The Important Role of Mental Health Social Support

The mental health social supporter’s roles and responsibilities that you have identified in our previous article may be only a part of the full role. When providing social support it is also critically important to understand how your support may effectively be delivered in a community which includes professional counselling, medical services, and other care and support systems.

The mental health social supporter as a resource to the professional

How can professional and “natural” support systems collaborate with one another? One study noted that people get lots of help for personal mental-health-linked problems but not all of it from mental health professionals. Rather, people may turn to those “helping agents” with whom they have contact in everyday lives (such as the community caregiver and friends, for example).

Because informal helping networks work so well to reduce and even prevent problems, it is useful to consider opportunities for the exchange of resources between them — mental health social supporters — and professionals. It is clear that social supporters can work effectively as “complements” to formal treatment services (Gottlieb and Schroter, 1978). What follows are some specific ways that the mental health social supporter can assist the professional.

Inform and advise health systems about services: Mental health social supporters are usually local people who can inform and advise health agencies about the effective delivery of human services. For example, let’s say you are supporting someone who is caring for her mother and you know that once a month the mother is scheduled to see a psychiatrist who works some distance away. Once you realise that this requires multiple changes of public transport (meaning all-day travel), you may be able to help the daughter access closer psychiatric support for the mother.

Strengthen professional practice: Mental health social supporters may be able to help strengthen professional practice. By making their helping acts visible and transparent, mental health social supporters can help professionals recognise and utilise the existing resources in the helpee’s social network (Clifford, 1976; Gottlieb, 1978).

Support compliance with prescribed treatment regimens: Mental health social supporters either are a care recipient’s principal helper (e.g. a daughter caring for her mother), or possibly they are a support person for that principal helper. At either “level” of aid, the mental health social supporter can ensure that any prescribed treatments are being followed and provide support to assist in the implementation of prescribed treatment regimens. Mental health social supporters can help to lower the stress for carers in the situation of being the primary caregiver.

Design and implementation of health care and social service delivery systems: Mental health social supporters may have acquired knowledge of gaps in health care delivery (Gottlieb and Schroter, 1978). As such they may be able to influence the urban planning process by having input into submissions dealing with the provision of health care and social services.

The Professional as a resource to the natural support system

What can professionals do to assist mental health social supporters?

Referrals to professionals: Because helpees already trust the mental health social supporter, he/she can, when appropriate, play a key role in the helpee seeing or accepting the need for more professional assistance. Such assistance may be in the areas of individual, couples or family counselling; financial counselling and budgeting; or social work services. The more that the mental health social supporter knows about which professional services are available, the better he/she is able to promote the helpee’s access to appropriate help.

Referral will often be the most constructive form of support that a mental health social supporter can deliver to a helpee experiencing or causing emotional or behavioural distress (in fact, a failure to refer when referral is indicated by the helpee’s mood, thoughts or behaviour would be a significant breach of the social supporter’s duty of care). Delaying referral likewise can interfere with the helpee’s right to timely assistance, and can result in less positive treatment outcomes (Luborsky, Auerbach, Chandler, and Cohen, 1971).

Professionals can update mental health social supporters about resources available: Since improving the accuracy and timeliness of referrals that mental health social supporterscould make is in the interest of professionals as well as their clients, it may be a win-win situation for supporters to periodically ask professionals in their area for updates about resources available, from modes of practice to fee schedules. The professionals will thank them, but the person turning to them for help can be grateful, too. The knowledge and information at the outset may help the care recipient to have a more realistic set of expectations about what professional help can accomplish. That may help to keep them in programs when the going gets tough.

Professionals can establish or broaden the helpee’s treatment plan: Professionals know that having personal support often helps a person to remain with a treatment plan, or even extend it. Personal support in this instance may entail being an empathetic listener for a victim of abuse or providing transport to therapy sessions, such as group-work relating to alcohol, abusive relationships, or compulsive gambling. The mental health social supporter’s local knowledge of resources can help turn the professional practitioner’s treatment plan for the helpee into actual access to appropriate services, such as access to a woman’s refuge shelter, or to employment skills training programs.

