self-help groups for mental health self-help groups for mental health self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing. despite the different approaches, many of the psychosocial processes in the groups are the same. self-help groups have had varying relationships with mental health professionals. due to the nature of these groups, self-help groups can help defray the costs of mental health treatment and implementation into the existing mental health system could help provide treatment to a greater number of the mentally ill population. types mutual support and self-help mutual support or peer support is a process by which people voluntarily come together to help each other address common problems. mutual support is social, emotional or instrumental support that is mutually offered or provided by persons with similar mental health conditions where there is some mutual agreement on what is helpful. mutual support may include many other mental health consumer non-profits and social groups. such groups are further distinguished as either individual therapy (inner-focused) or social reform (outer-focused) groups. the former is where members seek to improve themselves, where as the latter set encompasses advocacy organizations such as the national alliance on mental illness and psychiatric rehabilitation association. self-help groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. self-help groups are less bureaucratic and work on a more grassroots level. self-help organizations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favor of those affected. behavior control or stress coping groups of individual therapy groups, researchers distinguish between behavior control groups (such as alcoholics anonymous and tops) and stress coping groups (such as mental health support groups, cancer patient support groups, and groups of single parents). german researchers refer to stress coping groups as conversation circles. significant differences exist between behavioral control groups and stress coping groups. meetings of behavior control groups tend to be significantly larger than stress coping counterparts (by more than a factor of two). behavior control group members have a longer average group tenure than members of stress coping groups (45 months compared to 11 months) and are less likely to consider their membership as temporary. while very few members of either set saw professionals concurrently while being active in their group, stress coping members were more likely to have previously seen professionals than behavior control group members. similarly, stress coping groups worked closer with mental health professionals. member vs professional leadership member leadership. in germany, a specific subset of conversation circles are categorized as talking groups (gesprächsselbsthilfegruppen). in talking groups all members of the group have the same rights, each member is responsible only for themselves (group members do not make decisions for other group members), each group is autonomous, everyone attends the group on account of their own problems, whatever is discussed in the group remains confidential, and participation is free of charge. professionally led group psychotherapy. self-help groups are not intended to provide "deep" psychotherapy. nevertheless, their emphasis on psychosocial processes and the understanding shared by those with the same or similar mental illnesses does achieve constructive treatment goals. interpersonal learning, which is done through processes such as feedback and confrontation, is generally deemphasized in self-help groups. this is largely because it can be threatening, and requires training and understanding of small group processes. similarly, reality testing is also deemphasized. reality testing relies on consensual validation, offering feedback, seeking feedback and confrontation. these processes seldom occur in self-help groups, though they frequently occur in professionally directed groups. professional affiliation and group lifespan if self-help groups are not affiliated with a national organization, professional involvement increases their life expectancy. conversely, if particular groups are affiliated with a national organization professional involvement decreases their life expectancy. rules enforcing self-regulation in talking groups are essential for the group's effectiveness. typology of self-help groups in 1991 researchers marsha a. schubert and thomasina borkman created five conceptual categorizations for self-help groups. unaffiliated groups unaffiliated groups are defined as self-help groups that function independently from any control at state or national levels, and from any other group or professionals. these groups accept all potential members, and everyone has an equal opportunity to volunteer or be elected. leaders serve to help the groups function by collecting donations not through controlling the members. experiential knowledge is mostly found, and there is a high emphasis on sharing. an example of an unaffiliated group includes wildflowers' movement in los angeles. federated groups federated groups have superordinate levels of their own self-help organization at state or national levels which makes publicity and literature available. the local unit of the federated self-help group retains full control of its decisions. these groups tend to rely on experiential knowledge, and professionals rarely directly interact. the leaders of these groups would be any members comfortable with the format and willing to accept responsibilities. leaders do not need to have formal training to gain their title. examples of a federated self-help group would be depression and bipolar support alliance (dbsa) and recovery international. affiliated groups affiliated groups are subordinate to another group, a regional or national level of their own organization. local groups conform to the guidelines of the regional/national groups. leaders are self-helpers not professional caregivers, and meetings included educational activities and sharing, supplemented by research and professionals. examples of an affiliated self-help group would be the national alliance on mental illness (nami). managed groups managed groups are based on a combination of self-help and professional techniques. these groups are populated generally through referrals and group activities are led by group members. managed groups do not meet all the criteria for self-help groups, and so should be designated professionally controlled support groups. examples of managed groups are common with support groups in hospitals, such as those with breast cancer survivors and patients that may be managed by a nurse or therapist in some professional fashion. hybrid groups the hybrid group has characteristics of the affiliated and managed groups. like affiliated groups, hybrid groups are organized by another level of their own organization. to participate in