Chapter 2 VOLUME: A systematic review update on “Volunteering in the care
of people with severe mental illness: a systematic review”
Authors: Claudia Gulea, Megan Cassidy
Background
Individuals with a mental illness often have to deal with negative stereotypes and discriminatory
behaviour directed at them, with an observable tendency for people to distance themselves from
individuals with a mental illness (Angermeyer & Dietrich, 2006). Angermeyer and Diertrich (2006)
did find however, that there are a substantial proportion of the public who hold ‘positive attitudes’
towards those with a mental illness. One such group that these positive attitudes are found is in
volunteers in mental health care. In 2012, Hallett et al. published a systematic review looking at the
characteristics of volunteers in mental health care, their reasons for volunteering and their
experience, to investigate what type of person chooses to volunteer in mental health and what
motivates them. Furthermore the systematic review looked at the benefit of volunteering schemes
for people with a mental illness. This paper will update the review and report evidence published
since then.
The initial review found 14 papers, published between 1967 and 2011. The studies came from the
UK, Germany, the USA and Switzerland. In total the review included data of 540 mental health
volunteers and reported a number of characteristics, motivations and experiences of the volunteers
in mental health care. Characteristics reported included age, gender, employment status,
relationship status, psychiatric history and previous volunteering experience. The results found that
volunteers come from a range of age groups, from both genders (although slightly more females),
have mixed marital status and a mix of previous own experience of mental illness. Volunteer
motivations were also reported and categorised into two categories of what they can ‘give’ to others
and what they can ‘get’ for themselves. Both positive and negative experiences of the volunteers
were recorded, with the majority reporting positive experiences. Associated benefits for people
with a mental illness were also reported and highlight the benefit of the volunteer by gaining a close
companion from outside their immediate circle, who does not stigmatize them, and helps to
facilitate their social-community reintegration.
The initial review found little information on the educational background, religion and ethnicity of
the volunteers. The current update intended to identify any new papers that would further
contribute to our understanding of the types of people who volunteer in mental health, what their
motivations are and the type of experiences they have whilst volunteering, as well as the benefits
for those who have a mental illness. The research questions for this update are unchanged from the
initial review and are as follows:
1. What are the characteristics, motivations, experiences of and benefits for people who
volunteer with people with significant mental illness?
2. What are their reasons for volunteering, their experiences and what is the benefit of
volunteering schemes for people with a mental illness?
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Method
In this review update we sought to identify published papers that explored the characteristics,
motivations and experiences of volunteers in mental health, as well as any benefits for those
receiving the volunteering service. To identify relevant papers we replicated the original search
strategy performed by Hallett et al., (2012) with only one alteration. The search term “supported
socialisation” was included in the ‘volunteer’ descriptor search terms (listed below) as it was
discovered to describe a social intervention provided by volunteers for people with mental illness in
a paper published since the original review was performed (Sheridan et al. 2014).
The following databases searched on 13/02/2015 using three lists of search items: volunteer
descriptors (Group 1), mental health descriptors (Group 2) and outcome descriptors (Group 3). The
following databases were searched, between the years 2012-2015: BNI, CNIL, EMBASE, MEDLINE,
PsychINFO, Cochrane Registers, Web of Science (Psychiatry). The search terms used are as follows:
Group 1: Volunteer Descriptors
volunteer* OR lay helper*OR befriend*OR companion OR friend OR compeer OR peer OR buddy OR
unpaid carer OR informal caregiver OR voluntary caregiver OR naturalistic contact OR supported
socialisation OR psychosocial support OR supported friendship OR peer assistance OR intentional
friendship OR consumer run services OR consumers as providers OR consumers-as-providers OR
community support OR community services OR paraprofessional* OR nonprofessional volunteer* OR
nonprofessional worker* OR citizen participation OR civic participation
Group 2: Mental Health Descriptors
mental health OR mental illness OR mental problem OR mental disorder OR mental health scheme
OR mental health charity OR mental health project OR mental health program* OR mental health
organisation OR mental health service OR mental health care OR psychiatry OR psychiatric scheme
OR psychiatric charity OR psychiatric project OR psychiatric program* OR psychiatric organisation OR
psychiatric service OR psychiatric care OR psychosis OR schizophrenia OR severe mental illness OR
drug and alcohol OR depression
Group 3: Outcome Descriptors
motivation* OR motive* OR reason* OR opinion* OR attitude* OR experience* OR reward* OR
benefit* OR success* OR drawback* OR negative* OR failure* OR challenge* OR difficult*
Additional searches were also conducted in the following databases: American journal of psychiatry,
Archives of General Psychiatry, International journal of Social Psychiatry, British Journal of
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psychiatry, Psychiatric Bulletin (aka The Psychiatrist), Schizophrenia Bulletin, Non-profit and
Voluntary Sector Quarterly using the search term “Volunteering in Psychiatry”. Acta Psychiatrica
Scandinavica was also searched using the term “Volunteering in Mental Health Care”. Lastly, the
grey literature was searched using the terms “Volunteering AND Psychiatry” and “Volunteering AND
Mental Health”.
