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Mutual help: An important gateway to wellbeing and mental health
By Lizzie Finn and Dr Brian Bishop, School of Psychology, Curtin University, Western Australia
Mutual help groups provide an important gateway to wellbeing and mental health according to a study recently completed in Western Australia. The research indicates that these groups should be seen as complementary to other forms of therapy and an important aid in the reduction of relapse.
The finding comes in an Australian context where the potential of mutual help groups for improving wellbeing and mental health is largely unrecognised professionally. This omission can be explained by the dearth of research into mutual help groups (MHGs) in this country, and alongside this scarcity, a lack of teaching in mainstream health curricula About their potential benefits.
Mutual help research to date
The current WA study entitled 'Mutual help groups and psychological wellbeing: A study of GROW, a community mental health organisation' employed quantitative and extensive qualitative research methods to answer questions as to how GROW impacts on psychological wellbeing, how it helps GROW members and how people change in GROW?
This investigation builds on and extends more than 16 years of ongoing research into GROW in the United States by Professor Julian Rappaport and colleagues at Illinoi University, and the one other existing Australian doctoral study of mutual help conducted a decade ago by Dr Jim Young at Tasmania University, which also chose GROW as its focus. These studies indicated that increased length of membership in GROW was associated with lower levels of symptomatology (Rappaport & Seidman, 1986), a reduction in duration of hospitalisation (Kennedy, 1989) and a reduction in the use of medication and professional help (Young, 1991). GROW membership has also been associated with fostering independence (Toro, Rappaport & Seidman, 1987), development of coping strategies (Rappaport, 1988), increased sense of personal value and purpose (Young, 1991) and development of interpersonal skills (Rappaport, 1988; Young & Williams, 1989). In more recent research with GROW, qualitative methodology was employed to better capture a sense of change in social identity associated with involvement in GROW (Rappaport, 1993).
An interesting aspect of the current WA study is that wellbeing or quality of life is quantitatively assessed using a more recently developed scale which envisages a holistic picture of wellbeing, captured by multiple attributes such as the ability to make choices independently , life management and social skills, self-esteem, and a sense of purpose and personal growth (Ryff, 1989, 1995). These attributes can be seen to parallel and gather together the prior 'separate' findings cited above such as improved coping strategies, sense of personal value and social skills etcetera.
Background to GROW
In its early history, GROW sought to help its members recover from serious mental breakdowns, but later its goals broadened to the wider aims of prevention and mental health promotion (Young & Williams, 1989; Young 1991). Last year it was estimated that some 10,000 people Australia-wide had direct Contact with GROW with a total of 325 groups operating over all Australian States. Overseas some 200 GROW groups have been established in countries including America, Ireland and New Zealand (GROW, 2000).
Over time GROW members wrote down what helped them manage or overcome their problems and these aids or experiential knowledge are included in GROW literature. For instance the GROW program is encapsulated in what is called the 'Blue Book', a small booklet which is tapped into by group members at every GROW meeting to find solutions, aids or encouragement for others sharing problems or progress.. Interestingly the program most often used from this book can be described as layman's cognitive behavioral therapy.
Group meetings follow a highly structured 'Group Method' delineating how group time is to be spent. Importantly, this structured group procedure takes the place of a group facilitator, keeping the group on task, and preventing the meeting from becoming a free for all advice session. The meeting begins with a personal testimony by a group member sharing how GROW has helped them. A fair bit of time is then given to airing and discussion of problems or progress made. Group members are encouraged to give assistance with problems from GROW's experiential 'Blue Book' which additionally offers problem solving strategies, and emphasises personal enhancement and the development of social skills.
A unique aspect of the GROW organisation is its leadership structure for running the groups. This includes roles such as leading or chairing a meeting, or being the Organiser of a group meeting, setting it up and making sure it keeps on task. These roles are specifically designed to extend the social and life management skills of GROW members in areas such as encouragement, welcome and support of group members and assertiveness and challenge. GROW's emphasis on networking with other members by phone and participation in residential training weekends and social activities are a deliberate ploy to enhance social and communication skills. Given that isolation and deterioration of social skills are major problems for some of the GROW population, particularly those who have been hospitalised, it is evident that GROW's operations and structure are designed not only to counter these tendencies but to actively promote the development of new skills.
GROW operates with two-thirds government funding (although government interference is minimal) and a small team of paid staff, usually veteran GROW members, now employed as fieldworkers. The fieldworkers visit groups every six to eight weeks to monitor and advise on group proceedings. They also run training activities where leaders enter a wider community beyond their own GROW group, to share leadership problems and progress with other group leaders.
The WA GROW Study: Mutual help and psychological wellbeing
More than 900 surveys were returned, the majority of respondents coming from an Australian ethnic background and two thirds being female. The mean age was 47 years with an age range of 19 to 87 years. Nearly three quarters of the respondents had been given a diagnosis, depression (49%) and anxiety (34%) were the most frequent diagnoses, however panic attacks (23%) bipolar disorder (15%) and schizophrenia (12%) were among the diagnoses reported.
