A total of 30 patients and 20 volunteers provided written informed consent, completed the baseline assessments and participated in the study. At 6 months, we collected data from 23 patients. On average, patients attended 5.5 group meetings (range between 1 and 11) during the six-month intervention period. On average, group meetings were attended by 3.8 people.
Characteristics of participants
Table 1. Characteristics of volunteers and patients
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Volunteers (N = 20)
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Patients (N = 30)
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Sex
|
|
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Female
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13
|
18
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Male
|
7
|
12
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Age, mean and SD
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24.5 (5.7)
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41.2 (10.7)
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Marital Status
|
|
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Single
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20
|
21
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Married
|
0
|
2
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Free union
|
0
|
1
|
Separated
|
0
|
1
|
Divorced
|
0
|
4
|
Widow
|
0
|
1
|
Ethnicity
|
|
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Indigenous
|
1
|
1
|
Mestizo
|
7
|
11
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White
|
7
|
8
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Other
|
2
|
8
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Does not know/No response
|
3
|
2
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Education level
|
|
|
Primary
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0
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1
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Secondary
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7
|
12
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Technical
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2
|
2
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Professional
|
10
|
13
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Masters
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0
|
2
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Does not know/No response
|
1
|
0
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Occupation (%)
|
|
|
Self-employed
|
7
|
12
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Unemployed
|
4
|
12
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Student
|
9
|
1
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Homemaker
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0
|
1
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Retired due to disability
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0
|
3
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Retired due to age
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0
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1
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Housing Status
|
|
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Lives alone
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-
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3
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Shares with parents or family
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-
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24
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Shares with friends or partner
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-
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3
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Primary diagnosis (%)
|
|
|
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Schizophrenia
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-
|
14
|
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Bipolar disorder
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-
|
16
|
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SD = standard deviation
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|
|
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Volunteers worked in different areas, such as sales, teaching, arts, and social management. Their weekly commitment to their jobs or education was 34.9 hours (SD = 19.1). Their motivations for participating were mainly to serve their community, help others, grow as individuals, better understand mental health issues, reduce stigma, and raise awareness of mental illnesses.
Outcomes
Table 2 shows the means for the assessment measures at baseline and at 6-months. At baseline, patients had a relatively favourable scores on all scales, i.e. with high mean scores in MANSA and SIX and low levels of symptoms and self-stigma. During the intervention the SIX score increased further, showing improvement in objective social situation. The difference was statistically significant. There was no significant change on the MANSA, BPRS and ISMI.
Table 2
Outcome measures at baseline and after the six-month intervention 6 months (N = 23; means and SDs).
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Baseline
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6 months
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p value (t test)
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MANSA
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5.09 (0.96)
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5.18 (1.03)
|
0.347
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SIX
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4.17 (1.03)
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4.61 (1.03)
|
0.007
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ISMI
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1.99 (0.61)
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1.92 (0.65)
|
0.699
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BPRS
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1.26 (0.17)
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1.27 (0.37)
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0.434
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MANSA = Manchester Short Assessment of Quality of Life. SIX = Objective Social Outcomes Index. BPRS = Brief Psychiatric Rating Scale. ISMI = Internalized Stigma of Mental Illness.
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Considering the statistically significant difference on SIX, we conducted a post-hoc analysis to identify in which of the assessed areas (employment, accommodation and friendships/partnership) patients improved. Significant improvements were seen in the items on employment (mean = 2.78; SD = 3.07 to mean = 3.45; SD = 3.08; p = 0.05) and friendships (mean = 1.39; SD = 0.5 to mean = 1.65; SD = 0.49; p = 0.03), whilst there was no significant difference on the items assessing accommodation and partnership.
Qualitative results
We interviewed 12 patients and 12 volunteers. Five overarching categories represent the general experiences of the participants. These were: stigma reduction; personal growth; formation of relationships; continuity and sustainability of befriending; and acceptability of befriending.
Stigma reduction
Several volunteers expressed initial concerns that people with mental illnesses were dangerous or unstable and described feelings of fear before meeting the patients in their groups. Some of these concerns were based on how mental illness was portrayed in the media or on comments from relatives who advised them to be careful when participating in a study with psychiatric patients. However, some volunteers kept an open mind and described how they preferred to approach the patients with impartiality in order to genuinely understand them.
