Overview of papers
Papers were published between 1967 and 2011. Six studies came from the UK, four from Germany, three from the USA, and one from Switzerland. All identified papers were written in either English or German. Eight were naturalistic evaluations, descriptions or reviews of a single volunteer programme, four were large population surveys but still obtaining data on volunteering, and two were small questionnaire studies. Of the ten papers that interviewed volunteers, eight interviewed less than 30 volunteers and two interviewed more than 100. In total, the review included data of 540 mental health volunteers.
Volunteering programmes
Volunteers worked for programmes run by third sector, non-profit organisations, such as befriending or counselling schemes [
21‐
27] or for programmes run by psychiatric hospitals [
26,
28]. The most frequently reported aim amongst these programmes was ‘patient social and community enhancement’ [
22,
24,
27].
The information provided on the contexts in which the volunteers worked varied and was more detailed in papers that profiled a single service. These included befriending services attached to a psychiatric rehabilitation unit [
25] and a community alcohol team in the UK [
22]. Another befriending service was set up by parishioners from a local church with funding from local statutory authorities in Hastings, UK [
24]. A local ‘intentional friendship programme’ was run by a non-profit organisation in a medium-sized northern city in the USA, with nearly 100 affiliate offices across the USA [
29]. One volunteer reported of her time in a university linked psychiatric consultation service in Chicago, USA [
28].
Most schemes asked for a minimum length of commitment from volunteers to enable a successful volunteer-client relationship. On average this was 12 months, but actual relationship length varied between volunteer-client pairs [
24‐
27,
29,
30]. The highest level of commitment recorded was 5 hours a week [
21], with the lowest at 4 hours a month [
29]. Some organisations pre-matched the interests of the volunteers and people with a mental illness in order to increase the likelihood of a successful relationship. Factors such as gender, location, age and interests were typically taken into consideration [
22,
25,
27].
Volunteer training and supervision were compulsory elements of most schemes [
21‐
25,
29], although some volunteers received no training [
30,
31]. Examples of topics covered in training sessions included: expectations and responsibilities of a volunteer, preparation for managing initial meetings, general listening skills, boundaries and guidelines, mental illness, stigma, major diagnoses and symptoms, and conflict management [
22,
29]. Supervision for volunteers was offered in the form of monthly multi-disciplinary meetings, one-to-one supervision sessions or telephone support [
22,
24‐
26,
31].
Information on patients’ diagnoses was infrequently reported. Only five papers mentioned specific diagnoses, including: schizophrenia, manic depressive psychosis, depressive neurosis, anxiety states, dependent personality disorder, and alcohol addiction [
22‐
26]. Others referred to the ‘chronically/severely mentally ill’ [
29,
31‐
33], ‘psychiatric patients’ [
28,
30], and ‘general mental health population’ [
21,
34].
Three papers described the means by which volunteers were recruited [
22,
24,
25]. The most common method was adverts in local newspapers. Additional methods included: poster displays, word of mouth, local radio adverts, ceefax, handbills, and undergraduate/graduate enquiries.
Three schemes reported selection criteria for potential volunteers [
22,
25,
26]. One befriending programme rated potential volunteers from 0 to 10 on the criteria: ‘reliable, responsible, conscientious, has initiative, adaptable, prepared to receive and accept feedback, good listening skills, non-judgemental, ability to learn new skills, and awareness of boundaries’ [
22]. Only those who scored 6 or above in 7 out of the 9 items were invited to interview. One organisation required ‘intelligent, dedicated and motivated people’ [
26], and another recruited only ‘current psychology undergraduates or graduates who have expressed a desire to do clinical psychology training’ [
25].
One paper listed favourable volunteer characteristics from the vantage point of the service user and the mental health professional [
31]. Persons with a psychiatric illness requested volunteers to be ‘a nice person, funny but not curious, intelligent, open to the world, good at thinking far ahead, finished studies, able to deal with conflicts, self assured, eloquent, active, and have some life experience’. Mental health professionals required volunteers to be ‘physically healthy and stable, no need of own psychiatric help, self reflective, to be able to take initiative, active, sensible and able to listen.’