Inclusion Criteria
Papers were included if the volunteers were unpaid lay and/or non-professional volunteers, the
volunteer activity was a regular commitment with an adult (aged 18 and over) mental health
population and the volunteering activity involved face-to-face contact and provided direct care.
Exclusion criteria
Papers were excluded if the volunteers in the study were family members, paid carers, paid lay
workers, mental health professionals or already known friends. We excluded papers where the
volunteering activity was not specific to a mental health population or involved no face-to-face care
(for example, conduction on the telephone or online). Papers were also excluded if the volunteering
reported was part of a course requirement or was a one-off activity and not a regular commitment.
We also excluded literature that was not a peer-reviewed journal article or letter (for example,
charity advertising booklets).
Data Extraction
All potential studies were exported into EndNote version X5 bibliographic software (Thompson
Reuters) and duplicates removed. CG and MC conducted the initial screening of titles and abstracts
for inclusion. A random selection of 20% of the abstracts was conducted by CG. If there were any
ambiguity on the study, the full paper would be obtained and reviewed between the two authors.
Inter-reviewer agreement was 100%. Data extraction was completed by CG and MC and followed
the protocol established by Hallett et al. (2012). We extracted both qualitative and quantitative
documentation of the study as follows: study year, country, setting, aims, methods; volunteer
demographics : number, age, gender, education level, employment status, religion, ethnicity,
relationship status, living arrangements; and volunteer characteristics: motivations, previous
experience in mental health volunteering, previous connection to organisation, previous service
user, volunteer role, volunteer activities, length of commitment, positive and negative experiences).
Additional information was extracted on volunteering organisation characteristics: type, philosophy,
client group supported, benefits to persons with a mental illness, method of recruiting volunteers,
volunteer selection criteria, matching process, volunteer training and supervision).
Figure 1 shows a QUORUM diagram with the results of the literature search and selection process of
papers.
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Results
A total of 3,099 studies were retrieved and assessed for eligibility to be included in the review
update. After the removal of duplicates and unrelated papers, 1,717 papers were screened on title
and abstract. A further 1,708 were excluded based on the definition of volunteering not meeting the
inclusion criteria and not reporting data on volunteers. Nine full texts were reviewed from which
only three were included in the review.
Of the three papers included, one study was conducted in the UK, one in Nigeria and one in South
Africa. The papers were published between 2012 and 2014 and all were written in English. The
papers reported data on a total of 127 volunteers. Two were service evaluations and one was a small
questionnaire study. The follow data was extracted from the papers included:
(i)
Characteristics of volunteers
Age
All three papers provided an average age, an age range or both. In one paper the average age was 40
years (SD = 10.7) (Abayomi et al, 2012). In another paper the age range was between 20-60 years,
with over half in their 40s (Coe and Barlow, 2013) and in the other paper the average age was 41.8
years, with a range between 18-60 years (Vawda, 2014).
Gender
Only two of the three papers gave the proportion of male and female volunteers. One paper
reported 58.1% were female (Abayomi et al, 2012) and the other reported that all 16 participants
were female (Coe and Barlow, 2013). The remaining paper did not explicitly report the gender of the
volunteers, but did however note that half the sample had reported having had perinatal
depression, which would imply that at least half the volunteer sample was female (Vawda, 2014).