“Before, I thought that one should be very cautious, when talking to them.” (volunteer 019, attended 7 meetings)
“Well, the expectations that I had were like to integrate myself with that part of society that has always been rejected but in which I have always really felt interested for that same reason that they were a population a little bit excluded…” (volunteer 015, attended 8 meetings)
“… at first I tried not to have expectations. I liked to think that I have no prejudices, but in the end one has them…” (volunteer 026, attended 5 meetings)
However, after the study, some of the volunteers’ perspective changed and they began to empathise with the patients in their groups, recognising that they shared similar experiences, interests, and habits. Consequently, this reduced the stigma attached to mental illness perceived by the volunteers.
“…they were patients and they were alone, …they only had their family, they were isolated and lonely, so I did feel an empathy with that, because I have also felt lonely and marginalised at some point.” (volunteer 014, attended 8 meetings)
“We realise that the truth is that they are ordinary people who have a disease like any other, which complicated certain things in life. But …they are more normal, it is ironic, I should not say it, but yes, they are more normal than one thinks they are.” (volunteer 026, attended 5 meetings)
In contrast, other volunteers continued to view patients’ behaviours and appearances as shameful or embarrassing.
“… well, because we were walking down the street or something, and he acted strange, or sometimes he was very… the volume of his voice was sometimes very high, which, well, drew attention from other people and I sometimes felt that people pointed at me.” (volunteer 018, attended 9 meetings)
“… he was very badly dressed, like, I don’t know, he looked in very bad condition, like seriously at first we began to doubt if he was our befriendee or if he was someone who lives in the street, that’s how badly he was dressed.” (volunteer 022, attended 2 meetings)
Patients also reported that the befriending programme helped them to reduce their internalised stigma and feel more included and accepted by the community. Some patients stated that throughout the meetings, their background as a patient did not seem relevant for their interactions with the volunteers and that gradually the exchanges became less “hierarchical”, and more like conversations between “equals”.
“…we were all like super empathetic, like all good people, the illness was not noticeable, it was something great because we were like talking to any friend…” (patient 021, attended 4 meetings)
“… so I would talk about that issue, and look I think that many years will pass before we overcome this… [referring to mental illnesses]” (patient 009, attended 1 meeting)
Personal growth
Throughout the study, both patients and volunteers reported a positive impact on some personal aspects of their lives, ways of interacting with others, and self-care habits. As a result of seeing how the patients had to be mindful of the effect of their mental illness on their wellbeing, the volunteers also began to consider the necessity of caring for their own emotional needs and stress factors. Some of them reported daily problems in their emotional, professional, and academic lives.
“…well, I would like to greatly improve the attention I give to things, I feel that sometimes I am very absent minded.” (volunteer 018, attended 9 meetings)
“…this could happen to anyone who is under very high levels of stress, or in very complicated situations, so, first be aware that you have to take care of yourself…” (volunteer 026, attended 5 meetings)
Some patients also spoke about an improvement in their quality of life as they became more sociable and felt that their symptom levels were reduced. They mentioned that they were initially nervous about approaching new individuals, but through participating in different activities and becoming more comfortable in conversations with group members, they realised that they could actually have fun in these situations. Some of the patients even reported to feel more in control of their personal lives due to the interactions with the volunteers.
“…I liked it a lot, it made me more open to other individuals, not only the small social circle that I have, yes, I liked it a lot.” (patient 021, attended 4 meetings)
“It generated a lot of impact because I learned to know more, I learned to orientate myself, to walk, to breathe, to think, to reflect, meditate, to share with other people, it helped me a lot, it was a positive development.” (patient 023, attended 7 meetings)
Some volunteers however did not report a benefit and felt rather overwhelmed by the responsibility to coordinate the group. This led them to attend only a few meetings and prevented them from achieving a rewarding experience.
