In total, 34 (66%) of 51 befrienders and 28 (57%) of 49 patients who had participated in at least one befriending session, agreed to an interview at the end of the 12-month intervention. The participants interviewed varied considerably in the number of befriending sessions attended; patients attended 1-42 sessions, with a mean of 17.5 sessions attended, and befrienders attended 1 – 42 sessions, with a mean of 18 sessions attended). The remaining befrienders and patients either declined to be interviewed (e.g., did not want to be audio-recorded) or were lost to follow-up (e.g., were not able to be contacted post-intervention). Interviews ranged in length from 20 minutes to 2 hours. Demographics of the participants are presented in table 1. In contrast to their paired patients, befrienders were mostly female, younger, and more likely to be in paid employment.
Table 1
Socio-demographic characteristics of patients and befrienders
Patient characteristics (n = 28)
|
|
Gender (n, %):
Female
Male
|
12 (42.9%)
16 (57.1%)
|
Age (Mean, SD)
|
43 (10.3)
|
Ethnicity (n, %)
White
Black / Black British – African
Black / Black British – Caribbean
Bangladeshi
Other
|
7 (25%)
6 (21.4%)
5 (17.9%)
5 (17.9%)
5 (17.9%)
|
Years since diagnosis (Mean, SD)
|
25.52 (11.30)
|
Employment status (n, %)
Paid employment
Full time education or training
Retired
Unemployed
Withdrew from the scheme (n, %)
|
1 (3.6%)
1 (3.6%)
1 (3.6%)
25 (89.3%)
4 (14.3%)
|
Befriender characteristics (n = 34)
|
|
Gender (n, %):
Female
Male
|
24 (70.6%)
10 (29.4%)
|
Age (Mean, SD)
|
29.24 (9.95)
|
Ethnicity (n, %)
White
Black / Black British – African
Black / Black British – Caribbean
Bangladeshi
Indian
Pakistani
Other
Employment status (n, %)
Full time employment
Part time employment
Full time student
Unemployed
Retired
Other
Did not disclose
Previous experience of volunteering (n, %)
Yes
No
Withdrew from the scheme (n, %)
|
17 (50%)
6 (17.6%)
1 (2.9%)
2 (5.9%)
1 (2.9%)
1 (2.9%)
6 (17.6%)
12 (35.3%)
8 (23.5%)
4 (11.8%)
4 (11.8%)
1 (2.9%)
3 (8.8%)
2 (5.9%)
24 (70.6%)
10 (29.4%)
6 (17.6%)
|
Four overarching themes were developed from the data and are presented along with their sub-themes in table 2. These were: 1) Bridging the gap, 2) A genuine relationship that developed over time, 3) A big commitment, and 4) A flexible approach.
1. Bridging the gap
Some patients expressed feeling isolated from society due to having psychosis. As members of the community, befrienders were viewed by patients as being in a good position to bridge this perceived gap between mental illness and society. For some, this was simply the notion that the befriender, as a so called ‘normal’ member of society wanted to spend time with them.
“That’s what was helpful, being treated like I was normal and worthy of respect by a member of society who was considered to be a normal respectable member of society. In that respect, that makes you feel you fit in, you know.” (Patient 131, attended 12 meetings)
For some patients, however, the differences between the befriender and themselves were felt to be too large, with some feeling judged by their befriender.
“She was arrogant. […] because she was at college and that, because I never went to college, she asked about my college and school, and started asking all personal questions. I don't like that.” (Patient 15, attended 13 meetings)
Many befrienders admitted to being initially influenced by false preconceptions of psychosis, common throughout society and depictions in the media. This in turn affected how nervous they were when joining the scheme. As a result of taking part in the befriending programme, many befrienders reported that their perspective changed and they developed a better understanding of the reality of psychosis.
“My mother thinks that schizophrenic people go around killing people on the streets of London and that’s what most people think and that’s what potentially I may have had a slight thought about before doing this scheme and then meeting someone like [patient] and realising that she isn’t harmful to no one” (Befriender 23, attended 42 meetings)
Nevertheless, this changed perception of psychosis was not always generalised beyond their own befriending match. Some befrienders felt that they had been lucky to befriend an ‘easy match’, and that other patients in the programme were more challenging, expressing behaviours more in line with their initial perceptions of psychosis.
“To be able to see especially for those social events because there were people different from [patient] and [patient]’s a mild situation. You can’t differentiate her from anyone else. She looks completely normal. And I was fortunate” (Befriender 53, attended 22 meetings)
2. A genuine relationship that developed over time
To make a new friend and find companionship was one of the key motivators for many patients to join the scheme as they often expressed feeling lonely and isolated with few, if any, social contacts. For many this was achieved, with patients feeling that the befriending relationship developed into a friendship over the course of the programme.
“Because even for me I really value the friendship that me and her have made now, It’s always nice to make new friends, so I think having her in my life now, I do see us being friends for a long time” (Patient 103, attended 7 meetings)
Befrienders and patients spoke about how having certain commonalities, such as cultural background and mutual interests, enabled a friendship to develop between them. For some, the befriender opening up about their own life or even discussing their own difficulties also aided the development of a real friendship with reciprocal support.
