Psychoeducation and Problem-Solving Therapy as an Integrative Model of Mutual-Help Groups for People with Severe Mental Disorders: A Report from Brazil

  • Leonardo PalmeiraEmail author
  • Alexandre Keusen
  • Elias Carim
  • Silvana Barreto
  • Olga Leão
  • Maria T. Cavalcanti
Original Paper


This case study describes the “Entrelaços” Peer Support Program, a psychoeducational program of a psychiatric institution in the city of Rio de Janeiro that admitted, between 2011 and 2019, 246 people comprising family members and patients to participate in eight educational seminars followed by multifamily problem-solving groups in cycles that were 18 months in duration. Ninety percent of the participants who completed the program decided to create 7 mutual-help groups in the community independent of technicians and the institution. Community groups have already served spontaneously more than 214 families. They have organized scientific, social and anti-stigma events, expanded their social support network and demonstrated empowerment by switching from service users to peer providers to receive new families. This work is based on a pioneering model in Brazil that integrates psychoeducation with problem-solving therapy, spreading the benefits of education and peer-support with lower cost and greater representativeness.


Recovery Peer-support Psychoeducation Problem-solving therapy Mental health 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Alves, T. C., Oliveira, W. F. D., & Vasconcelos, E. M. (2013). A visão de usuários, familiares e profissionais acerca do empoderamento em saúde mental. Physis: Revista de Saúde Coletiva,23, 51–71. Scholar
  2. Anthony, W. A., & Liberman, R. P. (1986). The practice of psychiatric rehabilitation: Historical, conceptual, and research base. Schizophrenia Bulletin,12(4), 542–559. Scholar
  3. Bellack, A. S. (2006). Scientific and consumer models of recovery in schizophrenia: Concordance, contrasts, and implications. Schizophrenia Bulletin,32(3), 432–442. Scholar
  4. BRASIL. (2010). Sistema único de saúde, conselho nacional de saúde, comissão organizadora da IV conferência nacional de saúde mental. Relatório final da IV conferência nacional de saúde mental—Intersetorial, 27 Jun a 01 Jul 2010. In IV conferência nacional de saúde mental (p. 210).Google Scholar
  5. Burbach, F. R. (1996). Family based interventions in psychosis—An overview of, and comparison between, family therapy and family management approaches. Journal of Mental Health,5(2), 111–134. Scholar
  6. Carkhuff, R. R. (1972). New directions in training for the helping professions: Toward a technology for human and community resource development. The Counseling Psychologist,3(3), 12–30. Scholar
  7. D’Zurilla, T., Nezu, A., & Maydeu-Olivares, A. (2009). Social problem solving: Theory and assessment. In E. C. Chang, T. J. Zurilla, & L. J. Sanna (Eds.), Social problem solving: Theory, research, and training (pp. 11–27). Washington, DC: APA.Google Scholar
  8. Davidson, L., Bellamy, C., Guy, K., & Miller, R. (2012). Peer support among persons with severe mental illnesses: A review of evidence and experience. World Psychiatry,11(2), 123–128. Scholar
  9. Davidson, L., Schmutte, T., Dinzeo, T., & Andres-Hyman, R. (2008). Remission and recovery in schizophrenia: Practitioner and patient perspectives. Schizophrenia Bulletin,34(1), 5–8. Scholar
  10. de Miranda, A. M. P., Pimentel, F. D. A., & Villares, C. C. (2014). Anjos de uma asa só: Processos de superação na esquizofrenia em um grupo de ajuda mútua. Nova Perspectiva Sistêmica,23(48), 64–79.Google Scholar
  11. Deegan, P. E., & Drake, R. E. (2006). Shared decision making and medication management in the recovery process. Psychiatric Services,57(11), 1636–1639. Scholar
  12. Delgado, P. G. (2014). Sobrecarga do cuidado, solidariedade e estratégia de lida na experiência de familiares de centros de atenção psicossocial. Physis: Revista de Saúde Coletiva,24(4), 1103–1126. Scholar
  13. Dixon, L., Lyles, A., Scott, J., Lehman, A., Postrado, L., Goldman, H., et al. (1999). Services to families of adults with schizophrenia: From treatment recommendations to dissemination. Psychiatric Services,50(2), 233–238. Scholar
  14. Falloon, I. R. H., Boyd, J. L., McGill, C. W., Razani, J., Moss, H. B., & Gilderman, A. M. (1982). Family management in the prevention of exacerbations of schizophrenia. New England Journal of Medicine,306(24), 1437–1440. Scholar
  15. Farhall, J., Harvey, C., Kazantzis, N., King, R., Meadows, G. N., O’Hanlon, B., et al. (2012). Psychological therapies. In G. Meadows, J. Farhall, E. Fossey, M. Grigg, F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (pp. 468–501). New York: Oxford University Press.Google Scholar
  16. Frey, W. (1984). Functional assessment in the 8Cs: A conceptual enigma, a technical challenge. In A. Halpern & M. Fuhrer (Eds.), Functional assessment in rehabilitation (pp. 11–43). New York: Paul H Brookes Pub Co.Google Scholar
  17. Gartner, A. (1984). The self-help revolution. New York: Human Science Press.Google Scholar
  18. Haley, J. (1987). Introduction: Problem-solving therapy. In J. Haley (Ed.), Problem-solving therapy (pp. 1–7). San Francisco, CA: Jossey-Bass.Google Scholar
  19. Helgeson, V., & Gottlieb, B. (2000). Support groups. In S. Cohen, L. Underwood, & B. Gottlieb (Eds.), Social support measurement and intervention: A guide for health and social scientists (pp. 221–245). New York: Oxford University Press.CrossRefGoogle Scholar