Notable amongst the results, which were all statistically significant, was a moderate association between length of GROW membership, and involvement in GROW leadership and training activities - and a reduction in the use of medication and hospitalisation. Demographics including GROW membership duration, level of leadership role and involvement in training activities were also notably associated with scores on the wellbeing factors Autonomy, Environmental Mastery and Personal Growth.
Further statistical analysis showed significant differences amongst the different levels of GROW leadership and the use of medication and hospitalisation. For instance GROW members who had not yet held a leadership position in a group differed significantly on use of medication and hospitalisation compared to the Organiser of a meeting. Duration of membership also made a difference, with the wellbeing scales for example, there were significant differences on Environmental Mastery for members who had been in GROW for less than a year and members with 1 years and above membership.
A longitudinal study employing Ryff's (1989, 1995) psychological wellbeing scale was conducted with 28 GROW WA members who were surveyed at less than two months membership and then six months later. The mean age was 41 years, the majority of respondents being female. Again, nearly three quarters of the respondents had been given a diagnosis, the two dominant diagnoses being depression and anxiety. The results indicated statistically significant improvements on the wellbeing factors Autonomy, Environmental Mastery, Personal Growth and Positive Relations with Others. These results combined with the Australia-wide cross sectional findings present a cogent thesis that GROW does have an impact on psychological wellbeing.
An 'in vivo' training ground
A primary characteristic of the majority of GROW members interviewed for the study, ranging on the mental health continuum from the 'worried well' to people who had experienced severe mental health problems, was a history of increasing isolation and deterioration of interpersonal skills. The experiences they related, and observations made by me at GROW meetings, suggest that GROW offers a ('real') in vivo training ground for learning essential social and life management skills.
However, GROW's benefits go beyond this simple description. A major theme of the thesis is that GROW is a micro-community with an organisational purpose and structure endorsing a value system within which GROW members not only learn important lifeskills but have the opportunity for identity transformation in terms of feeling useful, valued and a sense of belonging.
It is within the context of a group/community, where relating to other people is virtually necessitated, that this transformation is facilitated, as expressed eloquently by one of the GROW members interviewed. The respondent, a man in his 40s, spent many years in isolation before he was finally hospitalised and given the diagnosis of schizophrenia. He talks About the way GROW residential training weekends put him in a safe context among a large group of people where he started to build social and communication skills:
'…by the end of the first year I started to live-in at GROW weekends and spending time, like up until then I hadn't spent much time with people but I was at GROW weekends, sitting out until 2am in the morning, talking to people. And actually being with people, speaking with people, and then gradually the fear, because I had boosted my confidence, the fear collapsed for quite a long time. I began to socialise and do things outside of GROW'.
A complement to mainstream mental health services
It is important for health professionals to realise the very real benefits which mutual help groups can offer, and to see them as being complementary to mainstream mental health services. Mutual help groups can be integrated with therapy where relevant. For some people, particularly those with the more severe diagnoses, mutual help can be a vital ingredient for maintenance within community and reduction of the risk of relapse.
REFERENCES
GROW (2000). Annual report. Presented to the 30th annual general meeting of GROW. Sydney: GROW World Community Men
In America and Europe, however, mutual help research flourishes, and the benefits of MHGs are increasingly recognised. The literature points to enhancement of quality of life and health maintenance as being more appropriate than a cure approach for psychiatric populations, particularly for people with chronic mental health problems (Mercier & King, 1994; Tudor, 1996). Where mental illness is associated with loss of social support and disintegration of lifestyle, mutual help groups are seen as being involved with the maintenance of wellbeing and as affecting the social consequences of psychiatric problems rather than primary symptomatology (Kaufman, 1996).
GROW was founded in Australia in 1957 by former psychiatric patients. The organisation's modus operandi falls within a well-utilised definition of a mutual help group, as being 'peers who have a common predicament or illness, come together to provide emotional and other support through sharing their personal lived experiences…citizens with the problem organise and control many such self help groups as voluntary associations' (Borkman, 1991, p.644). Important concepts here are notions of a common problem, mutual support, and exchange of experiential knowledge or knowledge based on lived experience, and self-governance or control of proceedings by members of the mutual help group.
In the current WA study of mutual help and psychological wellbeing, an initial survey of GROW members around Australia was undertaken employing a demographic survey and Ryff's (1989, 1995) six-factor scale of psychological wellbeing (Autonomy, Environmental Mastery, Positive Relations with Others, Self-Acceptance, Purpose in Life and Personal Growth).
By far the greater part of the work involved in the WA GROW study was qualitative research involving a year and more of total immersion in the culture of GROW, undertaking ethnographic work as a participant-observer at 5 meetings for 12 months, attending live-in training weekends and social events, and finally interviewing 24 GROW members at length About their experiences before and after joining GROW. This qualitative work supplements and extends the initial indications of the quantitative study, in terms of its added ability to describe process, a prime feature of group interaction, but above and beyond that, process of change at an individual level.
To conclude, GROW's major advantage is that it offers a 'real life' mini-community where people can develop new skills. The benefits are concrete in terms of developing communication, social, life management and problem solving skills. But there is also a sense of increase in the less tangible 'quality of life' arena via a sense of identity transformation.
Borkman, T. (1991). Introduction to the special issue. American Journal of Community Psychology, 19, 643-650.