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 illnessor otherwise increase their level of cognitive or emotional wellbeing.cite journal | last = Humphreys | first = Keith | coauthors = Rappaport, Julian | title = Researching self-help/mutual aid groups and organizations: Many roads, on journey | year = 1994 | month = Autumn | journal = Applied and Preventative Psychology |volume=3 |issue=4 |pages=217–231 |doi=10.1016/S0962-1849(05)80096-4] There are several international mental health self-help organizations including Emotions Anonymous, GROWand Recovery, Inc.Recovery, Inc. uses a cognitive therapyapproach, Emotions Anonymous uses a twelve-step approach, whereas GROW incorporates a combination of cognitive therapy and twelve-step methods. Despite the different approaches, many of the psychosocial processes in the groups are the same and they share similar relationships with mental health professionals. The terms 'self-help', 'mutual-help' and 'mutual-aid' are used interchangeably in this context.cite journal | last = Rappaport |first = Julian | title = Narrative studies, personal stories and identity transformation in the mutual help context | year = 1993 | journal = The Journal of Applied Behavioral Science |volume=29 |issue=2 | pages=239–256 |doi=10.1177/0021886393292007]
Self-help groups for mental health provide mutual support and
peer support. Mutual support is a process by which people voluntarily come together to help each other address common problems. Peer supportis social, emotional or instrumental support that is mutually offered or provided by persons with similar mental healthconditions where there is some mutual agreement on what is helpful.cite journal | last = Solomon | first = Phyllis | year = 2004 | title = Peer support/peer provided services underlying processes, benefits, and critical ingredients | journal = Psychiatric rehabilitation journal | volume = 27 | issue = 4 | pages = 392–401 | issn = 1095-158X | doi = 10.2975/27.2004.392.401] cite journal | last = Davidson | first = Larry | coauthors = Chinman, Matthew; Kloos, Bret; Weingarten, Richard; Stayner, David; Kraemer, Jacob; | year = 1999 | title = Peer Support Among Individuals with Severe Mental Illness: A Review of the Evidence | journal = Clinical Psychology: Science and Practice | volume = 6 | issue = 2 | pages = 165–187 | issn = 1468-2850 | doi = 10.1093/clipsy.6.2.165 | doi_brokendate = 2008-06-25]
The definitions of mutual support and peer support 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. In the former set members seek to improve themselves, wheres the latter set encompasses advocacy organizations such as NAMA, NAMI and USPRA.cite journal | last = Tomes | first = Nancy | year = 2006 | month = May | title = The Patient As A Policy Factor: A Historical Case Study Of The Consumer/Survivor Movement In Mental Health | journal = Health affairs (Project Hope) | volume = 25 | issue = 3 | pages = 720–729 | issn = 1544-5208 | doi = 10.1377/hlthaff.25.3.720 | pmid = 16684736] Self-helpgroups are subsets of mutual support and peer supportgroups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicapor life-disrupting problem. Self-help groups are less bureaucratic and work on a more grassrootslevel.cite journal | last = Levy | first = Leon H. | year = 1978 | title = Self-help groups viewed by mental health professionals: A survey and comments | journal = American Journal of Community Psychology | volume = 6 | issue = 4 | pages = 305–313 | issn = 0091-0562 | doi = 10.1007/BF00885522] Self-help Organizations are national affiliates of local self-help groups or mental health consumergroups that finance research, maintain public relations or lobby for legislation in favor of those affected.
