Samson Tse, Ph.D.
Senior Lecturer in Mental Health Development, School of
Associate Dean (International), Faculty of Medical and Health Sciences,
University of Auckland
Carolyn Doughty, Ph.D.
Research Fellow in Health Technology Assessment
Department of Public Health and General Practice
Christchurch School of Medicine and Health Sciences
University of Otago
Manager, New Zealand Bipolar Network
S., Doughty, C., Bristol, F.(2004).
Peer Support Groups for People With Bipolar Disorders in New Zealand:
A Pilot Study on Critical Success Factors. International
Journal of Psychosocial Rehabilitation. 9, 1, 47-58.
Private Bag 92019, School of Population Health,
Faculty of Medical and Health Sciences, University of Auckland, New
64- 9- 3737599 (Office) 64- 9- 3035932 (FAX)
Acknowledgements:The authors would like to express our gratitude
to group facilitators
who participated in this survey and the New Zealand
Bipolar Network for their support of this study.
Individuals with bipolar disorder may be at risk of not
maintaining positive social networks that are essential for health and
wellbeing. Peer support is an intentional form of social support that
may help individuals to develop new perspectives on one’s illness and
access information, including specific training. The aim of this pilot
study was to describe the running of peer support groups for people
with bipolar disorder in New Zealand and from the group facilitators’
point of view, to examine the critical factors that determine their
success. Data were collected via a descriptive survey of known bipolar
support groups within New Zealand. Three key elements of successful
peer support group emerged from the study: Firstly, a close partnership
between group facilitator and core group members; secondly, defining
the roles for mental health professionals in peer support groups; and
finally establishing the credibility of the group within the community.
Key words: recovery, social support, self-help
Bipolar disorder (BD) is a disruptive major mental disorder. It affects
approximately one in 100 adults at some stage in their lives in New
Zealand and has a lifetime prevalence in the general population of
between 0.3 and 1.5 percent across the world (Silverstone & Romans,
1995, Weissman, et al., 1996). BD has a relapsing and remitting course,
in which some individuals have full recovery between manic, depressed
or mixed episodes of illness. Nevertheless, research data to date
generally points to the relentless nature of BD (Staner, et al., 1997;
Winokur, et al., 1994), for example, eight out of 10 patients who
reached full recovery from their first episode went on to develop a new
episode within the next 10 years. Some clinicians and researchers
have suggested that relapse of illness may be related to the scars of
the episode themselves, the absence or inadequacy of treatment, the
presence of an organic syndrome, ongoing use of alcohol or unprescribed
drugs and/ or the absence of social support (Goodwin & Jamison,
1990). More recently it has been suggested that the dominant aspect
amongst people who had one episode, and then no further
hospitalizations, was the person’s acceptance of responsibility
for their own wellness (Copeland, 1998).
In an analysis of Global Burden of Disease, BD features in the top ten
most disabling conditions in the world (Murray & Lopez 1996). BD is
regarded as a psychiatric disorder is characterised by low prevalence
and high life span disease burden. The economic burden of BD alone in
the United States in 1990 was estimated to be US$15.5 billion in
diminished or lost productivity in work performance (Hitley, Brady
& Hales, 1999). In a recent Australian study, it has also been
found that mood disorder, which affects 100,000 Australians, costs the
health system A$300 million each year, with indirect costs of A$1.3
billion (Pezzullo, 2003). In modern workplaces, the leading source of
workers’ disability is depression (Stewart, Ricci, Chee, Morganstein,
& Lipton, 2003). A common thread that cuts through the optimal
management of BD is the need to minimize the intensity and duration of
the individual episodes and if possible, prevent the occurrence of
future episodes (Romans & Silverstone, 1994).
Social support has been associated with good health, well-being and
functional performance of individuals with BD (Edmonds, et al., 1998;
Goldberg, Harrow, & Grossman, 1995; Keck, et al., 1998; Michalak,
Wilkinson, Hood, Dowrick, & Wilkinson, 2003; McPherson, Dore, Loan,
& Romans, 1992). Social support generally refers to help that is
provided by one’s family or friends that facilitates the individual’s
ability to cope with stressful life events. It has an element of
intimacy, and an opportunity for reciprocal and socially motivated
behaviors (Berkman, 1995). However the question of whether and in what
form social support may be available is of particular importance for
individuals with BD because the social networks are at greater risk due
to a variety of reasons such as the stigma associated with mental
illness, the lack of effective social skills, the presence of socially
undesirable behaviors when the person is manic or depressed, and/or
other social sequelae wrought by the illness (e.g., loss of life roles,
financial hardship, unemployment).
