Atlas›Domain V · Systemic, relational, group & community›Guide 109
Guide V-109

Schizophrenics Anonymous

Joanne Verbanic1985Detroit, USA
A 42 · L 51 · M 717 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the peer support group model the organisation publishes today (Schizophrenia & Psychosis Action Alliance, S&PAA, sczaction.org, peer support groups page, October 2026), with the original Schizophrenics Anonymous (SA) six-step version (Joanne Verbanic's "Blue Book") as secondary sources report it. Verified from S&PAA's own press release and history page and a 2014 profile: the founding (Detroit, July 1985), SARDAA's naming (February 2008) and the SARDAA-to-S&PAA rebrand (announced 5 April 2021); the current S&PAA pages and a 2024 S&PAA-promoted online meeting listing make no mention of the six steps. Limits: the Blue Book is not used here, so the six-step wording rests on Wikipedia and pages copied from it [uncertain: secondary, unverified]; no available source describes a classic SA meeting's running order; whether local groups still use the six steps is unknown. [source: S&PAA Peer Support Groups; S&PAA press release 2021; S&PAA Our history; Disabled World 2014; Wikipedia] [uncertain: Blue Book wording and meeting running order]

What it is. Schizophrenics Anonymous is a mutual-help (peer support) fellowship, not a therapy that a clinician delivers. It was run "both by and for" people with schizophrenia or a related illness. Joanne (also spelled Joann) Verbanic, who was diagnosed with schizophrenia in 1970, founded it in Detroit in July 1985; it later ran for 14 years in partnership with the Mental Health Association in Michigan (MHAM). It adapted the twelve-step model into six steps. The groups serve people living with schizophrenia and related conditions: schizoaffective disorder, bipolar disorder, psychotic depression and other psychosis. [source: Disabled World 2014 (founding month, "by and for"); Salem, Reischl & Randall 2010 chapter abstract (MHAM partnership); Wikipedia; Hawaii PIER listing]

By 2007 more than 150 local groups ran in 31 US states and several other countries (Brazil, Australia, Canada, France, Mexico, Venezuela, India). The National Schizophrenia Foundation gave technical support until it closed in 2007. A steering committee of consumers, family members and providers formed in January 2008 and on 28 February 2008 named itself the Schizophrenia and Related Disorders Alliance of America (SARDAA), which adopted SA as its signature programme and administered the groups in partnership with them; in May 2012 it trained more than 30 people to lead SA groups. [source: Disabled World 2014; S&PAA Our history; Wikipedia] The groups were reportedly renamed Schizophrenia Alliance in 2015, with a Psychosis Support and Acceptance strand added in 2018. [source: Wikipedia] [uncertain: both dates are marked "citation needed" on Wikipedia and were not confirmed elsewhere]

A 2022 county mental-health flyer still listed SA under SARDAA, with telephone conference-call and Zoom meetings, including a Spanish-language meeting. [source: JCMH flyer] SARDAA announced on 5 April 2021 (Alexandria, VA) that it had rebranded and relaunched as the Schizophrenia & Psychosis Action Alliance (S&PAA); the announcement does not mention SA or the support groups. [source: S&PAA press release 2021; S&PAA Our history] S&PAA's peer-support page still links to SARDAA's social-media account. It now describes general peer support groups and does not use the "Anonymous" or six-step language; a 2024 S&PAA-promoted online meeting is listed simply as a weekly peer support group (75 minutes) with no steps or readings mentioned. [source: S&PAA page; HeyPeers listing] [uncertain: legal details of the rename]

How change is thought to happen. Members meet people with the same diagnosis who are managing it. This restores dignity and purpose, gives practical information about the illness, and supports self-directed "positive steps towards recovery". [source: Wikipedia, quoting SA's own description] The current groups describe a compassionate space where members share similar experiences, encouragement, practical advice and coping strategies, which builds belonging. They also state that treatment is necessary: peer community supports recovery alongside treatment and does not replace it. [source: S&PAA page]

The clinician's role is to assess fit, refer, prepare the client, connect group experience with individual treatment, work alongside groups that meet in clinical settings without taking them over, and handle problems. [synthesis]