Employment Status
Only one of the papers reported employment status of the volunteers (Abayomi et al, 2012). It
reported that 64.5% of volunteers were also in employment. It went on to note that 46.4% worked
in pastoral care and 39.2% worked as artisans (craftsmen/tradesmen). Some respondents (17.9%)
had previously been employed in auxiliary nursing care and traditional birth services within the
community.
Educational Level
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Only one paper included information on the educational level of the volunteers (Abayomi et al,
2012). It reported that 41.9% of volunteers had completed secondary education.
Religion
One paper included information on the reported religious affiliation of volunteers (Vawda, 2014). Of
the 16 volunteers, six were Christian, four were Hindu and six did not specify their religion.
Ethnicity
The ethnicity of the volunteers was reported in two of the three papers (Coe and Barlow, 2013,
Vawda, 2014). In one paper the volunteers were described as ‘mainly White British’. In the other
paper the ethnicity of volunteers was 10 Indian, 5 Black and 1 White.
Relationship Status
Volunteer relationship status was included in all three papers. Abayomi et al. (2012) reported 58.1%
were married. Coe and Barlow (2013) state most volunteers were married or in a stable relationship
and all but one had children. In the third paper, eight of the 16 volunteers were married, seven were
single and one is described as being divorced.
Past psychiatric history
Only one paper gave information about the volunteers’ past psychiatric history. In this paper only
two volunteers reported having seen a mental health professional for trauma whilst eight volunteers
reported having a personal history of violence/rape.
Previous volunteer experience
Only one of the papers stated whether the volunteers had previous volunteer experience.
(Abayomy et al 2014). 17.9% had been involved in auxiliary nursing care & traditional birth services;
61.3% had a history of caring for a person with mental illness; 32.3% had a family member/friend
with mental illness; 83.9% had previous contact with persons with mental illness.
(ii)
Reasons for volunteering
Only one paper (Coe & Barlow, 2013) reported the motivations of the volunteers in the study.
Volunteers identified reasons as either having suffered from perinatal depression, thus having
previous personal mental health problems or 'wanted to get involved with the community’.
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Even if they didn’t assess motivations, based on their results (religion acting as a protective factor
against depression and burnout), Vawda (2014), suggested that counsellors may be drawn to work
with trauma survivors due to their spiritual beliefs which provide them with the necessary strength
to do this work.
(iii)
Experiences of volunteers
Qualitative interviews from Coe and Barlow 2013 portray positive experiences such as ways in which
they supported the service users:
‘But I remember this particular girl the first time I met her she just ... I could tell by her eyes what
pain she was in. She just had ... she sort of glared at me. And now she does actually look happy again
and there is that sparkle in her eyes’ (Volunteer befriender #11)
Moreover, ways in which volunteering contributed to their personal benefits, such as feelings of selfacceptance and gratification was also noted:
‘It’s just really ... I just found it really re- warding. I wanted to give something back to the community
really and I feel that I have done that. Um. It’s kind of made me feel accepted in a way’ (Volunteer
befriender #11).
Coe and Barlow also report a significant increase in volunteers’ self-esteem post intervention.
No negative experiences were reported in any of the papers however, Vawda (2014) reported that
half the sample experienced mild depressive symptoms and a quarter moderate to severe
symptoms.
Discussion
Main findings
This updated review provided data on 127 volunteers from 3 studies. We found that demographic
information is not accurately reported and this varies across studies. The most often reported
characteristics are age, gender, relationship status and ethnicity and results show that volunteers
have an average age of 40 years old, most are married or in stable relationships and vary in ethnicity.
Comparison with previous review.
Like Hallett et al. (2012), we found that most volunteers have positive experiences whilst
volunteering with psychiatric populations. We also found there is no typical volunteer, with
characteristics varying and being specific to the area and culture where the study was carried out: in
an African sample, one new volunteer characteristic that emerged from is spirituality, This was
correlated with other outcomes such as depression and burnout and might be a specific feature to
consider when selecting volunteers for a specific type of work ie, lay counselling or crisis
intervention in a culture where most charities have religious based philosophies.