People with BD sometimes find support, acceptance and comfort in
discussing their experiences with other individuals who have experience
of similar illness in peer support or mutual-help groups. Davidson and
colleagues (1999) defined peer or mutual support as a process by which
people come together to help each other address common problems or
shared concerns. It is a system of giving and receiving help founded on
key principles of respect, shared responsibility, and mutual agreement
of what is helpful. It is about understanding another’s situation
empathically through the shared experience of emotional and
psychological pain. Mead, Hilton and Curtis (2001) added that when
people find affiliation with others they feel are “like” them, they
feel a connection. This connection, or affiliation, is a deep, holistic
understanding based on mutual experience where people are able to “be”
with each other without the constraints of traditional (expert/patient)
relationships. One of the main differences between peer support and
naturally occurring social support may be the intentional way in which
it occurs, that is, there is usually a specific setting involved where
new information, perspectives, training, skills and a supportive social
climate are fostered. Some types of peer or mutual support are offered
in the context of particular world-views and ideologies that are aimed
at assisting people to make sense of their experiences.
There has been increased popularity in the use of peer support groups
for people with mental health problems such as bipolar disorder,
schizophrenia, alcohol and substance abuse disorders (Corrigan, et al.,
2002; Felix-Ortiz, Salazar, Gonzalez, Sorensen, & Plock, 2000;
Kingree & Thompson, 2000; Powell, Yeaton, Hill, & Silk, 2001).
Several studies examined the attitudes, behaviors and experiences of
mental health professionals toward psychiatric peer support groups
(e.g., Chinman, Kloos, O’Connell & Davidson, 2003; Powell, Silk,
& Albeck, 2000). For instance, Powell and his colleagues
(2000) found that whether or not psychiatrists made referrals to peer
support groups depended upon several factors, the presence of such
groups in the same facility as the psychiatrists’ clinics, the
psychiatrists’ receipt of information about peer support groups and his
or her beliefs about its benefits and limitations. A number
of other variables may dictate who gets involved in peer support. Some
individuals with BD may avoid face-to-face support groups or fear
discrimination if employers, workmates or friends learn about their
difficulties. Some of these have turned to cyberspace in the form of
Internet support groups (ISGs) (Lamberg, 2003). Researchers have
found that, both face-to-face and online support groups offer emotional
support (it is often considered by group members as the chief benefit),
encouragement and information (Hoston, Cooper, & Ford, 2002; Klemm,
Reppert, & Visich, 1998; Powell, et al., 2001; Rappaport, 1993).
Corrigan and his associates’ (2002) work was the first that the authors
are aware of to examine the recovery processes that might account for
the positive outcomes occurred in peer support groups for people who
have serious mental illness. Yet despite the vast literature on social
support and mental illness, there is paucity of research on critical
factors influencing the outcomes of peer support groups for people with
There were two aims of the present study. The first was to describe the
running of peer support groups for people with BD in New Zealand. How
many groups existed in New Zealand and how were they distributed over
the country? What were the common types of activities? What was the
background of the group facilitators? The second objective was to
examine, from the group facilitators’ perspective, what were the
critical factors determining the success of peer support groups for
people recovering from BD?
Procedures and participants
This study was implemented as part of the evaluation framework for the
New Zealand Bipolar Network which is a voluntary, charitable
organization governed by consumers with mood disorders (primarily
bipolar disorder) in New Zealand. The network is funded by membership,
donations and community funding agencies (but not the central
government). The present descriptive survey used a naturalistic
design and the sampling frame was all the nineteen support groups (in
some regions there are multiple groups) within New Zealand. This
included groups identifying themselves as depression support groups,
where these groups were also members of the New Zealand Bipolar
Network. To be eligible for inclusion groups could be professionally
facilitated, peer-run support groups or groups that adopted a
combination approach but they needed to incorporate some aspect of
social support, broadly defined. Of these support groups, five were
excluded due to there being no group in existence or the former group
being in recess. A further member group was identified as not
specifically a BD support group and was not asked to return the survey
form. Groups offering support primarily to relatives or family members
were also excluded. A total of 13 surveys were mailed to the key
contact person or group facilitator in each region, further copies of
the survey were also emailed as an attachment to online members of the
newsletter mailing list to maximize the chances that any unknown groups
might also respond. Two reminders were circulated by email to group
facilitators in order to improve the response rate. From the 13 groups
surveyed, ten groups (77%) responded.