2. Framework

There is no phase structure or session count. Attendance is open-ended and voluntary. The framework below shows how the fellowship is organised, followed by a clinician pathway. [source: S&PAA page; Wikipedia]

How the fellowship is organised

  • Local groups. Independent groups meet weekly. Some meet in community centres, libraries, drop-in centres and peer-run programmes. Others meet inside psychiatric hospitals or jails and are closed to the public. [source: Wikipedia; S&PAA page]
    • S&PAA notes that its listed face-to-face groups are run by independent community leaders, not by S&PAA itself. Meetings typically last 60 to 90 minutes, judging by the times on the 2026 listing. [source: S&PAA page]
    • Some groups have extra rules, such as one centre that admits adults only. [source: S&PAA page]
  • Remote meetings. Under SARDAA there were several weekly SA conference calls, a Family and Friends call, Zoom meetings and a Spanish-language meeting. [source: Wikipedia; JCMH flyer]
    • S&PAA now uses a registration form and an online meeting platform (HeyPeers, which has a waiting list and a standby room for full meetings). It also runs an online message board (Inspire) and a Facebook "blended" support group. [source: S&PAA page]
  • Specialised groups. Current offerings include a young-adult peer group (Recovery Road), a social-connection games group (Games Matter!) and separate caregiver support groups. [source: S&PAA page]
  • Leadership. Groups are peer-led by volunteer facilitators and co-facilitators. S&PAA runs three facilitator-training cohorts a year and is recruiting volunteers to restore in-person groups. [source: S&PAA page]
    • Historically some groups were organised by professionals. Groups led by consumers lasted significantly longer than groups led by professionals. [source: Salem, Reischl & Randall 2008]
  • Eligibility. A formal schizophrenia diagnosis is not required: people who have experienced psychosis may join. Family groups exist separately. [source: Hawaii PIER listing]

Clinician pathway [synthesis; not a published protocol]

  1. Assess fit and readiness, usually in one session.
    • Goal: decide whether peer support adds something now.
    • Move on when the client is willing to try and has no acute crisis that a group cannot hold.
  2. Prepare and link, over one or two sessions.
    • Goal: choose a group format, rehearse the first meeting and plan logistics.
    • Move on when a specific meeting date has been agreed.
  3. Trial attendance. Ask the client to attend three or four meetings before judging the group.
    • Debrief briefly in each therapy session.
    • Move on when the client chooses to continue, switch format or stop.
  4. Integration, ongoing.
    • Use what the client brings from the group (coping ideas, the steps, peer examples) in the treatment plan.
    • Review fit every few months.
  5. Optional peer-role development. A stable client may want to co-facilitate.
    • Support training and boundaries.

3. Guiding principles

The current group guidelines are paraphrased below. [source: S&PAA page] They govern members' conduct. The clinician uses them to judge whether a group is healthy and to prepare clients.

  • Confidentiality. What is said in the group stays there. Practical meaning: reassure the client, but advise them to share only what they are comfortable with, because confidentiality is not legally guaranteed among peers. [synthesis]
  • Respectful, non-judgemental, compassionate listening. Practical meaning: a group that ridicules or argues with members is not following its own rules; help the client name this and choose another group.
  • Ask before advising. Members ask permission before offering advice or suggestions. Practical meaning: prepare the client that they can decline advice, including advice about medication.
  • The person is not the symptom or the diagnosis. Practical meaning: in therapy, reinforce the client's identity beyond the illness.
  • Zero tolerance for bullying or harassment. Practical meaning: tell the client to report harassment to the facilitator or to S&PAA, and debrief it with you.
  • Speak from your own experience. Members use "I" statements and do not diagnose others. Practical meaning: rehearse this with clients who tend to lecture others.
  • Value diversity and different views. Practical meaning: expect differing beliefs about illness, faith and medication; help the client tolerate the difference without having to adopt the view.
  • Remind people of their worth in a hopeful atmosphere. Practical meaning: hope is an active ingredient; ask the client what gave them hope that week.
  • Treatment is necessary, and community supports each person's own path. Practical meaning: the fellowship sees itself as working alongside treatment. Use this to frame the referral as "and", not "instead of".
  • Recognise strengths of people recovering from psychosis, such as resilience, creativity, empathy and humour. Practical meaning: gather the client's strengths in therapy and link them to what the group sees.

