Improving public sector mental health care through the use of consumers

Chinman M, Young AS. Improving public sector mental health care through the use of consumers. Paper presented at: VA HSR&D National Meeting; 2002 Feb 1; Washington, DC.

Objectives: Research has often demonstrated that the usual care for patients with serious mental illness (SMI) in public sector settings is of low quality. Studies outside the VHA have shown that the use of various consumer based interventions such as consumer providers, consumer run services, and mutual support groups can often improve public care. All are based on the mutual support philosophy; participants share personal experiences, serve as role models to facilitate the learning of problem-solving skills, and provide hope for recovery. Involving consumers in mental healthcare parallels substance abuse treatment, which often utilizes people in recovery from their own addictions due to their first-hand knowledge and credibility as role models. Although consistent with the VHA's emphasis on hiring veterans, the use of mentally ill veterans to provide mental health services appears not to be common. Therefore, we present a review of the literature and original empirical work in order to examine how to begin to consider this model for the VHA in order to improve SMI services for veterans. Methods: Several research databases were searched for studies using consumer-based services. Studies' methods and results were reviewed. The empirical work involved about 1000 homeless mentally clients from a national homeless outreach demonstration program. We compared those who received services from consumer case managers to those who received services from case managers who were not consumers with a series of one-way Repeated Measures of Analyses of Variance analyses across three timepoints on several clinical, social, and functioning outcomes. Results: The literature reviewed showed that employing consumers and mutual support groups are feasible, show positive client outcomes, and can improve care. In the consumer provider study, both groups of clients improved significantly over time on almost every outcome measure. There were no significant Time by Case Manager Type interactions. Staff age, race, or gender did not significantly alter the pattern of these results. Conclusions: The review of the literature and the empirical results show the ability of consumers to become involved in providing mental health services. Impact statement: Incorporating consumers into the VHA mental health system has promise to improve services for veterans with SMI.