Self‐initiated helping behaviors and recovery in severe mental illness: implications for work, volunteerism, and peer support
Open accessAbstract
OBJECTIVE: Despite recent interest in peer support workers in recovery-oriented services, little is known about how helping behaviors may affect recovery from severe mental illness outside of formal peer support roles. The current study is a mixed-methods approach to understanding naturalistic helping behaviors and their relationship with recovery outcomes among persons with serious mental illness. METHODS: Forty-six participants with schizophrenia-spectrum disorders completed a narrative interview and standardized measures of recovery, symptoms, hope, patient activation, quality of life, medication adherence, insight, and illness management. Interviews were coded using emergent, thematic analysis. The study compared individuals who (unprompted) mentioned helping behaviors in their interview to those who did not on recovery-related outcomes. RESULTS: Sixteen participant narratives (35%) described self-initiated helping behaviors. Themes included a desire to tell others their story, teach others recovery-promoting skills, become a peer support worker, give back to society, and be more active family members. Those who discussed helping others in narrative interviews scored significantly higher on measures of recovery, illness management, patient activation, hope, quality of life, medication adherence, and insight and scored significantly lower on measures of overall symptoms, as well as negative, positive, and cognitive symptoms, than did those who did not discuss helping behaviors. The groups did not differ on hostility or emotional discomfort symptoms. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings indicate associations between helping others and improved scores on measures of recovery outcomes. Potential implications include focusing on meaningful work/volunteerism and expanding roles for peer support in recovery-oriented services.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Better clinical insight is correlated with better personal and social skills and prosocial behavior.
“Consistent with this, better clinical insight was correlated with better personal and social skills 65 and prosocial behavior 66 .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [66]
Cited by
Sorted by citations
Lysaker, P. H., Pattison, M. L., Leonhardt, B. L., Phelps, S., & Vohs, J. L. (2018) · World Psychiatry · doi:10.1002/wps.20508 · Cited by 247 · see citing works
Self-citationLysaker, P. H., Gagen, E. C., Wright, A. C., Vohs, J. L., Kukla, M., Yanos, P. T., & Hasson‐Ohayon, I. (2018) · Schizophrenia Bulletin · doi:10.1093/schbul/sby142 · Cited by 66 · see citing works
Self-citationJaiswal, A., Carmichael, K., Gupta, S., Siemens, T., Crowley, P., Carlsson, A., Unsworth, G., Landry, T., & Brown, N. D. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.586230 · Cited by 61 · see citing works
Metacognition, Personal Distress, and Performance-Based Empathy in Schizophrenia
Bonfils, K. A., Lysaker, P. H., Minor, K. S., & Salyers, M. P. (2018) · Schizophrenia Bulletin · doi:10.1093/schbul/sby137 · Cited by 51 · see citing works
Self-citationTse, S. S.-K., Mak, W. W. S., Lo, I. W. K., Liu, L. L., Yuen, W. W. Y., Yau, S. S. W., Ho, K., Chan, S.-K., & Wong, S. H. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.05.007 · Cited by 45 · see citing works
“Peer support workers (PSWs) are individuals recovering from mental illnesses who identify themselves positively as such and have a strong desire to use their lived experiences to help others with similar conditions (Firmin et al., 2015; Moran and Russo-Netzer, 2016).”
Peer support specialists’ experiences of microaggressions.
Firmin, R. L., Mao, S., Bellamy, C. D., & Davidson, L. (2018) · Psychological Services · doi:10.1037/ser0000297 · Cited by 31 · see citing works
“For people with serious mental illness, finding ways to give back to others, through both informal means and formal involvement as a peer support specialist, have been associated with enhanced quality of life, reduced symptoms, and increased self-reported recovery (Eisen, et al., 2015; Firmin et al., 2015).”
