The Scheme to Support National Organisations is funded by the Government of Ireland through the Department of Rural and Community Development
Recovery
GROW in Ireland Recovery Outcomes in Mental Health 2019 National Report
Fiona Daly GROW IN IRELAND September 2020
Contents Executive Summary ...... 1 Introduction ...... 2 Background ...... 3 Recovery from mental health illness ...... 3 Research on GROW ...... 4 Methodology ...... 6 Research method ...... 6 Total Population and response rate ...... 6 Steps in data collection ...... 7 Limitations of the survey ...... 7 Data analysis ...... 8 Profile of respondents ...... 8 Gender ...... 8 Age ...... 9 Geographical location ...... 10 Current economic status ...... 11 Engagement with GROW ...... 12 Frequency of attendance at GROW Group meetings ...... 12 Duration of GROW Membership ...... 13 Attendance at GROW events ...... 14 Role in GROW ...... 15 Referral...... 15 Profile of mental health need ...... 16 Engagement with mental health services ...... 16 Self-perception of mental health need ...... 17 Factors contributing to mental health need ...... 18 Views on GROW ...... 19 Benefits ...... 19 Support with employment ...... 19 What could be better ...... 20 GROW’s contribution towards positive mental health ...... 22 Data on Recovery Outcomes and Social Supports ...... 24 Progress towards personal goals ...... 24
Social support...... 25 Symptoms ...... 26 Coping ...... 28 Relapse of symptoms and hospitalisation ...... 30 Participation in community activities and physical exercise ...... 32 Outlook on life and optimism about the future ...... 35 Conclusions ...... 38 References ...... 39
Executive Summary
This report presents the data findings from GROW’s National Survey 2019. Surveys were completed by 232 Members at their Groups, Regional Weekends and the National Weekend. The survey collected information on the following:
• socio-demographic characteristics • engagement with GROW • profile of mental health need • views on GROW Groups • individual recovery outcomes and social supports
The gender of respondents was 54.5% (122) female, 45.1% (101) male and 0.4% (1) other.1 In terms of age, just over one half of participants were in the middle age categories: 27% (62) aged 45-54 years old; and 26% (60) aged 55-64 years old. Respondents came from all regions around the country. Just over one quarter of participants, 28% (64), were currently working, while another 20% (46) were not working due to illness or disability.
More than three quarters of respondents, 77% (174), were attending a GROW group on a weekly basis. The majority of participants were GROW Members for a number of years – 25% (53) for 3-5 years and a further 23% (49) for 10 years or more. In relation to their role in GROW, 68% (158) were Members while others held a particular role, e.g. Recorder, Organiser. Just over one half, 53% (121) of respondents self-referred to GROW while 26% (60) were referred by a professional working in the area of mental health.
In relation to current engagement with mental health services, respondents were most likely to be seeing their GP, 44% (97), followed by a Psychiatrist, 41% (90). Anxiety and depression were the two most common mental health needs reported by participants, 48% (110) and 47% (107) respectively. When asked what factors contributed to their mental health need, respondents were most likely to say childhood experience (35%), followed by poor relationships with family (32%). Other issues included bereavement, relationship breakdown and work/employment, all at 19%.
The aspects of attending GROW that were rated as most beneficial were the structured program (56%), meeting other people (55%), weekly meetings (50%), along with practical tasks/goals (49%) and peer support (46%). A number of respondents said that the support they received from GROW had helped them to deal with their employer (11%) or keep their current job (13%). Suggestions put forward as to how GROW could be better included more
1 Data on gender was missing for the remaining 8 respondents.
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social activities/events (11%), more/new Members (8%) and more publicity about GROW (8%).
The results on individual recovery outcomes and social supports focus on the following indicators:
• progress towards personal goals • social support • symptoms • coping • relapse of symptoms and hospitalisation • participation in community activities and physical exercise • outlook on life and optimism about the future.
Analysis of recovery outcomes by duration of GROW Membership showed some patterns in the results where longer term Members of GROW were more likely to report more positive outcomes compared to those who had been attending for less than one year.
Introduction
GROW’s mission is to “nurture mental health, personal growth, prevention and full recovery from all kinds of mental illness.” GROW delivers a 12 Step Program of Recovery which is designed for people to take back control of their lives, overcome obstacles and start living a life full of meaning, hope and optimism. It provides a peer supported program for growth and personal development to adults with mental illness and those having trouble in coping with life’s challenges. It has been working in Ireland since 1969 and usually runs approximately 120 support groups around the country.2 GROW’s vision is to ensure that Growth, Recovery, Optimism and Well-being is possible for everyone.
This report presents the findings of a survey that was administered to GROW Members over a number of months in 2019. This comprised a National Survey, which has been conducted on an annual basis over the last four years. As well as giving an insight into the characteristics of Members and a profile of their mental health needs, data was collected on several indicators of well-being and recovery outcomes, e.g. last relapse of symptoms, family support and participation in community activities. The findings in this report will help
2 At the time of finalising this report, due to COVID-19 all GROW group meetings were taking place online. Approximately one half of former face to face groups made the transition to online meetings. Physical meetings are due to start again from mid-September onwards.
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to inform the future development of GROW in Ireland and the services it provides to promote mental health in all aspects of its work.
Background
Recovery from mental health illness
In recent years, the concept of recovery has become more widely used in mental health research and government policy informing the development of mental health services. In Ireland, the national policy ‘A Vision for Change’ (2006)3 identified recovery as a strategic priority for the Irish Mental Health Service. A review of this policy resulted in the publication of ‘Sharing the Vision’ in 20204 to provide a framework for the development of mental health services over the next ten years. One of its key priorities remains a focus on recovery. It adopts the definition of recovery set out in The National Framework for Recovery in Mental Health, 2018-2020 (HSE, 2017)5 as follows:
“Recovery is intrinsically about people experiencing and living with mental health issues in their lives and the personal goals they want to achieve in life, regardless of the presence or severity of those mental health issues.” (HSE, 2017: 1)
In much of the literature on mental health, recovery is deemed to be a personal process that varies from person to person. While clinical recovery refers to the absence of symptoms, personal recovery is focused on ‘healing, discovery and rebuilding a worthwhile life’ possibly at the same time as experiencing a varying degree of symptoms (Watts and Higgins, 2017). Based on their review of relevant literature, Leamy et al (2011) developed a conceptual framework for personal recovery known as CHIME. The presence of these factors was deemed to promote recovery from mental health illness.
• Connectedness – Positive relationships with family and friends and keeping linked in to local community supports.
3 Department of Health and Children (2006) A Vision for Change: Report of the Expert Group on Mental Health Policy https://www.gov.ie/en/publication/999b0e-a-vision-for-change/ (accessed 16th September, 2020). 4 Department of Health (2020) Sharing the Vision: A Mental Health Policy for Everyone https://www.gov.ie/en/publication/2e46f-sharing-the-vision-a-mental-health-policy-for-everyone/ (accessed 16th September, 2020). 5 See https://www.hse.ie/eng/services/list/4/mental-health-services/advancingrecoveryireland/national- framework-for-recovery-in-mental-health/recovery-framework.pdf (accessed 16th September, 2020).
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• Hope and optimism – Belief in recovery, motivation to change, positive thinking and having dreams and aspirations.
• Identity – Positive sense of self, overcoming stigma and being recognised as a whole person.
• Meaning in life – Living a meaningful and purposeful life, importance of feeling valued and contributing as an active Member of the community.
• Empowerment – Focusing on strengths, taking personal responsibility and control of one’s life.
CHIME has been adopted in the National Framework for Recovery in Mental Health (HSE, 2017). Based on a new understanding of recovery, the National Framework sets out key principles for the development of a recovery oriented mental health service to empower and facilitate individual recovery from mental health illness. The first principle highlights the importance of the service user’s lived experience and recognises that the individual must be at the centre of the recovery process. In order to support service users to avail of the resources to aid recovery, the National Framework recommends that they have access to peer support, either at group or individual level. Peer support is a unique aspect of the GROW program.
Research on GROW
The GROW program first started in Australia in 1957. Since then it has developed in many other countries and celebrated its 50th anniversary in Ireland in 2019. Central to the GROW program is a weekly meeting at which Members share experiences and learning, set themselves practical tasks for the week ahead and agree to take part in a particular activity which is known as ’12 Step work’. This may involve supporting another Member in the Group, e.g. meeting for coffee, or getting involved in the organisation, e.g. helping at a GROW event. Members are given the opportunity to play an active part in the Group by volunteering for certain roles, e.g. Recorder, Organiser or Leader. GROW groups are run by Members for Members with some input from a GROW staff Member from time to time.
