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The Effectiveness of Support Groups: A Literature Review
Worrall H, Schweizer R, Marks E, Yuan L, Lloyd C, Ramjan R,
Abstract
Purpose: Support groups are a common feature of the mental health support
engaged by carers and consumers. This paper updates and consolidates the
knowledge and the evidence for the effectiveness of mental health support groups.
Design/Methodology/Approach: This paper is based on a systematic literature
review of relevant databases around support groups for mental health.
Findings: The results show that there is a consistent pattern of evidence, over a
long period of time, which confirms the effectiveness of mental health support groups
for carers and people living with mental illness. There is strong, scientifically-rigorous
evidence which shows the effectiveness of professionally facilitated, family-led
support groups, psycho-education carers support groups, and professionally
facilitated, program-based support groups for people living with mental illness.
Research Limitations/Implications: This research implies the use of support
groups is an important adjunct to the support of carers and people with mental
illness, including severe mental illness.
Originality/Value: This research brings together a range of studies indicating the
usefulness of support groups as an adjunct to mental health therapy.
Keywords: Support groups, carers, consumers, mental illness
Paper Type: Literature review
Introduction
Support groups have been used in mental health for many decades as a means of
providing a forum to discuss problems and share experiences and information(Heller
et al., 1997). Support groups offered assistance at times when fewer services were
available for people with mental illness and the satisfaction that people expressed
with those services was low. The move to deinstitutionalise people from psychiatric
hospitals into the community, from the 1970s until now, also played a role in the
popularity of support groups, whereby families were reimagined as participants in
support and recovery rather than the cause of mental illness (Heller et al., 1997;
MacFarlane, 2004).
Many support groups were set up absent a scientific evidence-base. This literature
review aims to investigate current research regarding the effectiveness of support
groups for families and carers of people living with mental illness and people who
have experienced mental illness themselves.
While online support is mentioned, this is not a thorough study of online support
groups or forums.
Method
Literature searches were conducted using Ovid Medline(R), PsychInfo and Proquest
Central databases. The subject headings ‘mutual support’, ‘self-help groups’ and
‘support groups’ were filtered using various combinations of the subject headings
psychotic disorders, schizophrenia, bipolar disorder, Community Mental Health
Services, Social support, Grow program, hearing voices, anxiety, caregivers, carer,
family, depression. These searches resulted in a harvest of 57 relevant articles.
Findings
Support groups can also be known as mutual-aid groups, self-help groups, peer-led
support groups, consumer-led support groups, multi-family groups or family-led
support groups. There is a diversity in the way in which support groups are
organised and the content of their meetings (Seebohm 2013; MacFarlane 2004;
Ahmed et al. 2012). Throughout the literature there is a variety in the definition of
what constitutes a support group. This makes a study of the effectiveness of support
groups challenging.
Peer-led, self-help, mutual-help or mutual-aid groups
Peer work in the mental health sector is becoming more recognised and
professionalised (NSW Mental Health Commission, 2014). The concept of ‘peer-led’
usually means that a group is led by people who have had the experience of a
mental illness. Peer-led, however can also be applied to carers and family members
who lead support groups as ‘peers’ for other carers and family members. Provision
of peer led services has been emphasised as critical to integrating consumers’
perspectives in recovery based mental health services (Fukui et al., 2010).
‘Mutual support’, or ‘mutual aid’ groups operate to support people across a whole
range of health and welfare issues. Mutual support and mutual aid are the names
more likely to refer to volunteer-based groups. In the mental health sector these
groups tend to be organised and run by carers and family members of people living
with a mental illness or people who have experienced mental health problems, not
by mental health professionals.
Sometimes these distinctions are hard to maintain when support groups have mixed
membership or are supported by employees of organisations who may, or may not,
be carers or people with lived experience themselves.
A qualitative study by Seebohm et al. (2013) explores the contribution of self-
help/mutual-aid groups to mental wellbeing using the UK National Mental Health
Development Unit (NMHDU) indicators. Whilst five of the groups in their study are
mental health specific groups, most of the groups in their study are interested in
other health and social issues; for example, cancer. Using thematic analysis they
compared the experiences and mental wellbeing of participants before and after they
began participating in their group. They note that the core protective factors for
mental wellbeing are:
Enhancing control;
Increasing resilience and community assets;
Facilitating participation and promoting inclusion (NMHDU, 2011; Seebohm et
al., 2013).
