Self-help and mutual support among persons coping with severe mental illnesses has been an important part of psychiatric rehabilitation since the field's beginning. In fact, there are some peer support initiatives that predate the establishment of PsyR as a distinct practice. For example, the group of ex-psychiatric patients described in Chapter 6, who dubbed themselves WANA (We Are Not Alone) in the 1940s, and then went on to establish Fountain House, began as a self-help group.
Alcoholics Anonymous (AA), founded in 1935, is the oldest self-help organization in the United States (Robertson, 1988). Another early self-help initiative was started by a psychiatrist named Abraham Low. In the 1930s Low developed a treatment method similar to what is now known as cognitive-behavioral therapy. He worked with people who suffered from a wide range of mental and emotional disorders, teaching them to control their symptoms and take responsibility for their lives. His methods are outlined in Mental Health through Will Training (Low, 1950). In 1952, two years before his death, he founded Recovery Inc., the second oldest self-help organization in the United States, which concentrated on the self-help aspect of his treatment.
Over the years, Recovery Inc. has grown into an international organization totally run by its members. In meetings, members share examples of everyday life situations where they have applied Recovery Inc. principles. They share their stories in four steps. In the first step the members summarize situations that trigger emotional distress. In the second step members specify symptoms that they experienced. The third step involves relabeling diagnoses, symptoms, and stressful situations using Recovery Inc. terminology. For example, a person diagnosed with bipolar disorder might stop referring to himself as a "manic-depressive" and instead say, "I am an average nervous person." This part of the process helps members to cognitively reframe symptoms and situations that they previously experienced as devastating into manageable aspects of their day-to-day functioning. The last step involves members speculating on how they would have handled the situation before they learned self-help techniques (Ackerman, 1997). Recovery Inc. is an important resource for people who are recovering from a variety of mental illnesses (Lee, 1995).
A number of successful self-help initiatives have developed outside of the United States. In 1957, a mutual support organization dubbed GROW was established in Australia by ex-patients (Finn & Bishop, 2001). GROW groups are similar to Recovery Inc. and AA groups in that they are highly structured, offer members a strong sense of community, encourage the sharing of personal stories, and utilize materials developed by the members of the organization. GROW, Inc., like AA, has a Blue Book that helps members apply personal growth and problem-solving strategies. There are now more than 300 mutual support groups operated by GROW in Australia, and more than 200 GROW groups in other countries, including the United States (Finn & Bishop, 2001). Other well known self-help initiatives include Schizophrenics Anonymous, which has been in exis tence for more than 20 years and includes at least 70 groups in the United States and Canada (http://www.schizophrenia.com) and the Depressive and Bipolar Support Alliance, which consists of more than 1,000 consumer-run support groups (http://www. dbsalliance.org).
In the mid-1970s peer support initiatives got a boost when the National Institute of Mental Health (NIMH) sponsored a conference focused on the identification of essential supports and services needed by people being discharged from psychiatric hospitals. It was one of the first times that consumers of mental health services were invited to the table to participate in discussions about mental health systems. At the conference, and in subsequent publications, peer support was identified as one of the 10 essential ingredients of an ideal community support system (Stroul, 1989, 1993; Turner, 1977). Community support systems are described in Chapter 7.
Throughout the 1980s federal funding supported the expansion of self-help initiatives throughout the United States. The Substance Abuse and Mental Health Services Administration's Center for Mental Health Services' (SAMHSA/CMHS') Community Support Program provided technical assistance to a number of consumer-run programs and also funded various demonstration projects in order to promote the development of self-help groups and other innovative peer support programs (Brown & Parrish, 1995; Schmidt, 2005; Van Tosh & Del Vecchio, 2000). State mental health authorities also began to support the development of self-help initiatives. For example, in the early 1980s, the New Jersey Division of Mental Health Services provided funding needed to open and operate drop-in centers, now called self-help centers, throughout the State (Barrett, Pratt, Basto, & Gill, 2000). Self-help centers are alternative programs that offer a variety of mutual support, social, and advocacy activities. Based on the original drop-in center model, these initiatives now have an expanded focus on wellness, recovery, and employment (Swarbrick, 2005). We will look more closely at self-help centers later in the chapter.
Today peer support initiatives are prominent components of most U.S. state mental health systems. The federal government continues to emphasize the importance of peer support as an adjunct to the conventional mental health system. Two major federal reports, Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 1999) and the final report of the President's New Freedom Commission on Mental Health (2003), recommend the use of peer support to promote recovery-oriented services.
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