Principles drawn from the original SA steps, paraphrased. [source: Wikipedia, which cites Verbanic's Blue Book and a 2005 NAMI convention presentation; the same paraphrase appears on Mental Health Matters 2022, which is copied from Wikipedia and so is not independent confirmation] [uncertain: secondary, unverified]

  • Admitting the need for help.
  • Taking responsibility for one's own choices.
  • Believing in one's inner strength to help oneself and others.
  • Forgiving oneself and others.
  • Recognising and changing false beliefs that add to one's problems.
  • Deciding to entrust one's life to a higher power.

Principles for working with mutual-help groups. [source: Salem, Reischl & Randall 2008, abstract]

  • Keep consumers in control. Consumer-led groups lasted longer than professional-led ones. Formal partnership brought consistency and administrative capacity, but also a more hierarchical structure, reduced consumer control and less clearly defined leadership roles. Practical meaning: support a group; do not run it.
  • Maintenance matters as much as expansion. Members worried that energy went into starting new groups at the expense of sustaining existing ones. Practical meaning: when partnering, budget for keeping existing groups going (venue, reminders, backup facilitators), not only for launching new groups.
  • Institutional control undermines groups. In the Michigan partnership, SA groups became more often tied to formal mental-health settings; consumer control fell, member leadership roles became less clearly defined, and groups with consumer leaders lasted significantly longer than groups with professional leaders. [source: Salem et al. 2008, abstract (Deep Blue)] Wikipedia's summary of the research adds that staff-run groups in group homes and prisons, where staff decided who led, who attended and how meetings ran, fell apart [uncertain: secondary, unverified]. Practical meaning: protect the group's self-direction even within a ward.
  • Practical know-how drives perceived helpfulness. In a study of SA, members' perceptions of how helpful the group was depended more on expert power (the practical experiential knowledge the group offered) than on referent power (identification with members). The article's abstract describes SA as a mutual-help group for people with a schizophrenia-related illness and reports that leaders were rated higher than ordinary members on expert power. Practical meaning: when judging fit, ask whether the group offers usable coping information, not only fellowship. [source: Salem, Reischl, Gallacher & Randall 2000, abstract (Springer); encyclopedia.pub summary for the helpfulness finding]

4. Intervention inventory

This section has two parts.

  • Part A (items 1–7) covers the fellowship's own tools, as the organisation publishes them. Members and peer facilitators run these, not the therapist. They are described so that you can explain them to clients accurately.
  • Part B (items 8–17) covers clinician procedures for referring to the fellowship and working alongside it. SA and S&PAA publish no clinician manual among the cited sources, so Part B is the writer's synthesis unless a source is tagged. [synthesis]

Part A. Fellowship tools (run by members, not by the clinician)

1. The weekly peer support meeting

  • Purpose: Members share their experience of living with psychosis, give encouragement, practical advice and coping strategies, and build belonging. [source: S&PAA page]
  • Steps (what the client will meet):
    1. A volunteer facilitator or co-facilitator convenes the group in person, by phone or online. Registration may be required. [source: S&PAA page]
    2. The group guidelines (item 3) set the norms.
    3. Members speak in turn about their own experience.
    4. Others respond only with permission.
  • Uncertain detail: The cited sources (the current S&PAA pages, a 2024 S&PAA-promoted online meeting listing that says only "weekly support", the 2014 SARDAA profile, Wikipedia and the Salem et al. abstracts) do not describe the detailed running order of a classic SA meeting (opening, reading of the steps, step discussion, sharing round, closing). Do not tell clients what order to expect; tell them to ask the facilitator. [uncertain]
  • Example language (illustrative): "It's a group of people who've had experiences like yours. They talk about what helps them get through the week. You can just listen the first time."
  • Watch for:
    • Whether the client leaves feeling less alone or more distressed.
    • Whether the group keeps its own guidelines.