They found that prior to joining their groups many participants felt isolated, lacked
hope and were at risk of mental ill-health. They conclude that self-help/mutual-aid
groups can be measured against the NMHDU mental wellbeing protective factors
and that these factors do correspond with people’s experience of improved mental
wellbeing.
Support groups for people with the lived experience of mental illness
The literature demonstrates that support groups for people with lived experience of
mental illness are effective and have positive outcomes (Corrigan et al., 2002;
Knight, 2006; Mancini et al., 2013). Mutual help programs such as GROW have been
extensively studied. GROW is an international organisation which supports a
network of mental health support groups using the GROW model. The support
groups use standardised meeting procedures developed from the 12-step format of
AA and standardised literature as references to be read by “Growers” individually
and at meetings.
GROW was attributed with significant improvement in the quality of life and related
factors of members who have serious mental illness (Corrigan et al., 2002),
significantly reduced number of days hospitalised compared with similar people in an
Illinois psychiatric facility (49 for GROW members compared to 123 in controls),
improvements to self-esteem, self-efficacy, social support, spiritual well-being, and
psychiatric symptoms. Growers identified self-reliance, industriousness and self-
esteem as key ingredients of recovery.
The success of GROW has also been evaluated in the Australian context. A study by
Finn et al. (2009) found that the group community plays a vital role in supporting,
encouraging and holding group members during times of crisis and difficulty.
A survey conducted in 2013 by the Australian GROW organization (GROW, 2017)
found that:
85% felt an improved sense of personal value;
77% experienced an improved sense of belonging and connection with the
community;
81% reported an improved network of friends and personal supports;
67% said that GROW had directly contributed to their recovery from mental
illness.
Mancini et al. (2013) conducted a validated evaluation questionnaire of the
Procovery program in the US. Procovery is a voluntary program focused on
consumer choice and respect delivering discussion on a variety of topics from hope
and insight to addressing practical matters such as managing medications,
developing support networks, engaging in meaningful activities, self-care and getting
a job. Facilitators were either peer facilitators or mental health workers who were
trained to be neutral coordinators, allowing for other members of the group to
participate as equals.
Participants in the Procovery treatment group displayed an increased positive
perception of psychiatric staff and overall quality of life measures. However, no
effects were found for social relationships, consumer recovery attitudes or quality of
life subscales. Almost all Procovery facilitators believed that Procovery improved
consumers’ recovery attributes such as motivation, problem solving, hope,
socialization, communication, self-esteem, and confidence.
An extensive review of six 2-point-in-time studies conducted by Knight (2006)
examined the effectiveness of self-help groups for people with a serious mental
illness. Knight concluded these studies demonstrated reduced symptoms and
substance abuse over time; concomitant reduction in crises, hospitalisations and use
of services; improved social competence and social networks; and increased healthy
behaviours and perceptions of well-being. These healthy behaviours and perception
of wellbeing included: medication compliance, acceptance of illness, better coping
skills, quality of life, greater sense of security and self-esteem, creation of one’s own
meaningful structure, and changes in what healthcare consumers wanted from time
spent with their family.
It is worth noting that all of the studies included in the Knight review, with the
exception of the study of the GROW program (Kennedy, 1990) are closely
associated with mental health services, and staff from those services organise and
facilitate or co-facilitate the programs. Knight attributes the success of these
programs to increased social networks, the role of the facilitator acting as a support
for participants, peer-to-peer learning and role modelling, and the creation of group-
led meaningful structures.
Support groups for people living with a psychotic illness have a normative function as
members compare themselves to each other, learn from each other and incorporate
the culture of the group. Referent power, which is the identification with group
leaders and members, is a distinguishing factor of mutual help from professional
assistance, but is not necessary for people to identify the group as helpful. Expert
power refers to valuing the knowledge of group members, leaders and support
workers.
