Abstract
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.
Similar content being viewed by others
References
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. https://doi.org/10.1590/S0103-73312013000100004.
Anthony, W. A., & Liberman, R. P. (1986). The practice of psychiatric rehabilitation: Historical, conceptual, and research base. Schizophrenia Bulletin,12(4), 542–559. https://doi.org/10.1093/schbul/12.4.542.
Bellack, A. S. (2006). Scientific and consumer models of recovery in schizophrenia: Concordance, contrasts, and implications. Schizophrenia Bulletin,32(3), 432–442. https://doi.org/10.1093/schbul/sbj044.
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).
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. https://doi.org/10.1080/09638239650037018.
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. https://doi.org/10.1177/001100007200300303.
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.
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. https://doi.org/10.1016/j.wpsyc.2012.05.009.
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. https://doi.org/10.1093/schbul/sbm122.
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.
Deegan, P. E., & Drake, R. E. (2006). Shared decision making and medication management in the recovery process. Psychiatric Services,57(11), 1636–1639. https://doi.org/10.1176/ps.2006.57.11.1636.
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. https://doi.org/10.1590/s0103-73312014000400007.
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. https://doi.org/10.1176/ps.50.2.233.
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. https://doi.org/10.1056/nejm198206173062401.
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.
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.
Gartner, A. (1984). The self-help revolution. New York: Human Science Press.
Haley, J. (1987). Introduction: Problem-solving therapy. In J. Haley (Ed.), Problem-solving therapy (pp. 1–7). San Francisco, CA: Jossey-Bass.
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.
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.
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. https://doi.org/10.1080/09638230701530242.
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.
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. https://doi.org/10.1186/1471-244x-14-39.
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. https://doi.org/10.1111/j.1752-0606.2003.tb01202.x.
Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical perspective. Psychiatric Rehabilitation Journal,25(2), 134–141. https://doi.org/10.1037/h0095032.
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. https://doi.org/10.2174/1745017901208010022.
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. https://doi.org/10.1007/bf02287510.
Nezu, A., Nezu, C., & D’Zurilla, T. (2013). Problem-solving therapy: A treatment manual. New York: Springer.
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.
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. https://doi.org/10.1007/s10464-008-9181-0.
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. https://doi.org/10.1093/oxfordjournals.schbul.a006861.
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. https://doi.org/10.1590/S1413-81232013001000008.
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. https://doi.org/10.1176/ps.2007.58.7.955.
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. https://doi.org/10.1093/schbul/sbl006.
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. https://doi.org/10.1080/10973430208408443.
Salzer, M. S., & Shear, S. L. (2002). Identifying consumer-provider benefits in evaluations of consumer-delivered services. Psychiatric Rehabilitation Journal,25(3), 281–288. https://doi.org/10.1037/h0095014.
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. https://doi.org/10.1093/hsw/23.1.45.
Solomon, P. (2004). Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal,27(4), 392–401. https://doi.org/10.2975/27.2004.392.401.
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. https://doi.org/10.1007/bf02518754.
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. https://doi.org/10.1590/S1413-81232013001000007.
Villares, C. (2015). Comunidade de Fala—Contando histórias de superação nos transtornos mentais. Nova Perspectiva Sistêmica,53, 120–124.
Weingarten, R. (2017). Empowering the voice of the users. Cadernos Brasileiros de Saúde Mental,9(21), 146–157.
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.
Wood, P. H. (1980). Appreciating the consequences of disease: The international classification of impairments, disabilities, and handicaps. WHO Chronicle,34(10), 376–380.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Palmeira, L., Keusen, A., Carim, E. et al. Psychoeducation and Problem-Solving Therapy as an Integrative Model of Mutual-Help Groups for People with Severe Mental Disorders: A Report from Brazil. Community Ment Health J 56, 489–497 (2020). https://doi.org/10.1007/s10597-019-00505-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-019-00505-6