Outcomes From Consumer-Operated and Community Mental Health Services: A Randomized Controlled Trial

• Published in: Psychiatric services (Washington, D.C.) Vol. 62; no. 8; pp. 915 - 921
• Main Authors: Segal, Steven P, Silverman, Carol J, Temkin, Tanya L
• Format: Journal Article
• Language: English
• Published: Arlington, VA American Psychiatric Association 01.08.2011; American Psychiatric Publishing, Inc
• Subjects: Adult; Biological and medical sciences; Community health care; Community Mental Health Services - organization & administration; Consumer Organizations - organization & administration; Female; Health care delivery; Humans; Interinstitutional Relations; Male; Medical sciences; Mental Disorders - psychology; Mental Disorders - therapy; Mental health; Mental health care; Organization of mental health. Health systems; Power, Psychological; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality of service; Self Efficacy; Social psychiatry. Ethnopsychiatry; Treatment Outcome; United States; North America; America; Social environment; Human; Health system; Treatment efficiency; Mental health; Controlled therapeutic trial; Health service; Consumer association; Self-help group; Treatment; Partnership; Follow up study; Mental disorder; Community health; Public health
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/ps.62.8.pss6208_0915

Objective:Hierarchically organized board-and-staff-run consumer-operated service programs (COSPs) are viewed as organizations that promote recovery while working in concert with community mental health agencies (CMHAs). This study's objective was to determine the effectiveness of such combined services for people with serious mental illness. Methods:A board-and-staff-run consumer-operated drop-in center and colocated CMHA provided the context for the randomized clinical trial. In a weighted sample, 139 new clients seeking help from the CMHA were randomly assigned to agency-only service or to a combination of COSP and CMHA services. Client-members were assessed at baseline and eight months on a measure of symptom severity and on four recovery-focused outcome measures: personal empowerment, self-efficacy, independent social integration, and hopelessness. All scales used have high reliability and well-established validity. Differences in outcome by service condition were evaluated with multivariate analysis of covariance via dummy variable regression. Change scores on the five outcomes were the dependent variables. The covariates for the multivariate analysis included baseline status on each outcome measure and service condition between-group demographic differences. Results:Results indicated that significant changes in three recovery-focused outcomes were associated with service condition across time: social integration (p<.001), personal empowerment (p<.006), and self-efficacy (p<.001). All changes favored the CMHA-only condition. Neither symptomology nor hopelessness differed by service condition across time. Conclusions:Hierarchically organized board-and-staff-run COSPs combined with CMHA service may be less helpful than CMHA service alone. (Psychiatric Services 62:915–921, 2011)