The social influence that expert power affords has been identified as a major factor
in determining the perception of the helpfulness of a group (Salem et al., 2000).
Outcome variations exist within groups which may be attributed to the strength of the
social network. For example, people who attend support groups more often attain a
better quality of life score and lower use levels of healthcare resources than people
that attend less frequently (Terzian et al., 2013). The activation of social networks
should be considered a mandatory component of the care and rehabilitation of
patients with schizophrenia (Terzian et al.,2013).
The internet provides an alternative medium for mutual support and support groups.
However, studies evaluating unmoderated, unstructured internet peer support by
Kaplan et al. (2011) and Bauer et al. (2013) suggest that the internet cannot replace
health professionals and other traditional psychoeducational approaches. Rather, the
use of the internet may be a useful adjunct to traditional self-help groups.
Support groups for people with lived experience of bi-polar disorder
A number of different support group models have been demonstrated to be effective
for people living with bi-polar disorder. For example, Castle et al. (2010)
demonstrated that manualised, group-based therapy can be an effective adjunct to
treatment as usual for people. A randomised controlled trial in Victoria, Australia,
was used to evaluate a group program based on the “Collaborative Therapy
Framework”. This program was designed to help participants with their coping
strategies, to address their vulnerabilities and manage stress. Participants received a
workbook, information book and collaborative therapy journal. People in the
treatment groups had fewer relapses of any type (manic, depressive or mixed) and
spent less time unwell than those in the control group. There was, however, no
significant difference detected in the severity of symptoms between the treatment
and control groups (Castle et al., 2010)
Psychoeducation programs for people living with bipolar have also been shown to be
effective for a number of measures (Castle et al., 2010; Poole et al., 2012). A
randomised controlled trial evaluating the “Beating Bipolar” online psychoeducation
program demonstrated that the program was easy to deliver, engaging for the
participants and provided a modest effect on psychological quality of life (Poole et
al., 2004). Half the participants in this study reported that they would prefer a face-to-
face group rather than online, while the other half prefer the online environment.
Similarly, Bipolar Education Program Cymru (BEP-Cymru), which is a 10 session
program facilitated by two mental health workers, enabled people to therapeutically
share their experiences with their illness, care, treating professionals and hospital
treatment. Participants gained insight into ways of coping, particularly with stigma
associated with the illness through the program (Poole et al., 2015).
Groups for substance abuse or dual diagnosis
The 12 step approach adopted by Alcoholics Anonymous (AA) is established as one
of the leading, empirically validated treatments for drug and alcohol dependence
(Borganschutz, 2005). However, only a minority of people with a dual diagnosis
attend self-help groups despite sustained encouragement by health services
personnel to attend.
Specially designed groups for dual diagnosis have an advantage (e.g. Double
Trouble for Recovery) (Noordsy et al., 1996). A number of factors influence
attendance including social ability and diagnosis, with attendance particularly low for
those whose dual diagnosis includes a psychotic illness. Furthermore, forceful
referral of people to 12 step self-help groups without respecting their own
explanatory models of understanding their addictions and illness was counter-
productive.
Support groups for carers
The diagnosis of a severe mental illness in a family member can have a major
impact not only on the individual but on the family as well. Mutual support groups
have been used as an effective modality of family intervention to improve care,
family and patient functioning (Chien et al., 2005). The objectives of caregiver
support groups include:
To provide education and information in order to increase knowledge and
understanding of the disorder;
To encourage an atmosphere of mutual trust in which to explore strategies for
coping;
To provide emotional support conducive to open, honest sharing of feelings
(Chou et al., 2002).
Monking (1994) is one of the earliest studies to attempt to provide rigorous measures
for the effect of mutual support groups on both the participant living with a mental
illness and their families who joined the carer mutual support groups set up for their
study. Monking concluded that participation in self-help groups is effective in helping
relatives. Although not statistically significant, Monking found that decreased levels
of emotion and physical complaints were concurrent with the increased contact
frequency between the person they care for and their contact with other group
members. In this paper, Monking put weight on the social (community) impact of a
successful self-help group.
