« Previous | Contents | Next »
Listen
12.0 Patient/Client perspectives of Doing Well services in five Case Study Sites
Within the scope of the evaluation a small number of patient/client interviews were undertaken within each case study area (5-8). These numbers do not allow for any conclusive findings relating to individual service elements/sites but together they provide rich knowledge as to patient/client perspectives of a variety of self help type interventions.
Regardless of which model of service provision was being implemented, patient/client interviews reflected a consistent set of themes relating to their perceptions of self help, its delivery and impact, and how they used self help materials. However, it was not possible within the timescale, resources and practical operation of the services, to access respondents who did not attend or withdrew from services. This remains an under researched population for whom self help services may not have been perceived as appropriate or meeting their needs. Additionally, the self help materials used in all sites have only been available in English to date, and therefore their relevance (and the acceptability of self help approaches in general) to minority ethnic and non-English speakers has not been addressed within this research.
12.1 Key points
- Self help materials ( CDs, booklets, etc.) appeal to, and work for some but not for others
- The qualities of the workers delivering self help type interventions are more important to patients/clients than the materials they provide; therefore guided self help is the preferred model
- There was greater expressed preference for one to one interventions
- Materials may not be used immediately or continually, but are often retained as 'a back up' for if/when they experience similar problems in the future
- Similarly, signposting to other services/agencies may not be acted upon immediately, but knowledge of the service/agency is retained for future need
- Interventions need to coincide with people's beliefs about what they can do (motivation)
- The timing of self help is important to its success in many cases, with a degree of personal motivation required, which many perceived was less likely when their depression was at its most severe. Self help acts to further encourage personal motivation
- Self help services were seen as normalising the problems people were experiencing, they were seen as a 'common sense' and appropriate responses to most people's needs and were therefore highly acceptable
- Direct access to such resources out with the healthcare sector would be welcomed by many
12.2 What do people get from self help?
Motivation
Restoring an individual's get up and go, the push that is needed to change their lives, to be active again.
"I was looking for someone to help me get organised a bit better, and help me prioritise things in my life. I'd lost a bit of my get up and go and was having trouble getting things done. Things were getting worse as well - the less I wanted to do, the worse this made me feel. I felt a bit stuck, and in need of some goals and things to aim for."
"… as I say I'm the type of person that will help myself, so I don't know, I've probably not needed as much as maybe somebody else would have needed … somebody might take longer than what I did … I think it was just a wee kind of push I was needing, do you know what I mean?"
Understanding about their illness or problems
"Understanding is key too. A neighbour gave me a booklet about anxiety that they'd got from their GP. If I'd known about how it worked at the start it would have been easier to cope with. The GP should have taken time to do this. They need to be there to explain the physical side of things ... that's one side of it … then you need to look at the mental side too, the effect on you way of thinking, etc. You need both sides to be looked after."
"Self help alters your way of thinking and leads you to understand better, more positive ways of thinking, and why you shouldn't think in a negative way. I realised that negative thinking was putting me on a downward spiral and I had to train myself to think positive. You do have to train yourself. This is where the booklets and the self help worker came in - to help you teach yourself new ways of thinking."
Finding solutions and different ways of thinking
"I'm coping with things at the moment that I didn't think I would cope with before. My mum's house was flooded out and I'm her carer … and I'm dealing with all the insurance and replacing everything and that something I couldn't have done. A few months ago I couldn't have done that. I couldn't even have thought about doing it you know ... Before I was saying "I've got all this and how do I cope … where do I start?" … Through her, she was able to explain things to me … look at one thing at a time."
"There's loads of different ways … it's all just wee small things like, see putting things into perspective … instead of keeping everything to yourself and bottling it up … The dwelling on things was big for me because, see if somebody said something, see by the end of the day that completely harmless remark, I would have started World War III over it. And it's just a case you know, instead of dwelling on it; just put it out of your head."
12.3 Who is self help for?
Those on the edge of depression
"I think the service is designed for people on the edge of depression who have it quite mildly. It is not for those who have a lot to get through because you can only see the person for four sessions - after that you might have to start again with another counsellor, so that wouldn't be ideal."
Those on the mend/recovering
"When I first went to the doctor I was too ill for self help, but when the energy came back I could cope, and I was really on the mend by the time I finally saw the self help worker."
Personal motivation and timing
"I think it's got to be somebody that wants to help themselves … I think you need to be ready to help yourself. I think if somebody was in the depths of despair sort of thing it would maybe … actually I'm guessing, I don't know … but I was wanting to come out of this hole that I'd got myself into. I think I was ready to do it, but I think if you'd maybe said to me two years ago I wouldn't have been interested."
"There's nothing I could suggest offhand, other than getting the timing right.
I couldn't have gone to the self help worker too soon, because I was too ill. You have to go when you're ready. It was a real struggle to go to the GP at first, but once I had the energy back … it is up to them [ GP] to refer you at the right time."
"I'd already started making changes by the time I went to see the lifestyle coach. For example I'd been to the GP about coming off antidepressants. So the timing was right for me - I just wasn't feeling great and was down and stressed."
12.4 Perceptions of self help services
Guided self help needed
"The workbooks? I think I could have done them myself but I was at the stage of getting … No you'd need somebody to guide you through that, certainly if you were as messed up as I was, you'd need somebody to guide you through it. Sorry, I think I was messed up anyway."