Behavior Control and Stress Coping groups
Of Individual Therapy groups, researchers distinguish between Behavior Control groups (such as
Alcoholics Anonymousand TOPS) and Stress Coping groups (such as mental health support groups, cancer patient support groups, and groups of single parents).cite journal | last = Knight | first = Bob | coauthors = Wollert, Richard W.; Levy, Leon H.; Frame, Cynthia L.; Padgett, Valerie P. | year = 1980 | month = February | title = Self-help groups: The members' perspectives | journal = American Journal of Community Psychology | volume = 8 | issue = 1 | pages = 53–65 | doi = 10.1007/BF00892281 | issn = 0091-0562] German researchers refer to Stress Coping groups as Conversation Circles.cite journal | last = Moeller | first = Michael L. | title = History, Concept and Position of Self-Help Groups in Germany | journal = Group Analysis | volume = 32 | issue = 2 | pages = 181–194 | year = 1999 | doi = 10.1177/05333169922076653 | issn = 0533-3164]
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.cite journal | last = Knight | first = Bob | coauthors = Wollert, Richard W.; Levy, Leon H.; Frame, Cynthia L.; Padgett, Valerie P. | year = 1980 | month = February | title = Self-help groups: The members' perspectives | journal = American Journal of Community Psychology | volume = 8 | issue = 1 | pages = 53–65 | doi = 10.1007/BF00892281 | issn = 0091-0562] cite journal | last = Wollert | first = Richard W. | coauthors = Levy, Leon H.; Knight, Bob G. | year = 1982 | month = May | title = Help-Giving in Behavioral Control and Stress Coping Self-Help Groups | journal = Small Group Research | volume = 13 | issue = 2 | pages = 204–218 | issn = 1046-4964 | doi = 10.1177/104649648201300206]
In Germany a specific subset of Conversation Circles are categorized as Talking Groups ("Gesprachsselbsthilfegruppen"). 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.
Affiliation and 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.cite journal | last = Maton | first = Kenneth I. | coauthors = Leventhal, Gerald S.; Madara, Edward J.; Julien, Mariesa | year = 1989 | month = October | title = Factors affecting the birth and death of mutual-help groups: The role of national affiliation, professional involvement, and member focal problem | journal = American Journal of Community Psychology | volume = 17 | issue = 5 | pages = 643–671 | issn = 0091-0562 | doi = 10.1007/BF00922640] Rules enforcing self-regulation in Talking Groups are essential for the group's effectiveness.
Emotions Anonymous (EA) is a twelve-step program similar to
Alcoholics Anonymous(AA), but for the purpose of helping its members recover from depression and other mental illnesses. EA is the largest of three organizations that have adapted AA's Twelve Steps to create a program for people suffering from mental or emotional illness, replacing the word "alcohol" with "our emotions" in the First Step. Smaller organizations include Neurotics Anonymous(N/A or NAIL) and Emotional Health Anonymous(EHA). EA is a successor organization of Neurotics Anonymous.
EA and NAIL are open to anyone who desires to become emotionally well,cite book |last=Boydston |first=Grover |title=A history and status report of Neurotics Anonymous, an organization offering self-help for the mentally and emotionally disturbed |year=1974 |publisher=
Barry University|location= Miami, Florida|oclc=14126024 |pages=1-5 |chapter=Part I. Introduction] cite book |author=Emotions Anonymous |title=Emotions Anonymous |edition=Revised Edition |year=1996 |location= St. Paul, Minnesota|publisher=Emotions Anonymous International Services |language=English |isbn=0960735658 |oclc=49768287 |pages=1-6 |chapter=Chapter 1. An Invitation] EHA additionally requires that members are not suffering from problems that are specifically addressed by other twelve-step groups (e.g. substance abuse, eating disorders, sexual addiction, compulsive gambling, etc).cite web | last = Emotional Health Anonymous | title = Frequently Asked Questions | date = 2007-04-02| url = http://home.flash.net/~sgveha/faqs2.htm | accessdate = 2007-06-02] According to the Twelve Traditions, EA, NAIL, and EHA groups cannot not accept outside contributions.
GROW was founded in
Sydney, Australia, in 1957by a Roman Catholic priest, Father Cornelius Keogh, and people who had sought help with their mental illness at Alcoholics Anonymous(AA) meetings. After its inception, GROW members learned of Recovery, Inc. and integrated some of its processes into their program. GROW's original literature includes the Twelve Stages of Decline, which state that emotional illness begins with self-centeredness, and the Twelve Steps of Recovery and Personal Growth, a blend of AA's Twelve Steps and will-training methods from Recovery, Inc. GROW groups are open to anyone who would like to join, though they specifically recruit people who have been in psychiatric hospitals or are socioeconomically disadvantaged. GROW does not operate with funding restrictions and have received state and outside funding in the past.cite journal | last = Kurtz | first = Linda F. | coauthors = Chambon, Adrienne | year = 1987 | title = Comparison of self-help groups for mental health | journal = Health & social work | volume = 12 | issue = 4 | pages = 275–283 | issn = 0360-7283 | pmid = 3679015]
Recovery, Inc. was founded in
Chicago, Illinoisin 1937by psychiatrist Abraham Lowusing principles in contrast to those popularized by psychoanalysis. Low wrote the principal book, "Mental Health Through Will Training",cite book |last=Low |first=Abraham |title=Mental Health Through Will Training |year=1984 | publisher=Willett Pub |isbn=0915005018 |oclc=9878531] used in the organization. Recovery, Inc. is open to anyone identifying as "nervous" (a compromise between between the loaded term neurotic and the colloquial phrase nervous breakdown); strictly encourages members to follow their physician's, social worker's, psychologist's or psychiatrist's orders; and does not operate with funding restrictions.