Heller et al. (1997) conducted a statistical analysis of 14 family mental health support
groups from Chicago and Illinois. Of these groups, 4 were led by professionals and
the other 10 were led by family members. Heller et al. described an increase in two
outcome factors for support group participants. Firstly, information benefit increased,
which involved knowing how to advocate for the person they care for more
effectively, increased ability to cope emotionally and having more knowledge about
mental illness, the services available and the latest interventions. Secondly,
relationship benefit was increased, which involved an improved ability to cope with
social stigma, less anger toward the person they care for and better relationships
with both their person living with mental illness and other members of the family.
It is worth noting that negative factors were also reported by up to 30% of
participants as a result of participation in the group including an increase in the
feeling of being overwhelmed and less able to meet the needs of the person with
mental illness (Heller et al., 1997). It’s also worth noting that this study did not
distinguish the outcomes between the groups facilitated by professionals or family
members.
A number of other studies have also demonstrated the benefits of caregiver support
groups (Chou et al., 2002; Chiu et al., 2013; Chien and Norman, 2009). In one study
in Taiwan (Chou et al., 2002), members of the support group demonstrated less
depression and less of a sense of burden than controls by creating a sense of
commonality, validation of the caregiver’s experiences and opportunities to give and
receive help. Similarly, family psycho-education programs were found to be effective
in reducing worry and displeasure, significantly improving intra-psychic strain,
depression and empowerment (Chiu et al., 2013).
Support groups have also been shown to be more effective than standard care alone
in some settings (Chien et al., 2004; Chien et al., 2006). A randomised control trial of
family-led mutual support groups for Chinese caregivers demonstrated that support
group participants experienced significantly greater improvement in families’ burden,
functioning and number of support persons than those receiving standard psychiatric
care alone (Chien et al., 2008; Chien and Chen, 2004). Multivariate analyses have
also shown that, in conjunction with routine psychiatric care, family-led mutual
support groups are more effective than family psychoeducation groups in improving
the psychosocial health conditions of patients and their family members (Chien et al.,
2004; Chien and Thomson, 2013).
Multifamily support groups
Multifamily groups include people living with a mental illness, the people who are
their carers and other people in their family group.
McFarlane (2001) reviewed a unique model of multifamily groups for the treatment of
severe psychiatric disorders. These were long-term closed groups, in which new
members are unable to join the group once it starts. The group leaders were 2
clinicians who aimed to keep the group members attending. Rather than viewed as a
support group, they are referred to as “therapeutic social networks” or a “healing
community”.
The therapeutic effectiveness of multifamily groups resembles those described in
other support group studies and includes increased social networks, improved
coping and problem-solving capacities, increased ability to absorb anxiety and a shift
in identity from stigma to mastery (McFarlane, 2011).
McFarlane also describes how senior people in families begin to pay attention to the
person living with mental illness in other families. It is this multifamily aspect,
particularly the increased social network, which forms a multilevel intervention that is
linked to better long-term outcomes.
Support groups for families of people with lived experience of psychotic
illness
There is consistent evidence of the immediate or short-term positive effects of
mutual support groups on the physical and psychosocial health conditions of patients
and their families(Chien and Norman, 2009; Chien and Chan, 2004).
Chien et al. (2008) and Chien and Chan (2004) undertook a long-term program of
study including a randomised controlled trial with 106 families over a 3 year period.
They conclude that family-led mutual support groups are an effective intervention for
Chinese people with schizophrenia, resulting in long-term effects of improving patient
and family functioning and reducing rehospitalisations. Family mutual support was
shown to be more effective in improving self-maintenance, social functioning and
community living skills of patients with schizophrenia than either psycho-education or
standard care alone.
These effects were not limited to the people living with schizophrenia. The families
caring for the relative with schizophrenia also showed improved measures for mutual
support, acceptance of the caregiver role, increased knowledge of the illness,
adoption of new coping skills, perceived social climate of the group, informational
support, empowerment and psychosocial functioning (Chien et al., 2014).Chien et al.
(2006) noted that poorer group outcomes were experienced with low group
attendance, negative pressure from dominant members, and over-expression of
intense and negative feelings.
