Effectiveness of Combined Consumer-operated and CMHA Service

Background and Purpose:

Consumer-operated programs (COSPs) are viewed as organizations that effectively empower their members with severe mental illness in a fashion that promotes recovery. Given the severe mental health issues addressed by such programs COSPs most often are providing service in concert with community mental health agencies (CMHAs). The objective of this trial was to determine the effectiveness of combined COSP and CMHA services for new service users with severe mental illness.

Method

A COSP drop-in center program and a county-CMHA, located in close proximity to it, provided the context for the clinical trial. A weighted-sample of 106 new clients seeking help from the CMHA were randomly assigned to regular CMHA service or to a COSP/CMHA combined service. The COSP center was a well run organization—having all the “common ingredients” associated with excellent mental health service agency environments as evidenced by the high scores it received on the Community Oriented Program Environments scale, assessments made independently of the trial participants by COSP members who had used the agency for at least one month. COSP and CMHA efforts to empower their members/clients were measured with the Organizational Empowerment Scale. Clients/members were assessed at baseline, 1, 3, and 8 months on five recovery-focused outcome measurers: Empowerment of the individual in their everyday life was assessed by The Personal Empowerment Scale and The Self Efficacy Scale. Individual social integration was assessed with the Independent Social Integration Scale, developed to capture five social integration dimensions—social presence, access, participation, production and consumption behaviors. The individual's psychological functioning was assessed with the Brief Psychiatric Rating Scale, and the Hopelessness Scale. All scales possessed high degrees of reliability and independently established validity.

Outcomes were evaluated using a repeated measures multivariate analysis of covariance (MANCOVA).

Results

The MANCOVA indicated that service condition, time measured over the eight months of participation, and the interaction of service condition with time produced significant results--all reported with p<.000. These results indicated that taking all the measures into account the two groups changed differently across the four periods of assessment in the eight-month follow-up. Univariate outcomes also showed significant changes associated with service condition across time in Independent Social Integration (d.f. 3,103; F=14.17; p<.000), BPRS Scores (d.f. 3,103; F=4.07; p<.007), and Hopelessness (d.f. 3,103; F=8.25; p<.000)--all favoring the CMHA-only service condition. No differences in the organizational effort to empower members/clients were observed between the COSP/CMHA and the CMHA conditions. Neither personal empowerment nor self efficacy significantly differed by service condition across time.

Conclusions and Implications

COSPs failing to provide for the organizational empowerment of their members when acting in concert with CMHA service may actually be harmful to their members. COSPS offer an inexpensive form of service with no qualification other than the ascribed status of the consumers or former consumers running the organization. Without a clearly defined process for empowering their members such care should be supported with extreme caution in that it may be less helpful than CMHA service alone.