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What is Mental Health Social Support (MHSS)? As well as the everyday stresses in life, there are natural and accidental disasters with which we are all familiar. The 2011 Queensland floods, for example, directly affected many thousands, and more than 62,000 people registered to assist with the clean-up in Brisbane’s worst-affected suburbs. These volunteers and many others throughout Queensland, other states of Australia, and elsewhere offered support, compassion, encouragement, and guidance where it was needed. Support for those affected psychologically came from mental health workers co-ordinated by local and state government leaders. Whether major or minor, disasters inevitably cause direct trauma to victims, but also affect those near them. Much like an iceberg, the impacts of tragedy are clearly evident at one level, but may be less evident -- yet just as traumatic -- at another, “below the surface”, level. Thus, just as there is support at the visible, public level, there is also support needed at the less public, less visible level. Often this is where the supportive work of ordinary citizens takes place. The support person may be a neighbour, a relative or friend, the local hairdresser, a caring taxi-driver, or the local librarian. All of these and others, whether knowingly or just instinctively, may have provided Mental Health Social Support to people who require it. Perhaps you have found yourself in a situation among distressed people where you are asked to provide help, or you may see that help is needed, but you are not quite sure how to offer it. Yet you know that to do nothing is not an option, so you pitch in and do your best to provide comfort until professional help arrives. Perhaps you know of a situation where someone -- let’s say your colleague Patricia -- is providing either short- or long-term care to a relative. You can see that Patricia is affected herself by the support that she is providing, and you wonder how you could assist her, but you are not sure how to approach her in a way that would lead to her accepting your support. Definition Although the term “Mental Health Social Support” is recent, the broader concept of social support has been evolving over a number of decades. Most definitions include both practical components, such as financial assistance and physical aid, and less obvious aspects, such as encouragement and guidance. In this article, we will include in Mental Health Social Support those types of helping which, over time, serve to: Assist with a helpee’s mental, emotional, and social needs, such as those for self-esteem, comfort, encouragement, and belonging (our main focus) and; Maintain or improve the helpee’s physical wellbeing (Caplan, 1974). Social support research has identified five important functions, or types of Mental Health Social Support: Emotional: This can be defined as: “the availability of one or more persons who can listen sympathetically when an individual is having problems and can provide indications of caring and acceptance” (Wills and Shinar, 2000). It is about how to offer comfort, encouragement, and guidance to someone in distress. Instrumental: This happens when we provide help which is material -- a means to an end - such as food or shelter, to keep people going until they can be self-reliant again. Informational: Giving someone vital information may provide crucial support, such as details of where to go for a specific type of help. Companionship: This type of aid occurs, for example, when volunteers visit elderly community members who are lonely, or people who have few social outlets, such as those confined to hospitals. Validation support: This function of support is seen when mental health social supporters encourage helpees’ self-care efforts, such as engaging in weight-loss or stop-drinking programs (Wills and Shinar, 2000). Who are the mental health social supporters providing social support? There are at least four different support types or circumstances through which mental health social supporters can offer social support. They are listed below. Keep in mind this is not a complete list of all the forms Mental Health Social Support can take. It does, however, offer a clear idea of the sorts of places aid can come from. Social intimates: This type of mental health social supporter is often unpaid and offers emotional support to family members, friends, neighbours or colleagues or acquaintances. They are uniquely suited to help with not only home or neighbourhood emergencies and problems, but also the ongoing care that may be needed as a result of mental or physical illness. Self-help groups: This most visible and organised type of informal helping arrangement is comprised of people who share a common need or problem. Self-help groups assist a person to make sense of an experience, and they give the person a sense of belonging to a community. Membership in this sort of a group gives a person a new social setting in which the shared goals and norms may help to strengthen new, desired ways of living (Gottlieb and Schroter, 1978). An example of a self-help group is Alcoholics Anonymous. There are also Gamblers Anonymous, smoking cessation, cancer survivor, and rape/incest groups. Community caregivers: People in the community such as clergy, family doctors, and school personnel can and do offer much Mental Health Social Support. Because such people are already in relationship with the person who comes to need aid, the helpee feels comfortable to speak more frankly, thus being more likely to be directed to appropriate help (Graziano and Fink, 