Key questions for the present survey were formulated based on a forum
held in 2003 at the National New Zealand Bipolar Conference. That
particular forum was about an update on peer support groups in each
region which gave useful clues on what should be covered in the
questionnaire. The first author took notes of the session and discussed
the drafted questionnaire with the research team. The finalized
questionnaire included following areas:
• General description of the bipolar peer support
group in each region (e.g., background of group facilitators, frequency
of meeting, time of meeting);
• Types of activities organized in the meetings;
• A reflective question on how the group facilitators
rated the overall functioning of the group(s). “1” denotes “close to
not functioning at all, and “10” indicates “achieving the group set
• An open-ended question pertained to what were the
critical factors to successful peer support group.
Data from the 13 returned questionnaire were analysed using a general
inductive approach to identify key themes relevant to the research
objectives. This analytic strategy is similar to grounded theory and
leads to a theoretical framework developed inductively from data and
emerged themes (Strauss & Corbin, 1990, 1998; Thomas, 2003;
2000). The first and second author reviewed the data individually
and then the whole research team examined the overall results. Studying
the written data repeatedly enabled the development of themes and
sub-themes and their linkages. Analyses were performed primarily by
cross-case analyses of each returned responses and the constant
comparative method (Huberman & Miles, 1998). Focus for the present
data analyses included: general description on peer support groups,
respondents’ opinion on critical factors to successful peer support
groups. Special attention was given to possible meanings of each
emerging theme and sub-theme. All these findings were then synthesized
into a framework to explain the keys to successful peer support groups
for individuals recovering from bipolar illness.
Bipolar peer support groups in New Zealand
Four of the ten respondents came from New Zealand metropolitan cities
(Auckland, Wellington, Christchurch, Hamilton and Dunedin). Only one
out of the ten groups was led by mental health professionals whereas
the rest were facilitated by people with experiences of BD or co-led by
both professionals and service users. The average meeting attendance
was ten people. The average self-reported rating by facilitators on the
overall functioning of the peer support groups was about “7” out of a
ten-point scale, where a high score indicated optimal functioning.
Other key findings are summarized in Table1.
Table 1. Survey on
Bipolarpeer help Groups in New Zealand
Frequency of meeting
Average number of people attending
Impression on overall functioning: 1-
very poor; 10- very well
Combined- led by peer and professionals
Evening, (i.e., after )
Did not complete
Both- evening & day time meetings
Did not complete these items2
Did not complete
Did not complete
1 NMC Non MetropolitanCity, MC Metropolitan City 2 This respondent provided useful
data so her responses were not discarded in this survey.
The topics for education, sharing of personal experiences and
opinions were grouped as follows:
• Medication (values, benefits, side effects)
• Early warning signs (what they are when noticeable?
when to act? what to do and where to seek help?)
• Nutrition for the mind (use of food and supplements
that affect mood)
• Cognitive-behavioral therapy
• Spiritual well-being
• Life style issues (e.g., energy level, sleep
pattern, diet, opportunity for making life-style changes)
• Managing family (spouse/ partners, children) and
• Alternative treatments (what have people heard?
where to get information?)
• Dealing with discrimination and stigmatization (how
to deal with? what to say?)
• Diagnosis and its replications
• Talks from other non-government organizations about
the services they provided
• Talks by health professionals, social welfare
agencies and income support services
• Privacy law
• Educational video on people’s recovery journey
• Update on changes in mental health services or
• Report on national organizations and conferences
During the peer support group sessions, a range of activities was also
used to promote mental health. They are: yoga and meditation, physical
exercise, training in time and stress management, sharing of jokes,
recovery and depression awareness course.