“I do discuss my personal issues with her. She discuss[es] her own personal issues with me and she does ask me where I’m needing advice for some certain things she does advise me. And when she did advise, I did advise her, we became close.” (Patient 17, attended 23 meetings)
Many befrienders stated that as the relationship developed over time, they could attune to their match, which enabled them to pick up on subtle signals to understand how they were feeling.
“Like if there was a really busy place that we’d been to, like I say, I could see the change in her body language and needing to just leave. So, when we had the social where it was at a football stadium it was really busy and as we got out of the station, because it was really loads of people, I could tell she was like shutting down a bit” (Befriender 31, attended 29 meetings)
Whilst being able to relate to their match was viewed as important, with many befrienders reflecting that empathy was vital for the role, this also had a downside in that they could become too emotionally invested.
“I think one of the reasons I could do it and I was quite good I think at befriending him, is about empathy and emotional availability but I think if you have those things it can also be quite painful and quite intense and quite emotionally distressing” – (Befriender 39, attended 19 meetings)
This became especially poignant towards the end of the scheme where several befrienders felt that terminating the relationship could be cruel for the match who had become used to receiving social support from a befriender.
“I think that it’s quite cruel that it cuts off after a year and you then perhaps don’t have any contact with the person again. I do feel it’s quite harsh, that they have somebody once a week every week and then they have a social once a month and then that’s gone” (Befriender 60, attended 38 meetings)
3. A big commitment
Participation in the programme often felt like a big commitment to befrienders, and often a larger commitment than was originally expected. This was often due to unforeseen lifestyle changes for the befriender, competing commitments, and the additional impact of travelling to and from befriending appointments, particularly when the befriendee did not live close by.
“I had to try and coordinate having my own life, my family and I’ve got a boyfriend [...], so it did get at points some weekends where I was thinking, I’d love to spend it with my boyfriend or I’ve love to go away with my friends but I haven’t seen [patient] for a week and I need to see her” (Befriender 23, attended 42 meetings).
Many befrienders felt unable to meet their match on a weekly basis, which sometimes led to infrequent meetings, or having to cancel appointments last minute due to competing demands.
“I think as the year progressed because I was becoming a little bit more busy and I was finding the commitment a bit hard but I didn’t kind of want to let go of the commitment altogether especially because we’d built a good bond” (Befriender 62, attended 6 meetings).
However, some befrienders felt that as the programme was voluntary there was not the same obligation to be consistent within the role as there would be for a paid job. Some spoke about being attracted to this voluntary role in particular, because of the flexibility, and freedom to negotiate the timing and location of meetings.
“Like obviously it’s volunteering, so it’s nothing that you have to do every week, it’s something if you can make time and if your match has time then it’s nice to meet up” (Befriender 35, attended 14 meetings).
Patients had different views on the level of commitment they expected from their befriender. Some felt that the befriender could not provide the time that they felt they ought to give, whilst others expressed awareness that their befriender was a volunteer, and therefore understood that they had other commitments and priorities.
“She works ‘n all and she hasn’t got time for me most of the time […] she doesn’t have time for me and I don’t have time for her” (Patient 45, attended 13 meetings).
“She was a student, so she couldn't always give me time. Plus she had exams, so I kind of understand she couldn't always make time for me. But when she did make time, it was really enjoyable.” (Patient 46, attended 21 meetings).
4. A flexible approach
Both volunteers and patients agreed that the roles of the befriender and the programme needed to be flexible in acknowledging that every person is individual in terms of their needs. Patients appreciated a flexible approach to befriending, where they could be supported to achieve their goals, or to just have someone there to talk to.
“Each day is different; each day is a different battle. On a good day I will challenge myself. On a bad day I will hibernate, sleep.” (Patient 94, attended 25 meetings)
“You might look at an activity as a befriender, yes, somebody to do things with, but sometimes people are so stressed they just need somebody to talk to.” (Patient 30, attended 11 meetings)
Some befrienders were mindful of the need to encourage their match without appearing to be patronising; therefore, finding a balance in achieving this was necessary, but the difficulty of attaining this balance was acknowledged. Other times it felt necessary to gently push their match outside of their comfort zone and that this in hindsight was appreciated.
“There’s a feeling for me of I feel like it’s really delicate not to be the apparently well person coming into help the unwell person do things they should really be doing. I really didn’t want to do that. […] I didn’t want to be pushing him out of his life” (Befriender 39, attended 19 meetings)
“When we first met, he’d be like […] “I’m feeling really tired today,” or, “I’m feeling really unwell,” and then at the end when we were leaving […] he’d just say, “I’m really glad I came out today, it did sort of help.” (Befriender 33, attended 15 meetings)
Table 2
Main Theme
|
Sub-themes
patient
|
Sub-themes
befriender
|
Bridging the gap
|
Normalising schizophrenia
Is the gap too big to bridge?
|
Changing perceptions of schizophrenia
My match was an easy one
|
A genuine relationship that developed over time
|
Developing a genuine and reciprocal friendship
|
Attuning to my match
Befriending can be emotional
|
A big commitment
|
It doesn’t feel like they have time for me
Befriending is a voluntary role
|
Befriending is a bigger commitment than I originally thought
It’s volunteering so there is no obligation
|
A flexible approach
|
The scheme needs to be flexible to differing needs
Achieving goals vs. having someone to talk to
|
The balance between pushing and patronising
|