  20. Keusen, A., Palmeira, L., Leão, O., Neto, E., & Barreto, S. (2018). “Entrelaços” program: Building a peer network in the community of Rio de Janeiro. In XIII WAPR world congress. Madrid.Google Scholar
  21. Lawn, S., Smith, A., & Hunter, K. (2008). Mental health peer support for hospital avoidance and early discharge: An Australian example of consumer driven and operated service. Journal of Mental Health,17(5), 498–508. Scholar
  22. Leão, O., Palmeira, L., Neto, E. C., Barreto, S., & Keusen, A. (2018). “Entrelaços” program: The experience of peer group coordinators in the community of Rio de Janeiro. In XIII WAPR world congress. Madrid.Google Scholar
  23. Lloyd-Evans, B., Mayo-Wilson, E., Harrison, B., Istead, H., Brown, E., Pilling, S., et al. (2014). A systematic review and meta-analysis of randomised controlled trials of peer support for people with severe mental illness. BMC Psychiatry,14(1), 39. Scholar
  24. McFarlane, W. R., Dixon, L., Lukens, E., & Lucksted, A. (2003). Family psychoeducation and schizophrenia: A review of the literature. Journal of Marital and Family Therapy,29(2), 223–245. Scholar
  25. Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical perspective. Psychiatric Rehabilitation Journal,25(2), 134–141. Scholar
  26. Miyamoto, Y., & Sono, T. (2012). Lessons from peer support among individuals with mental health difficulties: A review of the literature. Clinical Practice & Epidemiology in Mental Health,8(1), 22–29. Scholar
  27. Mowbray, C. T., Moxley, D. P., & Collins, M. E. (1998). Consumers as mental health providers: First-person accounts of benefits and limitations. The Journal of Behavioral Health Services & Research,25(4), 397–411. Scholar
  28. Nezu, A., Nezu, C., & D’Zurilla, T. (2013). Problem-solving therapy: A treatment manual. New York: Springer.Google Scholar
  29. Palmeira, L., Leão, O., Neto, E. C., Barreto, S., & Keusen, A. (2018). Qualitative study on the recovery journey of peers affected by severe mental illness: The experience from the “Entrelaços” peer support program, Rio de Janeiro. In XIII WAPR world congress. Madrid.Google Scholar
  30. Pistrang, N., Barker, C., & Humphreys, K. (2008). Mutual help groups for mental health problems: A review of effectiveness studies. American Journal of Community Psychology,42(1–2), 110–121. Scholar
  31. Pitschel-Walz, G., Leucht, S., Bauml, J., Kissling, W., & Engel, R. R. (2001). The effect of family interventions on relapse and rehospitalization in schizophrenia—A meta-analysis. Schizophrenia Bulletin,27(1), 73–92. Scholar
  32. Presotto, R. F., Silveira, M., Delgado, P. G. G., & Vasconcelos, E. M. (2013). Experiências brasileiras sobre participação de usuários e familiares na pesquisa em saúde mental. Ciência & Saúde Coletiva,18, 2837–2845. Scholar
  33. Rowe, M., Bellamy, C., Baranoski, M., Wieland, M., O’Connell, M. J., Benedict, P., et al. (2007). A peer-support, group intervention to reduce substance use and criminality among persons with severe mental illness. Psychiatric Services,58(7), 955–961. Scholar
  34. Rummel-Kluge, C., Pitschel-Walz, G., Bäuml, J., & Kissling, W. (2006). Psychoeducation in schizophrenia—Results of a survey of all psychiatric institutions in Germany, Austria, and Switzerland. Schizophrenia Bulletin,32(4), 765–775. Scholar
  35. Salzer, M. S. (2002). Consumer-delivered services as a best practice in mental health care delivery and the development of practice guidelines. Psychiatric Rehabilitation Skills,6(3), 355–382. Scholar
  36. Salzer, M. S., & Shear, S. L. (2002). Identifying consumer-provider benefits in evaluations of consumer-delivered services. Psychiatric Rehabilitation Journal,25(3), 281–288. Scholar
  37. Segal, S. P., Gomory, T., & Silverman, C. J. (1998). Health status of homeless and marginally housed users of mental health self-help agencies. Health and Social Work,23(1), 45–52. Scholar
  38. Solomon, P. (2004). Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal,27(4), 392–401. Scholar
  39. Solomon, P., & Draine, J. (1995). The efficacy of a consumer case management team: 2-year outcomes of a randomized trial. The Journal of Mental Health Administration,22(2), 135–146. Scholar
  40. Vasconcelos, E. M. (2013). Empoderamento de usuários e familiares em saúde mental e em pesquisa avaliativa/interventiva: Uma breve comparação entre a tradição anglo-saxônica e a experiência Brasileira. Ciência & Saúde Coletiva,18, 2825–2835. Scholar
  41. Villares, C. (2015). Comunidade de Fala—Contando histórias de superação nos transtornos mentais. Nova Perspectiva Sistêmica,53, 120–124.Google Scholar
  42. Weingarten, R. (2017). Empowering the voice of the users. Cadernos Brasileiros de Saúde Mental,9(21), 146–157.Google Scholar
  43. Wexler, B., Davidson, L., Styron, T., & Strauss, J. (2008). Severe and persistent mental illness. In S. Jacobs & E. Griffith (Eds.), 40 years of academic public psychiatry (pp. 1–20). London: Wiley.Google Scholar
  44. Wood, P. H. (1980). Appreciating the consequences of disease: The international classification of impairments, disabilities, and handicaps. WHO Chronicle,34(10), 376–380.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Entrelaços Program, Institute of PsychiatryFederal University of Rio de JaneiroRio de JaneiroBrazil

Personalised recommendations