Knowledge is king. When we can rationalise the how and why of something with understanding, evidence and guidance, it can be easier to comprehend the effects and origins of any complications we may be experiencing. Psychoeducation is exactly that – evidence-based guidance on how to manage mental health difficulties such as depression, bipolar disorder and schizophrenia. But psychoeducation goes further by including family members or supportive loved ones to also understand and learn about these illnesses.
“A psychoeducation course will generally be delivered in a group setting over a number of weeks, by a mental health professional like a psychiatric nurse, occupational therapist or social worker,” says Derek Pepper, regional team leader with Shine, a national charity that supports people with lived experience of mental illness and their family members and supporters. “Psychoeducation courses can also be delivered in the community by voluntary-sector organisations such as Shine, Aware and Grow. Ideally, psychoeducation courses will be coproduced and codelivered by mental health professionals and people with self-experience of a mental health difficulty or family members.”
Pepper says modern psychoeducation courses should provide a balanced perspective on the reality of living with a mental health difficulty, while providing guidance on the biological, psychosocial and social supports available to those affected by these conditions.
“Every psychoeducation course should be delivered from a recovery-oriented perspective,” he says, “with the emphasis on providing participants with information and understanding that will enable and empower them to live rich and fulfilled lives, whilst managing a mental health difficulty.”
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Pepper, who has worked with Shine for 20 years and has been involved in creating, delivering and evaluating education courses throughout the country, says that due to a lack of knowledge, understanding and being influenced by stigmatised beliefs towards mental health difficulties, receiving a diagnosis of depression, bipolar disorder or schizophrenia can be a traumatic instance in a person’s life.
“It can also be equally as traumatic for their family members and loved ones,” he says. “By engaging in a psychoeducation course, individuals will become informed about the realities and ultimately challenge the misinformation and negative stereotypes that prevail. In doing so we can then bring hope to an individual and their family members, that this situation is one that can be managed and therefore motivate individuals to play an active role in their treatment and recovery.”
Psychoeducation courses are more than just information, and while evidence is an important aspect, there are other components to the process. Hearing the lived experience of others is also vital. “Psychoeducation provides an opportunity for participants to share their experience of living with a mental health difficulty with a group of people who have a similar life experience and, in doing so, gain support, understanding, and encouragement from those attending the course,” says Pepper. “Through this process of sharing, exploration, and discovery, individuals will not only gain information, insight and awareness, but will also develop hope for a future they may have previously believed was unattainable.”
Psychoeducation can support families in many ways. Aware offers a space for people to come together and learn about depression and bipolar disorder in their family support groups, which can help family support their loved ones.
“It can be useful to understand what can be a part of depression,” says Dr Susan Brannick, clinical director at Aware. “For instance low motivation and energy can be part of feeling very depressed, but it does not reflect something about the person’s personality. Also it can be useful to come together in this space and share experiences with other people who may have a shared understanding of what comes up. We are doing better in speaking openly about mental health in Ireland, but we do know there is more to do, and people can continue to feel stigmatised for experiencing depression, or if a loved one experiences depression, anxiety or bipolar, there can be a very real concern that this may impact on how others see or treat the person or the family.”
Brannick is passionate about tackling stigma in mental health and understanding how the sociopolitical context that people live within may affect psychological difficulties, and she says there are different ways to build your knowledge and understanding of depression, anxiety and mental health more generally. “In Aware we offer group sessions, where people can learn more about what depression and anxiety are, and how to make changes when you are feeling stuck. These groups are based on cognitive behavioural therapy ideas, which are proven to help people overcome mental health difficulties. There are also self-directed online programmes based on the same principles that you can do yourself with the help of a volunteer.”
Brannick, a clinical psychologist with several years’ experience of service development and innovation as well as offering psychological consultation and training to health and community organisations, suggests that the first step to making any change is to understand what is happening and what the problem is. “Psychoeducation offers an understanding of what can be typical in something like depression or anxiety, and crucially how to look at ways that a cycle may work for the individual.”
For example, she says, someone feeling anxious about going out may begin to go out less, which can lead them to feel more anxious and less confident, resulting in going out even less and less over time, which ultimately feeds into more anxiety and so on. She reiterates that psychoeducation can help people understand their triggers to stress, low mood and anxiety. But most importantly, people can learn ways to break the cycle, which helps with recovery in the longer term.
Opening ourselves up to learning about our mental wellness and any difficulties that arise is essential in order to break the continuing cycle of stigma. “Very often, when the term ‘mental health’ is used in conversation, there is an automatic assumption that we are referring to mental illness,” says Pepper. “However, whenever we hear the term ‘physical health’, there is generally an acceptance that we are referring to a state of physical wellbeing, without necessarily associating that with illness. It is also accepted that the physical health of every individual can and will be affected by illness, injury or a change in life’s circumstances at some stage during our life cycle. Therefore, it is vitally important that we develop a similar understanding of the term ‘mental health’ as being a state of emotional and psychological wellbeing, possessed by every individual, that can also change due to illness, injury or a change in circumstances. If we can develop this understanding, then hopefully we can reach a point where we accept mental health difficulties as being normal human experiences, just as we accept physical illnesses as being normal human experiences.”
Ultimately Pepper recognises that if we can achieve this level of understanding through psychoeducation and sharing of lived experiences, then we will be able to overcome the stigma associated with emotional distress and mental health difficulties and be more willing to reach out for help and support.
