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Teaching Residents About Self-Help Groups

Key Words: Self-Help • Group Therapy • Alcoholism

TO THE EDITOR: Self-help groups are well known in many countries and cultures. In the United States, some of the best known are Alcoholics Anonymous (AA), Recovery, Inc., the National Alliance for the Mentally Ill (NAMI), the National Depressive and Manic-Depressive Association, and Schizophrenics Anonymous. Galanter estimated that there are half-a-million self-help groups with several million members worldwide (1). Self-help is the term Lefley uses to describe organizations of groups with a common problem who meet for purposes of mutual aid, education, and personal growth (2). They have aided chronically mentally ill persons, substance abusers, cancer sufferers and their families, AIDS victims, Alzheimer's disease patients, and the families of elderly patients with dementia (3). This approach has been used for detecting and treating illness, restoring and promoting health, preventing disease, and helping individuals adapt to continuing disability. Self-help groups are largely self-governing and advocate self-reliance, but many use professionals as consultants, guides, or supervisors. In fact, many self-help groups were founded by professionals who proposed that their ongoing role would be a collaborative or cooperative one.

Psychiatrists Resist the Use of Self-HelpGroups
Although organizations such as the American Psychiatric Association's Task Force on Treatment of Psychiatric Disorder acknowledge the usefulness of self-help groups, mental health professionals have frequently resisted their use. This resistance often focuses on doubts regarding validity and efficacy. Recent surveys such as those reported by Looper et al. (4), Kates (5), and Emerick (6) found that there is often a lengthy period between identification of mental illness and involvement with support organizations. In these surveys, 70% of members of self-help groups reported little or no interaction with professionals, and only 10% were eventually referred to the organizations by psychiatrists (4–6). Psychiatrists fear that the qualifications of group leaders are unknown and that there is no "quality control." in such groups.

The Usefulness of Self-Help Groups
Traditionally, psychiatric treatment has focused on managing mental illness and its immediate sequelae, but Galanter found a consistent decline in symptoms in those attending Recovery, Inc. meetings (1). The subjects in his study were individuals with an extensive history of psychiatric disorders; half had been hospitalized, and 40% had taken antipsychotic medications. He concluded that peer-led groups have value as an adjunct to psychiatric therapy. Kates (5) points out that support groups can also address other important aspects of recovery, including enhancing self-esteem, improving coping skills, providing social support, and increasing the family's ability to deal with ill relatives. Murray (7) suggests that as managed care increasingly limits professional mental health services, self-help organizations may play an expanding role.

Self-Help Programs for Mentally IllPatients
Recovery, Inc. is one of the two oldest self-help organizations in the United States. It was started in 1937 by Dr. Abraham Low, a Chicago psychiatrist. He anticipated many later concepts about mental illness and health, including locus of control, learned helplessness, and character defenses. Dr. Low believed that optimal health is achieved when a person assumes responsibility for his/her own failure or success. At Recovery meetings, members learn to identify self-defeating and illness-promoting thoughts and actions, much as in cognitive–behavioral therapy. Recovery encourages continued involvement of its clients with mental health professionals. Psychiatrists would serve their patients well by reciprocating that involvement.

The National Alliance for the Mentally Ill (NAMI) is a nation-wide self-help organization that offers direct support services and education to mentally ill patients and their families. NAMI has been very successful in obtaining legislative support for these patients, since those in government are often more responsive to lay concerns than to professionals, who may appear to have selfish interests.

The National Depressive and Manic-Depressive Association is an organization of persons suffering from affective disorders and their friends and relatives. Schizophrenics Anonymous is another organization of present and former psychiatric patients focusing on illness management, self-knowledge, and personal growth. The oldest self-help organization is Alcoholics Anonymous (AA), which began in 1935. Its usefulness to alcoholics is well known. There are estimated to be more than 47,000 AA groups in the United States and Canada.

How Can We Make Future Psychiatrists More Aware of the Use of Self-Help Groups?
A number of psychiatric residency programs, including those at the University of Illinois at Chicago, UCLA, and the Mayo Clinic, have had representatives of Recovery, Inc., NAMI, and other self-help groups visit and make presentations to the residents and faculty. At Mayo, there have been demonstrations by local Recovery groups since the 1980s that have been well received. At UCLA, Vaccaro has assigned residents and medical students to visit consumer groups, including NAMI and Recovery, Inc. He advocates partnerships with self-help organizations with full integration into treatment systems, and the use of consumer advisory committees in training centers.

Proposal for Psychiatric Residency Programs
We propose that psychiatric residency programs should enhance the awareness of their students to the usefulness of self-help groups by 1) giving residents an academic exposure to this topic in seminars and readings; 2) inviting representatives of self-help groups, such as Recovery, Inc. and NAMI, to make presentations to residents; and 3) giving residents assignments to visit and participate in the meetings of self-help groups in the community as part of their clinical experience. Inviting representatives of self-help groups to come to seminars and to make presentations about their programs will give residents an opportunity to hear from individuals who have been patients themselves and who have benefited from the groups. This should help trainees to develop a broader view, which incorporates rehabilitation as well as symptom control, and should help them to appreciate opportunities to integrate the support of self-help groups with other aspects of treatment. It may be even more useful to have residents go out into the community to attend meetings of self-help groups. At the three programs cited (University of Illinois at Chicago, Mayo Clinic, and UCLA), residents are assigned to attend a self-help group of their choice as part of their community-psychiatry training. They are able to see how their former patients fare in these settings and how the groups engage members and promote healthier functioning.

REFERENCES

1. Galanter M: Zealous self-help groups as adjuncts to psychiatrist treatment: a study of Recovery, Inc. Am J Psychiatry 1988; 145:1248-1253
2. Lefley HP: Advocacy, self-help, and consumer-operated services, in Psychiatry. Edited by Tasman A, Kay J, Lieberman JA. Philadelphia, PA, WB Saunders, 1997, pp 1770-1780
3. Noordsy DL, Schwab B, Fox L, et al: The role of self-help programs in the rehabilitation of persons with severe mental illness and substance use disorders. Community Ment Health J 1996; 32:71-81[CrossRef][Medline]
4. Looper K, Fielding A, Latimer E, et al: Improving access to family support organizations: a member survey of the Quebec Alliance for the Mentally Ill. Psychiatr Serv 1998; 49:1491-1492
5. Kates N: Support groups in psychiatry: an untapped resource. Can J Psychiatry 1995; 40:367-368[Medline]
6. Emerick RR: Self-help groups for former patients: relations with mental health professionals. Hosp Community Psychiatry 1990; 41:401-407[Abstract/Free Full Text]
7. Murray P: Recovery, Inc. as an adjunct to treatment in an era of managed care. Psychiatr Serv 1996; 47:1378-1381

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