specialized roles, training is developed by a higher level and enforced through trained leaders or facilitators. like a managed group, a hybrid group cooperates and interacts with professionals, and that knowledge is highly valued alongside experiential knowledge. group processes no two self-help group are exactly alike, the make-up and attitudes are influenced by the group ideology and environment. in most cases, the group becomes a miniature society that can function like a buffer between the members and the rest of the world. the most essential processes are those that meet personal and social needs in an environment of safety and simplicity. elegant theoretical formulations, systematic behavioral techniques, and complicated cognitive-restructuring methods are not necessary. despite the differences, researchers have identified many psychosocial processes occurring in self-help groups related to their effectiveness. this list includes, but is not limited to: acceptance, behavioral rehearsal, changing member's perspectives of themselves, changing member's perspectives of the world, catharsis, extinction, role modeling, learning new coping strategies, mutual affirmation, personal goal setting, instilling hope, justification, normalization, positive reinforcement, reducing social isolation, reducing stigma, self-disclosure, sharing (or "opening up"), and showing empathy. five theoretical frameworks have been used in attempts to explain the effectiveness of self-help groups. social support: having a community of people to give physical and emotional comfort, people who love and care, is a moderating factor in the development of psychological and physical disease. experiential knowledge: members obtain specialized information and perspectives that other members have obtained through living with severe mental illness. validation of their approaches to problems increases their confidence. social learning theory: members with experience become credible role models. social comparison theory: individuals with similar mental illness are attracted to each other in order to establish a sense of normalcy for themselves. comparing one another to each other is considered to provide other peers with an incentive to change for the better either through upward comparison (looking up to someone as a role model) or downward comparison (seeing an example of how debilitating mental illness can be). helper theory: those helping each other feel greater interpersonal competence from changing other's lives for the better. the helpers feel they have gained as much as they have given to others. the helpers receive "personalized learning" from working with helpees. the helpers' self-esteem improves with the social approval received from those they have helped, putting them in a more advantageous position to help others. a framework derived from common themes in empirical data describes recovery as a contextual nonlinear process, a trend of general improvement with unavoidable paroxysms while negotiating environmental, socioeconomic and internal forces, motivated by a drive to move forward in one's life. the framework identified several negotiation strategies, some designed to accommodate illnesses and others designed to change thinking and behavior. the former category includes strategies such as acceptance and balancing activities. the latter includes positive thinking, increasing one's own personal agency/control and activism within the mental health system. relationship with mental health professionals a 1978 survey of mental health professionals in the united states found they had a relatively favorable opinion of self-help groups and there was a hospitable climate for integration and cooperation with self-help groups in the mental health delivery system. the role of self-help groups in instilling hope, facilitating coping, and improving the quality of life of their members is now widely accepted in many areas both inside and outside of the general medical community. the 1987 surgeon's general workshop marked a publicized call for egalitarian relationships with self-help groups. surgeon general c. everett koop presented at this workshop, advocating for relationships that are not superordinate-subordinate, but rather emphasizing respectful, equal relations. a survey of psychotherapists in germany found that 50% of the respondents reported a high or very high acceptance of self-help groups and 43.2% rated their acceptance of self-help groups as moderate. only 6.8% of respondents rated their acceptance of self-help groups as low or very low. surveys of self-help groups have shown very little evidence of antagonism towards mental health professionals. the maxim of self-help groups in the united states is "doctors know better than we do how sickness can be treated. we know better than doctors how sick people can be treated as humans." referrals a large majority of self-help users use professional services as a gateway to self-help services, or concurrently with professional service or the aftercare following professional service. professional referrals to self-help groups thus can be a cost-effective method of continuing mental health services and the two can co-exist within their own fields. while twelve-step groups, such as alcoholics anonymous, make an indispensable contribution to the mental and/or substance use (m/su) professional services system, a vast number of non-twelve-step groups remain underutilized within that system. professional referrals to self-help groups for mental health are less effective than arranging for prospective self-help members to meet with veterans of the self-help group. this is true even when compared to referrals from professionals familiar with the self-help group when referring clients to it. referrals mostly come from informal sources (e.g. family, friends, word of mouth, self). those attending groups as a result of professional referrals account for only one fifth to one-third of the population. one survey found 54% of members learned about their self-help group from the media, 40% learned about their group from friends and relatives, and relatively few learned about them from professional referrals. effectiveness self-help groups are effective for helping people cope with, and recover from, a wide variety of problems. german talking groups have been shown to be as effective as psychoanalytically oriented group therapy. participation in self-help groups for mental health is correlated with reductions in psychiatric hospitalizations, and shorter hospitalizations if they occur. members demonstrate improved coping skills, greater acceptance of their illness, improved medication adherence, decreased levels of worry, higher satisfaction with their health, improved daily functioning and improved illness management. participation in self-help groups for mental health encourages more appropriate use of professional services, making the time spent in care more