Evidence
Alert

Befriending programmes for people with psychosis can be challenging but beneficial to both parties

Befriending programmes are designed to help people who are likely to be socially isolated. This could be due to illness, including mental illness, or old age. Befrienders are often volunteers who make a commitment to have regular meetings with an individual they are put in touch with, often via a service.

People with psychosis are at a high risk of social isolation, and can take part in befriending programmes. It is understood that these schemes can be mutually beneficial, but there is little research into how befrienders and patients, particularly those with mental health problems, experience such schemes.

This is the first study to explore specific challenges, experiences and benefits of befriending in both volunteers and people with psychosis within the same programme.

What’s the issue?

Befriending schemes are popular forms of volunteering, but there can be a lack of clarity about what the role entails for befriender and patient.

The aim of many befriending schemes is to reduce the social isolation experienced by patients. However, much of the existing research looks at the overall benefits of befriending schemes, rather than how these schemes actually work for befrienders and patients, and what their experiences are.

What’s new?

A trial was held to look at the effects of befriending both on the befriender and the patient, with a group who took part in befriending and a group who did not. Those who took part in befriending were matched according to preference, such as gender and location, and they were encouraged to meet for an hour once a week. They were given information on inexpensive activities that could be carried out locally, and were invited to monthly group activities such as picnics or ice skating.

The scheme lasted a year. Interviews were then carried out with 34 befrienders and 28 patients to discuss their experiences of taking part. They had all taken part in at least one befriending session during the course of the study. Participants came from three East London boroughs: Newham, Tower Hamlets, and City and Hackney.

Four themes were identified in the interviews:

  • Bridging the gap. Befriending schemes could challenge and change befrienders’ perceptions of psychosis. Some befrienders admitted to being nervous due to their perceptions of psychosis beforehand. Many changed their perspective and developed a better understanding of psychosis as a result. Some changed their perception of the person they were partnered with, but not more widely. Patients found it empowering to have access to a non-judgemental and supportive member of society.
  • A genuine friendship. Befriending partnerships could result in genuine friendships, and many befrienders felt that empathy was vital. But this could lead to emotional over-investment in the role. Some felt that their partners were not a good match, and for some patients the differences between the befriender and themselves were felt to be too large.
  • A big commitment. Befrienders reported that the time commitment could be a barrier to taking part. Some patients felt that their befrienders did not have time for them, while others understood that their befriender was a volunteer with other commitments.
  • A flexible approach. Both befrienders and patients reported benefits to having mutual interests or backgrounds. The authors stressed that the scheme needs to be flexible to help partners come to a mutually agreeable situation.

Participants varied considerably in the number of sessions attended and most attended less than half. Two-thirds of befrienders (66%) and slightly fewer patients (57%) agreed to the interview at the end of the session. The remainder either did not want to be recorded or were lost to follow up.

Why is this important?

This is the first study looking specifically at the impact of befriending services on patients with psychosis and befrienders within the same programme. The findings could be used to shape future services or research into befriending services. In particular, it appears essential that participants – both patients and befrienders - have realistic expectations and goals. This can help them to avoid disappointments, find the experience worthwhile and maximise the benefit of these programmes.

What’s next?

More work needs to be done to understand why many befrienders and patients in befriending schemes drop out. It is also worth investigating whether the challenges in offering these services for people with psychosis, are similar to other peer-led interventions. The befrienders on this scheme were largely students and it would be valuable to see how their experiences compare with those of older people.

You may be interested to read

The full paper: Burn E, and others. Patient and befriender experiences of participating in a befriending programme for adults with psychosis: a qualitative study. BMC Psychiatry. 2020;20:368

The interviews for this paper were carried out with participants who took part in a wider trial, called VOLUME, which explored whether  there are benefits to befriending schemes. More information is available on the VOLUME project website: Volunteering in mental health.

Other papers to come out of the study include: Priebe S, and others. Effectiveness of a volunteer befriending programme for patients with schizophrenia: randomised controlled trial. The British Journal of Psychiatry. 2020;217:477-483

And: Priebe S, and others. Effectiveness of one-to-one volunteer support for patients with psychosis: protocol of a randomised controlled trial. BMJ Open. 2016;6:e011582

Funding

This study was supported by an NIHR Programme Grant for Applied Research.

Commentaries

Study author

Our population of befrienders were largely younger and often students, which was different from other populations of befrienders who tend to be older, and often retired. These younger participants found it a big commitment to meet weekly for the duration of a year. They had competing commitments including exams and wanting to spend time with their friends.

Some of the befrienders said that their motivation was to gain experience in mental health, often because they wanted to pursue a career in clinical psychology. Others had less altruistic reasons and volunteered because it was a requirement of their university course. This sometimes effected how engaged they were with befriending and how much of a commitment they perceived it to be.

It also meant that the befrienders were often much younger than the patients, which could make it harder for them to relate to each other, and definitely affected how confident the befriender felt to take on the role. A few befrienders were worried about seeming patronising and felt uncomfortable encouraging an older patient to engage in more activities.

Erin Burn, Researcher, Unit for Social and Community Psychiatry, Queen Mary’s University London

Befriending co-ordinator

There has been increased awareness of the effectiveness of befriending in person-centred mental healthcare in recent years, including the impact it has on the promotion of skills such as self-confidence, self-esteem, independence and self-advocacy. There persists, however, a conflict between the perception of ‘befriending’ as opposed to ‘friendship’. This can cause unmet expectations and frustrations, particularly where the onus is on the befriender to see the befriendee for a specific purpose, such as the achievement of a defined goal. It begs the question of whether a befriending relationship can ever be truly reciprocal.

Managing the balance of power within a befriending relationship can be complex, especially when one party encounters new life challenges. The findings give some indication as to how befriending programmes designed for adults living with psychosis may achieve better outcomes for both patients and befrienders.

Karen Doku, Former manager of a befriending scheme for older people living with mental health issues, London

Conflicts of Interest

None declared.