Since the ex-patient movement of the 1970s, mental health consumers have become more involved in mental health service provision. Consumer-centered services play an increasingly important role in the array of publicly-funded mental health services available. Consumer-centered services focus on individuals' needs and goals, as defined by the consumer. Consumer-run drop-in centers (CDIs) and clubhouses are two of the most common of these programs.

The main goal of CDIs is to provide a safe and supportive environment, offering recreational and social activities, where consumers can develop a peer support network. The program is run by those who use the services and tends to attract people who are less likely to affiliate with traditional mental health services. In contrast, clients in clubhouses (members) help operate the program, but ultimate decision making authority rests with staff who are usually not mental health consumers. Clubhouses are more routinized than CDIs, revolving around the “work ordered day,” with a greater focus on vocational rehabilitation.

Basic differences in the structure and goals of CDIs and clubhouses suggest that they may appeal to different types of consumers. However, we could not locate any published research on this topic. This information would be useful from a programming standpoint because if MH administrators knew how consumer characteristics reflect different needs, mental health systems could more effectively allocate resources.

In this presentation, we use data from an NIMH study of 31 geographically matched pairs of clubhouses and CDIs from a Midwest state and more than 1800 consumers to determine whether there are significant differences in the characteristics of individuals who use these programs. Based on program descriptions, we expected differences in demographics, psychiatric history, disability status, current service usage, symptomatology, and personal outcome variables for CDI versus clubhouse users.

Data were collected in 2-day site visits to each agency, including interviews with consumers/members, encompassing the above variables. Because consumers were nested within agencies, we used HLM software with full maximum likelihood estimation. Analyses were conducted in a stepwise fashion whereby demographic variables were tested first for type of program (CDI vs. clubhouse) as a predictor. These variables were then used as covariates (controls) in analyses of the significance of the effects of program type on psychiatric history variables; and so on through the six blocks of variables.

Membership across these programs is quite heterogeneous. Results indicate that clubhouse members were more likely to be female, be on SSI/SSDI, have a greater number of lifetime hospitalizations, have a schizophrenia (versus any other) diagnosis, get more traditional MH services, be living in dependent care, have a higher Quality of Life and report being in recovery. CDI consumers were more likely to have a substance abuse history. Possible reasons for these differences are discussed, including consumer characteristics (need for structure) and system practices (referral patterns). Administrators in mental health systems need to review whether individuals using CDIs do so out of choice or because they are or have been less adequately served by more traditional programs.

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