Several international research studies have been conducted on GROW. For example, Corrigan et al (2005) carried out research in America involving 57 Members and they found that the most important aspect of GROW in contributing to recovery was peer support. After carrying out research in America, Rappaport (1988) described GROW as “an extended family for people”. Finn et al (2009) conducted observation of Groups and interviews with Members in Australia to explore how GROW impacts on psychological well-being. One of their key conclusions was that attending GROW groups facilitated a process of identity transformation, whereby individuals were able to improve their interpersonal skills and
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build confidence within their Group, which represented a safe environment. After achieving this, they were then able to use these newly developed social skills in other settings outside of the Group.”
Based on their findings, Finn et al (2009) developed a multi-dimensional model of change to describe how this process worked across three levels: individual; group; and program/community. This model proposed that attending a GROW Group facilitated individual change in two key areas: firstly, the development of life management skills, e.g. communication skills, social skills; and secondly, a change in how Members perceived themselves in terms of having an improved sense of belonging and enhanced feelings of personal value and self-worth. The second aspect refers to the ‘helper’ therapy principle which supports the notion that those who help others are actually helped the most themselves (Reissman, 1965). Within GROW, this principle can be applied to Members agreeing to take responsibility for carrying out certain roles within the Group. These can be of a fairly informal nature, e.g. making tea/coffee, welcoming new Members, as well as more formal roles, e.g. Recorder, Organiser and Leader in Groups. These roles may support other individual Members in the Group and also promote the functioning of the Group itself.
In Ireland, Watts and Higgins (2017) conducted interviews with twenty six GROW leaders. Based on participants’ experiences of being involved in GROW, they argue that recovery from mental illness can be seen as a ‘re-enchantment with life’ (Watts and Higgins, 2017). This process involved three phases: a desire to escape mental illness; ‘a time of healing’ which was represented by becoming a GROW Member and the experience of attending Group meetings; and the opportunity to be involved in all aspects of life, e.g. education, employment, community activities etc. Some participants in Watts’ research described GROW as being a bridge between mental illness and life. One key theme that emerged from the experiences of participants was that at some point many accepted that they had to assume the responsibility for their own recovery rather than relying on others to get well, e.g. family, friends, professionals etc.
Much of the research on GROW has reported the benefits of attending group meetings for those experiencing mental health illness in their lives. One interesting finding from Rappaport’s (1988) research in America was that Members who had been attending for a longer period of time were more likely to have more positive outcomes compared to those attending for a shorter period. As a result, the length of time attending GROW will be an important independent variable to explore in the analysis of the data collected here from the GROW National Survey 2019. This will be reflected in the results and findings in the rest of this report.
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Methodology
This section explores how the GROW National Survey 2019 was carried out and who was involved.
Research method
The primary aim of the National Survey was to provide data on various recovery outcomes related to mental health for GROW Members. For example, symptoms, hospitalisation and participation in certain activities such as physical exercise and community activities. In addition, the survey aimed to compile information on the mental health needs of Members and their engagement in and views on GROW. As the nature of data collected was descriptive, a quantitative survey instrument was used. This made it possible to collect comprehensive data from a large number of respondents quickly and efficiently. Most questions were closed ended in that respondents could choose from a list of possible answers. This made it easier to fill in and facilitated the comparison of data across all respondents. A copy of the survey is attached at the end of this report.
Confidentiality was an important consideration when collecting data and respondents were not asked to include a name on the survey unless they wished to do so for contact purposes.
Total Population and response rate
The total population for the survey comprised all GROW Members who attend GROW Community groups around the country, which are typically run on a weekly basis. GROW collect data on various aspects of each Group meeting including the number of people who attend. In the first quarter of 2019, an average of 467 individuals attended Community Groups.6 The number of completed National Surveys was 232. Therefore, an estimate for the overall response rate is 50%, which was similar to 51% in 2018.
6 An average figure for attendance is more appropriate than a total figure as meetings are held on a weekly basis. Therefore, the same individuals are likely to attend more than once throughout the month. This data is collected in Group Evaluation Forms that are filled in on a monthly basis for all meetings that take place that month. Attendance data is recorded for each weekly meeting that takes place.
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Steps in data collection
Surveys were administered in three ways:
• Community Groups which took place around the country during the months of September to November 2019 – 148 completed surveys (64%), and • GROW National Weekend, an annual event which took place between 20th to 22nd September, 2019 – 63 completed surveys (27%) • A Regional Weekend event that involved Members in two regions during the year – 21 completed surveys (9%)
Therefore, data was collected at three different points in time throughout the year. At the National Weekend event, an announcement was made at the main session to ask attendees to only fill in the survey if they had not already done so at their Group or the Regional Weekend. As the survey was anonymous, it is not possible to establish if more than one survey was completed by the same person. However, appropriate measures were taken to try and prevent this from happening.
Limitations of the survey
As with any research method, there are some possible limitations of the National Survey.
• The survey data provides basic information on respondents’ views of their mental health at one single point in time. Therefore, it provides a snapshot of information on respondents’ mental health and aspects of their lives at this point only. • The information collected may not be fully representative of all GROW Members. As the survey was confidential and anonymous, it is not possible to track non-response and to establish if any particular cohort of Members is not included in the survey population. • The information provided cannot be probed for more detail as participants are anonymous. • It is possible that some GROW Members may have filled in the survey more than once as data was collected at three different points in time. • Compared to 2018, the number of respondents fell from 268 to 232, a decrease of 13% (36).
While acknowledging these potential limitations, the data from the survey provides a valuable insight into recovery outcomes for a large number of GROW Members, as well as their background characteristics and views on GROW. This information can be used by GROW to help inform the future development of the organisation and the services it provides.
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Data analysis
Survey data was input into Survey Monkey and exported into Excel. Data analysis was largely done in Excel using pivot tables. Further analysis was carried out to establish if there were any patterns or trends in recovery outcomes by selected criteria, in particular the duration of GROW Membership. This was done by running crosstabulations and comparing the percentage results. In addition, where appropriate the Chi-square test of statistical significance was run in Excel to establish if the results found were likely to indicate a real relationship or were due to chance factors.7 The discussion of any relationships between variables in this report focus on consistent patterns in the results that emerged from data analysis.
Profile of respondents
This section presents the findings on socio-demographic data and provides a profile of Members who responded to the survey.
Gender
Chart 1 shows the gender breakdown for all respondents.
Chart 1 shows that just Chart 1: Gender of respondents (n=224) Other, 0.4% over one half of (1) respondents were female, 54.5% (122) and 45.1% (101) were male. One respondent, 0.4%, Male, 45.1% selected the ‘other’ (101) category. Data were Female, missing for the remaining 54.5% (122) 8 respondents.
Compared to 2018, the gender breakdown was similar – 58% female and
42% male.
7 The Chi-square statistic is commonly used to test relationships between categorical variables when carrying out crosstabulations or frequency tables. The test assesses whether an association exists between variables by comparing the observed or actual % results to the expected % results if the variables were independent of each other. Comparing the Chi-square statistic against a critical value from the Chi-square distribution helps to decide whether the observed %s are significantly different to the expected %s. See https://www.statisticssolutions.com/using-chi-square-statistic-in-research/ (accessed 16th September, 2020)
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Chart 2 shows the gender breakdown for each GROW region. Four regions had a fairly even gender profile: East; Midwest; North East and South. The Midlands was the only region that had a gender profile similar to that nationally, with a 58% female and 42% male breakdown. While another two regions had a far greater number of females than male respondents: North West; and South East. The West countered these trends with a higher percentage of male respondents at 54% compared to 42% female.
Chart 2: Gender breakdown by region (n=218) 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% North North East Midlands Midwest South South East West East West Female 48.2% 58.1% 46.7% 50.0% 78.9% 48.6% 80.0% 42.3% Male 51.8% 41.9% 53.3% 50.0% 21.1% 51.4% 20.0% 53.8% Other 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 3.8%
Age
Chart 3 shows that Chart 3: Age group of respondents (n=227) respondents were most likely to be aged between 30% 27% 45-54 years old, 27% (62) 26% followed by 55-64 years old, 25% 26% (60). Therefore, respondents were most 19% likely to be in the middle age 20% 17% categories, 53%. Almost one fifth, 19% (44) were aged 35- 15% 44, while a further 17% (38) were aged 65-74. 10%
6% 3% Compared to 2018, the 5% proportion of respondents 1% aged 25-44 years old 0% increased from 21% to 25%, <25 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75+ while those aged 65+ fell from 23% to 20%.
