Peter J. Shannon and David L. Morrison
GROW is a self help group which commenced in Sydney 30 years ago to assist mental patients rehabilitate. Some fear that this is not occurring. This study aimed to assess, by questionnaires, the mental health status of GROW attenders in Western Australia. There was a 93% response rate with demographic variables similar to an earlier Australia-wide survey. Individual scores on the GHQ and a Work, Leisure and Family Life Questionnaire showed a higher level of dysfunction than that in a “normal” population with men, on the average, scoring higher than women. Questions on medical care indicated that between 50-70% of attenders had previously been treated for a nervous condition. It is concluded that GROW is reaching a group of people with significant mental morbidity. Australian and New Zealand Journal of Psychiatry 1990; 24:96-102 In his book, The Third Wave, Alvin Toffler 111 argues we are moving into the post-industrial society. The First Wave people consumed what they produced or caught. They were, according to Toffler, neither producers nor consumers in the usual sense, but “prosumers”, to use his term. In the Second Wave humans moved to an industrial society based on “production for exchange”. Producers and consumers became meaningful terms. We are now moving into an age where there is a rise of “prosumers”. An aspect of this is self-care. People are beginning to do for themselves, or with their fellows, things which professionals did for them previously. Self-help groups are a feature of that phenomenon. Toffler lists as an Australian example the organisation GROW. In its own literature, GROW defines itself as a “voluntary association of people who know they are inadequate or maladjusted to life; who earnestly desire ~
~
Fremantle Hospital, WA Peter J. Shannon, MB, BS, DPM, FRANZCP, Visiting Psychiatnst Department of Psychology, Murdoch University, WA David L. Momson, BA, MA, PhD, Senior Lecturer Correspond with Dr P. Shannon, 32 Holdsworth Street, Fremantle, WA 6160
to improve, and who are helping one another to grow in mental health or personal maturity” [2]. The emphasis is on personal improvement with the aid of their fellows. This fits with Stephen Lock’s definition of a self-help group 131 namely, “A self-help group is a voluntary organisation, usually of peers, who have come together for mutual help and support in satisfying a common need, overcoming a common handicap or life disrupting problem and bringing about desired social or personal change, or both”. GROW developed in Sydney over 30 years ago. It was modelled along lines similar to Alcoholics Anonymous but with a different group of people in mind. Initially called Recovery, a number of former mental patients began meeting together in a mutual help group. Over the years its membership broadened and people now attend for a wide number of reasons. A tenet of GROW is its anonymity. Records of names and personal details are not kept. At GROW, attenders are only asked to identify themselves by a given name. They may give full names and information such as address and telephone numbers to others if they so wish. This lack of formal records is felt to be a strength for the group. It does, however, inhibit the systematic study of the membership and function of the organisation. This study was
Downloaded from anp.sagepub.com at University of Manitoba Libraries on June 9, 2015
PETER J. SHANNON AND DAVID L. MORRISON
set up to learn something of the attenders of GROW in Western Australia and their level of functioning. The development of GROW is parallelled by the evolution of other self-help groups. It has also taken place at a time when there has been emphasis on community care of mental disorders. Long term hospitalisation has been seen as causing institutionalisation with resulting alienation from family and society together with poverty in psychological and economical terms. Thus, community care is to be preferred. Studies have shown that community care, given sufficient resources, can replace hospitalisation for most acute and chronically disabled psychiatric patients [4,5]. These same studies emphasise that the patients continue to have residual impairments at the end of the intensive programme. Further, they reported that if the intensive programme was replaced by a traditional community programme, deterioration occurred and hospitalisation increased. Perhaps self-help groups would be suited to assist community based treatment programmes with these long term problems. Kurtz and Chambon [6] studied three mental health self-help organisations: Recover Inc., Emotions Anonymous and GROW International. They concluded that all three associations provided structured, cognitively based programmes to support individual change, support for coping with life problems, and monitored interactions between group members. Each organisation differed from the others in some aspects. The authors were unable to state if these differences were important for individuals. This interest in the community care of psychiatric patients and the place of self-help groups in it led to undertaking this study. In the study that is reported in this paper, the emphasis was on learning something of the attenders of GROW in Western Australia. In particular, the aim was to learn about the mental health of the attendees. As an aid to doing this, we were able to make use of studies conducted by Finlay-Jones and Burvill [7] and Cooper, Osborn, Gath and Fegetter [8]. The former had contrasted the patterns of minor psychiatric morbidity (MPM) in general practice and community settings, the latter looked at social adjustment as a function of MPM in a community setting. The data from the earlier studies provides a useful benchmark from which to assess the rates of psychiatric morbidity of those attending GROW. A discussion of the interpretational problems associated with this approach is postponed until the discussion section of this paper. As
97
a final point, it should be noted that the present investigation was not designed as an examination of the efficacy of the GROW organisation, but as a first step in the characterisation of those individuals who may use such a group.
