Consumer self-help groups developed partly out of dissatisfaction with the mental health care system and the need for consumers to combat the stigma of mental illness (Emerick 1990). These groups have expanded to include a wide variety of programs and to also comprise family and carer support groups. Wissman (2003) outlines the following different types of support groups: education groups; skill-development; self-help and support groups; recreation groups; social and social skills development groups; issue or interest-based groups; and advocacy and community education groups.

There are few methodologically sound research studies available regarding the efficacy of self-help programs. Peer-based and self-help approaches are not amenable to randomised controlled trials because they grow out of the shared needs and experiences of people with mental illness and are not provided as specific and randomly assignable interventions. The complexity of group processes makes their elements and dynamics difficult to capture and quantify within a rigorous research design (McDermott 2003). One available study, Arns (1992, cited in Accordino & Herbert 2000), reported that length of attendance at a Clubhouse program was associated with more positive outcomes in terms of better employment status, better physical functioning, improved personal care and better social relationships.

Despite the lack of methodologically rigorous evaluations of self-help programs, descriptive and anecdotal evidence abounds regarding the importance and effectiveness of these groups for both consumers and carers (eg, Chamberlin, Rogers & Ellison 1996). Yalom cites 11 factors that he argues are the keys to group effectiveness. These are: instillation of hope; universality; imparting of information; altruism; corrective recapitulation of primary family group; development of socialising techniques; imitative behaviour; interpersonal learning; group cohesiveness; cartharsis; and existential factors (1975 see McDermott 2003 for a summary).

Most importantly, self-help groups provide social contact and fellowship. Many people with mental illness are socially isolated, as a result of the symptoms of their illness or the disruption to their lives that the illness has caused (Goldberg, Rollins & Lehman 2003). There is a growing evidence base of the positive impact of self-help groups on the social networks of people with mental illness (eg, Hardiman & Segal 2003). While the social support provided specifically by self-help groups has not been systematically studied, the positive effects of social support in general on health and wellbeing are firmly established in the literature (eg, House, Liandis & Umberson 1988).