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A breakdown by region found a similar age profile to the national figures presented in Chart 3, with some exceptions:
• 35-44 year age group - three regions had a higher percentage of respondents in this age category than the 19% national figure: East, 30%; South, 25%; and West, 25%. • 44-64 year age group – two regions had a higher percentage of respondents in this age category than the 53% national figure: Midwest, 59%; and North West, 72%. • 65+ age group – two regions had a higher percentage of respondents in this age category than the 20% national average: East, 23%; and Midlands, 25%.
Geographical location
Data was collected on the region of the GROW group that respondents were attending. Chart 4 shows the results below.
Chart 4: Region of GROW Group (n=226) 30% 26% 25%
20% 20% 16% 15% 12% 8% 9% 10% 8%
5% 1% 0% East North East South Midwest North West South East Midlands West
It can be seen that respondents came from GROW groups all around the country, ranging from 1% (2) in the North East to 26% (58) in the East.8 After the East, the next highest percentage of respondents came from the Midlands, 20% (45) followed by the South, 16% (37). These three regions with the highest number of respondents were the same in the previous year 2018. In 2019, data on region was missing for six respondents.
Another indicator of geographical location was collected by asking respondents if they lived in an urban, suburban or rural area. The results were as follows: • 36% (78) lived in an urban area • 22% (48) in a suburban area, and • 41% (89) in a rural location.
8 It should be noted that several GROW groups in the North East did not have an Area Co-ordinator at the time when surveys were being administered through GROW groups, which accounts for the relatively low percentage of respondents from the region.
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Compared to 2018, the results for those living in an urban or suburban area were similar, at 34% and 20% respectively. While the percentage living in a rural location fell from 46% in 2018 to 41% in 2019.
Current economic status
Chart 5 shows the current economic status for survey respondents. It shows that more than one quarter of respondents, 28% (64), were at work, followed by 23% (52) who were retired. A further one in five respondents, 20% (46), were not working due to illness or disability. Data was missing for two respondents. Compared to the previous year 2018, where 29% of respondents were at work, these results for 2019 were very similar.
Chart 5: Current Economic Status (n=230) 28% 30% 23% 25% 20% 20%
15% 12% 10% 7% 10% 6% 4% 5% 3%
0%
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Comparison with Census of Population 2016
It is interesting to draw some comparisons with data from the Census of Population 2016.9 Two key findings are of particular note:
• 53% of people aged 15 years and over were ‘at work’ based on the Census data10 – the figure from the GROW survey is far lower at 28% • 4% of people aged 15 years and over were ‘unable to work due to permanent sickness or disability’ based on the Census data – the figure from the GROW survey is 20%, which is five times the figure for the national population.11
Based on this data, it can be said that the GROW survey respondents are far less likely to be currently engaged in employment and far more likely not to be working due to sickness/disability compared to the national population.
Engagement with GROW
This section presents the findings on the nature and extent of respondents’ involvement in GROW.
Frequency of attendance at GROW Group meetings
Respondents were asked to say how often they attended a GROW Group in the last three months. Chart 6 shows the results.
9 It is acknowledged that the survey data and Census data have been collected at different times – 2019 and 2016 respectively. However, Census data provides a key benchmark that can be used to consider how the circumstances of GROW survey respondents compares to that of the national population. 10 See Table 1.1 in Census of Population 2016 – Profile 11: Employment, Occupations and Industry, see the link http://www.cso.ie/en/releasesandpublications/ep/p-cp11eoi/cp11eoi/pec/ (accessed 16th September, 2020) 11 See Figure 1.1 in Census of Population 2016 – Profile 11: Employment, Occupations and Industry, see the link http://www.cso.ie/en/releasesandpublications/ep/p-cp11eoi/cp11eoi/pec/ (accessed 16th September, 2020)
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Chart 6: Frequency of attendance at GROW group in last 3 months (n=226)
6% 4%
14%
77%
Once a week Every 2 weeks Once a month Less than once a month
Chart 6 shows that the majority of respondents, 77% (174), attended a GROW group meeting every week in the last three months. Another 14% (31) attended every two weeks. Therefore, most respondents attended GROW on a regular basis. Data was missing for six respondents. Compared to 2018, the percentage of respondents who attended GROW weekly fell slightly from 81%.
Duration of GROW Membership
The length of time that respondents have been a Member of a GROW Group is a valuable indicator as it may have some relationship with the data on recovery outcomes, which was highlighted in research by Rappaport (1988). It would be reasonable to suggest that recovery outcomes might improve over time, particularly when the appropriate supports can be accessed. GROW Membership might be one potential factor that contributes to an improvement in mental health outcomes. There are likely to be variations by individual based on the nature of their mental health needs and particular circumstances.
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Chart 7: Duration of GROW Membership (n=216) 30.0% 24.5% 25.0% 22.7% 18.5% 18.5% 20.0% 15.7% 15.0%
10.0%
5.0%
0.0% <1 year 1-2 years 3-5 years 6-10 years >10 years+
Chart 7 shows that respondents were most likely to have been GROW Members for 3-5 years, at 24.5% (53). Individuals who filled in the survey were likely to be long term Members of GROW - almost one quarter of respondents, 22.7% (49), for more than ten years and a further 18.5% (40), for six to ten years. Therefore, combining these two categories shows that 4 out of 10 respondents, 41.2% (89), had been GROW Members for six years or more. Looking at the results for newer Members, Chart 7 shows that almost two in ten respondents, 18.5% (40), had been Members for less than one year. Data was missing for sixteen respondents.
Compared to 2018, there had been an increase in the proportion of respondents who had been Members for more than six years from 28% to 41% in 2019. At the other end of the scale, the percentage of respondents who had been Members for less than one year fell from 24% to 19% in 2019.
It would be interesting to carry out some analysis of recovery outcomes to see if there is any relationship by duration of GROW Membership. This will be covered in the findings on recovery outcomes.
Attendance at GROW events
Respondents were asked how many GROW events they had attended in the previous year 2018. The results were as follows:
• National Weekend – 35% (82) • Regional Weekend – 28% (64) • Group Weekend – 10% (24) • Group social event – 37% (86)
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Therefore, respondents were most likely to have attended a Group social event followed by the National Weekend.12
Role in GROW
Respondents were asked to indicate what role(s) they held in GROW. The results were as follows:
• Member – 68.1% (158) • Recorder – 14.7% (34) • Organiser – 15.9% (37) • Leader – 4.7% (11) • Regional team Member – 5.2% (12) • Board Member – 1.7% (4) • Other – 0.4% (1)
Therefore, almost seven out of ten respondents were GROW Members, which was followed by Organisers at 15.9% and then Recorders at 14.7%. As respondents could hold more than one role at the same time, the results added up to more than 100%. Compared to 2018, the results were very similar.
Referral
The survey asked respondents to say how they were referred to GROW. Chart 8 shows the results.13
Chart 8: Source of referral to GROW (n=229) 60% 53% 50%
40%
30% 25%
20% 11% 10% 4% 6% 3% 2% 0% GP (Doctor) Psychologist Psychiatrist Counsellor Counsellor No-one, I Other (HSE) (Private) referred (please myself specify)
12 In 2019, most GROW regions did not have a Regional Weekend as the National Weekend event was extended to three days to celebrate GROW’s 50th anniversary in Ireland. 13 In some cases, respondents gave more than one answer. Therefore, the total adds up to more than 100%.
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Chart 8 shows that more than half of all respondents, 53% (121), said they referred themselves to GROW. Just over one quarter of respondents, 26% (60), reported that they were referred by a professional, most likely a GP, 11% (26), or a Counsellor (HSE), 6% (13). Data was missing for three cases. Compared to 2018, the percentage of self-referrals to GROW increased from 46% to 53% in 2019.
Other sources of referral included a friend (18), someone in GROW (Member or staff) (11), family/partner (5), psychiatric nurse (3), other mental health organisation (2), hospital (2), local community group (2), local newspaper (2) and GROW website (2).