Discussion
Across many types of support groups, there is a strong, scientifically rigorous
evidence base for the effectiveness of support groups in providing positive
improvements to wellbeing and the recovery of participants. Outcomes include
reduced symptoms, substance abuse, number of crises, hospitalisations and use of
services, as well as improved social competence and social networks, increased
healthy behaviours and perceptions of wellbeing.
Regardless of the type of support group, participants report many of the same
perceived benefits from participation:
Fostering hope;
Learning about the issue that brings them to the support group;
Learning coping strategies;
Overcoming isolation;
Building social and support networks;
Learning from successful role models;
Feeling more in control over the situation
Overcoming stigma;
Learning about the services available and being able to advocate more
effectively.
The exact mechanisms by which support groups achieve these perceived benefits
are, however, not always clear. For most mental health support groups there is
professional mental health worker involvement in the development and facilitation of
the group. Commonly, workers provide assistance to set up groups, to support the
group leaders and maintain their contacts with, and knowledge of, the mental health
system.
There are a range of matters that affect the success of the use of a support group
program and the involvement of professionals health workers. These include:
The value placed on, and the techniques used, to promote the involvement of
participants and peer-leaders;
Professional worker rigidness or flexibility with the program and willingness to
let participants contribute to the process rather than being ‘lectured’;
Co-facilitation of a group by a professional mental health worker with a group
participant (peer leader) can contribute to the effectiveness of support groups.
Peer leadership has been identified as an important component by
participants.
This doesn’t mean that support groups without professional leadership and
programmed materials are not effective. Studies aiming to reach rigorous standards
of scientific evidence usually require controlled variables and professionally-led,
programmed-based groups to enable this kind of study. It is less likely that
community-based, unfunded programs are going to be suitable for rigorous scientific
study or attract the funding that is required to confirm a program as evidence-based.
Barriers to achieving positive outcomes include the person’s diagnosis, irregular
group attendance, negative pressure from dominant, experienced members, and the
overexpression of intense and negative feelings during group meetings.
Regardless of the model of support group, there are some consistent challenges to
the functioning of the groups. These include the management of disagreements
between participants, having to repeatedly talk about your problems, the idea of
spending a lot of time with other people living with mental illness, resources, the
personal energy required to maintain the group and the difficulties of getting people
to attend and maintain attendance at the groups. Training professional workers, peer
leaders and volunteer group leaders is crucial for overcoming these challenges.
Conclusions
The results show that there is a consistent pattern of evidence, over a long period of
time, which confirms the effectiveness of mental health support groups for carers
and people living with mental illness. There is strong, scientifically-rigorous evidence
which shows the effectiveness of professionally facilitated, family-led support groups,
psycho-education carers support groups, and professionally facilitated, program-
based support groups for people living with mental illness.
This review has identified a number of elements that may contribute to the success
of support groups, such as peer leadership, family involvement, professional
facilitation or co-facilitation, and the use of manualised programs.
The studies in this review describe a range of outcome factors and the benefits
experienced by support group participants. Further studies elucidating the
mechanisms by which the benefits are achieved and, in particular, the contribution to
the effectiveness of groups by professionals would be beneficial. This field would
also benefit from further research on whether people living with mental illness use
other types of community groups for support such as writing and music groups and
sport clubs, and how the effectiveness of this compares with recognised support
groups.
Limitations of the conclusions drawn here and by others include the low number of
studies with a rigorous statistical base. Challenges to conducting research in this
area include the lack of attention to treatment, poor follow-up, the lack of testing
around the involvement of psychiatric nurses or other health professionals and
consideration of social-cultural conditions.
References
Ahmed, A.O., Doane, N.J., Mabe, P.A., Buckley, P.F., Birgenheir, D. and Goodrum,
N.M., 2012. Peers and peer-led interventions for people with
schizophrenia. Psychiatric Clinics of North America, 35(3), pp.699-715.
Bauer, R., Bauer, M., Spiessl, H. and Kagerbauer, T., 2013. Cyber-support: an
analysis of online self-help forums (online self-help forums in bipolar
disorder). Nordic journal of psychiatry, 67(3), pp.185-190.
Bogenschutz, M.P., 2005. Specialized 12-step programs and 12-step facilitation for
the dually diagnosed. Community Mental Health Journal, 41(1), pp.7-20.