2. The six steps (original SA version)

  • Purpose: A short, self-directed recovery sequence adapted from the twelve-step model and set out in Verbanic's Blue Book. [source: Wikipedia; Mental Health Matters 2022 (copied from Wikipedia)] [uncertain: secondary, unverified; wording below is a paraphrase of a secondary paraphrase] Paraphrased, the six steps are:
    1. Admitting that you need help.
    2. Taking responsibility for your choices and their consequences.
    3. Believing you have the inner strength to help yourself and others.
    4. Forgiving yourself and others.
    5. Recognising that false beliefs feed your problems, and changing them.
    6. Deciding to entrust your life to a higher power.
  • Steps (how members use them): Members work through the steps in their own recovery. How groups used them in meetings is not documented in the sources. [uncertain] Current S&PAA groups publish ten guidelines rather than steps, and neither the S&PAA peer support page, its 2021 rebrand announcement nor a 2024 S&PAA-promoted meeting listing mentions the six steps. [source: S&PAA page; S&PAA press release 2021; HeyPeers listing] Whether independent local groups still use them is unknown: ask the local facilitator. [uncertain]
  • Example language (illustrative): "Some older groups use six steps, a bit like AA's. One of them is about noticing beliefs that make things harder. We could look at that together if it interests you."
  • Watch for:
    • The higher-power step can conflict with the client's faith or lack of faith, or can be absorbed into religious delusions. Explore what it means to the client. [synthesis]
    • The "responsibility" and "false beliefs" steps can turn into self-blame or into arguments over whether voices are "real". Frame them as matters of coping, not fault. [synthesis]

3. Group guidelines (ground rules)

  • Purpose: Keep the group safe and hopeful. [source: S&PAA page]
  • Content (paraphrased):
    • Confidentiality.
    • Respectful, non-judgemental listening.
    • Ask permission before advising.
    • The person is separate from the diagnosis.
    • Zero tolerance for bullying.
    • Speak only from your own experience.
    • Value diversity.
    • Affirm each person's worth.
    • Treatment is necessary, and the community supports each person's own path.
    • Recognise strengths.
  • Steps (clinician use): Go through the guidelines with the client before the first meeting. Use them afterwards as a checklist to judge whether the group felt safe. [synthesis]
  • Example language (illustrative): "The group's own rules say nobody should push advice on you without asking first. If that happens, you're allowed to say no thanks."
  • Watch for: Guidelines that are routinely broken in a particular group. If that happens, help the client choose another group.

4. Remote and online formats

  • Purpose: Access for people who are rural, housebound or socially anxious, and for anyone without a local group. [synthesis, based on the formats listed]
  • Formats published:
    • Under SARDAA: several weekly conference calls, Zoom meetings and a Spanish-language meeting. [source: JCMH flyer; Wikipedia]
    • Under S&PAA: a registration form; an online platform with a waiting list and a standby room when meetings are full; the Inspire message board; and a Facebook blended group. [source: S&PAA page]
  • Steps (clinician):
    1. Help the client register.
    2. Test the device and audio in session if needed.
    3. Agree whether the client will keep the camera on or off.
    4. Plan what to do if the call is full. [synthesis]
  • Example language (illustrative): "Would phone or video feel easier for a first try? You can keep your camera off."
  • Watch for:
    • Paranoid clients may fear surveillance on video platforms or social media. Offer phone formats, and respect a client who declines. [synthesis]
    • Watch for overuse of message boards late at night when distressed. [synthesis]

5. Specialised groups: young adults and social connection

  • Purpose: S&PAA lists Recovery Road, a young-adult peer support group for schizophrenia and psychosis, and Games Matter!, a social-connection group. [source: S&PAA page]
  • Steps (clinician): Match these to clients in early psychosis or with prominent social withdrawal. A low-demand activity group can be a gentler first step than a sharing group. [synthesis]
  • Example language (illustrative): "There's one that's mostly about playing games and hanging out. No one has to talk about their diagnosis."
  • Watch for: Whether the activity format reduces anxiety enough for the client to keep coming.

6. Family and caregiver groups

  • Purpose: Support for relatives. SARDAA ran a weekly Family and Friends call, and S&PAA runs separate caregiver support groups. [source: Wikipedia; S&PAA page; Hawaii PIER listing]
  • Steps (clinician): Offer these to relatives as a parallel resource. Keep the client's group and the family group separate unless the client wants otherwise. [synthesis]
  • Example language (illustrative, to a parent): "There's a group just for family members, separate from your son's. Many parents say it helps to talk to others who've been through the same thing."
  • Watch for: Relatives using the family group to monitor the client. Keep the client's confidentiality in your own communications.