Profile of mental health need
This section asked respondents to answer questions on the following:
• current use of mental health services • perception of mental health need, and • contributory factors to mental health need.
Engagement with mental health services
Chart 9 shows the mental health services that respondents were currently using.14
Chart 9: Current engagement with mental health services (n=219) 50% 44% 41% 45% 40% 35% 30% 25% 20% 19% 20% 12% 15% 11% 10% 5% 2% 0% GP Psychologist Psychiatrist Counsellor Support None of the Other group (other above (please than GROW) specify)
14 In some cases, respondents selected more than one mental health service. Therefore, Chart 9 adds up to more than 100%.
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Chart 9 shows that respondents were most likely to be engaging with their GP, 44% (97), or a Psychiatrist, 41% (90). One in five respondents, 20% (43), were seeing a Counsellor. Just over one in ten were seeing a Psychologist, 12% (27). Just under one fifth of respondents, 19% (42) were not accessing any of these mental health services. Therefore, the majority of respondents were currently engaging with at least one mental health service or support other than GROW. Data was missing for 13 respondents. Compared to 2018, the results were very similar.
One in ten respondents, 10% (23), said they were engaging with an ‘other’ mental health service. These included Alcoholics Anonymous (5), art therapy (1), women’s group (1), prayer group (1), Arthritis Ireland (1), addiction group (1) and Shine (1).
Self-perception of mental health need
Respondents were asked to state the nature of their mental health need. This provides information based on the respondent’s own understanding of their mental health. Chart 10 presents the results.15
Chart 10: Perception of mental health need (n=227) 60% 48% 50% 47% 40% 30% 14% 20% 4% 9% 5% 5% 8% 10% 6% 2% 0%
Chart 10 shows that almost one half of respondents, 48% (110), said that they experienced anxiety, which was closely followed by 47% (107) who reported having depression. Therefore, anxiety and depression were the two most common mental health needs identified by respondents. Just over one in ten respondents, 14% (31), said they had Bipolar Disorder while Schizophrenia was identified by 9% (21) of respondents.16 Compared to 2018, the percentage of respondents reporting anxiety increased from 42% to 48% in 2019, while the numbers identifying depression fell slightly from 51% to 47% in 2019.
15 In some cases, respondents gave more than one response. Therefore Chart 10 adds up to more than 100%. 16 Respondents could select more than one type of mental health need, so the total percentage results are higher than 100%.
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It is not surprising that depression was one of the two most common mental health needs reported by GROW Members. The Irish Health Survey 2015 (Central Statistics Office, 2015) found that 8% of all people aged 15 years or over experienced symptoms of moderate depression at least. This figure increased to 26% when mild depression was included.17 Therefore, it is widely prevalent in the general population.
Factors contributing to mental health need
Respondents were asked to indicate if any particular factors contributed to their mental health need. This information gives a better understanding of the life events that may have a negative impact on mental health, as experienced by those who took part in the survey. Chart 11 shows the results.18
Chart 11: Contributory factors to mental health need (n=216) 35% 40% 35% 32% 30% 25% 19% 19% 19% 20% 14% 14% 15% 13% 8% 10% 6% 5% 0%
Chart 11 shows that over one third of respondents, 35% (76), said that childhood experience contributed to their mental health need. This was followed by poor relationships with family, 32% (70). Other life events also affected respondents’ mental health, namely bereavement, work/employment and relationships breakdown, each at 19% (40). A further 8% (18) said that none of these factors contributed to their mental health need. While 14% (30) identified other factors, which included poor physical health (4), addiction (4), bullying (3), post-natal depression (2), being a carer (1) and studying (1). Data was missing for 16 cases. Compared to 2018, the results were very similar.
17 See Table 6 in the Irish Health Survey 2015, Central Statistics Office. See the link http://www.cso.ie/en/releasesandpublications/ep/p-ihs/irishhealthsurvey2015/ct/ accessed 16th September, 2020. 18 In some cases, respondents gave more than one response. Therefore, Chart 11 adds up to more than 100%.
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Views on GROW
Respondents were asked to give their views on GROW. They were invited to state the benefits of attending GROW and what could be improved.
Benefits
Chart 12 shows the benefits that attending GROW had for respondents.19
Chart 12: Most beneficial aspects of GROW (n=226)
60% 56% 55% 46% 49% 50% 50%
40% 26% 30% 22% 20% 13% 10% 2% 0%
The benefit that was rated highest by respondents was having a structured program, 56% (127), which was closely followed by meeting other people, 55% (125). Weekly meetings is a feature of most of GROW’s Community Groups, and was selected by one half of respondents, 50% (113). The next two most popular responses were practical tasks/goals, 49% (111) and peer support, 46% (103). Compared to 2018, results were broadly the same, although structured program increased from 49% to 56% in 2019.
Support with employment
Survey respondents were asked if the support they received from GROW helped them with different aspects of employment. Chart 13 shows the results.
19 Respondents were asked to name the top three benefits from a pre-defined list of possible answers. Therefore, Chart 12 adds up to more than 100%.
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Chart 13: Support with employment (n=190) 66% 70%
60%
50%
40%
30%
20% 11% 13% 9% 8% 10%
0% Deal with your Retention of Gain employment Change job/career Not applicable employer employment
Chart 13 shows that 13% (24) of respondents said the support they received from GROW had helped them to remain employed, which was followed by 11% (21) who reported that it helped to deal with their employer. A further 9% (17) answered that they were able to gain employment and 8% (16) stated the support from GROW helped them to change their job or career. Compared to 2018, retention of employment increased from 9% to 13% in 2019, and the percentage of respondents who chose gain employment rose slightly from 5% to 9% in 2019.
The data in Chart 13 is based on a relatively small number of respondents as the question was not applicable to all, e.g. many people were retired or looking after home/family. However, it shows that engagement with GROW can contribute to better employment outcomes for several respondents.
What could be better
Respondents were asked to say what could be better about GROW? It was answered by 118 people. The most popular comments were as follows:
• More social activities/events, e.g. family day – 11% (13) • More/new/better retention of Members – 8% (10) • More publicity about GROW – 8% (10) • More younger Members/youth groups/work in schools – 6% (7) • Better adherence to the GROW program, e.g. regular 12 Step Work, less irrelevant talk – 6% (7) • More opportunities to mix with Members from other local groups – 5% (6) • Communication/better communication from National Office – 3% (4) • Longer meetings – 3% (4) • Remove references to God in GROW literature – 3% (3)
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Some other individual comments included in this section are presented below:
“The language of GROW could be simplified. Far too much GROW literature is over complicated. GROW logo does not convey who we are and what we do, i.e. mutual support.”
“A structured policy for inappropriate behaviour i.e verbal warning then written warning, if necessary.”
“I think a new person needs more explanation of the meeting.”
“Regularly ask Members what we need. Ask us what GROW should lobby for. Involve GROW Members more about event planning etc.”
“Re-instate leadership training and update. More leadership roles and training.”
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GROW’s contribution towards positive mental health
An additional question was asked in the 2019 survey to coincide with the 50th anniversary of GROW in Ireland. This question asked respondents ‘In 10 words or less, how has GROW helped you on the journey towards positive mental health?’ Two thirds of all respondents, 66% (154), gave an answer to this question. A content analysis was carried out to group the answers into themes. It was possible to apply the CHIME framework (see pages 3 and 4) in this analysis as many of the responses could be grouped under one of the CHIME headings. In addition, many of the answers given mentioned aspects of the GROW program that had contributed to positive mental health. Figure 1 presents the results below.
Figure 1: Classification of responses on how GROW has helped Members towards positive mental health
• Peer group support (29) • Friendship (25) Connectedness • Shared experience (15) 59% (91) • Talking/listening and being open (14) • Community participation/alleviate isolation (8)
• Practical tasks/goals/challenges (13) GROW program • Regular weekly meetings (11) 26% (40) • Reading material (9) • Structured program (7)
Hope and optimism • More positive outlook on life (16) 16% (24) • Greater self-confidence (8)
Identity • Greater self-awareness and acceptance 7% (11) (11)
Empowerment • Better coping skills to deal with everyday 5% (7) life (7)
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Figure 1 shows that almost 6 out of 10 responses related to Connectedness, 59% (91), in particular the value of peer group support from other Members and friendship/company of others. This was followed by aspects of the GROW program, 26% (40), where the highest responses related to having practical tasks/goals/challenges and regular weekly meetings. The CHIME heading of Hope and Optimism was highlighted in 16% (24) of responses where comments were made about having a more positive outlook on life and improved self- confidence. The CHIME headings of Identity, 7% (11) and Empowerment, 5% (7) were also evident from a smaller number of responses. As several respondents gave more than one answer, the total adds up to more than 100%.
