Potential Barriers

Potential Barriers to Self-Help Group (SHG) Referral as Identified by the Literature

Quotes from the research

“ More than 80% of participants [family physicians in Ontario] identified sharing experience and information, overcoming isolation, and feeling understood as specific positive effects of cancer self-help groups.”   Gray, R., Orr, V., Carroll, J., Chart, P., Fitch, M., & Greenberg, M. (1998). Self-help groups: .Family physicians` attitudes, awareness, and practices. Canadian Family Physician, 44, 2137-2142.

“… Peer-led support groups improve communication between patients and physicians and increase medication compliance.”  Sheffield, A. (2003). Referral to a peer-led support group: An effective aid for mood disorder patients. Primary Psychiatry, 10(5), 89-94.

“Physicians should inform patients about the benefits of support groups and patients… should seek the involvement of physicians in their communities.” Sheffield, A. (2003). Referral to a peer-led support group: An effective aid for mood disorder patients. Primary Psychiatry, 10(5), 89-94.

“The program [educational/support group program] increased knowledge about osteoporosis and increased self-reposted adherence to pharmacological treatment over a two year period [in comparison to the control group].”  Neilsen, D., Ryg, J., Nielsen, W., Knold, B., Nissen, N., & Brixen, K. (2010). Patient education in groups increases knowledge of osteoporosis and adherence to treatment: A two-year randomized controlled trial.  Patient Education and Counselling, 81(2), 155-160.

“People living with a problem have the capacity to develop experiential knowledge and wisdom about their situation by participating in self-help/mutual aid. This experiential perspective is different from that of the involved professional or lay bystander, partly because of the different relationship each has to the problem”. Borkman, T. (1999). Understanding self-help/mutual aid: Experiential learning in the commons. Piscataway, NJ: Rutgers University.

“Perspectives on recovery have changed dramatically over the past few years. It is increasingly plausible that not referring patients to recovery and rehabilitation-oriented groups-to self-help groups, supported employment, supported education, and other similar community participation and consumer run programs – may now raise liability issues, whereas such referrals may have been viewed as risky decades earlier.”Salzar, M., & Kundra, L. (2010). Law & Psychiatry: Liability issues associated with referrals to self-help groups. Psychiatric Services, 61(1), 6-8.

Is your client ready for a self-help group? Is a self-help group ready for your client? Is it your decision or your client’s decision?

  • Is your client in active crisis, suicidal, actively using drugs/alcohol? Are there other things that might prevent or affect your client from participating in a group – too angry, are their emotions all over the place, behaviours that would make it difficult for them to “take” care of themselves in a group?
  • Will your client’s behaviour adversely affect the group?
  • Is the group actively dealing with issues that may trigger your client to the state where they can’t participate in the group, or they function less in life, or the group is causing them harm?
  • The group will have guidelines, norms around safety, confidentiality, airtime, trust – is your client seeing a professional? – can your client conform?
  • Do you believe self-help has benefits, and have you discussed this with your client?
  • Are you willing to help your client work through the issues that may come up as a result of their participation in a group?
  • Is self-help the only source of support for your client – are there support groups, clubs, independent recreational/learning resources, a social network?
  • Does your client have one other person they can talk to besides you?
  • Does the group have an action plan to deal with a distressing situation before it happens?
  • Has your client contacted a self-help group to find out if it might be a good fit?
  • Do you know about local groups, and are you willing to refer your client?
  • If there is no group available locally, are you willing to help your client start a group, and what role are you willing to play in the maintenance of the group?

If you answered yes to any of the above statements, suggest your patient contact the Self-Help Connection or consult the Self-Help Group Directory for more information on self-help groups and self-help resources. Remember, the job of the group is not to go deeply into issues, but to offer support and practical help from lived experience as your patient heals.  Your patient may never find a better place than a self-help group to learn about boundaries, safety, to explore their inner lives, and to recover.

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