The Value of Peer Support and Self-help

1. The Value of Peer Support and Self-help Geoffrey Nelson Department of Psychology Wilfrid Laurier University Presentation to “Building Connections: Making Peer Support Work” May 26, 2006, Guelph, Ontario

2. A Few Stories about How I Learned about Peer Support and Self-help • Counseling a student in high school • Meeting members of Consumer/Survivor Initiatives

3. Overview of Presentation • Why peer support and self-help are important • How well does peer support and self-help work • Why it works • How to promote it

4. Backdrop: Growing Social Trends • Individualism • Consumerism • Global capitalism • Solitary activities • Scientific reasoning and professionalism • Declining social capital

5. Psychological Sense of Community • In modern life, many people feel isolated, alienated, disconnected, or that their life is lacking in meaning and purpose • Community psychologist Seymour Sarason (1974) argued that the pursuit of a psychological sense of community should be the central mission of psychology

6. Sarason’s (1988) definition of psychological sense of community “the sense that one belongs in and is meaningfully a part of a larger collectivity; the sense that although there may be conflict between the needs of the individual and the collectivity, or among different groups in the collectivity, these conflicts must be resolved in a way that does not destroy the psychological sense of community; the sense that there is a network of and structure of relationships that strengthens rather than dilutes feelings of loneliness.”

7. Examples of Ways to Promote Psychological Sense of Community • Social networks – family, friends, neighbors, and other community members as providers of social support • Informal caregivers - Have you ever talked a personal problem or concern with a friend, a mentor, a teacher, someone from your faith community (e.g., priest, pastor, rabbi), a bartender, a barber or hairdresser? • Organized one-to-one peer support programs – the importance of emotional support, guidance, tangible support, financial support • Self-help/mutual aid groups and organizations run entirely by people who share a common concern (e.g., AA, weight loss support groups)

8. Canada: A Leader in Peer Support and Self-help • Canadian Council on Social Development • Self Help Resource Centre of Toronto and OSHNET • Self-help clearinghouses across the country • Peer support and self-help research

9. How Well Does Peer Support and Self-help Work? • Widow to Widow program in Toronto (Vachon et al., 1980) • Recently bereaved women paired with other widows who provided emotional and practical support • After one year, participants in the Widow to Widow program were more likely than non-participants to feel "much better," to have made new friends, and to have begun new activities, and were less likely to feel constantly anxious or to feel the need to hide their true emotions

10. How Well Does Peer Support and Self-help Work? • One-to-one peer support for women at risk for postpartum depression (Dennis, 2003) – study in BC • Women at risk for postpartum depression received either standard care or standard care plus telephone based peer support from a mother who had previously experienced postpartum depression • Two months later, 15% of the women who received peer support experienced high levels of depression compared with 52% of those who received only standard care

11. How Well Does Peer Support and Self-help Work? • Evaluation of a peer support program (T2U) for first year Laurier students to help them cope with the transition to university (Pancer et al., 2006) • T2U consisted of groups of 10 students with more advanced students as group facilitators, 7 meetings in 1st term, 2 in 2nd term • By 4th year, 28% of control group had dropped out of university without completing a degree compared with 8% of those in T2U • T2U students also reported less stress, depression, and loneliness, more social support, better adjustment to university; and they got drunk less often

12. How Well Does Peer Support and Self-help Work? • Study of three Parent Mutual Aid Organizations (PMAOs) in southwest Ontario for families involved with child protection agencies (Cameron, 1995) • Those in the PMAOs were involved in activities designed to promote social integration, emotional support, education, and concrete support • Compared with those who received only child protection services, those who were also involved in the PMAOs had lower rates of their children being placed in care (14% vs 29%), were more involved in the community, reported more social support and improved self-esteem and less stress

13. How Well Does Peer Support and Self-help Work? • Evaluation of four mental health Consumer/Survivor Initiatives (CSIs) (Nelson et al., 2006) • CSIs are operated exclusively by and for people who have experienced mental health issues; members participate in internal activities, one-to-one peer support, drop-ins, self-help groups, and external activities • At 3-year follow-up, relative to those in a comparison group, active CSI members showed greater improvement in community integration, symptom distress, quality of life (daily activities), and work, volunteer and educational activities

14. How Well Does Peer Support and Self-help Work? Joyce spoke of being more assertive with her family doctor about changing her medication. “If I don’t like something in my life I change it so I have more power and control over that. Before I kind of went into a pit and complained.” She recently got married, and she is volunteering with a community centre. She was working at 2 jobs which overwhelmed her and led to a hospitalization, but she found that this experience helped her learn her limits. “The last time I was depressed I literally walked in and wasn’t escorted by the police this time. I really took charge even of that. I was treated a lot better. . . I can see myself taking more charge every day. I think that is what made me more healthy and it helps to have a partner behind you saying ‘you are doing good. Don’t worry about it.’”

15. How Well Does Peer Support and Self-help Work? • Self-help organizations also play a significant role in public education, advocacy, and social change • Mothers Against Drunk Driving • Various ability organizations (Independent Living Centres, Associations for Community Living, CSIs, etc.)

16. One Other Important Finding about Peer Support and Self-help It is far less expensive than professional help!

17. What Is It about Peer Support and Self-help that Helps? • “You feel at home here [at CSI]. . . It is somewhere to go.”(CSI member) • “When I talk to people, I see that I am not the only one that it helps because I get down in the dumps sometimes. . . It helps to talk. It really does.” (CSI member) • “Now I am in a position to help other people because I have a friend of mine who was diagnosed with severe depression and I have taken her to support groups and stuff and she has found that very helpful.” (CSI member)

18. What Is It about Peer Support and Self-help that Helps? • Promotes psychological sense of community • Provides social support and information from people who have been in the same boat • Gives people an opportunity to help as well as be helped – helper therapy principle, “helping you helps me” • Teaches practical coping strategies • Provides an alternative world view • Gives people an opportunity to tell their stories • Provides a network of new social relationships • Provides inspiring role models

19. How to Promote Peer Support and Self-help • Relationships between self-helpers and professionals • Constantino & Nelson (1995) – Mental health consumers want changes in professional ideology and practices and shifts in power and control between consumers and professionals, keep professionals “on tap, not on top” • Recovery approaches, efforts to “shift the paradigm,” more synergistic approaches and collaboration between professionals and self-helpers – consumers as service-providers (Grant, 2006)

20. How to Promote Peer Support and Self-help “We know from our own experience here at CAMH that consumer-run businesses, training programs, peer support groups are enormously valuable in developing skills, building social relationships, and promoting independence. They are making a tremendous difference here at CAMH. The trouble is there aren’t enough of them.” Paul Garfinkel, CEO of the Centre for Addiction and Mental Health (CAMH)

21. How to Promote Peer Support and Self-help • Researchers can help by linking with peer support and self-help initiatives around conferences and participatory action research • Agencies can help by supporting self-help resource centres, which provide technical assistance to peer support and self-help initiatives • Government can provide financial support to peer support and self-help initiatives

22. Thank You!