Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual’s ability to enjoy life and procure a balance between life activities and efforts to achieve psychological resilience. Mental health is an expression of emotions and signifies a successful adaptation to a range of demands.
The World Health Organization defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. It was previously stated that there was no one “official” definition of mental health. Cultural differences, subjective assessments, and competing professional theories all affect how “mental health” is defined. There are different types of mental health problems, some of which are common, such as depression and anxiety disorders, and some not so common, such as schizophrenia and Bipolar disorder.
Most recently, the field of Global Mental Health has emerged, which has been defined as ‘the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide’.
In the mid-19th century, William Sweetzer was the first to clearly define the term “mental hygiene”, which can be seen as the precursor to contemporary approaches to work on promoting positive mental health. Isaac Ray, one of thirteen founders of the American Psychiatric Association, further defined mental hygiene as an art to preserve the mind against incidents and influences which would inhibit or destroy its energy, quality or development.
An important figure to “mental hygiene”, would be Dorothea Dix (1808–1887), a school teacher, who had campaigned her whole life in order to help those suffering of a mental illness, and to bring to light the deplorable conditions which they were put it in. This was known as the “mental hygiene movement”. Before this movement, it was not uncommon that people affected by mental illness in the 19th century would be considerably neglected, often left alone in deplorable conditions, barely even having sufficient clothing. Dix’s efforts were so great that there was a rise in the number of patients in mental health facilities, which sadly resulted in these patients receiving less attention and care, as these institutions were largely understaffed.
At the beginning of the 20th century, Clifford Beers founded the National Committee for Mental Hygiene and opened the first outpatient mental health clinic in the United States of America.
The importance of maintaining a good mental health is crucial to living a long and healthy life. Mental health when good can enhance, when poor prevent, someone from living a normal life. According to Richards, Campania, & Muse-Burke (2010) “There is growing evidence that is showing emotional abilities are associated with prosocial behaviors such as stress management and physical health” (2010). It was also concluded in their research that people who lack emotional expression lead to misfit behaviors. These behaviors are a direct reflection of their mental health. Self- destructive acts may take place to suppress emotions. Some of these acts include drug and alcohol abuse, physical fights or vandalism. Also without emotional support, mental health is at risk. According to a study done by Strine, Chapman, Balluz and Mokdad, “Inadequate social and emotional support is a major barrier to health relevant to the practice of psychiatry and medicine, because it is associated with adverse health behaviors, dissatisfaction with life, and disability” (2008, p. 154). By receiving emotional support your health can increase and prevent mental health disorders. Support systems are a valuable asset and those whom do not have social and emotional support are more likely to lead to disorders. This support can lead to “an increase personal competence, perceived control, sense of stability, and recognition of self- worth and can have a positive effect on quality of life”(Strine, Chapman, Balluz & Mokdad, 2008).
Signs and Symptoms of Emotional Mental Disorder
There are several signs and symptoms that indicate a mental disorder. According to Hertel, Schütz, & Lammers “ Some of the early symptoms of mental illness are related to emotional problems” (2009). People who cannot modulate or express normal emotions encountered in daily life, are faced with such deficits. A study done by Hertel, Schütz, & Lammers tested three mental disorders which are a direct reflection of emotional abilities. “Major depressive disorder, borderline personality disorder, and substance abuse disorder were all associated with significant deficits to emotional abilities” (Hertel, Schütz & Lammers, 2009). Many people who feel as if they cannot express their emotions turn to other things for a temporary fix to avoid dealing with their emotions. This temporary fix can lead to more severe problems, often resulting in making the emotional health issue more severe. This is becoming extremely common in our society. Recent evidence from the World Health Organization indicates, “mental illness affects nearly half the population worldwide” (Storrie, Ahern & Tuckett, 2010). Many of the people suffering from mental illness have issues functioning in everyday life. “Symptoms of mental illness and the associated stigma negatively affect people’s self-esteem, disrupt relationships and limit the ability to obtain housing, jobs and an education” (Storrie, Ahern & Tuckett, 2010).
