people who willingly choose it as a job/career. While sex trafficking does exist, not everyone who does sex work is doing so under duress. Social stigma is a major hurdle sex workers encounter, with many people trying to ‘save’ them. Peer support workers and peer educators are seen as best practice by the Sex Industry Network (SIN) when engaging with community members because peers can understand that someone could willingly choose to do sex work.

Social Support & Mental Health Needs: Carers of Those with Intellectual Disabilities

Research Paper Title

Effect of the covid-19 pandemic on the mental health of carers of people with intellectual disabilities.

Background

The measures implemented to manage the COVID-19 pandemic have been shown to impair mental health. This problem is likely to be exacerbated for carers.

Methods

Informal carers (mainly parents) of children and adults with intellectual disabilities, and a comparison group of parents of children without disabilities, completed an online questionnaire. Almost all the data were collected while strict lockdown conditions were in place.

Results

Relative to carers of children without intellectual disability, carers of both children and adults with intellectual disability had significantly greater levels of a wish fulfilment coping style, defeat/entrapment, anxiety, and depression. Differences were 2-3 times greater than reported in earlier pre-pandemic studies. Positive correlations were found between objective stress scores and all mental health outcomes.

Conclusions

Despite their greater mental health needs, carers of those with intellectual disability received less social support from a variety of sources. The researchers consider the policy implications of these findings.

Reference

Willner, P., Rose, J., Kroese, B.S., Murphy, G., Langdon, P., Clifford, C., Hutchings, H., Watkins, A., Hiles, S. & Cooper, V. (2020) Effect of the covid-19 pandemic on the mental health of carers of people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities. doi: 10.1111/jar.12811. Online ahead of print.

Person-Centred Approach: Mental Health Needs & COVID-19

Research Paper Title

Person-Centered Approach to the Diverse Mental Healthcare Needs During COVID 19 Pandemic.

Background

In this COVID-19 pandemic, many mental health problems arose.

The mental health difficulties are sufficiently significant to disturb the peace and wellbeing of the people involved.

A poor population’s mental health needs are complex (elderly individuals, those with chronic co-morbidity, youth and disadvantaged population, emergency care professionals, police officers, and patients with pre-existing mental health issues).

In resource-scarce environments, in the light of the person-centered treatment paradigm, there is an immediate need to plan to meet the emerging challenge.

Reference

Kar, S.K. & Singh, N. (2020) Person-Centered Approach to the Diverse Mental Healthcare Needs During COVID 19 Pandemic. SN Comprehensive Clinical Medicine. 15;1-3. doi: 10.1007/s42399-020-00428-4. Online ahead of print.

On This Day … 08 August

  • Happiness Happens Day,

What is Happiness Happens Day?

In 1999 the Society declared 08 August as the “Admit You’re Happy Day”, now known as the “Happiness Happens Day”.

The idea was inspired by the event that happened the previous year on the same date- the first member joined the Society.

In 1998 the Society asked the governors in all 50 states for a proclamation, with nineteen of them sending one.

What is the Secret Society of Happy People?

Secret Society of Happy People (SOHP) is an organisation that celebrates the expression of happiness.

Founded in August 1998, the society encourages thousands of members from all around the globe to recognise their happy moments and think about happiness in their daily life.

Purpose of SOHP?

The Secret Society of Happy People supports people who want to share their happiness despite the ones who don’t want to hear happy news.

Their mottos include “Happiness Happens” and “Don’t Even Think of Raining on My Parade”.

The main purpose of the Society is to stimulate people’s right to express their happiness “as loud as they want”.

Other Events

  • Happiness Happens Month:
    • Celebration of happiness was expanded in 2000, and thanks to the support of not-so-secretly-happy members from around the world, the Society declared August as Happiness Happens Month.
    • The purpose of Happiness Happens Day and Month is to share happiness and encourage people to talk and think about happiness.
  • HappyThon:
    • Every year, the Society organises an online social media event known as HappyThon, on Happiness Happens Day.
    • The aim of this event is to send inspirational messages via social networks, emails or texts, share happy moments, philosophy, quotes, etc.
    • HappyThon is the first online social media event that promotes happiness around the world.
  • Since 1998 the Society have been organising voting and announcing the Happiest Events and Moments of the Year.
  • Before the end of the century, a vote for 100 of the Happiest Events, Inventions and Social Changes of the Century was organised.
  • In the third week of January the Society hosted Hunt for Happiness Week.
  • They asked the current governors for a proclamation, with seven of them providing one.

What is the Social Impact of Health Insurance Care Utilisation in Low- & Middle-Income Countries?

Research Paper Title

The impact of social, national and community-based health insurance on health care utilisation for mental, neurological and substance-use disorders in low- and middle-income countries: a systematic review.

Background

Whilst several systematic reviews conducted in Low- and Middle-Income Countries (LMICs) have revealed that coverage under social (SHI), national (NHI) and community-based (CBHI) health insurance has led to increased utilisation of health care services, it remains unknown whether, and what aspects of, these shifts in financing result in improvements to mental health care utilisation.

The main aim of this review was to examine the impact of SHI, NHI and CBHI enrolment on mental health care utilisation in LMICs.

Methods

Systematic searches were performed in nine databases of peer-reviewed journal articles: Pubmed, Scopus, SciELO via Web of Science, Africa Wide, CINAHL, PsychInfo, Academic Search Premier, Health Source Nursing Academic and EconLit for studies published before October 2018.

The quality of the studies was assessed using the Effective Public Health Practice Project quality assessment tool for quantitative studies.

Results

Eighteen studies were included in the review.

Despite some heterogeneity across countries, the results demonstrated that enrollment in SHI, CBHI and NHI schemes increased utilisation of mental health care.

This was consistent for the length of inpatient admissions, number of hospitalisations, outpatient use of rehabilitation services, having ever received treatment for diagnosed schizophrenia and depression, compliance with drug therapies and the prescriptions of more favourable medications and therapies, when compared to the uninsured.

The majority of included studies did not describe the insurance schemes and their organizational details at length, with limited discussion of the links between these features and the outcomes.

Given the complexity of mental health service utilisation in these diverse contexts, it was difficult to draw overall judgements on whether the impact of insurance enrollment was positive or negative for mental health care outcomes.

Conclusions

Studies that explore the impact of SHI, NHI and CBHI enrolment on mental health care utilisation are limited both in number and scope.

Despite the fact that many LMICs have been hailed for financing reforms towards universal health coverage, evidence on the positive impact of the reforms on mental health care utilisation is only available for a small sub-set of these countries.

Reference

Docrat, S., Besada, D., Cleary, S. & Lund, C. (2020) The impact of social, national and community-based health insurance on health care utilization for mental, neurological and substance-use disorders in low- and middle-income countries: a systematic review. Health Economics Review. 10(1), pp.11. doi: 10.1186/s13561-020-00268-x.