Professionals can help mental health social supporters reduce environmental stress: Professional practitioners such as social workers may be able to assist a mental health social supporter to recognise and address environmental stressors present in a helpee’s living environment. Aiders may be aware of social issues that their helpee is grappling with.

Mental Health Social Support: is there a downside?

Is there a downside to providing Mental Health Social Support? Do either the givers or the receivers of support experience ill effects? How might social support services do harm?

Conflicted support relationships: “Supportive relationships” are not always beneficial, as they may be a source of conflict as well. An elderly spouse supporting a partner with dementia or brain injury, or parents caring for an adult who is mentally retarded are likely to experience episodes of real frustration and distress that affects their own and their dependent’s quality of life. The active involvement of social service agencies in the caregivers’ daily lives, issues of privacy and confidentiality, and the adequacy of financial support all impact on the emotional and physical resources of those at the “sharp end” of care.

Dysfunctional behaviours may develop, such as “patients” placing excessive demands on caregivers’ time (over-dependence). Caregivers may begin to neglect or to bully those whom they have previously treated with the utmost of respect (Chu et al, 2010). The mental health social supporter must have regard not just for the wellbeing of the “patient” but for the well-being and quality of life of the primary caregiver as well.

Dismissive, unsupportive help: Some research has shown how, when attempting to share about the witnessing or experience of violence, victims have received dismissive or unsupportive comments from a supposed “helper”.  This situation has created what is called “social constraint” in the victim. That is, the response of the discloser (the victim) to poor quality support was to feel that they should keep their trauma-related thoughts to themselves. But doing that makes it hard for victims to move on from the trauma. For example, they may avoid thinking about or discussing the trauma. This may reduce opportunities for them to make sense of stressful experiences. Thus, while appropriate social support helps to reduce symptoms of depression after exposure to violence, ineffective “support” may increase the effects of trauma (Kaynak, et al 2011).

Competition instead of collaboration: Social support systems can misfire when roles and responsibilities are not clear between mental health social supporters and the professionals with whom they must deal. It would be unhelpful for a mental health social supporter to try to imitate a professional style of helping with their helpee. Too, there is the danger of professional and informal helping systems trying to limit one another’s influence, or competing for the same resources. Mental Health Social Support works best when it is complementary to professional support systems, and works in direct collaboration with them (Gottlieb and Schroter, 1978).

In summary, mental health social supporters are an effective way of addressing the problem of insufficient professional resources in the community. Many mental health social supporters work beyond the 9-to-5 limits set by professional practitioners, and they may continue to see and support their helpees after the helpees’ initial presenting problems have been addressed (Becker, et al, 2004). It is a matter of trust, sense of duty, and even friendship that the mental health social supporter may bring to the situation.

Recognising symptoms of distress

How do you know when someone could use your help? This section includes two types of indicators which may be helpful to mental health social supporters in making a decision to approach a person with offers of support regarding their concerns. The first indicators are the observable aspects of a person (mostly, the non-verbal and physical aspects). The second class of indicators includes those of mood, anxiety, and ability to control impulses. Together these provide a reasonable indication of how severe a helpee’s needs may be. It is important to bear in mind, however, that some people are highly skilled at masking their emotions, acting as though they are coping, when actually they are not.

It is vital when evaluating needs based on these indicators to assess whether the needs can be safely met at the Mental Health Social Support level, or whether the distressed person — the potential helpee — should be referred to a general practitioner or other specialised person. Overconfidence on the part of the mental health social supporter, leading to a failure to refer, can have damaging outcomes for the helpee, with subsequent consequences for the mental health social supporter (Gilbert, Allan, Nicholls and Olsen, 2005).

Is Mental Health Social Support needed?

The first question is: does the person that mental health social supporter is observing need their assistance? The mental health social supporter may be a person with high empathy. People who have what are commonly called “people skills” – that is, empathy – are often very competent at recognising signs of distress in others. But it is useful to discern whether it is true empathy, or merely sympathy.