Castelein, S., Bruggeman, R., Van Busschbach, J.T., Van Der Gaag, M., Stant,
A.D., Knegtering, H. and Wiersma, D., 2008. The effectiveness of peer support
groups in psychosis: a randomized controlled trial. Acta Psychiatrica
Scandinavica, 118(1), pp.64-72.
Castle, D., White, C., Chamberlain, J., Berk, M., Berk, L., Lauder, S., Murray, G.,
Schweitzer, I., Piterman, L. and Gilbert, M., 2010. Group-based psychosocial
intervention for bipolar disorder: randomised controlled trial. The British Journal of
Psychiatry, 196(5), pp.383-388.
Chien, W.T. and Chan, S.W., 2004. One-year follow-up of a multiple-family-group
intervention for Chinese families of patients with schizophrenia. Psychiatric
services, 55(11), pp.1276-1284.
Chien, W.T., Chan, S., Morrissey, J. and Thompson, D., 2005. Effectiveness of a
mutual support group for families of patients with schizophrenia. Journal of
advanced nursing, 51(6), pp.595-608.
Chien, W.T. and Norman, I., 2009. The effectiveness and active ingredients of
mutual support groups for family caregivers of people with psychotic disorders: a
literature review. International journal of nursing studies, 46(12), pp.1604-1623.
Chien, W.T., Norman, I. and Thompson, D.R., 2004. A randomized controlled trial
of a mutual support group for family caregivers of patients with
schizophrenia. International journal of nursing studies, 41(6), pp.637-649.
Chien, W.T., Norman, I. and Thompson, D.R., 2006. Perceived benefits and
difficulties experienced in a mutual support group for family carers of people with
schizophrenia. Qualitative Health Research, 16(7), pp.962-981.
Chien, W.T., Thompson, D.R. and Norman, I., 2008. Evaluation of a Peer‐Led
Mutual Support Group for Chinese Families of People with
Schizophrenia. American journal of community psychology, 42(1-2), pp.122-134.
Chien, W.T. and Thompson, D.R., 2013. An RCT with three-year follow-up of peer
support groups for Chinese families of persons with schizophrenia. Psychiatric
Services, 64(10), pp.997-1005.
Chiu, M.Y., Wei, G.F., Lee, S., Choovanichvong, S. and Wong, F.H., 2013.
Empowering caregivers: impact analysis of familylink education programme (FLEP)
in Hong Kong, Taipei and Bangkok. International Journal of Social
Psychiatry, 59(1), pp.28-39.
Corrigan, P.W., Calabrese, J.D., Diwan, S.E., Keogh, C.B., Keck, L. and Mussey,
C., 2002. Some recovery processes in mutual-help groups for persons with mental
illness; I: qualitative analysis of program materials and testimonies. Community
Mental Health Journal, 38(4), pp.287-301.
Corrigan, P.W., Slopen, N., Gracia, G., Phelan, S., Keogh, C.B. and Keck, L., 2005.
Some recovery processes in mutual-help groups for persons with mental illness; II:
Qualitative analysis of participant interviews. Community Mental Health
Journal, 41(6), pp.721-735.
Chien, W.T. and Norman, I., 2009. The effectiveness and active ingredients of
mutual support groups for family caregivers of people with psychotic disorders: a
literature review. International journal of nursing studies, 46(12), pp.1604-1623.
Chou, K.R., Liu, S.Y. and Chu, H., 2002. The effects of support groups on
caregivers of patients with schizophrenia. International journal of nursing
studies, 39(7), pp.713-722.
Finn, L.D., Bishop, B.J. and Sparrow, N., 2009. Capturing dynamic processes of
change in GROW mutual help groups for mental health. American journal of
community psychology, 44(3-4), pp.302-315.
Fukui, S., Davidson, L.J., Holter, M.C. and Rapp, C.A., 2010. Pathways to
Recovery (PTR): Impact of peer-led group participation on mental health recovery
outcomes. Psychiatric Rehabilitation Journal, 34(1), p.42.