“Informal tea/ coffee and biscuits time” was the most commonly used
activity to promote social interaction and emotional support among
group members. Some groups had set time for each attendee to discuss
how things have been in between the meeting time with special emphasis
on how they were coping instead of why they are not. Shared dinners,
meals and festival gathering were also very popular social activities.
Occasionally friends, partners and family members were invited to come
along and they brought a different social dimension to the peer support
Critical factors contributing to the success of bipolar peer support
groups from group facilitators’ perspective
There were three major factors or themes emerged from the results.
Factor one was related to the qualities of group facilitators and how
they worked with their core members in the group. Factor two captured
key issues arising from the group that members and facilitators alike
have to deal with in order to run the group successfully. Peer support
groups do not exist in a vacuum. Respondents identified additional
issues external to the group in factor three, which would potentially
determine the outcome of peer support groups.
Factor one: Group leaders and group
• Successful group
can benefit from support provided by professionals or mental health
services during the establishment phase.
• “Adequate support from faithful and dependable
group members was equally important” (group facilitator 9). “It often
starts with the energy and commitment from one person but to ensure
sustainability this person needs the backing and support of others”
(group facilitator 3). Group facilitator 4 added “Good, strong
collective leadership and communication among leaders and core group
• Characteristics of effective facilitator or speaker
were: providing ideas, to empower, not to control group members or take
over the group, good listening skills, unconditional positive regard
and congruence, effective interpersonal skills, no “talking down”
attitude to group members, good role models, effective organization
skills, networking skills with relevant agencies.
Factor two: Coping with internal
challenges arising within the group
The most important challenge identified by facilitators has been to
ensure confidentiality and trust is maintained among group members. One
respondent mentioned that having clear rules about safety in the group,
knowing how to manage differences in opinions was a useful way to
reinforce that. Coping with different level of wellness among group
members or people at different stages along the recovery continuum of
bipolar affective disorder was mentioned as another important
Another key factor to successful peer support group was related to the
group’s ability to strike a balance in group size, and a right mix of
gender and people with different personalities and energy level.
“Getting the right mix of people for each group and keeping groups
small” (group facilitator 10). It also needs to have a balance of
structured (i.e., had set topic, format and process) versus free, open
discussion. Respondent 4 added, “Variety is a spice and having a
variety of activities, speakers, and group members makes for no two
nights being the same”.
Along a similar vein of findings, some respondents mentioned how it was
important to manage the balance in terms of the group being facilitated
by mental health professionals (that usually do not have experience of
mental illness) or peers who have experience of bipolar illness. If
professionals led the group, people attending peer support group would
start looking to paid mental health practitioners for opinions and
support rather than peers. Tension did start to happen as the
peer support group went in a different direction to a recovery model.
One respondent reflected on the value of adopting the recovery model in
peer support group such as the principles of promoting personal
responsibility, individual and collective self-determination,
“I think that support groups have the most to offer if they run on a
peer support model and that health professionals have an important role
to play in building the capacity of group members to take the group
over for themselves. Having said this, from personal experience it can
be very hard to extricate yourself once people have come to rely on
you” (group facilitator 3).
Some respondents showed reluctance in accepting input from
professionals who did not have appropriate interpersonal and
communication skills. One example is:
“The group had difficulty with a mental health professional talking
down to attendees with a condescending attitude. The need for good
listening and conversational skills, an unconditional positive regard
for others in the group and good congruency became very apparent in
both group and individual support” (group facilitator 2).
On a practical note, having good up-to-date library resources and
solving group members’ transport problem were important issues in
enabling people to attend and stay involved in a peer support group.
Factor three: Coping with external
The greatest external challenge for a bipolar peer support group is to
create credibility among the people the group seeks to give support to,
and importantly with the government mental health services and other
non-government mental health service providers such as family doctors
through whom referrals come. Group facilitator 4 elaborated, “It is
important for the group to have a good front people who can represent
the group well in the community and as people first make contact
through the telephone people who have a good phone manner and knowledge
of the group”. Ongoing success of the peer support group in each region
depends on the group’s ability in obtaining funding to cover the
ongoing costs for venue hire, staff costs and information provision and
other specific activities like educational workshops, festival
gatherings, and small research projects. “We have good leadership among
the group members however funding has become a limiting factor in the
effectiveness and versatility of the group” (group facilitator 4).
