Treatment conditions
The 32 participants in the mutual support group received a six-month program of mutual support as well as routine psychiatric outpatient care. The group met every two weeks for 12 sessions, each lasting two hours. A peer leader, elected by group members and trained by researchers during a two-day leadership workshop, worked closely with a group facilitator (principal researcher), assisting and encouraging the development of the group in stages, as recommended in the mutual support literature (23). The major contents of the group sessions in these five stages are summarized in Table 1. Emphasis was given to specific Chinese cultural characteristics and issues, including a strong social stigma associated with mental illness and seeking mental health services, a hierarchical but interdependent family structure, and a strong tendency to expect immediate and practical help (14,23,24). Time was given to individual problem solving and to helping individual members deal with particular troubles. Post meeting practice in caring for the mentally ill relative at home was also emphasized and evaluated after each group stage.