Sympathy, which is about feeling sorry for another person, can interfere with the goal of providing the helpee with the right assistance, at the right time, in the right way, by the right helper. Empathy, on the other hand, refers to the more complex skill of “seeing the world through the eyes of the other person”. It is a necessary skill for effective Mental Health Social Support, whereas sympathy is less useful.

If the mental health social supporter can describe the person they are observing in a way that would allow a third party who has not met the person to understand what is happening for them, they are likely to be most accurate, and thus most helpful, with minimal distraction from “sympathy”. An empathetic and discerning observation is likely to yield the most appropriate course of action. With that in mind, here is the first group of aspects for a mental health social supporter to recognise:

Speech: What is the person’s tone of voice: calm or anxious, stressed or subdued? Is there anything about the person’s speech that suggests distress or depression: a lack of clarity in speech, general disinterest, or agitation or anxiety?

Clothing: If the person is known to the mental health social supporter, have there been any changes in the way of dressing, the clothing chosen, or its appropriateness to the present situation? Is the clothing “out-of-character” for this person?

For a new acquaintance, what impression does the social supporter form of this person’s present state of mind, as suggested by their dress? Is the person merely “different” – perhaps just eccentric – or might there be more to it? As with all the indicators mentioned in this section, being mindful of judging others by your one’s standards is vital. A homeless person is unlikely to observe the prevailing social standards of appearance and dress, and yet the person may be quite well adjusted.

Body, posture, and way of walking: What can the social supporter reasonably detect from the person’s stance and movement? How do they walk – with confidence, or in a way that indicates a lack of energy or drive?

Bodily movements: Is there fidgeting, restlessness or agitation? Is there a lack of animation, and apparent lethargy?

Facial expressions: What is their eye contact like? Is the social supporter’s gaze returned? Is the person’s gaze averted, or eye contact avoided? Is there noticeable disinterest? Is there an indication in facial expressions of emotions being suppressed?

Feeling in the social supporter: Perhaps the social supporter notices that they feel somewhat depressed in this person’s company. These emotions may be the social supporter’s own, but on the other hand this person may trigger this reaction in others as well, meaning that what is happening (feelings) could be a clue to problems in the person’s relational style (adapted from Young, 2005).

General impressions: Is this person in touch with reality? Are they aware of their surroundings, time of day, and the weather? Are there difficulties with memory, attention, or concentration (Young, 2005)?

Mental and emotional symptoms of distress

Mental health problems, including depression and anxiety disorders, appear to be on the increase (Fombonne, 1999). There is evidence that fewer than 14 percent of people with disorders are receiving treatment for them (Bebbington, Brugha, Meltzer, Jenkins, Ceresa, Farrell, and Lewis, 2000). Mental problems get worse over time, yet communities are struggling to cope with the current level of problems (Bebbington, et al, 2000).

The checklist below, adapted from the Adult Psychological Symptoms Checklist (Gilbert et al, 2005) describes the major mental and emotional symptoms of un-wellness of individuals who are well enough to reside in the community (as opposed to in an institution).

Anxiety symptoms:

• Specific fears (e.g., of animals, heights, thunderstorms)
• Feelings of intense fear coming “out of the blue”, possibly with racing heart, difficulty breathing, and thoughts that something bad will happen soon
• Fear of going out of the house
• Feelings of un-realness, as if watching one’s life as a film
• Worry that there is something wrong with one’s body and needing constant reassurance that there is not a physical illness
• Generalised feelings of anxiety, but not being certain of the cause of the anxiety
• Repetitive thoughts, images, or ideas coming into the mind which are frightening and hard to dismiss
• A compulsion to check things or clean repetitively because of fear about something happening
• Anxiety that important people in one’s life might leave
• Avoidance of situations because of fear about what others may think or feel about one
• Fears that certain people are out to harm one in some way
• Difficulty getting over a major event in one’s life, and images of the event coming to mind again and again

Mood symptoms:

• Losing the ability to enjoy or take interest in things going on around, as if life has become empty
• Feeling tired with little energy
• Losing sleep or sleeping poorly
• Suffering from various aches and pains in the body and generally feeling that one is not right physically
• Having sexual difficulties or worries
• Feeling like life is hopeless and that that is unlikely to change in the future
• Being in a state of grief from the loss or death of someone close
• Suffering from change in mood since having a baby
• Feeling so excited for no obvious reason that one cannot sleep, and so brimming with ideas that one can hardly focus
• Mood changing for no reason: some days are good, but other days are terrible
• Mood change strongly at certain times of the month
• Suicidal thoughts: feeling like ending it all

Impulse control symptoms:

• Anorexia: dieting because of fear of gaining weight, and keeping weight well below what it should be
• Bulimia: binge eating until it is not possible to eat any more
• Vomiting: vomiting to get rid of food which has been eaten
• Laxative use: using laxatives to avoid putting on weight
• Using any non-prescribed drugs to induce various feelings or states of mind
• Finding difficulty going more than a day or two without alcohol
• Deliberately hurting oneself
• Finding it difficult to control one’s temper and lashing out
• Feeling like one is boiling up inside with anger, but being unable to express it
• Impulsively doing things that one later regrets

Supporters should keep the above examples of symptoms in mind while thinking about whether a person might need Mental Health Social Support. Some people compensate for their symptoms and cope to their own satisfaction, whereas others do not.

Mental Health Social Support is a broad-based way of helping those who may need mental, emotional, or social support; receiving it is highly correlated to wellbeing. It is offered in myriad situations in communities around the world, and there are many roles a mental health social supporter can take up. It is important to be able to recognise the symptoms in someone that signal distress, in order to assess whether support should be offered, and to be able to work out who is best trained to offer the help.

It is also important to understand that Mental Health Social Support may not have a positive impact if it is offered in a dismissive, judging way, or by someone who is either in conflict with the helpee, or in competition with other helpers.

Get MHSS Certified and help others in your community: www.mhss.net.au/lz

References:

1. Bebbington, P.E., Brugha, T.S., Meltzer, H., Jenkins, R., Ceresa, C., Farrell, M., & Lewis, G. (2000). Neurotic disorders and the receipt of psychiatric treatment. Psychological Medicine, 30, 1369—1376.
2. Chu, P.S., Saucier, D.I., and Hafner, E. (2010). Journal of Social and Clinical Psychology, 29 (6), pp. 624-645.
3. Clifford, D. L. (1976). A comparative study of helping patterns in eight urban communities (Doctoral dissertation, University of Michigan, Dissertation Abstracts International, 1976, 37, 1838A. (University Microfilms No. 76-19,108), in Gottlieb, B., and Schroter, C. (1978). Professional Psychology, American Psychological Association, Inc., 614. Retrieved from: 0033- 0175/78/0904-0614S00.75.
4. Gilbert, P., Allan, S., Nicholls, W., and Olsen, K. (2005). The assessment of psychological symptoms of patients referred to community mental health teams: Distress, chronicity and life interference. Clinical Psychology and Psychotherapy. 12, 10-27.
5. Mental Health Social Support Student Workbook 20-21, www.mhss.net.au.
6. Gottlieb, B., and Schroter, C. (1978). Professional Psychology, American Psychological Association, Inc., 614. Sourced from: 0033-0175/78/0904-0614S00.75.
7. Gottlieb, B. H. (1978). The development and application of a classification scheme of informal helping behaviors. Canadian Journal of Behavioural Science, 10, 105-115, in Gottlieb, B., and Schroter, C, November (1978). Professional Psychology, American Psychological Association, Inc., 614. Retrieved from: 0033-0175/78/0904-0614S00.75.
8. Luborsky, W., Auerbach, A. H., Chandler, H., & Cohen, J. (1971). Factors influencing the outcome of psychotherapy: A review of quantitative research. Psychological Bulletin, 75, 145- 185, in Gottlieb, B., and Schroter, C, (1978), Professional Psychology, American Psychological Association, Inc., 614. Retrieved from: 0033-0175/78/0904-0614S00.75.
9. Young, M. (2005). Learning the art of helping: building blocks and techniques. New Jersey: Pearson/Merrill Prentice Hall.