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Consumer-run services research and implications for mental health care

  • S. P. Segal (a1) (a2) and S. L. Hayes (a1)

Abstract

Mental health consumers/survivors developed consumer-run services (CRSs) as alternatives to disempowering professionally run services that limited participant self-determination. The objective of the CRS is to promote recovery outcomes, not to cure or prevent mental illness. Recovery outcomes pave the way to a satisfying life as defined by the individual consumer despite repetitive episodes of disorder. Recovery is a way of life, which through empowerment, hope, self-efficacy, minimisation of self-stigma, and improved social integration, may offer a path to functional improvement that may lead to a better way to manage distress and minimise the impact of illness episodes. ‘Nothing about us without us’ is the defining objective of the process activity that defines self-help. It is the giving of agency to participants. Without such process there is a real question as to whether an organisation is a legitimate CRS or simply a non-governmental organisation run by a person who claims lived experience. In considering the effectiveness of CRSs, fidelity should be defined by the extent to which the organisation's process conveys agency. Unidirectional helping often does for people what they can do for themselves, stealing agency. The consequence of the lack of fidelity in CRSs to the origins of the self-help movement has been a general finding in multisite studies of no or little difference in outcomes attributable to the consumer service. This, from the perspective of the research summarised herein, results in the mixing of programmatic efforts, some of which enhance outcomes as they are true mutual assistance programmes and some of which degrade outcomes as they are unidirectional, hierarchical, staff-directed helping efforts making false claims to providing agency. The later CRS interventions may provoke disappointment and additional failure. The indiscriminate combining of studies produces the average: no effect.

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Copyright

Corresponding author

*Address for correspondence: S. P. Segal, Mental Health and Social Welfare Research Group, and The Mack Center on Mental Health and Social Conflict, School of Social Welfare, University for California, Berkeley, CA 94720-7400, USA. (Email: spsegal@berkeley.edu)

