Improving Mental Health through Social Support: Building positive and Empowering Relationships

Citation

Julie Repper (2015), "Improving Mental Health through Social Support: Building positive and Empowering Relationships", Mental Health and Social Inclusion, Vol. 19 No. 2, pp. 102-104. https://doi.org/10.1108/MHSI-03-2015-0009

Whether we work in mental health services or struggle with our own mental health – or that of a family member – we are all aware of the importance of friends and the challenges of making and keeping friends in times of distress. In our practice we are so often challenged by people who say “I just want a girl/boyfriend” or “I can’t go out and do stuff because I don’t want to do it on my own […]”. Family members tell us that they are worried that this person spends all their time alone, does not go anywhere to make friends, refuses to contact old friends or go out. And for myself, I know that at my lowest, I find it difficult to call on friends because I do not want to burden them, I cannot imagine why anyone would want to see me. I have not the capacity to listen to them and I know that I will either speak obsessively about my own feelings or I would not have the energy to even talk.

Friends are important, they can offer emotional support, practical help, advice, understanding – and helping us to achieve understanding – of what is going on, they help us to define ourselves, our value and our identity, they connect us with other activities, opportunities, roles and relationships. Indeed it is increasingly recognised that loneliness and isolation carry a mortality risk greater than that of obesity and physical inactivity and on a par with smoking (Holt-Lunstad et al., 2010). In 2004, Mind reported that 84 per cent of respondents who had used mental health services in the UK felt isolated compared with 29 per cent of the general population. Data from the Office for Disability Issues (2013) shows that people facing mental health challenges are more socially isolated than any other group of disabled people.

With these challenges in mind, I was delighted to receive a book on improving mental health through social support and more than willing to review it. Jonathon Leach was inspired to explore everyday support for people “disadvantaged by their experience of mental health problems” by his experience of working alongside such folk over ten years teaching horticultural skills in a voluntary sector organisation. He recognised the inadequacy of medical and psychological approaches to explain or guide the development of positive and empowering relationships outside services. He brings an accessible sociological approach to develop a broad and human(e) understanding of the formal and informal “social support that arises out of the network of friends, family and acquaintances such as neighbours and work colleagues, surrounding an individual”.

The book provides a comprehensive analysis of the interactions between mental health problems and social relationships. It articulates the cyclical effect of self-stigmatisation combined with the cognitive and emotional effects of mental health problems on the individuals’ behaviour in relation to others who are also influenced by their pre-conceptions of mental illness and their experiences of relationships with others who have mental health problems. These dynamics can both impair the reciprocal nature of relationships and it can erode the pattern of friendships so that they are displaced or neglected and all too quickly fade away.

Leach draws on the personal accounts of people with mental health problems to illustrate the meaning, nature and value of friendships, the need for altruism at times and the two way benefits of relationships even when one party is at their most distressed and might appear to give no return. (Although I initially baulked at the notion of “one way” friendships, I can see that there may be times when it feels this way – to both people involved.) He demonstrates the importance of social support in every domain of our lives – family, work, education and in communities and goes on to define ways in which social support can be offered and accepted in these domains.

This is a helpful, informative and timely book. However, there are some aspects of social support that are glossed over. Although Leach acknowledges the shortcomings of relationships that are over prescriptive or offer unwelcome or inaccurate advice, I wonder whether evidence of unhelpful social support, damaging relationships and the value of isolation needs to be included. I also feel that the barriers facing professionals in promoting, facilitating and supporting social relationships need to be explored and debated further. Hitherto, professionals have been wary of connecting people with shared interests, common goals and ambitions in case they bring additional burden and stress for each other (implicitly by virtue of having mental health problems). Fear of breaching confidentiality lies at the core of this. If we introduce two people who appear to have similar wishes and could potentially benefit from company in, for example joining a club, going to the cinema or doing an activity together then where do we stand if the relationships turns out to be exploitative or damaging?

However, we now have much greater opportunity to support the development of friendships and the social support borne out of community integration for those with whom we work. Leach describes the potential benefits of social prescribing in primary care (enabling people to join social groups, clubs and activities of their choice); of personal health budgets and self-directed care. He could go much further than this.

As we have seen from papers published in this journal, there are increasing examples of people using mental health services to form peer led, peer run communities, networks and movements and access community activities. “Recovery Rocks” in Western Australia (Waegeli, 2014) fosters recovery within a peer community and “Prosper” in South London (Barrett et al., 2014) offers a self-directed network and movement of over 150 people that is continuously influenced and changed by the skills and energy of its members. Creative Minds in South Yorkshire (Walters, 2015) develops community partnerships and co-funds creative projects designed to provide supportive, creative opportunities in communities that enable people to reach their potential and live well in those communities. These are part of a larger social movement in which people with mental health problems are actively creating opportunities for themselves, with others who share similar experiences, to do the things they want to do in their own communities (geographical, cultural, with common interests, backgrounds and ambitions). Whilst these may begin with a strong focus on peer support amongst those with mental health problems, there is clearly evidence that they lead on to extending networks, friendships, valued roles and identities alongside others with similar interests and goals – rather than similar backgrounds and past experiences.

Added to this, the development of Recovery Colleges (Perkins et al., 2012), where people can learn with and from each other about their own conditions and ways in which they can move on, has led to the overwhelming finding that the main benefit is not so much what they learn about their condition, but about how they perceive themselves, their potential and their value. They develop lasting friendships with fellow students – based on shared experiences, shared interests and shared ambition, just as anyone else would when they attend college. And these relationships take them into the world beyond mental health services, achieving recovery together.

So whilst I recommend this book to everyone working in mental health services because it really does provide a convincing account of the importance and benefits of social support. I would suggest that they go further and foster opportunities for people with shared experiences, challenges and ambitions and interests to meet and trust them to be able to manage these relationships. I would also advise them to seriously consider how they facilitate social support by considering all of the opportunities available in their locality – not just those connected with services, work and education.

And one last word. A new tool has been developed by the McPIN Foundation to map individuals’ social networks and identify their contacts in terms of their value (Pinfold and Sweet, 2015). This provides guidance on how to support a person to build on their positive connections. It may well be worth introducing this within community mental health teams to make the social support of people using the service something that is everybody’s business.