Mental health can be seen as a continuum, where an individual’s mental health may have many different possible values. Mental wellness is generally viewed as a positive attribute, such that a person can reach enhanced levels of mental health, even if the person does not have any diagnosed mental health condition. This definition of mental health highlights emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with life’s inevitable challenges. Many therapeutic systems and self-help books offer methods and philosophies espousing strategies and techniques vaunted as effective for further improving the mental wellness of otherwise healthy people. Positive psychology is increasingly prominent in mental health.
A holistic model of mental health generally includes concepts based upon anthropological, educational, psychological, religious and sociological perspectives, as well as theoretical perspectives from personality, social, clinical, health and developmental psychology.
An example of a wellness model includes one developed by Myers, Sweeney and Witmer. It includes five life tasks—essence or spirituality, work and leisure, friendship, love and self-direction—and twelve sub tasks—sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self care, stress management, gender identity, and cultural identity—which are identified as characteristics of healthy functioning and a major component of wellness. The components provide a means of responding to the circumstances of life in a manner that promotes healthy functioning. The population of the USA in its’ majority is considered to be mostly uneducated on the subjects of mental health.
Lack of a mental disorder
Mental health can also be defined as an absence of a major mental health condition (for example, a condition diagnosed in the Diagnostic and Statistical Manual of Mental Disorders for the U.S.A or the fifth chapter of the International Classification of Diseases and Related Health Problems ICD-10 Chapter V: Mental and behavioural disorders used in countries of the world other than the U.S.A) though recent evidence stemming from positive psychology (see above) suggests mental health is more than the mere absence of a mental disorder or illness. Quite simply, mental health refers to a persons health of the mind. Therefore the impact of social, cultural, physical and education can all affect someone’s mental health.
Cultural and religious considerations
Mental health is a socially constructed and socially defined concept; that is, different societies, groups, cultures, institutions and professions have very different ways of conceptualizing its nature and causes, determining what is mentally healthy, and deciding what interventions, if any, are appropriate. Thus, different professionals will have different cultural, class, political and religious backgrounds, which will impact the methodology applied during treatment.
Many mental health professionals are beginning to, or already understand, the importance of competency in religious diversity and spirituality. The American Psychological Association explicitly states that religion must be respected. Education in spiritual and religious matters is also required by the American Psychiatric Association.
Emotional Mental Health in the United States of America
According to the World Health Organization in 2004, depression is the leading cause of disability in the United States of America for individuals ages 15 to 44 (Thomson, 2007). Absence from work in the U.S. due to depression is estimated to be in excess of $31 billion dollars per year (Thomson, 2007). Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis (Munce, 2007; Blumenthal et al., 2007, Moussavi, 2007). Each year, roughly 30,000 Americans take their lives, while hundreds of thousands make suicide attempts (Centers for Disease Control and Prevention). In 2004, suicide was the 11th leading cause of death in the United States of America (Centers for Disease Control and Prevention), third among individuals ages 15–24 (Thomson, 2007). Despite the increasingly availability of effectual depression treatment, the level of unmet need for treatment remains high (Thomson, 2007). Reducing depression within the U.S. population has been an essential priority of governmental organizations over the last decade. Mental illness, disability, and suicide are ultimately the result of a combination of biology, environment, and access to and utilization of mental health treatment (Thomson, 2007). Public health policies can influence access and utilization, which subsequently may improve mental health and help to progress the negative consequences of depression and its associated disability (Thomson, 2007). Emotional mental illnesses should be a particular concern in the United States of America since the U.S.A has the highest annual prevalence rates (26 percent) for mental illnesses among a comparison of 14 developing and developed countries (Demyttenaere et al, 2004). While approximately 80 percent of all people in the United States with a mental disorder eventually receive some form of treatment, on the average persons do not access care until nearly a decade following the development of their illness, and less than one-third of people who seek help receive minimally adequate care. Research conducted by Mental Health America found the following factors to be considerably allied with improved depression status and lower suicide rates . “Mental health resources — On average, the higher the number of psychiatrists, psychologists, and social workers per capita in a state, the lower the suicide rate. Barriers to treatment — The lower the percentage of the population reporting that they could not obtain healthcare because of costs, the lower the suicide rate and the better the state’s depression status. In addition, the lower the percentage of the population that reported unmet mental healthcare needs, the better the state’s depression status. Mental health treatment utilization — holding the baseline level of depression in the state constant, the higher the number of antidepressant prescriptions per capita in the state, the lower the suicide rate. Socioeconomic characteristics — The more educated the population and the greater the percentage with health insurance, the lower the suicide rate. The more educated the population, the better the state’s depression status. Mental health policy — The more generous a state’s mental health parity coverage, the greater the number of people in the population that receive mental health services (Thomson, 2007).”