7. Volunteer facilitator training and co-facilitation (peer role)

  • Purpose: Groups are led by trained volunteers. S&PAA runs three facilitator-training cohorts a year and recruits co-facilitators to restore in-person groups. [source: S&PAA page]
  • Steps (clinician): See item 15.
  • Watch for:
    • Role strain in a member whose condition is not yet stable.
    • The leadership role becoming poorly defined. Members reported this in the Michigan partnership. [source: Salem et al. 2008]

Part B. Clinician procedures [synthesis unless tagged]

8. Fit assessment

  • Purpose: Decide whether, when and which group format to recommend.
  • Steps:
    1. Check the client's diagnosis or experience of psychosis. A formal diagnosis is not required. [source: Hawaii PIER listing]
    2. Assess current mental state. Defer in-person group work during acute psychosis, active suicidal crisis, or hostility likely to breach the guidelines. Consider phone or online formats, or an activity group, instead.
    3. Ask about the client's earlier experience of groups, including twelve-step groups, and their stance on faith or a higher power.
    4. Ask about social anxiety, paranoia about groups, transport, and hearing or cognitive difficulties.
    5. Ask what the client hopes to get from a group: belonging, coping tips, or wanting to help others.
  • Example language (illustrative): "What would make a group feel worth going to? And what would make you want to leave?"
  • Watch for: Ambivalence. Treat it as information, not as resistance.

9. Referral conversation

  • Purpose: Present peer support as an addition to treatment, in line with the groups' own stance that treatment is necessary. [source: S&PAA page]
  • Steps:
    1. Explain what a peer group is and is not. It is not therapy, and it is not run by staff.
    2. Give the choice of formats.
    3. Address stigma about attending a "schizophrenia" group. The founder's purpose included challenging stigma. [source: Wikipedia]
    4. Agree on a trial of three or four meetings.
  • Example language (illustrative): "Your treatment here continues. This would be an extra, with people who know first-hand what it's like."
  • Watch for: The client hearing the referral as a sign that you are discharging them. Name continuity of care explicitly.

10. Preparing for the first meeting

  • Purpose: Lower the anxiety of a first attendance.
  • Steps:
    1. Look up the time, place or link, and any rules such as an age limit. [source: S&PAA page]
    2. Plan the journey or the device setup.
    3. Rehearse a one-line introduction, or practise saying "I'll just listen today".
    4. Decide in advance what not to share: legal matters and identifying details.
    5. Plan coping for symptoms during the meeting, such as a grounding object or permission to step out.
    6. Agree on a brief check-in afterwards.
  • Example language (illustrative): "Let's practise what you might say if they go round the room. 'I'm Sam, I'm new, I'll listen today' is enough."
  • Watch for: Rising anticipatory anxiety. Shrink the first step, for example to an online meeting with the camera off.

11. Bridged first contact

  • Purpose: Help hesitant clients across the threshold.
  • Steps: With the client's consent, use one or more of the following.
    • Contact the facilitator so they expect the client.
    • Ask a peer support worker to accompany the client.
    • Sit with the client while they log in.
    • Respect any rule that a group is for members only. Do not attend a closed group meeting yourself unless the group invites you.
  • Example language (illustrative): "Would it help if I let the facilitator know you're coming, so someone says hello?"
  • Watch for: Dependence on the clinician. Fade the support over two or three meetings.

12. Debrief and integration

  • Purpose: Turn group experiences into material for treatment.
  • Steps: Spend 5–10 minutes of each therapy session on four questions.
    1. What happened at the group?
    2. What did you hear that you might try?
    3. What was hard?
    4. Do you want to keep going? Then write any coping strategies the client picked up into the care or relapse-prevention plan.
  • Example language (illustrative): "You said someone uses music to drown out the voices at night. Do you want to try that this week and tell me how it goes?"
  • Watch for:
    • Advice from peers that conflicts with the treatment plan, especially about stopping medication. Discuss it openly, without disparaging the group.
    • Signs the group is working: the client mentions other members by name, uses new coping strategies, or attends without prompting.