Method Subjects With the permission of both the WA Programme Team and the National Management Team of GROW all attenders at GROW groups in Western Australia, during November 1986, were requested to complete and return a questionnaire. This was distributed by group co-ordinators at the weekly meeting and returned via the GROW organisational structure or through the post.
Questionnaire The questionnaire was comprised of several different sections: 1. Demographic items (age, sex, education, marital status). 2. Mental health history (length of time the current problem had been present, whether or not professional assistance had been sought, diagnosis, medication etc.). 3. The 60 item version of the General Health Questionnaire (GHQ) [9] was also included. This is a questionnaire used to detect minor psychiatric illnesses in current mental health. Previous research [ 101has identified subjects as “cases” if scores on the GHQ are greater than 1 1. Using this as a cut-off score has proved to be sensitive and specific at around the 90% level. Since we are interested in patients with long-standing disorders, a modified scoring technique, applied by Goodchild and Duncan-Jones [ 111 was also adopted. Since their method of scoring was designed for the 30-item version of the GHQ only those items were included in the present analysis. Using their technique, caseness is determined by a criterion score greater than 12, the levels of specificity and sensitivity reported in previous research being 80.2% and 84% respectively. 4. Aquestionnaire dealing with disruptions to work, leisure and family life was also included. The questionnaire used in this case was the Social Adjustment Scale (SAS-M) [8]. This instrument has been shown to correlate well with subjects’ concurrent mental state as measured by the GHQ and other instruments. In
Downloaded from anp.sagepub.com at University of Manitoba Libraries on June 9, 2015
WHO GOES TO GROW?
98
GROW attenders at that time. This represented a response rate of 93%.
Table 1 . Age and sex of the WA and national [12] samples Marital status
Demographic variables
i
% composition
Male
Female
Total
%
%
%
Single Married Sep/Div Widowed
27.0 47.0 22.9 2.1
13.7 57.3 20.5 8.5
18 55 21 6
26 45 22 7
Total
100.0
100.0
100
100
National sample%
I
Of the respondents, 72% were women. The age of the sample ranged from 16-76 years with 60% falling in the 30-49 years age range (mean age 42 years). Median time at GROW is 18months with a range from 1 month to 17 years. The time for which the problem had been present also varied widely (range 0-52 years) with a median of 9 years. Tables 1-3 show the composition of the sample who completed the questionnaires in terms of marital status, education and length of time that they have been attending GROW. In general, the Western Australian sample that responded to the questionnaire is representative of those who were included in a nationwide survey [ 121.The minor variations were not statistically significant.
I Table 2 . Level of education for GROW (WA) and the national GROW sample [12]
i
Level of education
GROW (WA) %
Natlonal Sample %
16 Tertiary Total
1
Table 3 . Attendance time at GROW (WA) compared with a national sample [I21 GROW attendance
4 2 months >12 months >24 months Total
GROW (WA) %
37 23 40 100
Natlonal sample % 48 18 34 100
addition, this measure has also been shown to be sensitive to small changes in psychiatric well-being.
Mental health history Professional assistance had been sought by 8 1% of those attending GROW (WA). Psychiatrists were the group who were consulted by most attenders (54%) followed by general practitioners (4 1%), then psychologists (29%). These figures sum to more than 100% because it was often the case that a number of attenders (24%) had been to see more than one class of professional. Only 48.5% of respondents were aware that their condition had been diagnosed with 42.5% of these claiming that they understood what the diagnosis was. The most common diagnoses given were: various forms of depression (16.8%), nervous tension (7%) and schizophrenia (4%). Finally, 70% of respondents had at some stage used psychotropic medication with 44% currently using drugs. Twelve percent of the sample population reported using multiple drugs. Other drug usage reported was: tricyclic antidepressants (1 2%), benzodiazepines (7%), major tranquillisers (5%) and lithium (2%). Almost a quarter (23%) of the respondents had been on drugs for more than five years and almost half (45.5%) had, at some stage, been hospitalised.
