in Aotearoa New Zealand . The value of relationships and wh�nau care is already well recognised for ��ori .
There are also promising recent studies showing the value of group interventions for mental health among young people , and the contribution of kaimahi ( non-regulated health workers ) to improve outcomes for people with chronic conditions .
Why group-based therapy ? Group interventions have been shown to improve mental health outcomes in both community trials and systematic reviews . A recent meta-analysis of 81 studies showed talk therapy is the best initial treatment for depression .
If psychosocial interventions were a pill , their effectiveness would be trumpeted globally . �et Western biomedicine ( mental health care that requires psychiatrists and psychologists to deliver it ) continues to command the majority of resources because of hierarchies and global economic structures that privilege psychiatry and medicines .
As well as being effective , there are other advantages to group-based interventions because they :
• do not rely on expensive specialist providers
• can be delivered in communities and therefore improve access to care
• are responsive to local contexts such as groups in rural areas
• improve outcomes for groups that typically experience worse health , including new migrants to New Zealand
• increase engagement with mental health services
• and are highly cost-effective and scalable .
Group therapy improves mental health and social connection and is at least as effective as individual therapy .
It can be used for a wide range of mental health problems and is more cost-effective than one-to-one individual therapy . In communities that have a more collective approach to health and wellbeing , such as Indigenous groups , mental health care delivered in groups can better re�ect these values . This in turn may increase accessibility and uptake .
How group therapies work Most quantitative health studies only ask whether a particular intervention works . But we used an approach that looks for how interventions work by examining the contexts , mechanisms and outcomes . As well as e�amining effectiveness , a �realist� evaluation seeks to provide an explanatory analysis of how and why complex social interventions lead to improved health outcomes . This helped us assess what works , for whom and in what circumstances . In this review of 42 peer-reviewed research publications , we identified five key mechanisms that groups offer to improve mental health : 1 . They increase opportunity to be part of trusted relationships , which is a key social determinant of health . Group members described new friendships that continue after the intervention was over .
2 . They trigger a sense of social inclusion and support , meaning people access resources and services more easily . Social inclusion is an important factor that determines mental health . Studies gave examples of how group members supported each other emotionally and with child care , agricultural and home responsibilities .
3 . Groups can strengthen people ’ s ability to manage mental distress because they provide an opportunity to rehearse and use mental health skills and knowledge in a safe social space . This is key to building communication skills and self esteem .
4 . They trigger a sense of belonging , and members can manage emotions better . This enabled behaviour changes . For example , widows in northeast India described how they were able to identify and control feelings of anger because of their sense of connection with the group .
5 . Groups provide a sense of collective strength and can act collaboratively for their own wellbeing . Group interventions are particularly beneficial for minorities , such as non-binary and transgender people , who experience higher rates of mental distress as well as social exclusion . A group can offer social support and affirmation , which have also been identified as key mental health determinants .
These mechanisms are relevant in Aotearoa New Zealand as well as across the wider South Asian region we studied . The recent government inquiry into mental health and addiction , He Ara Oranga , underlined the value of non-biomedical and local solutions for mental health , including therapeutic groups . It called for a move from “ big psychiatry ” to “ big community ”.
Group therapy fits well with a community approach as it can meet mental health needs without medicines , hospitals or expensive professionals . Psychosocial group therapies do not seek to replace formal mental health care . They complement it by providing accessible , cost-effective care in communities and among people who have unmet mental health needs . n
Group interventions have been shown to improve mental health outcomes in both community trials and systematic reviews .
GlobalHealthAsiaPacific . com ISSUE 6 | 2023
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