The information in Figure 1 is important as it shows how GROW has contributed to the positive mental health of Members, many of which align with the CHIME framework. In addition, it also highlights the value of many aspects of the GROW program. Some of the comments made by respondents are given below.
“The support from other Members is fabulous and I feel cared for.”
“It helps to have people’s feedback and reassures me that I’m not alone in my thinking, my thoughts and struggles.”
“GROW has helped me by giving me a
task to do in the weekly meeting.”
“GROW has helped me realise that I can live a good life despite my symptoms.”
“When I attend a GROW meeting, I feel lucky that my life is that good and I look forward to the week ahead.”
“I came into GROW on my knees. Now I can walk.”
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Data on Recovery Outcomes and Social Supports
The final section of results in this report presents data on eleven questions which attempt to measure recovery outcomes for respondents at the time of doing the survey. Most of these questions were all asked in the previous year’s survey in 2018. Therefore, some comparisons can be made in the results for both years. However, the data only gives a snapshot of respondents’ well-being at one particular point in time.
Further analysis on recovery outcomes was carried out to explore whether the duration of GROW Membership made any difference to these results.20 It might be expected that individuals who were attending GROW for a longer period of time could have more positive recovery outcomes. In addition to comparing differences in the percentage results for recovery outcomes by duration of Membership, a Chi-square statistical test of significance was run where appropriate.21 Given the nature of the data and the analysis carried out, even where an association was found and furthermore, it was deemed to be statistically significant, it is not possible to claim causation, i.e. that attending GROW for a longer period of time directly results in better outcomes. Nevertheless, any association found might indicate that long term GROW Membership could be one possible contributory factor where better outcomes are found and is worthy of further exploration.
Progress towards personal goals
Respondents were asked if they had made progress towards personal goals in the last three months. The results were as follows:
• 27% (60) said they had a personal goal and had achieved it • 25% (55) said they had a personal goal and had gotten pretty far in achieving it • 37% (80) said they had a personal goal and made a little way towards achieving it • 7% (15) said they had a personal goal but had not done anything to achieve it, and • 4% (9) said they had no personal goals.22
Therefore, just over one half of respondents, 52% (115), said they had a personal goal and had either achieved it or were near to achieving it. This had fallen slightly from 58% in the previous year 2018. This is accounted for by the increase in the next category where respondents said they had made ‘a little way towards achieving’ their personal goal from 29% in 2018 to 37% in 2019.
20 To facilitate this analysis, the variable for duration of GROW Membership was recoded from five into three categories: (1) <1 year; (2) 1-5 years; and (3) 6 years or more. This would help to increase the number of respondents in each sub-category, which helps to improve the validity of the data analysis results. 21 The results of the Chi-square test are included where an association was found to be statistically significant or of borderline significance (where the Chi-square statistic is close to the critical value in the Chi-square distribution). It is not reported where the result was not significant. 22 These results are based on 219 respondents as data was missing for 13 cases.
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Social support
One question in the National Survey looked at the importance of social support to recovery outcomes by asking ‘how much are family members, friends, spouse/partner and other people important to you (outside of GROW) involved in your recovery?’
Chart 14 shows that most Chart 14: Involvement of spouse/partner, family and friends to individual recovery respondents received social (n=221) support from their spouse/partner, family and friends with just over one A lot of the time 28% half, 53% (118), saying a lot or much of the time, and a Much of the time 25% further 20% (45) replying ‘sometimes’. Just over 1 in Sometimes 20% 10, 15% (34) did not receive such social support. Only if a serious problem 11% Compared to 2018, respondents were more Not at all 15% likely to receive this social support, with the percentage 0% 5% 10% 15% 20% 25% 30% saying ‘sometimes’ or more increasing from 65% to 73% in 2019.
Further analysis by duration of GROW Membership
Table 1: Support from family/friends by duration of GROW Membership (n=206)
<1 year 1-5 years 6 years+ Total A lot of the time 21% 33% 24% 28% (8) (28) (20) (56) Much of the time 26% 24% 29% 25% (10) (20) (24) (54) Sometimes 18% 20% 21% 20% (7) (17) (17) (41) Only if a serious problem 15% 9% 11% 11% (6) (8) (9) (23) Not at all 21% 14% 15% 15% (8) (12) (12) (32) Total 100% 100% 100% 100% (39) (85) (82) (206)
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Table 1 shows that respondents who had been GROW Members for less than one year were less likely to report receiving support from family/friends ‘a lot of the time’, 21% (8), compared to those who had been Members for one to five years, 33% (28), or 6 years or more, 24% (20). Similarly, at the other end of the scale, respondents who had been attending GROW for less than one year were most likely to say they got no support from family/friends, 21% (8), compared to those who were Members for one to five years, 14% (12), or 6 years+, 15% (12). There is some indication that respondents who were Members for less than one year were more likely to receive such support if there was a serious problem, 15% (6), compared to those who were longer term Members, although this result is based on a relatively small number of total respondents (n=23). The results for the other levels of support from family/friends were similar for all durations of GROW Membership. Overall, the differences in whether Members received social support by duration of GROW Membership are not large enough to draw any concrete conclusions.
Symptoms
Respondents were asked how much symptoms of their mental health need got in the way of doing things that they would like to or need to do. Chart 15 presents the results.
Chart 15 shows that one third of Chart 15: Extent to which symptoms get in the way of doing things (n=219) respondents, 33% (73), said their symptoms bothered them somewhat, followed by 22% (48) who said ‘quite a 33% 35% bit’. One in ten, 10% (21), reported that they were bothered ‘a lot’ by their 30% symptoms. When these three categories 25% 22% are combined, almost two thirds of 19% 20% 16% respondents, 65% (142), reported being 15% bothered by their symptoms to some 10% extent, which was similar to 66% in the 10% previous year 2018. 5% 0% Between 2018-19 there was a fall in the percentage who said ‘a lot’ from 15% in 2018 to 10% in 2019. In 2019, 16% (35) of respondents said they were not bothered
at all by their symptoms, which had risen slightly from 13% in 2018.
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Further analysis by duration of GROW Membership
Table 2: Extent to which symptoms get in the way by duration of GROW Membership (n=204)
<1 year 1-5 years 6 years+ Total A lot 16% 9% 9% 10% (6) (8) (7) (21) Quite a bit 34% 16% 20% 22% (13) (14) (16) (43) Somewhat 29% 36% 31% 33% (11) (31) (25) (67) Very little 13% 22% 20% 19% (5) (19) (16) (40) Not at all 8% 15% 21% 16% (3) (13) (17) (33) Total 100% 100% 100% 100% (38) (85) (81) (204)
Table 2 shows that respondents who were attending GROW for less than one year were more likely to say their symptoms had a negative impact on their lives compared to those who had been GROW Members for a longer period of time. For example, just over one third of those who were Members for less than one year, 34% (13), said their symptoms got in their way ‘quite a bit’, which compared to 16% (14) of those attending for one to five years and 20% (16) who had been Members for 6 years or more. Similarly, looking at the results for the ‘very little’ and ‘not at all’ categories, those who had been attending GROW for longer were more likely to say they were not affected by their symptoms compared to those who had been Members for less than one year. In conclusion, the results in Table 2 show that respondents who were GROW Members for longer reported being less affected by their symptoms compared to newer Members. While these differences remain as shown in the variation in the % results in Table 2, they were not large enough to be statistically significant.
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Coping
Respondents were asked how well they felt they were coping with their mental or emotional well-being on a day to day basis. Chart 16 shows the results.