One hundred and sixty seven questionnaires were returned from a total of one hundred and seventy nine
Downloaded from anp.sagepub.com at University of Manitoba Libraries on June 9, 2015
PETER J. SHANNON AND DAVID L. MORRISON
Table 4 . The percentage of males and females in the GROW (WA)and community and GP [7] samples showing minor psychiatric morbidity (caseness)
Sample
Male %
Female %
99
it was found that the male attenders were significantly more likely to suffer MPM (x2=5.45, df=l, p
GROW is a self help group which commenced in Sydney 30 years ago to assist mental patients rehabilitate. Some fear that this is not occurring. This study aimed to assess, by questionnaires, the mental health status of GROW attenders in Western Australia. There was a 93% response rate with demographic variables similar to an earlier Australia-wide survey. Individual scores on the GHQ and a Work, Leisure and Family Life Questionnaire showed a higher level of dysfunction than that in a “normal” population with men, on the average, scoring higher than women. Questions on medical care indicated that between 50-70% of attenders had previously been treated for a nervous condition. It is concluded that GROW is reaching a group of people with significant mental morbidity. Australian and New Zealand Journal of Psychiatry 1990; 24:96-102 In his book, The Third Wave, Alvin Toffler 111 argues we are moving into the post-industrial society. The First Wave people consumed what they produced or caught. They were, according to Toffler, neither producers nor consumers in the usual sense, but “prosumers”, to use his term. In the Second Wave humans moved to an industrial society based on “production for exchange”. Producers and consumers became meaningful terms. We are now moving into an age where there is a rise of “prosumers”. An aspect of this is self-care. People are beginning to do for themselves, or with their fellows, things which professionals did for them previously. Self-help groups are a feature of that phenomenon. Toffler lists as an Australian example the organisation GROW. In its own literature, GROW defines itself as a “voluntary association of people who know they are inadequate or maladjusted to life; who earnestly desire ~
~
Fremantle Hospital, WA Peter J. Shannon, MB, BS, DPM, FRANZCP, Visiting Psychiatnst Department of Psychology, Murdoch University, WA David L. Momson, BA, MA, PhD, Senior Lecturer Correspond with Dr P. Shannon, 32 Holdsworth Street, Fremantle, WA 6160
to improve, and who are helping one another to grow in mental health or personal maturity” [2]. The emphasis is on personal improvement with the aid of their fellows. This fits with Stephen Lock’s definition of a self-help group 131 namely, “A self-help group is a voluntary organisation, usually of peers, who have come together for mutual help and support in satisfying a common need, overcoming a common handicap or life disrupting problem and bringing about desired social or personal change, or both”. GROW developed in Sydney over 30 years ago. It was modelled along lines similar to Alcoholics Anonymous but with a different group of people in mind. Initially called Recovery, a number of former mental patients began meeting together in a mutual help group. Over the years its membership broadened and people now attend for a wide number of reasons. A tenet of GROW is its anonymity. Records of names and personal details are not kept. At GROW, attenders are only asked to identify themselves by a given name. They may give full names and information such as address and telephone numbers to others if they so wish. This lack of formal records is felt to be a strength for the group. It does, however, inhibit the systematic study of the membership and function of the organisation. This study was
Downloaded from anp.sagepub.com at University of Manitoba Libraries on June 9, 2015
PETER J. SHANNON AND DAVID L. MORRISON
set up to learn something of the attenders of GROW in Western Australia and their level of functioning. The development of GROW is parallelled by the evolution of other self-help groups. It has also taken place at a time when there has been emphasis on community care of mental disorders. Long term hospitalisation has been seen as causing institutionalisation with resulting alienation from family and society together with poverty in psychological and economical terms. Thus, community care is to be preferred. Studies have shown that community care, given sufficient resources, can replace hospitalisation for most acute and chronically disabled psychiatric patients [4,5]. These same studies emphasise that the patients continue to have residual impairments at the end of the intensive programme. Further, they reported that if the intensive programme was replaced by a traditional community programme, deterioration occurred and hospitalisation increased. Perhaps self-help groups would be suited to assist community based treatment programmes with these long term problems. Kurtz and Chambon [6] studied three mental health self-help organisations: Recover Inc., Emotions Anonymous and GROW International. They concluded that all three associations provided structured, cognitively based programmes to support individual change, support for coping with life problems, and monitored interactions between group members. Each organisation differed from the others in some aspects. The authors were unable to state if these differences were important for individuals. This interest in the community care of psychiatric patients and the place of self-help groups in it led to undertaking this study. In the study that is reported in this paper, the emphasis was on learning something of the attenders of GROW in Western Australia. In particular, the aim was to learn about the mental health of the attendees. As an aid to doing this, we were able to make use of studies conducted by Finlay-Jones and Burvill [7] and Cooper, Osborn, Gath and Fegetter [8]. The former had contrasted the patterns of minor psychiatric morbidity (MPM) in general practice and community settings, the latter looked at social adjustment as a function of MPM in a community setting. The data from the earlier studies provides a useful benchmark from which to assess the rates of psychiatric morbidity of those attending GROW. A discussion of the interpretational problems associated with this approach is postponed until the discussion section of this paper. As
97
a final point, it should be noted that the present investigation was not designed as an examination of the efficacy of the GROW organisation, but as a first step in the characterisation of those individuals who may use such a group.
