ABSTRACT
In the introductory chapter to this book Ramon and Williams suggest that a paradigm shift is beginning in the field of mental health, what they call ‘psychosocial’ of which there will be a plurality of versions. In this chapter we offer a model of self-help/mutual aid groups focusing on persons with mental health problems who autonomously run them. We suggest that experienced selfhelpers and self-help/mutual aid groups that have developed experiential knowledge of living with mental health problems and navigating the mental health and social services systems embody a psychosocial approach to mental health problems that is holistic, person-centred, contextual, and integrates the psychological, social, and biological. Drawing primarily on the literature from our reciprocal countries, the UK and USA, we provide an overview of the distinguishing features of selfhelp/mutual aid groups and explore the nature of the collective knowledge built over time by peers who share their direct experiences and the potential challenge this poses to the existing medical model of mental health. Throughout the chapter we highlight the unique support that people can gain from self-help/mutual aid groups, whilst providing example(s) of the innovation in practice that can occur when mental health practitioners work alongside people with direct experience of mental health problems. Finally we suggest an emerging approach developing from our cross-cultural research with self-help/mutual aid groups that focuses on selfdirected ‘recovery’ with the assistance of experiential peers (Borkman et al., 2004). Context Mutual support and voluntary action have always been a part of human societies; but, it is only since the 1970s that single issue self-help/mutual aid groups have been observed and documented across Europe, North America, Japan, Australia and New Zealand (Borkman, 1999; Hastie, 2000; Munn-Giddings, 2003). Selfhelp/mutual aid groups have formed the backbone of the mental health service user movement in both the UK and North America and are cited as a significant component of peer-orientated and led initiatives in these other countries (Everett, 1994; Wallcraft and Bryant, 2003). Underlying the movements has been the
collective concern to change both traditional mental health services and broader societal attitudes. However, it is from the 1970s in UK and the USA that groups explicitly critical of psychiatry began to emerge raising awareness about issues such as conditions on psychiatric wards, closures of long-stay hospitals and matters affecting their quality of life. Wallcraft and Bryant (2003) note that in UK patient only groups such as the Mental Patients Union and the Campaign Against Psychiatric Oppression (CAPO formerly COPE) emerged at this time alongside pressure group organisations (not led by service users) such as MIND and the National Schizophrenic Fellowship (now Rethink). Some alliances were also being formed between patients and professionals such as Survivors Speak Out (SSO). In North America extensive diversity was found in the ideologies of groups and their relationships with mental health professionals and the mental health system. Radical groups such as ‘Mad Liberation’ distanced themselves from professionals and the system feeling they had been victimised by it whilst others such as Recovery Inc (initially founded in 1937 by the psychiatrist Abraham Low) had groups willing to work with professionals. Everett (1994) viewed the loose network of groups as an important social movement distinguishable because service users rather than professionals or philanthropists led it. However it was in the 1980s in the UK that there was a major increase in patients councils, self-help groups and user forums (the latter of which were often instigated by professionals specifically to influence local services). The model for both groups and councils were heavily influenced by the Dutch Patients Councils and US User Movement which underlined the importance of mutual support and consciousness-raising. Wallcraft and Bryant (2003) state that four significant UK user networks with associated self-help groups were formed in this time: UK Advocacy Network (UKAN), Survivors Speak Out (SSO); National Voices Network (NVN) and the Hearing Voices Network all to provide support, share information, campaign for change and challenge discrimination. Brandon (1991) and Lindlow (1994) also describe a number of grassroots self-help groups from specific localities in a number of countries, such as Womankind set up in Bristol, England in 1985 to promote mental health in women. Womankind was a multi-racial project that enabled over 50 women to meet monthly and share experiences. They organised a conference of 100 women who specifically addressed from their own experience what helped and hindered them in the psychiatric system. Brandon notes that a distinctive feature of UK groups is that few have taken a separatist line and have tended to work towards partnership and co-operation with progressive professionals, citing a number of examples of this work (1991: 154-5). Lindlow (1994) concurs with this view although raises concerns about the possible co-option of service users by the system. By contrast, the US service movement has from early days emphasised self-help alternatives to existing services. Although as Chamberlin (1990) notes, as self-help alternatives proliferated the radical voices within the US movement tended to weaken.