BackgroundSelf-citationIntrinsic motivation and amotivation in first episode and prolonged psychosis
Luther, L., Lysaker, P. H., Firmin, R. L., Breier, A. F., & Vohs, J. L. (2015) · Schizophrenia Research · doi:10.1016/j.schres.2015.08.040 · Cited by 30 · see citing works
Self-citationFirmin, R. L., Lysaker, P. H., McGrew, J. H., Minor, K. S., Luther, L., & Salyers, M. P. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.09.063 · Cited by 27 · see citing works
Self-citationPérez‐Corrales, J., Pérez‐de‐Heredia‐Torres, M., Martínez-Piédrola, R. M., Sánchez‐Camarero, C., Parás‐Bravo, P., & Palacios‐Ceña, D. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-025363 · Cited by 20 · see citing works
Zhu, X., Li, M., Liu, P., Chang, R., Wang, Q., & Liu, J. (2020) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2020.08.001 · Cited by 18 · see citing works
Markham, S. E., Markham, I. S., & Smith, J. W. (2016) · The Leadership Quarterly · doi:10.1016/j.leaqua.2016.10.001 · Cited by 16 · see citing works
Vincent, H. K., Vasilopoulos, T., Zdziarski-Horodyski, L., et al. (2017) · Injury · doi:10.1016/j.injury.2017.12.004 · Cited by 16 · see citing works
“00 adherence and insight, adoption of healthier lifestyle) [27,28].”
BackgroundSocial support perceptions of Turkish people with schizophrenia: What helps and what doesn’t help
Karanci, A. N., Gök, A. C., Yıldırım, B., & BORHAN, N. (2017) · International Journal of Social Psychiatry · doi:10.1177/0020764017726931 · Cited by 14 · see citing works
The wages of peer recovery workers: underpaid, undervalued, and unjust
Smith, K. D. (2024) · Critical Public Health · doi:10.1080/09581596.2024.2332796 · Cited by 13 · see citing works
“Finally, there is evidence that peer support work can improve the mental health of PRWs (Firmin et al., 2015; Poremski et al., 2022).”
Firmin, R. L., Luther, L., Lysaker, P. H., & Salyers, M. P. (2016) · American Journal of Psychiatric Rehabilitation · doi:10.1080/15487768.2016.1231642 · Cited by 12 · see citing works
Self-citationAshdown‐Franks, G., Sabiston, C. M., Stubbs, B., Atkinson, M., Quirk, H., Bullas, A. M., & Haake, S. J. (2023) · Psychology Health & Medicine · doi:10.1080/13548506.2023.2185643 · Cited by 11 · see citing works
“reported greater levels of hope, better mental health outcomes, and greater medication adherence and condition management (Firmin et al., 2015).”
BackgroundHopes and Wishes of Clients with Mentally Illness in Hong Kong
Lai, D. W. L., Chan, K. C., Daoust, G. D., & Xie, X. (2021) · Community Mental Health Journal · doi:10.1007/s10597-021-00779-9 · Cited by 10 · see citing works
Hinchey, L. M.-E., Pernice, F. M., Christian, J. N., Michon, A., & Rice, K. (2023) · Psychiatric Quarterly · doi:10.1007/s11126-023-10051-w · Cited by 9 · see citing works
“As QOL is reciprocally linked with mental health and other recovery outcomes [14, 62, 87], evidence thus far indicates the Clubhouse model as a promising candidate for expansion, from both clinical and financial perspectives.”
BackgroundLinz, S. J., Hanrahan, N. P., DeCesaris, M., Petros, R., & Solomon, P. (2016) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20160420-04 · Cited by 8 · see citing works
Held, M. L., & Lee, S. (2019) · Community Mental Health Journal · doi:10.1007/s10597-019-00475-9 · Cited by 6 · see citing works
Improving Volunteer Engagement in Nonprofit Healthcare Organizations
Hudson, S. K. (2021) · Open Journal of Business and Management · doi:10.4236/ojbm.2021.93074 · Cited by 6 · see citing works
Sulaiman, I. H., Taib, N. I. A., Lim, J. T. Y., Daud, T. I. M., & Midin, M. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05901-1 · Cited by 4 · see citing works
“PSWs are individuals recovering from mental illnesses who identify themselves positively and strongly desire to use their lived experiences to help others with similar conditions [16, 17].”