Chart 16 shows that respondents were Chart 16: Extent to which respondents most likely to say they were coping ‘alright’ are coping with their mental or with their mental or emotional well-being, emotional well-being (n=225) 43% (97), followed by 27% (61) who said 50% ‘well’. Just under one in ten said they were 45% 43% coping ‘not very well’, at 9% (21). 40%
35% 27% Compared to 2018, the results are very 30% similar, with some signs of better coping in 25% 20% 2019 – those who said ‘not very well at all’ 20% 15% fell from 3% in 2018 to 0% in 2019, while 9% ‘very well’ was selected by slightly more 10% respondents, 17% in 2018 and 20% in 2019. 5% 0% 0% Not well Not very Alright Well Very well at all well
Further analysis by duration of GROW Membership
Table 3: Extent to which respondents are coping with their mental or emotional well-being by duration of GROW Membership (n=209)
<1 year 1-5 years 6 years+ Total Not very well 18% 6% 7% 9% (7) (5) (6) (18) Alright 54% 45% 37% 43% (21) (39) (31) (91) Well 21% 28% 30% 27% (8) (24) (25) (57) Very well 8% 21% 26% 20% (3) (18) (22) (43) Total 100% 100% 100% 100% (39) (86) (84) (209)
X2 (6, N=209) = 13.10, p>0.0523
23 The Chi-square test of statistical significance (X2) was run for this result to see if the variation in the percentages by duration of GROW membership were likely to be due to chance factors or a real difference. The Chi-square statistic of 13.10 is based on the difference between the expected and observed values and was of borderline statistical significance at the probability (p) level of 0.06 (94%), which is just slightly below the widely accepted probability level of 0.05, which indicates a high likelihood (95%) of an association between coping and duration of GROW Membership. While a link has been established, this does not imply causation.
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The main finding from Table 3 is that respondents who have been attending GROW for longer are more likely to report better coping with their mental or emotional well-being compared to those attending for less than one year. For example, 21% (8) of respondents attending for less than one year said they were coping ‘well’. This figure increased to 28% (24) of those attending for one to five years and further still to 30% (25) of respondents who had been GROW Members for six years or more. While a higher percentage of respondents who were attending for less than one year reported they were feeling ‘alright’ (54%) compared to those attending longer, those attending for a shorter period of time were almost three times more likely to say ‘not very well’ compared to those attending longer – 18% (7) compared to 6% (5) of those attending one to five years and 7% (6) of those attending for six years or more. This result is worth noting as it was of borderline statistical significance which indicates that it is highly unlikely to be due to chance and that better coping skills are more likely to be reported by those attending GROW for longer.
A second question on coping was included in the National Survey 2019. It asked respondents what extent had going to GROW meetings contributed to being able to cope with day to day life? This question was added to give some indication of respondents’ views on the possible benefits that were experienced by attending GROW. It was the second year in which the question had been asked as it was a new question in the 2018 survey. The results are below.
Chart 17 shows that the majority of Chart 17: Extent to which going to GROW meetings has contributed to coping with day to respondents said that going to day life (n=222) GROW meetings contributed to 45% better coping with everyday life 42% 40% 40% with 82% (182) saying ‘quite a lot’ 35% or ‘very much’. A further 16% (35) 30% said it had helped ‘somewhat’. Just 25% 2% (4) replied ‘not that much’. Compared to 2018, the percentage 20% 16% 15% of respondents who selected the ‘very much’ category increased 10% from 33% to 40% in 2019. 5% 0% 2% 0% Not at all Not that Somewhat Quite a lot Very much much
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Further analysis by duration of GROW Membership
Table 4: Extent to which respondents felt that attending GROW meetings had contributed to better coping with day to day life by duration of GROW Membership (n=205)
<1 year 1-5 years 6 years+ Total Not that much 3% 1% 1% 2% (1) (1) (1) (3) Somewhat 31% 10% 14% 16% (11) (9) (12) (32) Quite a lot 49% 44% 40% 42% (17) (38) (34) (89) Very much 17% 44% 44% 40% (6) (38) (37) (81) Total 100% 100% 100% 100% (35) (86) (84) (205)
X2 (4, N=205) = 13.67, p<0.0524
Table 4 shows that respondents who are long term GROW Members are more likely to report that attending GROW meetings has contributed ‘very much’ to coping with day to day life – almost one half of those attending one to five years and six years or more, at 44%. This compares to 17% (6) of those attending GROW for less than one year. By contrast, newer GROW members were more likely to respond ‘somewhat’, at 31%, compared to those attending for longer, at 10% and 14%. Therefore, these results indicate that where respondents attend GROW for a longer period of time, they are more likely to say that attending GROW has helped them to cope better in their day to day lives. This result was statistically significant.
Relapse of symptoms and hospitalisation
Respondents were asked to say when they last had a relapse of symptoms and the most recent time they had been hospitalised for mental health reasons. Charts 18 and 19 show the results.
24 The Chi-square statistic of 13.67 is higher than the critical value of 9.49. The result of the chi-square test is that the p-value of p=0.009 is statistically significant as it is less than the widely accepted probability level of 0.05, which indicates a high likelihood (95%) of an association between the extent to which GROW has helped respondents to cope with day to day life by duration of GROW Membership. While a statistically significant result has been found, this does not imply causation. As the Chi-square test is not appropriate where 20% of cells in the crosstabulation contain less than 5 cases, the two categories ‘Not that much’ and ‘Somewhat’ were combined to remedy this. The resulting table was then used for the Chi-square test.
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Chart 18 shows that 51% (104) Chart 18: Last relapse of symptoms (n=202) of respondents did not have a relapse in the last year, which 60% 51% compared to 49% (98) who did 50% have a relapse in the last year – the sum of the other four 40% categories. This was most likely to have happened in the last two 30% to three months, at 16% (33). 16% 20% 12% 9% 11% Compared to 2018, fewer 10% respondents experienced a relapse in the last year. Between 0% 2018-19, the percentage who Within the In the last In the last In the last No relapse had no relapse in the last year last month 2 - 3 4 - 6 7 - 12 in the last months months months year increased from 43% to 51%, while those who did have a relapse fell from 57% to 49%.
Further analysis by duration of GROW Membership
Table 5: Last relapse of symptoms by duration of GROW Membership (n=190)
<1 year 1-5 years 6 years+ Total Within the last month 15% 9% 7% 9% (5) (7) (5) (17) In the last 2-3 months 24% 13% 12% 16% (8) (11) (9) (28) In the last 4–6 months 9% 12% 12% 11% (3) (10) (9) (22) In the last 7-12 months 24% 12% 7% 12% (8) (10) (5) (23) No relapse in the last year 29% 54% 62% 51% (10) (44) (46) (100) Total 100% 100% 100% 100% (34) (82) (74) (190)
X2 (8, N=190) = 15.06, p>0.0525
Table 5 shows that respondents attending for less than one year are more likely to report a relapse of symptoms in the last month, two to three months and seven to twelve months compared to longer term GROW Members. Furthermore, those attending GROW for longer were almost twice as likely to report having no relapse in the last year – 54% (44) of those
25 The chi-square statistic of 15.06 was just below the critical value of 15.51. Similarly, the p-value of 0.07 is just above the widely accepted probability level of 0.05. Therefore, while this result is not statistically significant it is very close to being so.
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who had been Members for one to five years and 62% (46) who were Members for six years or more. These non-relapse rates were almost twice as high as that for respondents who had been attending GROW for less than one year, at 29% (10).
Chart 19: Most recent hospitalisation for mental health reasons (n=212) 60%
49% 50% 44%
40%
30%
20%
10% 4% 1% 1% 2% 0% In the last In the last 2 - 3 In the last 4 - 6 In the last 7 - Not in the last Never month months months 12 months year
Chart 19 shows that most respondents had not been hospitalised for mental health reasons, 49% (103) were not hospitalised in the last year and 44% (93) had never been hospitalised. Almost one in ten respondents, 8% (16), had been hospitalised in the last year, one half of whom in the last seven to 12 months, 4% (8).26 Compared to 2018, the percentage of respondents who had been hospitalised in the last year fell slightly from 11% to 8% in 2019.
Participation in community activities and physical exercise
Respondents were asked if they had the opportunity to be involved in community activities and events outside of GROW. Chart 20 shows the results.
26 As the number of respondents who had been hospitalised in the last year was relatively low (n=16), it was not appropriate to compile a crosstabulation by duration of GROW Membership and run the Chi-square test.