“… I didn’t see any solution, no, I seriously had to abandon this and have someone else take this, that maybe could organise the schedules better, or something like that, then you told me no that it was going to end and so I stayed.” (volunteer 009, attended 2 meetings)
Formation of relationships
New, special bonds were formed between the participants. The trust generated within these ties led them to have honest and open conversations about their personal and emotional lives.
“Yes, some told me about their love relationships, they also fall in love. I also told them about my love relationship, it was like a fairly reciprocal relationship, to the extent that we opened our hearts and mentioned private things…” (volunteer 014, attended 8 meetings)
“One felt trust, they inspired trust.” (patient 023, attended 7 meetings)
Additionally, the volunteers highlighted that the patients were, in return, always available to listen to them and offer them advice when necessary.
“…for me it was a very nice experience, like going there to vent and to share.” (volunteer 026, attended 5 meetings)
“…one time I said I was very overwhelmed and one of them gave me some very good advice…” (volunteer 027, attended 5 meetings)
Furthermore, the distinction between those participants with and without a mental illness became blurred over the course of the 6-month programme. Although volunteers were the ones who handled the money for the expenses and initially arranged the meetings, volunteers and patients described that their relationships evolved through solidarity and an environment free of judgment and criticism, where each individual participated in the organisation of later events.
“…realising that, let’s say, that although people have a diagnosis or not, we were all five people, for me everything was always normal, five people sharing, chatting, talking about life, movies, things and that.” (volunteer 027, attended 5 meetings)
“I felt very good because they are like relaxed people, like very friendly, they weren’t arrogant people, nor did they judge us, or anything.” (patient 030, attended 7 meetings)
Other participants however who saw each other only a few times engaged in superficial conversation and formed friendly, but not close, relationships.
“No, honestly no, we never got to talk about deep topics or specific topics about one another, like to give out information that, that I wouldn’t give another person. I don’t know I consider myself an open person, but, well, something like a confidante or something like that, no.” (volunteer 028, attended 2 meetings)
Continuity and sustainability of befriending
The participants also described barriers to arranging meetings during the 6-month period, and to continue with the meetings after the end of the programme. In particular, the volunteers regretted that after the 6 months, there was no formal closure to the befriending relationship, despite being encouraged at the beginning of the study to continue the meetings without financial support from the research team. Additionally, the busy schedules of the volunteers made organising further meetings difficult.
“We never completed a closing, we just tried to arrange several meetings, that is, before the six months were up. We suggested five or six dates, but then it did not fit into one person’s schedule nor another, then the other person did not answer, as like we eventually stopped trying and then we lost contact. In other words, there was no closure as such...” (volunteer 022, attended 2 meetings)
“Look, we haven’t spoken again, but I think it’s because of the academic load that I’ve honestly had...” (volunteer 015, attended 8 meetings)
Some patients wanted to continue and also encountered difficulties in co-ordinating the different schedules of everyone in the group.
“I would like the opportunity to meet again, but it did not happen. I understand them, they organise the conversation and it is difficult that all agree.” (patient 019, attended 2 meetings)
“…for volunteering to continue, like it has, if anyone else wants to come along, ….they are welcomed.” (patient 023, attended 7 meetings)
Acceptability of befriending
At the end of the study, several participants expressed appreciation for their encounters and felt that the programme was very beneficial to the patients.
“I believe that this type of experience is like a new treatment for them, which helps us to realise that they may have their problems, but it is not as serious as you imagine, it is not something from another world.” (volunteer 028, attended 2 meetings)
“It is a good thing because they are trying to help us people with mental disorders, not to be in the same routine every day at home, and go out. Or that maybe the family circle isn’t the only one that exists, instead that one can also have friends.” (patient 030, attended 7 meetings)
Participants also spoke about the many activities that the city offered them, such as visiting the park, going to the library, and bird watching. This variety facilitated the feasibility of the meetings, and allowed the participants to have enjoy activities throughout the study and appreciate the cultural spaces in the city.
“We also completed an activity… of riding little boats. It was super cool. I had never done that in my life and neither had they, that moment was very exciting…” (volunteer 015, attended 8 meetings)
“…within the cultural agenda of Bogota there are many things to do.” (patient 009, attended 1 meeting)