13. Linking the six steps to individual work

  • Purpose: For clients whose group uses the steps, connect them with therapy goals.
  • Steps:
    1. Ask which step the client is thinking about.
    2. For the step on false beliefs, use collaborative belief exploration of the kind used in CBT for psychosis. Avoid direct confrontation of delusions.
    3. For the forgiveness step, work on shame and self-stigma.
    4. For the inner-strength step, list concrete strengths.
    5. For the higher-power step, explore the client's own meaning and how it relates to their spiritual history. Liaise with a chaplain if the client wishes. This is an adaptation and is not prescribed by SA. [synthesis]
  • Example language (illustrative): "When you think about the step on beliefs that make things worse, which belief comes to mind? How sure are you of it, from 0 to 100?"
  • Watch for: Spiritual content merging with grandiose or persecutory themes. Track this in your mental-state assessment.

14. Coordinating with family groups

  • Purpose: Support the family system around the client.
  • Steps:
    1. Give relatives the caregiver group details. [source: S&PAA page]
    2. Agree with the client what you may share with family.
    3. Use what relatives learn in the group as material for a family meeting if the client wishes.
  • Example language (illustrative): "Would it be OK if I gave your mum the details of the family group? I won't share anything you've told me."
  • Watch for: Conflict when relatives use group language to pressure the client.

15. Supporting a client who wants to facilitate

  • Purpose: Peer leadership can build purpose and identity, and consumer-led groups were the more durable ones. [source: Salem et al. 2008]
  • Steps:
    1. Review stability and stressors with the client.
    2. Encourage formal facilitator training through S&PAA. [source: S&PAA page]
    3. Plan boundaries: the facilitator is not a therapist and not on call.
    4. Build co-facilitation and a backup into the plan.
    5. Add early warning signs linked to the role into the relapse plan.
  • Example language (illustrative): "Leading a group sounds meaningful to you. What would tell us it's becoming too much?"
  • Watch for: Overextension, rescuing other members, and secondary traumatic stress.

16. Partnering with or hosting a group in a service

  • Purpose: Make groups available in clinical, hospital, residential or justice settings without undermining them.
  • Steps:
    1. Offer a room, publicity and administrative help.
    2. Recruit a consumer leader, ideally someone who has attended other groups.
    3. Agree in writing that the peers decide who leads, who attends and how the meeting runs.
    4. Staff stay out of meetings unless invited.
    5. Fund ongoing support for existing groups, not only new launches. These steps are drawn from the findings that consumer-led groups outlasted professional-led groups and that formal partnership reduced consumer control, blurred leadership and drew effort towards developing new groups rather than maintaining existing ones [source: Salem et al. 2008, abstract (Deep Blue)], and from Wikipedia's report that staff-controlled groups in group homes and prisons collapsed [uncertain: secondary, unverified].
  • Example language (illustrative, to a manager): "We provide the room and the flyers. The members run the meeting."
  • Watch for:
    • The group drifting into a staff-run psychoeducation class.
    • Attendance becoming compulsory or linked to privileges.

17. Including the group in crisis and relapse plans

  • Purpose: Use the group as a support while making clear that it is not a crisis service.
  • Steps:
    1. In the safety plan, list group attendance as a coping and connection step.
    2. List professional crisis contacts and emergency services separately. S&PAA directs anyone at risk of self-harm to an emergency department or the 988 crisis line in the US. [source: S&PAA page]
    3. Agree with the client what they will do if a group member discloses suicidal plans: tell the facilitator and suggest crisis services.
  • Example language (illustrative): "The group is great for staying connected. If things get dangerous, though, it's 988 or A&E, and then me."
  • Watch for: The client relying on peers in place of crisis care.