Recently, there has been a challenge from funders about the value of
having a peer support group specifically for people with BD as opposed
to a group supporting the full spectrum of mental illness.
While the mental health recovery movement appears to have gained
significant momentum in countries like the United States and the United
Kingdom, its impact on mental health sector is gradually becoming more
visible in New Zealand. The recovery approach was developed and
endorsed in New Zealand by the Mental Health Commission as a new and
fresh approach to working with people suffering from mental health
problems (Mental Health Commission, 1998). The New Zealand Mental
Health Commission (1999, p. 1) defines recovery as “the ability to live
well in the presence or absence of one’s mental illness (or whatever
people choose to name the experience)” and emphasizes the importance of
acknowledging one’s cultural background, in particular the Maori
culture (the indigenous people in New Zealand). “Recovery orientation
is compatible with Maori mental health models, in that a balance is
sought between the body, person, whanau (extended family), and the
environment and ecologies within which they exist” (Lapsley, Nikora,
& Black 2002, p. 2).
If people with bipolar illness are going to get well and stay well,
ongoing education about the principles of recovery and elf-management
skills specific to bipolar disorders is important. Individuals should
be encouraged to obtain as much information as possible, through books,
educational videos, health professionals and talking with other people
recovering from BD. Results from the present study highlight three
aspects support group facilitators see as paramount.
Firstly, this study found that in addition to personal qualities and
effective skills of a group leader, it is important to create a close
partnership between group facilitator and core group members to ensure
successful running of peer support groups. This study challenges
the conventional view that the group facilitators or leaders in
clinical settings hold the key to successful group experiences. The
group leader is seen as having the primary responsibility to manage
behaviors and reduce anxiety inherent in bringing together a group of
strangers who enter the group because they are in need (Dies, 1983;
Yalom, 1985). In this study, according to group facilitators, a
successful group experience requires strong commitment of certain
members to the caring community created in the peer support group.
These core group members need to work closely with the group
facilitator regardless of whether the facilitator is coming from a
service user’s background or not. This finding is consistent with
recent work on recovery processes in mutual-help groups. In a study on
a structured educational program and a caring community found that
“(to) decentralize from self and participate in community” was one of
the key recovery processes inherent in peer support group (Corrigan et
al., 2002, p. 291). In turn, participation in a sharing and caring
community helps lighten the group facilitators’ workload thereby
contributing to the long-term survival and successful outcomes of the
peer support group.
Secondly, some respondents in the present survey indicated their
reluctance in accepting help from mental health professionals in
facilitating bipolar peer support groups. This comment equates with the
findings of Kurtz (1990) that stated over-involvement of the
professional, including leadership or facilitation, risks
professionalizing the group and reducing the opportunities for members
to help one another. Doughty (2002) argued this was not meant to
undermine mental health professionals’ expertise and knowledge about
the nature, or clinical treatment, of psychiatric symptoms, but simply
to acknowledge that experiential wisdom and personal struggle are
important facets in helping others to seek their own wellness and
recovery. However other studies suggested that professional leadership
could have a positive impact (Stewart 1990, Stewart, Banks, Crossman,
& Poel, 1995) while others found few or no differences between
peer-led and professional-led groups (Shepherd et al., 1999). We tend
to agree with Shepherd and associates that the dichotomous view of
comparing peer-led versus professional-led support groups was
artificial and that professional involvement in mutual aid was a
continuum, with most groups having a moderate level of professional
involvement. Furthermore one should not ignore the fact that the number
of people with a mental illness taking up professional training in
mental health sector is on the rise, both in New Zealand and
internationally (Hansen, 2003). It was suggested that professionals
should be engaged in a dialogue with peer-led support groups about the
realities of the potential benefits and conflicts for example, what to
do when a peer support group gives a service user a suggestion contrary
to the advice of their treating psychiatrists or mental health workers
(Chinman et al., 2002).
The third major finding of this study was about establishing
credibility of the peer support groups for people with bipolar illness.