"I don't know if maybe other people find it difficult as well, while you're on medication, medication which has a sedative effect … maybe not quite find it easy filling out the forms because it takes a lot of thinking you know. But when
I came back and discussed with [self help worker] the issues and he went over with me all the questions, I seemed to understand more, I appreciated more."
One to one approach
"I'm no mixer. I'm really a loner and the groups were helpful at the time but
I prefer one to one and it really was so informal that it was like sitting talking to a friend."
"Combined groups wouldn't suit me - a friend went to a group and it was unfortunate that one of the other people there was his neighbour. He didn't want to talk about personal stuff in front of them. One to one was better for me."
Resources as backup
"I was given a relaxation CD and a booklet on anxiety. I still have them somewhere but I haven't really used them. I have bought relaxation CDs in the past. I know they are there though if I want to look at them."
"I've got a drink problem - I've actually stopped drinking now - and she gave me the number for [addiction services] and [ AA] and there's a group up in [name's place] as well that she mentioned. I've not actually went to any of them but she did give me the information and she gave us something to think about, and I have actually stopped drinking … it's been two months now … I know they're there as backup if I need them."
"Some of the booklets were quite handy. I haven't read them for about two or three weeks now - but I know they are there though."
Not for everyone
"Some of the booklets I didn't find so helpful … perhaps it would be for other people though. You have to try different things to see what works for you. Like with the pills - they were utterly dreadful for me but my friend's wife was given the same ones and she really benefited from them. So some stuff that the self help worker has might work for others."
"I didn't fill them in, I looked at the workbooks but I just felt the whole thing was geared to people that had a low self esteem, who were telling themselves that they were the problem and needing help in turning that around -to have a more positive attitude to life. I think when you're very angry; actually, you're almost the opposite of depressed"
Normalising, natural and less mysterious
"I think just the talking to someone is kind of helping you to actually help yourself really … She [ SH coach] was empowering you to kind of not see it all as something really serious and uncommon, that it was a very common problem and that we can do an awful lot to help ourselves … it's not in the doctor's surgery, it's not even in a hospital, it's just in a voluntary organisation. So you felt it was very kind of natural."
"It wasn't what I was expecting. I don't know what I was expecting but it was more informal. I was feared it was going to be like...I've had a lot of depression problems and I went to day groups and it was like [group] sessions and I kind o' was expecting that but it wasn't … it was just like chatting but I felt really at ease with it. I felt better with her [Self help coach] … Like when a psychologist comes in and there's long silences and you're going "Oh ..." I get all panicky when there's long silences. I know it's part of their job but I hate it. But it was just like having a chat with somebody."
"She gave me a booklet, "Mind over Mood", and I think these are all in the library, the local libraries as well, which seems to make it all much more accessible and less mysterious than going to see a psychologist or something … you can actually do an awful lot of stuff yourself to change your thinking."
"She actually at one of the sessions introduced me to someone there and then and said, I think you'd be really good doing this and this is person so-and-so, you know, that kind of accessibility and I think natural flow of common sense things."
Welcome alternative to medication
"To be honest with you, I thought I was walking in that room, getting a prescription, walking back out. And I thought "Oh another couple of months of this drudgery". And then it actually gave me kind of "Oh right, something else that I can do" sort of thing. Because I think people go to the doctor and they just assume that they're going for pills … which isn't really a good thing."
Varied access routes
"Getting access to the service through the GP worked for me, but not everyone will want to go that route. It would be good if you could dial the service directly and get a confidential appointment. Some people might prefer to access the service that way. The Samaritans could also refer people."
"I think it would be particularly good for occupational health nurses to be aware of it, you know to actually be sent … because there are so many people in the workplace … you realise there's people off with depression. You could give them leaflets, phone them and point them in that direction [towards self help service]."
12.5 Qualities of self help workers
"… depends on the person as well, you know, [ SHW's name] has been very good, whether it's been listening to me or … it wasn't just doing the forms but also being sympathetic and having the right kind of nature for that kind of thing. Yeah, just listening to me and my problems and things like that, sometimes other things come out you know, when you're doing the forms, you're worried about this or something. You can talk to him you know."
"Well she was very down to earth. You always expect these people to be very intelligent and intimidating and … she was just like, she could have stayed next door to me, that kind of thing. She was kind of saying well … she was telling me bits of things that she'd been through - not too much just like wee things - and you think well, this woman actually knows what I'm talking about. Because
I thought it was going to be somebody that would have intimidated me and thought that my problems were silly, where she was really very nice."
"It gives you a different approach to try, and someone different to talk to. I found it difficult talking to my GP, and didn't feel they were helping. The lifestyle coach really put me at ease … she was excellent. She was a good listener and was able to put you at your ease. She wasn't judgemental either. Some of the things I told her were difficult to say, and she is the only person I've told certain things to."
"I don't know how many of these life coaches there are going to be or whether it's a one off or a trial, but it seems to make a lot of sense - someone who has a big broad knowledge of depression and stress but yet has the overall, a good training and background to know and spot the things that are maybe needing further sort of professional help."
« Previous | Contents | Next »