BackgroundConneely, M., Giacco, D., Hickling, L. M., Priebe, S., & Jones, J. M. (2024) · Clinical Psychological Science · doi:10.1177/21677026241263522 · Cited by 4 · see citing works
“…recognizing that they can belong to multiple groups and vary in their sense of identification and connection with these groups, and allow researchers to simultaneously measure different social identity features (Beckwith et al., 2019; Bentley et al., 2020; Cruwys et al., 2016; Firmin et al., 2015).”
Martín-Ordiales, N., Montesinos, M. D. H., Martín, P., Ballester‐Plané, J., & Barrios, M. (2024) · Behavioral Sciences · doi:10.3390/bs14040340 · Cited by 3 · see citing works
Sofronov, A. G., Dobrovolskaya, A. E., Trusova, A. V., Getmanenko, I. A., & Gvozdetckii, A. N. (2021) · V M BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY · doi:10.31363/2313-7053-2021-1-77-90 · Cited by 1 · see citing works
“Исследования показывают, что больные шизофренией, которые в своём большинстве, в силу характерных особенностей заболевания, являются реципиентами, оценивают возможность самостоятельно оказывать поддержку окружающим, как крайне позитивно сказывающуюся на их психологическом благополучии [11, 14].”
The roles of emotion regulation and metacognition in performance based-empathy
Bonfils, K. A. (2017) · Purdue e-Pubs (Purdue University System) · doi:10.7912/c2m64m · Cited by 1 · see citing works
Study on Peer Support to Improve Radiotherapy Compliance of Nasopharyngeal Carcinoma Patients
张, 诞. (2024) · Advances in Clinical Medicine · doi:10.12677/acm.2024.1441112
Yang, Z., & Li, X. (2025) · Issues in Mental Health Nursing · doi:10.1080/01612840.2025.2537796
“Evidence from high-income countries shows that peer support reduces relapse, promotes empowerment, and enhances engagement (Firmin et al., 2015; Miyamoto & Sono, 2012).”
Maruta, M., Nakashima, A., Eguchi, K., Han, G., Yamazono, D., Kawano, T., Yamashita, M., Onomichi, Y., Imamura, A., Shimokihara, S., et al. (2026) · American Journal of Occupational Therapy · doi:10.5014/ajot.2026.051394
“This process can enhance self-efficacy and foster a form of expertise grounded in experience (Firmin et al., 2015; Vayshenker et al., 2016).”
- Authors
- Firmin, R. L., Luther, L., Lysaker, P. H., & Salyers, M. P.
- Affiliations
- Indiana University – Purdue University Indianapolis (US)
- Indiana University School of Medicine (US)
- Venue
- Psychiatric Rehabilitation Journal
- Published
- 2015-12
- Volume
- 38
- Issue
- 4
- Pages
- 336-341
- ISSN
- 1095-158X (ISSN-L)
- 1559-3126
- OpenAlex
- W2467769105
- Cited by
- 29
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2023: 2 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 5 · 2016: 3 · 2015: 1
- FWCI
- 7.91
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychiatric Rehabilitation Journal (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Funders
- Department of Veterans Affairs (IIR 08-324 and IAC 05-254)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Keywords
- schizophrenia spectrum disorders, peer support, peer support workers, volunteering, meaningful work, patient activation, hope, quality of life, medication adherence, insight, illness management, symptom severity, family involvement
- MeSH terms
- Peer Influence, Psychiatric Rehabilitation, Female, Helping Behavior, Humans, Interview, Psychological, Male, Middle Aged, Quality of Life, Schizophrenia, Schizophrenic Psychology, Social Support, United States, Volunteers, Treatment Outcome, Medication Adherence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