Indeed without a good reputation in the community, it is very difficult
to secure continuous funding for the group. Credibility of a peer
support group for specific illness is often associated with helpfulness
perceived by group members. It was found in a recent study that
members’ perceived helpfulness of a mutual help group was strongly
correlated with ratings of referent power (influence based on sense of
identification among members, peer leaders and mental health
professionals) and expert power (influence based on knowledge and
expertise) (Salem, Reischi, Gallacher, & Randall, 2000). Group
members reported experiencing high level of referent power with their
fellow members and peer leaders. They reported higher levels of expert
power for mental health professionals and peer leaders than for fellow
Implications for implementation
Chinman et al. (2002) and Powell et al. (2000) drew attention to the
encouraging nature of research on the utility of peer support groups
for those with serious psychiatric disabilities, including bipolar
disorder. Specifically, they highlighted research that related
participation in such groups to lower hospitalization rates, fewer days
spent in hospital, less substance use, reduced symptomatology, more
positive social functioning, enhanced social networks and promoting
advocacy. Despite overwhelming anecdotal evidence (e.g., Lish,
Dime-Meenan, Whybrow, Prince, & Hirschfield, 1994, Doughty, 2002)
that illness-specific peer support groups play an integral role in
allowing individuals and families timely access to information, there
still are relatively few New Zealand organizations that receive funding
for peer support. To date less than one quarter of the peer support
groups surveyed in the present study received adequate financial
support. Employing people with a mental illness as group facilitators
reflects a recognition that professionally credentialed and formally
trained health professionals cannot meet all of the needs of people
with serious mental illness and that service users themselves bring
something distinctive to the service process (Mowbray, Moxley, &
In a survey of 1,100 mental health professionals, it was found that
participants tended to view professionally led groups more positively
than they did peer support groups on a number of dimensions (Salzer,
Rappaport, & Segre, 1999). Their analyses suggested that the
curative factor associated with professionally led groups was valued
over factors associated with peer support groups. Salzer and colleagues
(1999) suggested that one of the implications of their study is that
professionals may be less willing to provide much needed resources and
referrals to peer support groups as long as they are evaluated from a
professional services framework. Adoption by funders and policy makers
of an alternative framework that values the benefits of both
professional and consumer-run initiatives would recognize their unique
contribution to mental health services (Salzer & Shear, 2002).
Strengths and limitations of the
One of the strengths of this study is it is a pilot study to explore
critical factors contributing to successful outcomes of peer support
groups. This study also provides a description of a range of
activities used in peer support group to promote education, enhance
social networking and support among people with BD. However, the study
is limited by assessing only one perspective on critical factors to
successful peer support groups.
In summary, the present study provides a useful account of the key
factors that make up a for successful peer support groups from a
facilitator’s perspective. What seems to work best is that the peer
support group has clear purposes, a simple group process and a suitable
governance structure. It especially highlights the need to manage any
tensions that arise and strike a balance in the area of working
cooperatively with health professionals. Future studies should seek to
incorporate some elements of experimental design. For example even if
random allocation to groups was not possible it may be useful to
examine psychosocial outcomes for individuals by making comparisons
between those participating in a group with factors critical to
successful peer support and those assigned to control group without
additional qualities. The demographic and cultural background of people
attending the bipolar peer support groups was not included in this
study. Further studies of factors predicting the success of peer
support group should aim for more heterogeneous samples inclusive of
indigenous people, ethnic minorities, different age groups and men .
Berkman, L. (1995). The role of
relations in health promotion. Psychosomatic
Medicine, 57, 245-254.
Copeland, M. E. (1998). Living without depression and manic depression:
workbook for maintaining mood stability. Oakland, CA: New Harbinger.
Chinman, M., Kloos, B., O'Connell, M., & Davidson, L. (2002).
Service providers' views of psychiatric mutual support groups. Journal
of Community Psychology, 30, 349-366.
Corrigan, P. W., Calabrese, J. D., Diwan, S. E., Keogh, C. B., Keck,
L., & Mussey, C. (2002). Some recovery processes in mutual-help
groups for persons with mental illness; I: Qualitative analysis of
program materials and testimonies. Community Mental Health Journal, 38,
Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D.,
& Tebes, J. K. (1999). Peer support among individuals with severe
mental illness: A review of the evidence. Clinical Psychology-Science
and Practice, 6, 165-187.