Emotional Mental Health Issues Across The World
Emotional mental disorders are a leading cause of disabilities worldwide. Investigating the degree and severity of untreated emotional mental disorders throughout the world is a top priority of the World Mental Health (WMH) survey initiative, which was created in 1998 by the World Health Organization (WHO). “Neuropsychiatric disorders are the leading causes of disability worldwide, accounting for 37% of all healthy life years lost through disease.” (Thornicroftt, 2007). These disorders are most destructive to low and middle-income countries due to their inability to provide their citizens with proper aid. Despite modern treatment and rehabilitation for emotional mental health disorders, “even economically advantaged societies have competing priorities and budgetary constraints” (Thornicroftt, 2007). The World Mental Health survey initiative has suggested a plan for countries to redesign their mental health care systems to best allocate resources. “A first step is documentation of services being used and the extent and nature of unmet needs for treatment. A second step could be to do a cross-national comparison of service use and unmet needs in countries with different mental health care systems. Such comparisons can help to uncover optimum financing, national policies, and delivery systems for mental health care.” (Thornicroftt, 2007). Knowledge of how to provide effective emotional mental health care has become imperative worldwide. Unfortunately, most countries have insufficient data to guide decisions, absent or competing visions for resources, and near constant pressures to cut insurance and entitlements.”(Thornicroftt, 2007). WMH surveys were done in Africa (Nigeria, South Africa), the Americas (Colombia, Mexico, U.S.A), Asia and the Pacific (Japan, New Zealand, Beijing and Shanghai in the Peoples Republic of China), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), and the middle east (Israel, Lebanon). Countries were classified with World Bank criteria as low-income (Nigeria), lower middle-income (China, Columbia, South Africa, Ukraine), higher middle-income (Lebanon, Mexico), and high-income (all others) (Thornicroftt, 2007). The coordinated surveys on emotional mental health disorders, their severity, and treats were implemented in afore mentioned countries. These surveys assessed the frequency, types, and adequacy of mental health service use in 17 countries in which WMH surveys are complete. The WMH also examined unmet needs for treatment in strata defined by the seriousness of mental disorders. (Thornicroftt, 2007). Their research showed that “the number of respondents using any 12- month mental health service was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries’ percentages of gross domestic product spent on health care” (Thornicroftt, 2007). “High levels of unmet need worldwide are not surprising, since WHO Project ATLAS’ findings of much lower mental health expenditures than was suggested by the magnitude of burdens from mental illnesses. Generally, unmet needs in low-income and middle-income countries might be attributable to these nations spending reduced amounts (usually
Emotional mental health improvement
Being mentally and emotionally healthy does not exclude the experiences of life which we cannot control. As humans we are going to face emotions and events that are a part of life. According to Smith and Segal, “People who are emotionally and mentally healthy have the tools for coping with difficult situations and maintaining a positive outlook in which also remain focused, flexible, and creative in bad times as well as good” (2011). People who are emotionally and mentally healthy have the tools for coping with difficult situations and maintaining a positive outlook. They remain focused, flexible, and creative in bad times as well as good. In order to improve your emotional mental health the root of the issue has to be resolved. “Prevention emphasizes the avoidance of risk factors; promotion aims to enhance an individual’s ability to achieve a positive sense of self-esteem, mastery, well-being, and social inclusion” (Power, 2010). It is very important to improve your emotional mental health by surrounding yourself with positive relationships. We as humans, feed off companionships and interaction with other people. Another way to improve your emotional mental health is participating in activities that can allow you to relax and take time for yourself. Yoga is a great example of its meditating aspect which calms your entire body and nerves. According to a study on well-being Richards, Campania and Muse-Burke found, “mindfullness is considered to be a purposeful state, it may be that those who practice it believe in its importance and value being mindful, so that valuing of self-care activities may influence the intentional component of mindfulness” (2010).
Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing. There are several international mental health self-help organizations including Emotions Anonymous, the Depression and Bipolar Support Alliance (DBSA), GROW, and Recovery International. Mental Health America (MHA) and the National Alliance on Mental Illness (NAMI) are also large organizations based in the United States. Both MHA and NAMI have networks of state and/or local organizations that sponsor support groups and various public advocacy forums. Recovery International uses a cognitive training approach similar to cognitive-behavioral therapy, Emotions Anonymous uses a twelve-step approach, whereas GROW incorporates a combination of cognitive training and twelve-step methods. DBSA affiliates sponsor support groups using a variety of techniques 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.
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 support is social, emotional or instrumental support that is mutually offered or provided by persons with similar mental health conditions where there is some mutual agreement on what is helpful.
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 Mental Health America, NAMI and USPRA.
Self-help groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. Self-help groups are less bureaucratic and work on a more grassroots level. Self-help Organizations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favor of those affected.
Of Individual Therapy groups, researchers distinguish between Behavior Control groups (such as Alcoholics Anonymous and TOPS) and Stress Coping groups (such as mental health support groups, cancer patient support groups, and groups of single parents). German researchers refer to Stress Coping groups as Conversation Circles.
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.
In Germany a specific subset of Conversation Circles are categorized as Talking Groups (Gesprächsselbsthilfegruppen). 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. 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, 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.). According to the Twelve Traditions, EA, NAIL, and EHA groups cannot accept outside contributions.
GROW was founded in Sydney, Australia, in 1957 by 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. (the organization now known as Recovery International) and integrated 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 International. 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.
Recovery, Inc. was founded in Chicago, Illinois in 1937 by psychiatrist Abraham Low using principles in contrast to those popularized by psychoanalysis. During the organization’s annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. Recovery International is open to anyone identifying as “nervous” (a compromise 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 instincts but 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 Sagarin compared it to a modern, reasonable, and rational implementation of Émile Coué’s psychotherapy. Recovery International is “twelve-step friendly.” Members of any twelve-step group are encourage to attend Recovery International meetings in addition to their twelve-step group participation.
Professionally led 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.
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 safety and simplicity. Elegant theoretical formulations, systematic behavioral techniques, and complicated cognitive-restructuring methods are not necessary.
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.
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-esteem improves with the social approval received from those they have helped, putting them an a more advantageous position to help others.
A framework derived from common themes in empirical data describes recovery as a contextual nonlinear process, a trend of general improvement with unavoidable paroxysms while negotiating environmental, socioeconomic and internal forces, motivated by a drive to move forward in one’s life. The framework identified several negotiation strategies, some designed to accommodate illnesses and others designed to change thinking and behavior. The former category includes strategies such as acceptance and balancing activities. The latter includes positive thinking, increasing one’s own personal agency/control and activism within the mental health system.
Relationship with mental health professionals
A 1978 survey 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. 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 Germany found 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.
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.”
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.
Self-help groups are effective for helping people cope with, and recover from, a wide variety of problems. German Talking Groups have been shown to be as effective as psychoanalytically oriented group therapy. Effects of 12-step programs exceed those of congnitive-behavioral inpatient programs. 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. 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. The therapeutic effects are attributed to the increased social support, sense of community, education and personal empowerment.
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 procedures to follow-up with members, absence of formal screening procedures for new members, lack formal leadership training, and 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, over-generalization, 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. 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 few as 17% of people invited to attend a self-help group will do so. Of those, only one third will stay for longer than 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. Referent power is only one factor contributing to group effectiveness. A study of Schizophrenics Anonymous found expert power to be more influential in measurements of perceived group helpfulness.