Method Subjects With the permission of both the WA Programme Team and the National Management Team of GROW all attenders at GROW groups in Western Australia, during November 1986, were requested to complete and return a questionnaire. This was distributed by group co-ordinators at the weekly meeting and returned via the GROW organisational structure or through the post.
Questionnaire The questionnaire was comprised of several different sections: 1. Demographic items (age, sex, education, marital status). 2. Mental health history (length of time the current problem had been present, whether or not professional assistance had been sought, diagnosis, medication etc.). 3. The 60 item version of the General Health Questionnaire (GHQ) [9] was also included. This is a questionnaire used to detect minor psychiatric illnesses in current mental health. Previous research [ 101has identified subjects as “cases” if scores on the GHQ are greater than 1 1. Using this as a cut-off score has proved to be sensitive and specific at around the 90% level. Since we are interested in patients with long-standing disorders, a modified scoring technique, applied by Goodchild and Duncan-Jones [ 111 was also adopted. Since their method of scoring was designed for the 30-item version of the GHQ only those items were included in the present analysis. Using their technique, caseness is determined by a criterion score greater than 12, the levels of specificity and sensitivity reported in previous research being 80.2% and 84% respectively. 4. Aquestionnaire dealing with disruptions to work, leisure and family life was also included. The questionnaire used in this case was the Social Adjustment Scale (SAS-M) [8]. This instrument has been shown to correlate well with subjects’ concurrent mental state as measured by the GHQ and other instruments. In
Downloaded from anp.sagepub.com at University of Manitoba Libraries on June 9, 2015
WHO GOES TO GROW?
98
GROW attenders at that time. This represented a response rate of 93%.
Table 1 . Age and sex of the WA and national [12] samples Marital status
Demographic variables
i
% composition
Male
Female
Total
%
%
%
Single Married Sep/Div Widowed
27.0 47.0 22.9 2.1
13.7 57.3 20.5 8.5
18 55 21 6
26 45 22 7
Total
100.0
100.0
100
100
National sample%
I
Of the respondents, 72% were women. The age of the sample ranged from 16-76 years with 60% falling in the 30-49 years age range (mean age 42 years). Median time at GROW is 18months with a range from 1 month to 17 years. The time for which the problem had been present also varied widely (range 0-52 years) with a median of 9 years. Tables 1-3 show the composition of the sample who completed the questionnaires in terms of marital status, education and length of time that they have been attending GROW. In general, the Western Australian sample that responded to the questionnaire is representative of those who were included in a nationwide survey [ 121.The minor variations were not statistically significant.
I Table 2 . Level of education for GROW (WA) and the national GROW sample [12]
i
Level of education
GROW (WA) %
Natlonal Sample %
16 Tertiary Total
1
Table 3 . Attendance time at GROW (WA) compared with a national sample [I21 GROW attendance
4 2 months >12 months >24 months Total
GROW (WA) %
37 23 40 100
Natlonal sample % 48 18 34 100
addition, this measure has also been shown to be sensitive to small changes in psychiatric well-being.
Mental health history Professional assistance had been sought by 8 1% of those attending GROW (WA). Psychiatrists were the group who were consulted by most attenders (54%) followed by general practitioners (4 1%), then psychologists (29%). These figures sum to more than 100% because it was often the case that a number of attenders (24%) had been to see more than one class of professional. Only 48.5% of respondents were aware that their condition had been diagnosed with 42.5% of these claiming that they understood what the diagnosis was. The most common diagnoses given were: various forms of depression (16.8%), nervous tension (7%) and schizophrenia (4%). Finally, 70% of respondents had at some stage used psychotropic medication with 44% currently using drugs. Twelve percent of the sample population reported using multiple drugs. Other drug usage reported was: tricyclic antidepressants (1 2%), benzodiazepines (7%), major tranquillisers (5%) and lithium (2%). Almost a quarter (23%) of the respondents had been on drugs for more than five years and almost half (45.5%) had, at some stage, been hospitalised.
One hundred and sixty seven questionnaires were returned from a total of one hundred and seventy nine
Downloaded from anp.sagepub.com at University of Manitoba Libraries on June 9, 2015
PETER J. SHANNON AND DAVID L. MORRISON
Table 4 . The percentage of males and females in the GROW (WA)and community and GP [7] samples showing minor psychiatric morbidity (caseness)
Sample
Male %
Female %
99
it was found that the male attenders were significantly more likely to suffer MPM (x2=5.45, df=l, p