Dies, R. R. (1994). Therapist variables in group psychotherapy
research. In A. Fuhriman & G. Burlingame (Eds.), Handbook of group
psychotherapy (pp. 114- 154). New York: Wiley.
Doughty, C. J. (2002). Peer support for bipolar disorder: a Winston
Churchill Fellowship report. Wellington, NZ: Winston Churchill Memorial
Trust. Available online at http://www.balance.org.nz (official website
of Balance, the New Zealand Bipolar Network)
Edmonds, L. K., Mosley, B., Admiraal, A. J., Olds, R. J., Romans, S.
E., Silverstone, T., & Walsh, A. E. S. (1998). Familial bipolar
disorder: Preliminary results from the Otago familial bipolar genetic
study. Australian and New Zealand Journal of Psychiatry, 32, 881-887.
Felix-Ortiz, M., Salazar, M. R., Gonzalez, J. R., Sorensen, J. L.,
Plock, D. (2000). A qualitative evaluation of an assisted self-help
group for drug-addicted clients in a structured outpatient treatment
setting. Community Mental Health Journal, 36, 339-350.
Goldberg, J. F., Harrow, M., & Grossman, L. S. (1995). Course and
outcome in bipolar affective disorder: A longitudinal follow-up study.
American Journal of Psychiatry, 152, 379-384.
Goodwin, F. K., & Jamison, K. R. (1990). Manic-depressive illness.
New York: Oxford.
Hansen, C. (2003). Strengthening our foundations: Service user roles in
the mental health workforce. Wellington: New Zealand Mental Health
Hilty, D. M., Brady, K. T., & Hales, R. E. (1999). A review of
bipolar disorder among adults. Psychiatric Services, 50, 201-213.
Houston, T. K., Cooper, L. A., & Ford, D. (2002). Internet support
groups for depression: a 1-year prospective cohort
study. American Journal of Psychiatry, 159(12),
Huberman, A. M., & Miles, M. B. (1998). Data management and
analysis methods. In N. K. Denzin & Y. S.
Lincoln (Eds.), Collecting and interpreting qualitative
materials (pp. 179-210). Thousand Oaks, CA: Sage.
Keck, P. E., McElroy, S. L., Strakowski, S. M., West, S. A., Sax, K.
W., Hawkins, J. M., Bourne, M. L., & Haggard, P. (1998). 12-month
outcome of patients with bipolar disorder following hospitalization for
a manic or mixed episode. American Journal of Psychiatry, 155, 646-652.
Kingree, J. B., & Thompson, M. (2000). Mutual help groups,
perceived status benefits, and well-being: a test with adult children
of alcoholics with personal substance abuse problems. American Journal
of Community Psychology, 28, 325-342.
Klemm, P., Reppert, K., & Visich, L. (1998). A nontraditional
support group: the Internet. Computer and Nursing,
Kurtz, L. F. (1990). The self-help movement: Review of the past decade
of research. Social Work Groups, 13, 101-115.
Lamberg, L. (2003), Online empathy for mood disorders: patients turn to
Internet support groups. Journal of American Medical Association, 289,
Lapsley, H., Nikora, L. W., & Black, R. (2002). Kia Mauri Tau!
Narrative of recovery from disabling mental health problems.
Wellington: Mental Health Commission.
Lish, J., Dime-Meenan, S., Whybrow, P., Prince, R., & Hirschfield,
R. (1994) The National Depressive and Manic Depressive Association
(DMDA) survey of bipolar members. Journal of Affective Disorders, 31,
Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: a
theoretical perspective. Psychiatric Rehabilitation Journal, 25,
Mental Health Commission (1999). Review of progress: Blueprint for
mental health services in New Zealand. Wellington: Author.
Mental Health Commission (1998). Blueprint for mental health services
in New Zealand: How things need to be. Wellington: Author.
Michalak, E., Wilkinson, C., Hood, K., Dowrick, C., & Wilkinson, G.
(2003). Seasonality, negative life events and social support in a
community sample. British Journal of Psychiatry, 182, 434-438.
Mowbray, C. T., Moxley, D. P., & Collins, M. E. (1998). Consumers
as mental health providers: first-person accounts of benefits and
limitations. Journal of Behavioral Health Services & Research, 25,
Murray, C., & Lopez, A. (1996). The Global Burden of Disease:
Harvard University Press.