Grow. Mental Health Support Organisation [Online]. Available:
https://www.grow.org.au/ [Accessed July 18 2017].
Heller, T., Roccoforte, J.A., Hsieh, K., Cook, J.A. and Pickett, S.A., 1997. Benefits
of support groups for families of adults with severe mental illness. American Journal
of Orthopsychiatry, 67(2), p.187.
Kaplan, K., Salzer, M.S., Solomon, P., Brusilovskiy, E. and Cousounis, P., 2011.
Internet peer support for individuals with psychiatric disabilities: a randomized
controlled trial. Social science & medicine, 72(1), pp.54-62.
Kell, J. and Yeterian, J. 2008. Chapter 4: Mutual Help Groups. In: WT, O. D. & NA,
C. (eds.) In Evidence-based Adjunctive Treatments.: Elsevier.
Kennedy, M., 1989, June. Psychiatric hospitalization of GROWers. In second
biennial conference of community research and action, East Lansing, MI.
Knight, E.L., 2006. Self-help and serious mental illness. Medscape General
Medicine, 8(1), p.68.
Mancini, M.A., Linhorst, D.M., Menditto, A.A. and Coleman, J., 2013. Statewide
implementation of recovery support groups for people with serious mental illness: a
multidimensional evaluation. The journal of behavioral health services &
research, 40(4), pp.391-403.
Mcfarlane, W. 1983. Multiple family therapy in schizophrenia. In McFarlane (ed.)
Family Therapy in Schizophrenia. New York: Guilford Press.
Mcfarlane, W. 2001. Multifamily Groups in the Treatment of Psychiatric Disorders,
New York, United States, Guilford Publications.
Monking, H.S., 1994. Self-help groups for families of schizophrenic patients:
formation, development and therapeutic impact. Social psychiatry and psychiatric
epidemiology, 29(3), pp.149-154.
National Mental Health Commission. 2014. The National Review of Mental Health
Programmes and Services. ACT.
Noordsy, D.L., Schwab, B., Fox, L. and Drake, R.E., 1996. The role of self-help
programs in the rehabilitation of persons with severe mental illness and substance
use disorders. Community Mental Health Journal, 32(1), pp.71-81.
NSW Mental Health Commission. 2014. Living Well: A Strategic Plan for Mental
Health in NSW. Sydney.
Patterson, T.L., Bucardo, J., McKibbin, C.L., Mausbach, B.T., Moore, D., Barrio, C.,
Goldman, S.R. and Jeste, D.V., 2005. Development and pilot testing of a new
psychosocial intervention for older Latinos with chronic psychosis. Schizophrenia
Bulletin, 31(4), pp.922-930.
Poole, R., Simpson, S.A. and Smith, D.J., 2012. Internet-based psychoeducation
for bipolar disorder: a qualitative analysis of feasibility, acceptability and
impact. BMC psychiatry, 12(1), p.139.
Poole, R., Smith, D. and Simpson, S., 2015. Patients’ perspectives of the feasibility,
acceptability and impact of a group-based psychoeducation programme for bipolar
disorder: a qualitative analysis. BMC psychiatry, 15(1), p.184.
Salem, D.A., Reischl, T.M., Gallacher, F. and Randall, K.W., 2000. The role of
referent and expert power in mutual help. American Journal of Community
Psychology, 28(3), pp.303-324.
Seebohm, P., Chaudhary, S., Boyce, M., Elkan, R., Avis, M. and Munn‐Giddings,
C., 2013. The contribution of self‐help/mutual aid groups to mental well‐
being. Health & social care in the community, 21(4), pp.391-401.
Stant, A.D., Castelein, S., Bruggeman, R., van Busschbach, J.T., van der Gaag,
M., Knegtering, H. and Wiersma, D., 2011. Economic aspects of peer support
groups for psychosis. Community mental health journal, 47(1), pp.99-105.
Terzian, E., Tognoni, G., Bracco, R., De Ruggieri, E., Ficociello, R.A., Mezzina, R.
and Pillo, G., 2013. Social network intervention in patients with schizophrenia and
marked social withdrawal: a randomized controlled study. The Canadian Journal of
Psychiatry, 58(11), pp.622-631.