Fundamentally, Low believes "Adult life is not driven by
instinctsbut guided by Will," using a definition of will opposite of Arthur Schopenhauer's. Low's program is based on increasing determination to act, self-control and self-confidence. Edward Sagarincompared it to a modern, reasonable, and rational implementation of Émile Coué's psychotherapy.cite book |last=Sagarin |first=Edward |authorlink=Edward Sagarin |title=Odd Man In: Societies of Deviants in America |year=1969 |publisher=Quadrangle Books |location= Chicago, Illinois|isbn=0531063445 |oclc=34435 |pages=210-232 |chapter=Chapter 9. Mental patients: are they their brothers' therapists?] Recovery, Inc. is "twelve-step friendly." Members of any twelve-step group are encourage to attend Recovery, Inc. meetings in addition to their twelve-step group participation.cite web | author = Recovery, Inc. | title = RI and 12 Step Compatability [sic] | date = 2006-10-14 | url = http://www.recovery-inc.org/Sober-Bob_Outreach.html | accessdate = 2007-06-02]
Professional lead 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.cite journal | last = Davidson | first = Larry | coauthors = Chinman, Matthew; Kloos, Bret; Weingarten, Richard; Stayner, David; Kraemer, Jacob; | year = 1999 | title = Peer Support Among Individuals with Severe Mental Illness: A Review of the Evidence | journal = Clinical Psychology: Science and Practice | volume = 6 | issue = 2 | pages = 165–187 | issn = 1468-2850 | doi = 10.1093/clipsy.6.2.165 | doi_brokendate = 2008-06-25]
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
safetyand simplicity. Elegant theoretical formulations, systematic behavioral techniques, and complicated cognitive-restructuring methods are not necessary.cite journal | last = Wollert | first = Richard W. | coauthors = Levy, Leon H.; Knight, Bob G. | year = 1982 | month = May | title = Help-Giving in Behavioral Control and Stress Coping Self-Help Groups | journal = Small Group Research | volume = 13 | issue = 2 | pages = 204–218 | issn = 1046-4964 | doi = 10.1177/104649648201300206]
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 too:
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.cite journal | last = Solomon | first = Phyllis | year = 2004 | title = Peer support/peer provided services underlying processes, benefits, and critical ingredients | journal = Psychiatric rehabilitation journal | volume = 27 | issue = 4 | pages = 392–401 | issn = 1095-158X | doi = 10.2975/27.2004.392.401] cite journal | last = Sargent | first = Judy | coauthors = Williams, Reg A.; Hagerty, Bonnie; Lynch-Sauer, Judith; Hoyle, Kenneth | year = 2002 | title = Sense of Belonging as a Buffer Against Depressive Symptoms | journal = Journal of the American Psychiatric Nurses Association | volume = 8 | issue = 4 | pages = 120–129 | issn = 1532-5725 | doi = 10.1067/mpn.2002.127290]
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 increase their confidence.
Social learning theory: Members with experience become creditable 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-esteemimproves with the social approval received from those they have helped, putting them an a more advantageous position to help others.
Relationship with mental health professionals
1978survey 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.cite journal | last = Levy | first = Leon H. | year = 1978 | title = Self-help groups viewed by mental health professionals: A survey and comments | journal = American Journal of Community Psychology | volume = 6 | issue = 4 | pages = 305–313 | issn = 0091-0562 | doi = 10.1007/BF00885522] 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.