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Chart 20: Interest and participation in community activities and events outside of GROW (n=216) 40% 35% 35% 30% 25% 25% 19% 20% 13% 15% 10% 7% 5% 0% I have no Occasionally I Yes, but I am not I am interested in I participate in opportunity have the interested community community opportunity activities but have activities & not participated events regularly in the past year
Chart 20 shows that just over one third of respondents, 35% (76), said they took part in community activities on a regular basis. A further 25% (55) said that they occasionally had the opportunity to participate in community activities, while 19% (40) reported that they had no such opportunity. Compared to 2018, the results were largely the same, although the percentage who said they had no opportunity to participate increased from 12% to 19% in 2019. Countering this negative trend somewhat, the percentage who said they only had the opportunity occasionally fell from 32% to 25% in 2019. Therefore, there were mixed results here when comparing the results over the two years.
Further analysis by duration of GROW Membership
Table 6: Interest and participation in community activities by duration of GROW Membership (n=200)
<1 year 1-5 years 6 years+ Total I have no opportunity 17% 17% 17% 19% (6) (14) (14) (34) Occasionally I have the 20% 27% 25% 25% opportunity (7) (23) (20) (50) Yes, but I am not interested 11% 8% 6% 7% (4) (7) (5) (16) I am interested but have not 20% 12% 14% 13% participated in the past year (7) (10) (11) (28) I participate in community 31% 36% 38% 35% activities and events regularly (11) (30) (31) (72) Total 100% 100% 100% 100% (35) (84) (81) (200)
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Table 6 shows that longer term GROW Members were slightly more likely to take part in community activities and events on a regular basis than those attending for less than one year. This was reported by 36% (30) of those attending GROW for one to five years and 38% (31) of respondents who have been GROW Members for six years or more, which compares to 31% (11) of those attending for less than one year. The percentage of respondents who said they had no opportunity to take part was the same for all three durations of GROW Membership at 17%, while those who said they were interested but had not taken part in the last year was higher for shorter term Members, at 20% (7), compared to 12% (10) of those engaged for one to five years and 14% (11) for six years or more.
Chart 21 shows that 3 out of 10 Chart 21: Frequency of physical exercise respondents did physical exercise (n=220) almost every day, 30% (67). This 35% was followed by 27% (60) who 30% 27% exercised occasionally and 26% 30% 26% (57) who said ‘two to three times 25% a week’. Just 3% (6) said they 20% never did any physical exercise. 14% 15% 10% Compared to 2018, while the 3% percentage who exercised once a 5% week increased from 8% to 14% 0% in 2019, those who exercised nearly every day fell from 37% to 30% in 2019. Therefore, between 2018-19, there was a fall in the number of respondents who exercised on a daily basis.
Further analysis by duration of GROW Membership
Table 7: Frequency of physical exercise by duration of GROW Membership (n=205)
<1 year 1-5 years 6 years+ Total Never 5% 1% 2% 3% (2) (1) (2) (5) Occasionally 36% 25% 27% 27% (14) (21) (22) (57) Once a week 5% 14% 15% 14% (2) (12) (12) (26) 2 to 3 times a week 26% 29% 23% 26% (10) (24) (19) (53) Nearly every day 28% 31% 33% 30% (11) (26) (27) (64) Total 100% 100% 100% 100% (39) (84) (82) (205)
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Table 7 shows little variation in the frequency of physical exercise by duration of GROW Membership. While respondents who have been GROW Members for less than on year are more likely to exercise ‘occasionally’, 36% (14), compared to longer term Members (25% and 27% respectively), they are similarly as likely to exercise two to three times a week or nearly every day compared to longer term Members. So, there is no clear consistent pattern in the frequency of physical exercise by duration of GROW Membership.
Outlook on life and optimism about the future
A new question was asked in the 2019 survey on respondents’ outlook on life. This question is based on Australian academic research by Andresen, Caputi and Oades in 2016, which resulted in the Stages of Recovery Instrument (STORI), a five-stage recovery model. The aim of STORI is to measure individual recovery from mental health illness using evidence from people who have experienced mental ill health themselves combined with other research evidence on recovery. It comprises a questionnaire of 50 items which represent the different components of recovery: Hope; Identity; Meaning; and Responsibility.
Andresen, Caputi and Oades (2016) conducted preliminary testing on the STORI framework involving individuals who had experienced mental health illness. They concluded that it was a valid measure of the ‘consumer definition of recovery’ (Andresen, Caputi and Oades, 2016: 2). While the authors note that it requires further testing and refinement, a summary of the five stages were included as one question in the GROW National Survey so that respondents could give some indication of how they perceived their own recovery at a particular point in time. The results can be seen in Figure 1 below.
Figure 1: Respondents’ classification using the STORI model (n=215) • Stage 1: Moratorium - a time of withdrawal characterised by a sense 3% of loss and hopelessness
• Stage 2: Awareness - a realisation that all is not lost and a fulfilling 19% life is possible
• Stage 3: Preparation - taking stock of strengths and weaknesses, 20% starting to work on recovery skills
• Stage 4: Rebuilding - actively working towards a positive identity, 33% setting meaningful goals and taking control of one's life
• Stage 5: Growth - living a full and meaningful life, self-management 26% of symptoms, resilience and a positive sense of self
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Figure 1 shows that the most common response was Stage 4, the Rebuilding stage, which was selected by 33% (71) of respondents. This was followed by 26% (55) who chose Stage 5, the Growth stage. Therefore, almost 6 out of 10 respondents chose the two highest levels of recovery in the STORI framework to represent their current outlook on life. A further 20% (42) selected Stage 3, Preparation. Looking at the results for the lower levels of the STORI model, the Moratorium stage, was chosen by just 3% (7) of respondents, while almost 2 out of 10, 19% (40), chose the second stage Awareness. It is important to note that the survey question only included the description of each stage as set out in Figure 1, and did not include the description, e.g. Moratorium, Awareness, Growth etc. as this could bias the response.
Further analysis by duration of GROW Membership
Table 8: STORI classification by duration of GROW Membership (n=198)
<1 year 1-5 years 6 years+ Total Stage 1 - Moratorium 3% 2% 3% 3% (1) (2) (2) (5) Stage 2 - Awareness 30% 17% 17% 19% (11) (14) (13) (38) Stage 3 - Preparation 22% 24% 17% 20% (8) (20) (13) (41) Stage 4 - Rebuilding 32% 33% 30% 33% (12) (28) (23) (63) Stage 5 - Growth 14% 24% 34% 26% (5) (20) (26) (51) Total 100% 100% 100% 100% (37) (84) (77) (198)
Table 8 shows some variation in the results on respondents’ STORI classification by duration of GROW Membership. As might be expected, those who were GROW Members for a longer period of time were more likely have an outlook on life that represented the highest stage in the STORI model compared to newer Members. The response for Growth was chosen by 34% (26) of Members for six years or more and 24% (20) of Members for one to five years, which were both higher than the figure of 14% (5) of Members for less than one year. Similarly, the second stage of Awareness was more prevalent for respondents who were GROW Members for less than one year, 30% (11), compared to longer term Members, 17%. The response for the Rebuilding stage is similar across all three categories of GROW Membership. While these results show some variation in the percentage results, it was not statistically significant.
The final question in the survey asked respondents if they felt optimistic about the future. Chart 22 presents the findings.
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Chart 22: Optimism about the future (n=223)
40% 38%
35% 32% 30%
25% 22% 20%
15%
10% 6% 5% 2% 0% No Rarely optimistic Somewhat Often feel Very optimistic optimistic optimistic
Chart 22 shows that respondents were most likely to feel somewhat optimistic, 38% (84), followed by often feel optimistic, 32% (72). A further two in ten respondents said they were very optimistic, 22% (49). Therefore, more than one half of respondents, 54%, often felt optimistic or were very optimistic about the future, which had increased from 47% in the previous year 2018. In 2019, just 6% (14) of respondents said they rarely felt optimistic and 2% (4) said they were not optimistic about the future, which were similar to the 2018 results of 7% and 3% respectively. In conclusion, the majority of respondents in 2019 said they felt optimistic about the future.