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More so, we found educational programmes improve the attitude of volunteers towards people with
mental illness (Abayomi et al. 2012) and this has implications in changing the general public attitude
towards mental illness and reduce stigma. Another finding in like with Hallet et al. (2012) comes
from Coe and Barlow (2013) that presented evidence showing the positive experiences of both
service users and volunteers during their volunteering programme.
However, longitudinal studies investigating whether improved attitude results in behavioural
changes in the long term are needed in order to strengthen this finding.
Strengths and limitations
We used a systematic way to gather all available literature since 2012 on volunteering in mental
health. The search strategy allowed for including studies from 3 countries (UK, South Africa and
Nigeria) and identifying similarities and differences in volunteering across these regions.
In order to minimise the possibility of missing relevant data, independent researchers reviewed the
data.
However, there are limitations with witch this updated review should be considered: the number of
volunteers for which data is provided is very small. The two studies that focused on service
evaluations didn’t include control groups which makes it difficult to interpret the true effects of the
service effectiveness and information on patient diagnoses was scarce (only reported in one paper).
Conclusion
The results reported in this review do not substantially differ from those found by Hallett et al.
(2012). We also found that volunteering has benefits for both volunteers and patients. Volunteers
therefore might play an important role in delivering mental health interventions and promoting
social inclusion of people that have mental illness.
Compared to Hallet et al. (2012) we report characteristics of smaller number of volunteers (127
versus 540).
Adding to Hallett et al. (2012) we found data on volunteering in Africa (2 studies) – here one new
implied motivation rendered by the spirituality of the sample in one study (spirituality – believing in
a higher force) and the belief that previous trauma makes people more inclined to want to help
peers not only because of the shared experience but also because suffering is part of spiritual
growth. Whilst this may be a reflection of general cultural differences between Western Europe
countries and African ones, this needs to be interpreted with caution as only 1 paper with a limited
number of volunteers in a specific area (volunteer counsellors) reports this characteristic.
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Table 1. Summary of papers
Author
Country
Year
Study design
Number
Volunteer Volunteer
of
age
gender
volunteers
(%)
31
Mean of
58.1%
40 years
females
old
Abayomi et
al.
Nigeria
2012
Service
evaluation
Coe and
Barlow
UK
2013
Service
evaluation
80
Between
20-60
Vawda
South Africa 2014
Naturalistic
16
Mean of
41.8
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Implied
all
females
All
females
Type of volunteering
Type of mental health
population
Spiritual therapy
Individuals with mental
illness
Befriending
Mothers with perinatal
depression
Counselling
Women who experienced
interpersonal violence
Figure 1. QUORUM flow diagram for paper selection
Potentially relevant
studies identified for
retrieval and titles
screened (N = 3,099)
Studies excluded (N = 1,382)
Duplicates (N = 647)
Irrelevant format (N=160)
Unrelated (N= 575)
Abstracts screened
for more detailed
evaluation (N =
1,717)
Studies excluded (N = 1,708)
-
No data on volunteers (N = 1)
Definition of ‘volunteer’ was not in accordance
with inclusion criteria (N = 1,707)
Full texts screened
for more detailed
evaluation (N =9)
Studies excluded (N =6)
-
Volunteering was not in
accordance with inclusion criteria –
paid role (N = 6)
Papers included in
review
(N =3)
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References
1) Angermeyer, M.C., & Dietrich, S. (2006). Public beliefs about and attitudes towards people
with mental illness: a review of population studies. Acta Psychiatra Scandinavia, 113, 3.
2) Abayomi, O., Adelufosi, A.O., & Olajide, A. (2012). Changing attitude to mental illness among
community mental health volunteers in south-western Nigeria. International Journal of
Social Psychiatry, 59, 6.
3) Coe, C., & Barlow, J. (2013). Supporting women with perinatal mental health problems: the
role of the voluntary sector. Community Practitioner, 86, 2.
4) Hallett, C., Klug, G, Lauber, C. & Priebe, S. (2012). Volunteering in the care of people with
severe mental illness: a systematic review. BMC Psychiatry, 12, 226.
5) Vawda, N.B.M. (2014). Depressive symptoms, burnout and the impact of events in nonprofessional volunteer counsellors in Durban, South Africa. Journal of Psychiatry, 17.
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