A survey of psychotherapists in
Germanyfound 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.cite journal | last = Friedhelm | first = Meyer | coauthors = Matzat, Jürgen; Höflich, Anke; Scholz, Sigrid; Beutel, Manfred E. | year = 2004 | month = December | title = Self-help groups for psychiatric and psychosomatic disorders in Germany—themes, frequency and support by self-help advice centres | journal = Journal of Public Health | volume = 12 | issue = 6 | pages = 359–364 | issn = 0943-1853 | doi = 10.1007/s10389-004-0071-0]
Surveys of self-help groups has 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 a sickness can be treated. We know better than doctors how sick people can be treated as humans."cite journal | last = Moeller | first = Michael L. | title = History, Concept and Position of Self-Help Groups in Germany | journal = Group Analysis | volume = 32 | issue = 2 | pages = 181–194 | year = 1999 | doi = 10.1177/05333169922076653 | issn = 0533-3164]
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 the their group from friends and relatives, and relatively few learned about them from professional referrals.cite journal | last = Knight | first = Bob | coauthors = Wollert, Richard W.; Levy, Leon H.; Frame, Cynthia L.; Padgett, Valerie P. | year = 1980 | month = February | title = Self-help groups: The members' perspectives | journal = American Journal of Community Psychology | volume = 8 | issue = 1 | pages = 53–65 | doi = 10.1007/BF00892281 | issn = 0091-0562]
Self-help groups are effective for helping people cope with, and recover from, a wide variety of problems.cite book | last = Kyrouz | first = Elaina M. | coauthors = Humphreys, Keith; Loomis, Colleen | year = 2002 | month = October | title = American Self-Help Group Clearinghouse Self-Help Group Sourcebook | edition = 7th edition | chapter = Chapter 4: A Review of Research on the Effectiveness of Self-help Mutual Aid Groups | chapterurl = http://facesandvoicesofrecovery.org/pdf/kyrouz%20humphreys%20loomis%202002.pdf | editor = White, Barbara J.; Madara, Edward J. | isbn = 1930683006 | pages = 71-86 | url = http://www.mentalhelp.net/selfhelp/ | publisher = American Self-Help Group Clearinghouse | accessdate = 2008-01-06] German Talking Groups have been shown to be as effective as psychoanalytically orientated group therapy.cite journal | last = Daum | first = K.W. | coauthors = Matzat, J.; Moeller, M.L. | year = 1984 | title = Psychologisch-therapeutische Selbsthilfegruppen: Ein Forschungsbericht. | journal = Schriftenreihe des Bundesministers fur Jugend, Familie und Gesundheit. | issue = Stuttgart: Kohlhammer | language = German] 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 efficient. The amount of time spent in the programs, and how proactive the members are in them, has also been correlated with increased benefits.cite journal | last = Powell | first = Thomas J. | coauthors = Hill, Elizabeth M.; Warner, Lynn; Yeaton, Willian; Silk, Kenneth R. | year = 2000 | title = Encouraging People With Mood Disorders to Attend a Self-Help Group | journal = Journal of Applied Social Psychology | volume = 20 | issue = 11 | pages = 2270–2288 | issn = 0021-9029 | doi = 10.1111/j.1559-1816.2000.tb02436.x] Decreased hospitalization and shorter durations of hospitalization indicate that self-help groups result in financial savings for the health care system, as hospitalization is one of the most expensive mental health services. Similarly, reduced utilization of other mental health services may translate into additional savings for the system.