Pezzullo, L. (2003). Bipolar disorder Costs: An analysis of the burden
of bipolar disorder and related suicide in Australia. A Report by
Access Economics for SANE Australia. Retrieved January 30, 2004, from
world wide web: http://www.sane.org/
Powell, T. J., Silk, K. R., & Albeck, J. H. (2000). Psychiatrists’
referrals to self-help groups for people with mood disorders.
Psychiatric Services, 51, 809-811.
Powell, T. J., Yeaton, W., Hill, E. M., & Silk, K. R. (2001).
Predictors of psychosocial outcomes for patients
with mood disorders: The effects of self-help group
participation. Psychiatric Rehabilitation Journal, 25(1), 3-11.
Rappaport, J. (1993). Narrative studies, personal stories, and identity
transformation n the mutual help context. Journal of
Applied Behavioral Science, 29, 239-256.
Romans, S. E., & Silverstone, T. (1994). Bipolar disorder: Optimal
management. New Ethicals, November issue, 67-78.
Salem, D. A., Reischi, T. M., Gallacher, F., & Randall, K. W.
(2000). The role of referent and expert power in mutual help. American
Journal of Community Psychology, 28, 303-324.
Salzer, M. S., Rappaport, J., & Segre, L. (1999). Professional
appraisal of professionally led and self-help groups. American Journal
of Orthopsychiatry, 69, 536-540.
Salzer, M. S., & Shear, S. L. (2002). Identifying consumer-provider
benefits in evaluations of consumer-delivered services. Psychiatric
Rehabilitation Journal, 25, 281-288.
Shepherd, M. D., Schoenberg, M., Slavich, S., Wituk, S., Warren, M.,
& Meissen, G. (1999). Continuum of professional involvement in
self-help groups. Journal of Community Psychology, 27, 39-53.
Silverstone, T., & Romans, S. (1995). The prevention of relapse in
bipolar disorder. New Zealand Medical Journal, 108, 397-398.
Staner, L., Tracy, A., Dramaix, M., Genevrois, C., Vanderelst, M.,
Vilane, A., Bauwens, F., Pardoen, D., & Mendlewicz, J. (1997).
Clinical and psychosocial predictors of recurrence in recovered bipolar
and unipolar depressive: A one-year controlled prospective study.
Psychiatry Research, 69, 39-51.
Stewart, M. J. (1990). Professional interface with mutual aid groups: A
review. Social Science Medicine, 31, 1143-1158.
Stewart, M. J. Banks, S., Crossman., & Poel, D. (1995). Health
professionals perceptions of partnership with self-help groups.
Canadian Journal of Public Health, 86, 340-344.
Stewart, W. F., Ricci, J. A. Chee, E., Morganstein, D., &
Lipton, R. (2003).
Lost Productive Time and Cost Due to Common Pain
Conditions in the US Workforce, Journal of American
Medical Association, 290, 2443- 2454.
Strauss, A., & Corbin, J. (1998). Grounded theory methodology: An
overview. In N. K. Denzin & Y. S. Lincoln
(Eds.), Strategies of qualitative inquiry (pp. 158-183).
Thousand Oaks, CA: Sage.
Thomas, D. (2004). A general inductive approach for qualitative data
analysis. (Will be available from the University of Auckland, Health
Research Methods Advisory Services, September Newsletter 72, world wide
Thomas, D. (2000). Qualitative data analysis: Using a general inductive
approach. Retrieved August 19, 2003, from world wide
Weissman, M., Bland, R., Canino, G., Faravelli, C., Greenwald, S., Hwu,
H.-G., et al. (1996). Cross-National Epidemiology of Major Depression
and Bipolar Disorder. Journal of the American Medical Association, 276,
Winokur, G., Coryell, W., Akiskal, H. S., Endicott, J., Keller, M.,
& Mueller, T. (1994). Manic-depressive (bipolar) disorder: The
course in light of a prospective ten-year follow-up of 131 patients.
Acta Psychiatric Scandinavica, 89, 102-110.
Yalom, I. D. (1985). The theory and practice of group psychotherapy
(3rd ed.). New York: Basic Books.