References

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Berman-Rossi, T, Cohen, M (1988). Group development and shared decision making working with homeless mentally ill women. Social Work with Groups 11, 6378.
Chamberlin, J (1978). On Our Own: Patient-controlled Alternatives to the Mental Health System. McGraw-Hill: New York.
Chamberlin, J (1990). The ex-patient's movement: where we've been and where we're going. Journal of Mind and Behavior 11, 323336.
Clay, S (2005). On our own, Together: Peer programs for People with Mental Illness. Vanderbilt University Press: Nashville, TN.
Cohen, MB (1989). Social work practice with homeless mentally ill people: engaging the client. Social Work 505509.
Davidson, L, Chinman, M, Kloos, B, Weingarten, R, Stayner, D, Tebes, JK (1999). Peer support among individuals with severe mental illness: a review of the evidence. Clinical Psychology Science and Practice 6, 165187.
Dodd, P, Gutierrez, L (1990). Preparing students for the future: a power perspective on community practice. Administration in Social Work 14, 6378.
Doughty, C, Tse, S (2011). The effectiveness of consumer-led mental health services: an integrative review. Community Mental Health Journal 47, 252266.
French, JRP, Raven, B (1959). The bases of social power. In Group Dynamics (ed. Cartwright, D. and Zander, A.), pp. 311320. Harper & Row: New York.
Gruber, J, Trickett, EJ (1987). Can we empower others? The paradox of empowerment in the governing of an alternative public school. American Journal of Community Psychology 15, 353371.
Gruenberg, EM (1966). Evaluating the Effectiveness of Community Mental Health Services. Milbank Memorial Fund: New York.
Hasenfeld, Y (1987). Power in social work practice. Social Service Review 469483.
Kaufmann, CL, Freund, PD, Wilson, J (1989). Self help in the mental health system: a model for consumer-provider collaboration. Psychosocial Rehabilitation Journal 13, 521.
Leete, E (1988). The role of the consumer movement and persons with mental illness. In Rehabilitation of Persons With Long-Term Mental Illness in the 1990s: Report of the 12th Mary E. Switzer Memorial Seminar. National Rehabilitation Association: Washington, DC.
Lloyd-Evans, B, Mayo-Wilson, E, Harrison, B, Istead, H, Brown, E, Pilling, S, Johnson, S, Kendall, T (2014). A systematic review and meta-analysis of randomised controlled trials of peer support for people with severe mental illness. BMC Psychiatry 14, 39.
McLean, A (1995). Empowerment and the psychiatric consumer/ex-patient movement in the United States: contradictions, crisis and change. Social Science and Medicine 40, 10531071.
Mowbray, CT (1990). Community treatment for the seriously mentally ill: Is this community psychology? American Journal of Community Psychology 18, 893902.
Ostrow, L, Hayes, SL (2015). Leadership and characteristics of nonprofit mental health peer-run organizations nationwide. Psychiatric Services 66, 421425.
Ostrow, L, Leaf, PJ (2014). Improving capacity to monitor and support sustainability of mental health peer-run organizations. Psychiatric Services 65, 239241.
Pinderhughes, EB (1983). Empowerment for our clients and for ourselves. Social Casework 64, 331338.
Ralph, R, Kidder, K, The Recovery Advisory Group (2000). Can we Measure Recovery? A Compendium of Recovery and Recovery Related Measures. Human Services Research Institute: Cambridge, MA.
Rappaport, J (1985). The power of empowerment language. Social Policy 16, 1521.
Rappaport, J, Reischl, T, Zimmerman, M (1992). Mutual help mechanisms in the empowerment of former mental patients. In The Strengths Perspective in Social Work Practice (ed. Saleebey, D.), pp. 8497. Longman: New York.
Repper, J, Carter, T (2011). A review of the literature on peer support in mental health services. J Mental Health 20, 392411.
Rogers, ES, Teague, GB, Lichenstein, C, Campbell, J, Lyass, A, Chen, R, Banks, S (2007). Effects of participation in consumer-operated service programs on both personal and organizationally mediated empowerment: results of multisite study. Journal of Rehabilitation Research and Development 44, 785799.
SAMHSA (Substance Abuse and Mental Health Services Administration) (2011). Consumer-Operated Services: Building Your Program. HHS Pub. No. SMA-11–4633, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services: Rockville, MD.
Scheff, TJ (1970). Being Mentally ill: A Sociological Theory. Transaction Publishers: Piscataway, NJ.
Segal, SP (1994). Self-help Agency Functions, Empowerment, and Member Outcomes. Center for Self Help Research: Berkeley, CA.
Segal, SP, Silverman, C, Temkin, T (1993). Empowerment and self-help agency practice for people with mental disabilities. Social Work 38, 705712.
Segal, SP, Silverman, C, Temkin, T (1995). Measuring empowerment in client-run self help agencies. Community Mental Health Journal 31, 215227.
Segal, SP, Silverman, CJ, Temkin, TL (2010). Self-help and community mental health agency outcomes: a recovery-focused randomized controlled trial. Psychiatric Services 61, 905910.
Segal, SP, Silverman, CJ, Temkin, TL (2011). Outcomes from consumer-operated and community mental health services: a randomized controlled trial. Psychiatric Services 62, 915921.
Segal, SP, Silverman, CJ, Temkin, TL (2013). Self-stigma and empowerment in combined-CMHA and consumer-run services: two controlled trials. Psychiatric Services 64, 990996.
Simon, BL (1987). Rethinking empowerment. Journal of Progressive Human Services 1, 2739.
Susser, E, Goldfinger, SM, White, A (1990). Some clinical approaches to the homeless mentally ill. Community Mental Health Journal 26, 463480.
The President's New Freedom Commission on Mental Health (2003). Achieving the Promise: Transforming Mental Health Care in America. U.S. Department of Health and Human Services: Rockville, MD.
US Department of Health and Human Services (1999). Mental Health: a Report of the Surgeon General. Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health: Rockville, MD.
WHO (World Health Organization) (2001). Mental Health: A Call to Action by World Health Ministers. World Health Organization: Geneva.
WHO (World Health Organization) (2008). Policies and Practices for Mental Health in Europe- Meeting the Challenges. WHO Regional Office for Europe: Copenhagen O, Denmark.
Yeich, S, Levine, R (1992). Participatory research's contribution to a conceptualization of empowerment. Journal of Applied Social Psychology 22, 18941908.
Zimmerman, MA, Rappaport, J (1988). Citizen participation, perceived control, and psychological empowerment. American Journal of Community Psychology 16, 725750.
Zinman, S (1987). Definition of self-help groups. In Reaching Across: Mental Health Clients Helping Each Other (ed. Zinman, H., Harp, H. and Budd, S.), pp. 715. California Network of Mental Health Clients: Sacramento, CA.

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