While self-help groups for mental health increase
self-esteem, reduce stigma, accelerate rehabilitation, improve decision-making, decrease tendency to decompensate under stress, and improve social functioning, they are not always shown to reduce psychiatric symptomatology.cite journal |last=Kaufman |first=C. L. |year=1996 |title=The lion's den: Social identities and self help groups |journal=The Community Psychologist |volume=29 |pages=11–13 |oclc=14089992] The therapeutic effects are attributed to the increased social support, sense of community, educationand personal empowerment.cite journal | last = Hatzidimitriadou | first = E. | title = Political ideology, helping mechanisms and empowerment of mental health self-help/mutual aid groups | journal = Journal of Community and Applied Social Psychology | volume = 12 | issue = 4 | pages = 271–285 | doi = 10.1002/casp.681 | issn = 1099-1298 | oclc = 43956503 | year = 2002] cite journal |last=Kurtz |first=Linda |year=1990 |title=The self-help movement: review of the past decade of research |journal=Social Work with Groups |volume=13 |issue=3 |pages=101–115 |doi=10.1300/J009v13n03_11 |issn=0160-9513] cite journal | last = Maton | first = Kenneth I. | month = February | year = 1988 |title = Social support, organizational characteristics, psychological wellbeing and group appraisal in three self-help populations | journal = American Journal of Community Psychology | volume = 16 | issue = 1 | pages = 53–77 | issn = 0091-0562 | doi = 10.1007/BF00906072]
Members of self-help groups for mental health rated their perception of the group's effectiveness on average at 4.3 on a 5-point
Likert scale.cite journal | last = Knight | first = Bob | coauthors = Wollert, Richard W.; Levy, Leon H.; Frame, Cynthia L.; Padgett, Valerie P. | year = 1980 | month = February | title = Self-help groups: The members' perspectives | journal = American Journal of Community Psychology | volume = 8 | issue = 1 | pages = 53–65 | doi = 10.1007/BF00892281 | issn = 0091-0562]
There are several limitations of self-help groups for mental health, including but not limited to their: inability to keep detailed records, lack of formal procedure to follow-up with members, absence of formal screening procedures for new members, lack formal leadership training, likely inability of members to recognize a "newcomer" presenting with a serious illness requiring immediate treatment; additionally, there is a lack of professional or legal regulatory constraints determining how such groups can operate, there is a danger that members may disregard the advice of
mental health professionals, and there can be an anti-therapeutic suppression of ambivalence and hostility. Researchers have also elaborated specific criticisms regarding self-help groups' formulaic approach, attrition rates, overgeneralization, and "panacea complex."
Researchers have questioned whether formulaic approaches to
self-help group therapy, like the Twelve Steps, could stifle creativity or if adherence to them may prevent the group from making useful or necessary changes.cite journal | last = Dean | first = Stanley R. | year = 1971 | month = January | title = The Role of Self-Conducted Group Therapy | journal = American Journal of Psychiatry | volume = 127 | issue = 7 | pages = 934–937 | issn = 0002-953X | doi = 10.1176/appi.ajp.127.7.934 | doi_brokendate = 2008-06-25] cite book |last=Sagarin |first=Edward |title=Odd man in; societies of deviants in America |year=1969 |publisher=Quadrangle Books |location= Chicago, Illinois|isbn=0531063445 |oclc=34435 |pages=56-77 |chapter=Chapter 3. Gamblers, addicts, illegitimates, and others: imitators and emulators] Similarly others have criticized self-help group structure as being too rigid.
High attrition rates
There is not a universal appeal of self-help groups, as little as 17% of people invited to attend a self-help group will do so. Of those, only one third will stay past four months. Those who continue are people who value the meetings and the self-help group experience.
Since these groups are not specifically diagnosis-related, but rather for anyone seeking mental and emotional health, they may not provide the necessary sense of community to evoke feelings of oneness required for recovery in self-help groups.cite journal | last = Powell | first = Thomas J. | coauthors = Warner, Lynn; Hill, Elizabeth M.; Yeaton, William; Silk, Kenneth R. | year = 2000 | title = Encouraging People With Mood Disorders to Attend a Self-Help Group | journal = Journal of Applied Social Psychology | volume = 30 | issue = 11 | pages = 2270–2288 | issn = 0021-9029 | doi = 10.1111/j.1559-1816.2000.tb02436.x]
Referent poweris only one factor contributing to group effectiveness. A study of Schizophrenics Anonymousfound expert power to be more influential in measurements of perceived group helpfulness.cite journal |last=Salem |first=Deborah |coauthors=Reischl, Thomas M.; Gallacher, Fiona; Randall, Katie Weaver |title=Referent and Expert Power in Mutual Help |journal=American Journal of Community Psychology |issn=1573-2770 |volume=28 |number=3 |month=June |year=2000 |pages=303-324 |doi=10.1023/A:1005101320639]
There is a risk that self-help group members may come to believe that group participation is a Panacea; that the group's processes can remedy any problem.
Addiction recovery groups
Depression and Bipolar Support Alliance
Hearing Voices Movement
List of twelve-step groups
National Alliance on Mental Illness
Social work with groups
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