1973). Some community caregivers’ normal work is in a helping profession (for example, teachers, health workers, and ministers). Perhaps you are also familiar with a less formal sort of caregiving, such as that provided by hairdressers, manicurists, or even sympathetic bartenders. When they are supportive, they are in effect being community caregivers. Volunteers: Volunteers are mental health social supporters who provide help during and after catastrophes and natural disasters, even when they are personally affected by what is happening. Different volunteer skills may be required at different phases of a disaster (Halpern, 1974; Caplan, 1974). This has been demonstrated well in recent years in countries such as Indonesia, New Zealand, Japan, and Australia, where teams of volunteers have arrived on the disaster scene immediately. Their timely employment of specialist rescue skills has enabled numerous victims to have life-saving medical attention, and emotional support. Similarly, not only during times of disaster, but also during normal daily existence, many agencies such as Lifeline (which offers telephone counselling) receive donations of time from people who would like to offer support. Who are the Mental Health Social Support recipients: the helpees? All of us could find ourselves in need of help, of being a helpee. It would be rare to find a person who did not need Mental Health Social Support at some stage of their lives. So who are some of the groups who have received aid? There is no shortage of international examples: Befrienders International is an organisation of volunteers helping to prevent suicide in places as diverse as Japan, Sri Lanka, Estonia, and Denmark (Scott, 1996); Older husbands care for wives with dementia and other chronic diseases (Sanders and Power, 2009); St John’s Ambulance in New Zealand has a “friend on the phone” program, in which volunteers become a “friend” to a lonely older person, ringing that person at least once a week for chats, and to offer companionship (albeit by telephone); A public hospital in Albuquerque, New Mexico has for years had a program in which volunteers go coddle newborn babies who are in incubators, and therefore not able to receive much-needed comfort in their first weeks of life. Many communities have a “big brother” or “big sister” program in which the mental health social supporter is a young person who informally “adopts” and mentors a pre-teen child who might otherwise be at risk. The mental health social supporter also provides caring and role modelling for wise life choices. Australia has Community Watch groups in many cities, towns and rural areas, and the State Emergency Service of volunteers who assist in all forms of emergency. Some studies have discovered what sort of aid the supporters need: Australia’s STEPS program has mental health professionals who run educational and counselling programs to support those who are caring for community members. The programs do much to prevent burnout in the carers. Support providers to those with spinal cord injury sometimes need extra support for themselves. They can feel ill-prepared for their new roles as physical and mental health social supporters, especially when the patients are first discharged from the rehabilitation centre or hospital (Boschen, Tonack, and Gargaro, 2005). Chaplains working within hospice situations in the U.K. need social support due to high levels of stress from multiple factors (Williams, Wright, Cobb, and Shiels, 2004). Finally, on an informal level but no less significant than the formal programs, there are the “everyday” helpers. These are the neighbours, friends, family members, colleagues, and others in “everyday life” – perhaps people much like yourself -- who simply realise that someone they know is stressed or in distress. They respond with caring concern, compassion, and support, whether the distress is as a result of an incident or trauma, or because the distressed person is weighed down by supporting a third party. When such “ordinary” people stop to support another, the person they are listening to becomes a helpee, and another helper/helpee relationship is born. In short, if there is a problem or stressful situation, mental or physical illness, natural disaster or major life change, there will be people needing Mental Health Social Support. From the poor, to the violence-exposed, to at-risk youth and disaster victims, Mental Health Social Support helpees are everywhere, and their helpers increasingly so. You may be wondering why supporting in this way is so important, and how it is relevant to the wellbeing of the recipients. Mental Health Social Support: important, relevant support What does the research show in regard to providing Mental Health Social Support? What does support offer someone in need? How does it affect their lives, the lives of their family members, and the general wellbeing of the community (including that of the mental health social supporter)? An internet search yields thousands of articles on “social support”. Countless studies have examined nearly every angle of this topic, and one thing stands out: receiving Mental Health Social Support helps us. There is a very strong relationship between support and wellbeing because: MHSS offers the supported person positive emotions, a sense of self-worth, and predictability; Social support buffers people from stress; Perceiving that one is receiving aid can strengthen one’s self-esteem and capacity for effectiveness; Problem-solving becomes easier when a person is supported (Chu et al, 2010). Satisfying support gives the helpee hope, which is related to quality of life (Yadav, 2010); Support from one’s partner is shown to increase by around 50% the willingness to obtain needed medical care (the partner/supporter functions as a referral system); Support from one’s partner is shown to decrease utilisation of mental health services by around 60% (the partner has a function of emotional support) (Maulik, Eaton, and Bradshaw, 2011) and; MHSS helps young people to cope with the effects of violence by: – Empathising with their experience of harm; – Reducing feelings of vulnerability; – Enhancing feelings of being “OK” and the ability to act effectively (Kaynak, et al, 2011). How Mental Health Social Support affects lives: the “MOMobile” Case Study Increased personal effectiveness upon receiving Mental Health Social Support was a key finding in a study by Becker et al (2004). While many mental health social supporters work informally, as opposed to in a program such as below, it is nevertheless instructive to see how the extended relationship and emotional support offered to the helpees in this formal program greatly changed their lives. Observing the high infant mortality rate in Philadelphia, a MOMobile program was set up in 1988 as an outreach and family support service. Mental health social supporters, called “Advocates” (trained community health workers), began to go door-to-door and in “MOMobile” vans to underserved neighbourhoods to locate pregnant women and provide prenatal and after-birth support through home visits, telephone follow-ups, health education, and referral to needed services. Results showed that the women became more empowered, that is: – More able to alter their lifestyle – More able to alter their environment – More stable – More integrated into their communities. The capacity to change their conditions and influence their own actions came about as a result of believing that they could do so: that is perceived personal effectiveness. This quality was shown to grow in the pregnant women because of their ongoing relationship with the mental health social supporters. Doing the Mental Health Social Support work also helped the Advocates – some of whom had once been low-income pregnant women -- make more positive choices in their own lives. While the “MOMmobile” case study is based on a formal program, it provides useful examples of how Mental Health Social Support benefits helpees. Regardless of the population studied or the type of support rendered, Mental Health Social Support is able to improve the lives of those involved with it. In the next edition of Institute Inbrief we will outline how the support of mental health social supporters can be effectively delivered in communities through existing support systems. References: Becker, J., Kovach, A., and Gronseth, D., Individual empowerment: How community health workers operationalize self-determination, self-sufficiency, and decision-making abilities of low-income mothers. (2004). Journal of Community Psychology, 32 (3), 327–342. Wiley Periodicals, Inc. Retrieved from: Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/ jcop.20000. Boschen, K.A., Tonack, M. and Gargaro, J. The impact of being a support provider to a person living in the community with a spinal cord injury. (2005). Rehabilitation Psychology, 50 (4), 397–407. Retrieved from: DOI: 10.1037/0090-5550.50.4.397. Caplan, G. (1974). Support systems and community mental health. New York: Behavioral Publications, in Halpern, E., Volunteering in times of community crisis: An integration within Caplan’s theory of support systems, The Canadian Psychologist, 15 (3). Chu, P.S., Saucier, D.I., and Hafner, E. (2010). Journal of Social and Clinical Psychology, 29 (6), pp. 624-645. Gottlieb, B., and Schroter, C. (1978). Professional Psychology, American Psychological Association, Inc., 614. Sourced from: 0033-0175/78/0904-0614S00.75. Graziano, A. M., & Fink, R. S. (1973). Second-order effects in mental health treatment. Journal of Consulting and Clinical Psychology, 40, 356-364. In Gottlieb, B. and Schroter, C, November, 1978, Professional Psychology. Halpern, E., (1974). Volunteering in times of community crisis: An integration within Caplan’s theory of support systems, The Canadian Psychologist, 15 (3). Maulik, P., Eaton, W., and Catherine, B. (2011). The effect of social networks and social support on mental health services use, following a life event, among the Baltimore epidemiologic catchment area cohort. Journal of Behavioural Health Services and Research, 38 (1), pp 29 – 50. Sanders, S. and Power, J. (2009). Roles, responsibilities, and relationships among older husbands caring for wives with progressive dementia and other chronic conditions. Health & Social Work, 34 (1). Scott, V. (1996). Reaching the suicidal: The volunteer’s role in preventing suicide, Crisis 17 (3). Williams, M.L., Wright, M., Cobb, M., and Mersey, C.S. (2004). A prospective study of the roles, responsibilities and stresses of chaplains working within a hospice, Palliative Medicine, 18, pp 638 - 645. Wills, T. A., & Shinar, O. (2000). Measuring perceived and received social support. In Cohen, S., Underwood, L.G., & Gottlieb, B.H. (Eds.), (2009). Social support measurement and intervention: A guide for health and social scientists (pp. 86–135). Oxford: Oxford University Press. DOI: 10.1111/j.1467-9507.2009.00540. Yadav, S. (2010). Perceived social support, hope, and quality of life of persons living with HIV/ AIDS: A case study from Nepal. Qual Life Res, 19, pp 157–166. Retrieved from: DOI 10.1007/s11136-009-9574-z. Did you enjoy this article? Then share the feeling and forward it to a friend! 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