5. Handling problems

The sources do not address these problems. Everything below is clinician synthesis unless a source is tagged. [synthesis]

  • Client won't go, or stops after one meeting.
    • Explore what happened, without pressure.
    • Offer a lower-demand format: phone with the camera off, a message board, or the games group. [source: S&PAA page, for the formats]
    • Try a different group. Groups differ, and many are independently run. [source: S&PAA page]
    • Accept "not now" and revisit in three months.
  • Paranoia or fear of being watched in the group.
    • Gather the evidence for and against with the client.
    • Choose a smaller or phone-based group.
    • Agree on safe topics to share.
    • Never insist on attendance.
  • Overwhelm during or after a meeting (other members' stories, voices getting louder).
    • Plan an exit and a grounding routine beforehand.
    • Shorten exposure, for example by attending part of a meeting.
    • Debrief within the week.
    • If symptoms rise over several meetings, pause attendance and review the treatment plan.
  • Peer advice to stop medication, or anti-treatment views.
    • Acknowledge the client's experience of side-effects.
    • Note that the groups' own guidelines say treatment is necessary. [source: S&PAA page]
    • Make a shared decision about medication with the prescriber, rather than arguing against the group.
  • The higher-power step is unwelcome or becomes part of delusional content.
    • Point out that current S&PAA guidelines do not require it. [source: S&PAA page]
    • Help the client find a group that does not use the steps, or interpret the step in secular terms.
    • Assess mental state if religious content escalates. [uncertain: whether local groups still use the six steps; current S&PAA materials do not mention them]
  • Unsafe group conduct (bullying, exploitation, romantic or financial pressure, breaches of confidentiality).
    • The groups have zero tolerance for bullying. [source: S&PAA page]
    • Help the client report the problem to the facilitator or to S&PAA, or leave the group.
    • Take safeguarding action if an adult at risk is being exploited.
  • A member in crisis during a meeting.
    • Prepare the client to tell the facilitator and to point the person to emergency services or the crisis line. [source: S&PAA page]
    • Tell the client they are not responsible for treating anyone.
    • Debrief any vicarious distress afterwards.
  • Non-adherence or erratic attendance.
    • Treat attendance as optional support, not as a treatment requirement.
    • Explore practical barriers such as transport, cost, timing and cognitive load.
    • Use phone reminders if the client wants them.
  • Rupture with the clinician over the referral ("you're passing me off").
    • Repair openly and restate that therapy continues.
    • Let the client lead decisions about the group.
  • Professional over-involvement (a service-run group losing members or collapsing).
    • Step back.
    • Hand leadership to consumers.
    • Stop compulsory attendance.
    • Keep practical support going. [source: Salem et al. 2008; Wikipedia, summarising Salem's research]
  • Group dissolves, or leaders burn out.
    • Help the client find a remote meeting.
    • Encourage stable members to train as co-facilitators. [source: S&PAA page]
    • Members' concern that new-group expansion crowded out maintenance suggests supporting existing groups first. [source: Salem et al. 2008]
  • Closed institutional groups (hospital, jail).
    • Membership is restricted. [source: Wikipedia] [uncertain: secondary, unverified]
    • On discharge, link the client to a community or remote group before they leave.
  • Outdated listings.
    • Names, schedules and sponsors have changed several times: SA (1985), then SARDAA (2008) and Schizophrenia Alliance, then S&PAA (2021). [source: Disabled World 2014; S&PAA press release 2021; Wikipedia]
    • Check the current S&PAA listing before referring. Treat older flyers as possibly obsolete. [source: JCMH flyer, which advises checking the schedule; S&PAA page]

Sources

Pages used:

Cited (abstracts or secondary summaries only):

  • Salem, D. A., Reischl, T. M., & Randall, K. W. (2008). The effect of professional partnership on the development of a mutual-help organization. American Journal of Community Psychology, 42(1–2), 179–191. https://doi.org/10.1007/s10464-008-9193-9. Abstract: University of Michigan Deep Blue record.
  • Salem, D. A., Reischl, T. M., Gallacher, F., & Randall, K. W. (2000). The role of referent and expert power in mutual help. American Journal of Community Psychology, 28(3), 303–324. Abstract: Springer article page; further detail from the encyclopedia.pub summary.
  • Salem, D. A., Reischl, T. M., & Randall, K. W. (2010). Helping mutual help: Managing the risks of professional partnerships. In L. Brown & S. Wituk (Eds.), Mental Health Self-Help (pp. 303–334). Springer. (Abstract only.)
  • Verbanic, J. Schizophrenics Anonymous ("The Blue Book"). [uncertain]

The classic SA meeting running order, the Blue Book's step wording, the 2015 and 2018 renames, and whether local groups still use the six steps remain unverified [uncertain].

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