CLINICAL HANDBOOK OF SCHIZOPHRENIA

30. Self-Help Activities 299In this capacity, as both a recipient and a provider of mental health services, I have hadthe opportunity to observe tremendous changes in the care of persons with serious mentalillness. During my four-decade-long career, the primary locus of this care has shifted fromthe hospital to the community, medications have greatly improved, and, increasingly, ageneral feeling has arisen that those of us with these conditions are expected to recover.Of the many changes that have occurred, certainly one of the most consequential hasbeen the rise of various forms of participation of mentally ill persons, and their familymembers, in the process of their own care. Although it is probably a broader use of theterm than the manner in which it has traditionally been employed, in this chapter, I usethe term self-help to refer to the various aspects of how mentally ill persons and theirfamilies have come to participate in the recovery process. In reviewing these efforts I focuson three ways of viewing these self-help activities.First, I discuss the traditional, more restricted, use of the self-help concept, that is,situations in which persons with the condition take responsibility, individually or withthe assistance of others, for engaging in activities that are expected to enhance their abilityto cope with their conditions and, they hope, contribute to their well-being and recovery.Second, I address activities in which such persons address individual and collectiveactivities aimed at not only improving their abilities to cope with their conditions but alsoadvocating for societal improvements in how mentally ill persons are perceived andtreated.Third, I address efforts whereby persons with mental illnesses organize so that theythemselves increasingly take charge of treatment and recovery activities.Finally, I make some brief comments about a recent government-sponsored effort toevaluate the effectiveness of self-help activities.GROUPS FOCUSING ON SELF-CARE AMONGPERSONS WITH SIMILAR CONDITIONSThe term self-help has traditionally been employed to describe efforts by groups of recipientsof health services to care for themselves, operating with varying degrees of independencefrom the traditional health care provider system. AA is often pointed out as an exampleof one such large, successful, self-help entity. This group, founded in Akron, Ohio,by a local surgeon and a New York stock broker, is probably the largest and most successfulself-help group. AA has over 2 million members and over 1,000 groups in some150 countries. AA groups usually meet once or twice a week. The primary purpose of AAis to have members stay sober and for alcoholics to achieve sobriety. Importantly, AAdoes not affiliate with other organizations or take stands on controversial issues. It takesno formal advocacy role.Although AA limits its activities to persons with alcoholism, similar groups havebeen established for persons with mental and emotional illnesses. Perhaps the oldest ofsuch organizations is GROW (2006), originally established in Australia in 1957, by asmall group of former mental patients who had been attending an AA meeting. Its programis based on a 12-step model and, similar to AA, is anonymous in its membership.Originally known as Recovery, it changed its name in 1975. Shortly thereafter, in 1978,GROW started offering residential services. In addition to having numerous branchesthroughout Australia, GROW currently has over 130 branches in Ireland, as well as additionalgroups in New Zealand, Canada, Mauritius, and the United States. It is describedon its website as a community of persons working toward mental health through mutual