Employment status
Employment profiles were mentioned in four papers [
22,
27,
30,
31]. In the first paper, three volunteers were employed, one was unemployed, one was unwaged (mother in the home), and one was a student [
22]. Of the eight volunteers in the second, four were retired, two were unemployed, one was studying, and one was engaged in other voluntary work [
27]. In the third paper, of the 330 volunteers interviewed, 65% were not in full time employment and 16% were [
30]. In the fourth, ten out of the thirteen volunteers were students, six of these students in psychology [
31].
Negative experiences
Negative experiences were reported less often than positive experiences. One grievance amongst volunteers was that their role was often unclear. Some befrienders found themselves in more of a counselling or carer role, which did not always sit easily with being a friend [
22,
27]. Other volunteers found it difficult to assess the extent to which they were accepted and viewed as complimentary to paid professionals [
22]. One hospital volunteer recalls feeling inadequate as ‘a layman among professionals’ [
28].
Another source of negative experience was the volunteer-client relationship. 44% of the 330 volunteers in one paper experienced a ‘normal’ amount of conflict, whereas 4% experienced a ‘more than normal’ amount [
30]. Concerns early on in the relationship were based on how to deal with resistances’ from people with a mental illness, whereas later concerns were focused on the ending of the relationship [
27,
28].
‘I feel like it’s slightly kind of a bit like a taboo subject [ending the relationship]. Um, I think I would be scared of saying the wrong thing, if it came up.’[
27] [Volunteer]
Client behaviour was another factor in volunteer satisfaction. People with a mental illness who were ‘passive in decision making, inactive, inflexible or disengaged in their time together’, made volunteers feel unappreciated [
29]. Those who used their volunteer ‘as a taxicab’ provoked ‘unpleasant feelings’ in the volunteer [
29]. These feelings were further exacerbated when there were break downs in communication; clients failing to show up for scheduled activities, or being difficult to contact [
29]. Volunteers also reported difficulties in knowing how to respond to information disclosed by the client. They found it difficult to balance being non-judgemental with their personal reaction [
27].
‘…the hardest thing is not giving a true reaction to the things she says, and biting my lip rather than making or voicing my judgements or opinions…’ [
27] [Volunteer].
(iv) benefits for people with a mental illness
Three papers assessed the benefits for people with a mental illness in being involved with a volunteering programme [
22,
27,
29]. The most consistently reported type of benefit was having a one-to-one friendship with someone outside of their immediate circle. Having a ‘casual, relaxed, informal interaction’ was of particular benefit to people whose most frequent exchanges were with ‘professionals with clinical agendas’ [
29].
‘It’s a great experience. I recommend it highly to people, especially people that have psychiatric problems. They need a friend, they need somebody to open up and talk to, and somebody they can be close to. You need it, a little intimacy, the friendship, the ability to talk to somebody other than your immediate [family. [
29] [Client].
Meeting someone who was already aware of their mental illness alleviated a lot of the initial anxiety people with a psychiatric illness often feel when making new friends.
‘Some friends of mine in the system have said what do you need a befriender for, you’ve got a relationship, you’ve got friends. But actually this is more, somebody who’s aware of my history, it’s not like meeting a new friend whose first question is what do you do, why aren’t you working, what is wrong with you… it’s nice to dip your toe in the water by meeting someone, not as a friend, but meeting somebody fresh who knows your history but still respects you’[
27] [Client].
Clients also benefited from having a close companion who was intentional about pushing them outside of their comfort zone [
27,
29]. Volunteers encouraged clients to stand up for themselves in the face of families, employers, and the mental health system, and would introduced them to novel activities, or those that they were reluctant to do on their own [
27,
29]. As a result, clients would grow in ‘self-esteem, self-worth and self-confidence’, [
22,
29] and become more ‘outgoing, socially active, verbal, attentive to arrangements with others and flexible in accommodating others’ [
29].