Further analysis by duration of GROW Membership
Table 9: Optimism about the future by duration of GROW Membership (n=207)
<1 year 1-5 years 6 years+ Total Very optimistic 10% 23% 26% 22% (4) (20) (21) (45) Often feel optimistic 31% 34% 32% 32% (12) (29) (26) (67) Somewhat optimistic 46% 35% 35% 38% (18) (30) (29) (77) Rarely optimistic 10% 5% 7% 6% (4) (4) (6) (14) No 3% 3% - 2% (1) (3) (4) Total 100% 100% 100% 100% (39) (86) (82) (207)
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Table 9 shows that longer term GROW Members report being ‘very optimistic’ about the future compared to those who have been attending for a shorter period of time – almost one quarter of those attending for one to five years, 23% (20), and 26% (21) of those who were Members for six years or more, which compared to 10% (4) of respondents attending for less than one year. Respondents who had been attending GROW for less than one year were most likely to say they felt ‘somewhat optimistic’, 46% (18). While this result shows some differences in level of optimism by duration of GROW Membership, it was not statistically significant.
Conclusions
This report has presented the main findings from the GROW National Survey 2019. It gives an insight into the socio-demographic characteristics of the 232 Members who took part. It also provides some understanding of the nature of their mental health needs and views on GROW.
Anxiety was found to be the most common mental health need identified by nearly one half of all respondents (48%), closely followed by Depression (47%). The key life events that were reported to contribute to their mental health need were childhood experiences and poor relationships with family. The survey data also contributes to a better understanding of what aspects of GROW were deemed to be most beneficial to Members. A structured program was closely followed by the opportunity to meet other people.
The survey findings also shed some light on the differences in life chances experienced by Members compared to the national population. In particular, just over one quarter (28%) of respondents were currently engaged in employment, which was far less than in the national population (53%) based on Census data.
Data on recovery outcomes give a valuable insight into the well-being of respondents at the time of completing the survey. Overall, results were fairly positive with the majority of Members reporting they received social support from their spouse/partner, family and friends and just under 1 in 10 having been hospitalised due to mental health reasons in the last year. However, 49% of Members said that they had experienced a relapse within the last year, which shows the cyclical nature of mental wellness and mental illness. In relation to how GROW has contributed to positive mental health, 8 out of 10 of respondents said that going to GROW meetings helped ‘quite a lot’ or ‘very much’ to cope with everyday life. In particular, respondents who were GROW Members for a longer period of time were more likely to respond ‘very much’ here compared to newer Members, which was a statistically significant result.
One new addition to the 2019 National Survey was a question based on the STORI classification, a five-stage mental health recovery framework developed by Australian academic researchers. Almost 6 out of 10 respondents chose the two highest levels of recovery in the STORI framework, Rebuilding and Growth, to represent their current outlook on life. Furthermore, additional analysis found that longer term GROW Members were more likely to select the highest stage compared to more recent Members. This result along with
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some of the other findings reported here indicate that Members attending GROW for a long period of time are more likely to report more positive outcomes compared to newer Members. This requires further exploration to gain a better understanding of this and to help establish the possible reasons. For now, it is clear that GROW has an important role to play in contributing to the positive mental health of its Members.
References
Andresen, R., Caputi, P. & Oades, L. (2006) ‘Stages of recovery instrument: development of a measure of recovery from serious mental illness’ in Australian and New Zealand Journal of Psychiatry, Vol. 40, No. 11-12, p.972-80
Corrigan, P.W., Slopen, N., Gracia, G., Phelan, S., Keogh, C.B. & Keck, L. (2005) ‘Some recovery processes in mutual help groups for persons with mental illness, II: Qualitative analysis of participant interviews’ in Community Mental Health Journal, 41, p.721-735
Finn, L.D., Bishop, B.J. & Sparrow, N. (2009) ‘Capturing dynamic processes of change in GROW mutual help groups for mental health’ in American Journal of Community Psychology, 44, p.302-315
Leamy, M., Bird, V., Le Boutillier, C., Williams, J. Slade, M. (2011) ‘Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis’ in The British Journal of Psychiatry 199 (6) p.445-452
Rappaport, J. (1988) The evaluation of GROW in the USA and its significance for community and mental health. GROW National Seminar, Sydney, Australia. Cited in Finn, L., Bishop, B. & Sparrow, N. (2007) Australian Health Review, 31 (2), p.246-255 Reissman, F. (1965) ‘The ‘helper’ therapy principle’ in Social Work, 10, p.27-32
Watts, M. and Higgins, A. (2017) Narratives of Recovery from Mental Illness: The role of peer support London and New York: Routledge
39 | P a g e GROW in Ireland National Survey 2019
Please answer the following questions – your feedback is important to GROW. All the data is anonymous and confidential. Background characteristics 1. Are you…. Male Female Other 11. At the moment are you engaging with any of the following? 2. How old are 24 years or less 25 to 34 35 to 44 GP Psychologist Psychiatrist Counsellor you? 45 to 54 55 to 64 65-74 75+ years Support group (other than GROW) specify ______ Other (specify) ______None of the above 3. Would you describe the Urban Suburban Rural 12. How would you define your mental health need? (tick one) area you live in as: Anxiety Depression Obsessive Compulsive Disorder 4. What is your current status? At work Retired Post-traumatic Stress Disorder Bipolar Disorder Looking after home/family Volunteering Student Schizophrenia Personality Disorder Eating disorder Seeking employment Not working due to illness/disability None Other (specify) ______Training course Other (specify) ______13. Did any of the following contribute to your mental health need? Engagement with GROW Separation/divorce Poor relationships with family Bereavement Redundancy Relationship breakdown 5. Region of East North East Midlands Midwest GROW West South East South North West Childhood experience Work/employment Physical illness Group: None of the above Other (specify) ______6. In the last 3 months did you attend a GROW group……. 14. What do you find most beneficial about GROW? (tick up to 3) Once a Every 2 Once a Less than once a Structured program Reading material Peer support week weeks month month Practical tasks/goals Social events Weekly meetings 7. How long have you been a Member of a GROW group? Meeting other people Learn new skills Other (specify) less than 1 year OR ______years ______8. In the last year 2018, did you attend any of the following? National weekend Regional weekend 15. Has the support you have received from GROW helped you with any of the following? Group weekend Group social event Deal with your employer Retention of employment 9. What is your role in GROW? (tick as many that apply) Member Recorder Organiser Leader Gain employment Change job/career Not applicable Regional team Member Board Member Staff 16. What could be better about GROW? 10. Who referred you to GROW? ______GP Psychologist Psychiatrist Counsellor (HSE) ______Counsellor (Private) No-one, I referred myself ______Other professional (specify) ______Please turn over
Outcomes 23. When were you last hospitalised for mental health reasons? 17. In the past 3 months, I have come up with…….. Within the last In the last 2-3 In the last 4-6 In the last 7-12 No personal A goal but have not done A goal and made a little way month months months months goals anything to achieve it towards achieving it Haven’t been hospitalised in the last year Never A goal and have gotten pretty far in A goal and have achieved it 24. Have you the opportunity to be involved in community activities achieving it and events outside of GROW? 18. How much are family Members, friends, spouse/partner and I have no Occasionally I have Yes but I am not interested other people who are important to you (outside of GROW) opportunity the opportunity involved in your recovery? I am interested in community activities but I participate in community Not at all Only when there is a Sometimes, like when things have not participated in the last year activities/events regularly serious problem are starting to go badly 25. Do you take regular physical exercise? Much of the time A lot of the time, they really help me Never Occasionally Once a week 2-3 times Nearly every day with my recovery a week 19. How much do your symptoms get in the way of you doing 26. Which one of the following best describes your outlook on life at things that you would like to or need to do? the moment? Really get in my way Get in my way quite Get in my way I feel that it is a time of withdrawal characterised by a profound sense a lot a bit somewhat of loss and hopelessness Get in my way very little Don’t get in my way at all I realise that all is not lost and that a fulfilling life is possible 20. How well are you coping with your mental or emotional I am taking stock of my strengths and weaknesses regarding recovery well-being from day to day? and starting to work on developing recovery skills Not well at all Not very well Alright I am actively working towards a positive identity, setting meaningful Well Very well goals and taking control of my life I am living a full and meaningful life characterised by self- 21. To what extent has going to GROW meetings contributed to management of symptoms, resilience and a positive sense of self being able to cope with day to day life? Not at all Not that much Somewhat 27. Do you feel optimistic about the future? Quite a lot Very much No Rarely optimistic Somewhat optimistic Often feel optimistic Very optimistic 22. When was the last time you had a relapse of symptoms (that is, when your symptoms had gotten much worse)? 28. Finally, in 10 words or less, how has GROW helped you on the journey towards positive mental health? Within the last In the last 2-3 In the last 4-6 month months months ______In the last 7-12 months I haven’t had a relapse in the last year