Self-Stigma and Organizational Empowerment In Combined-Community Mental Health and Consumer-Run Services: Two Randomized Controlled Trials

Purpose: Self-help agencies (SHAs) are consumer-operated service organizations, managed as participatory democracies involving members in all aspects of organizational management. SHAs assume that organizational empowerment promotes recovery. Hierarchically organized board-and-staff-run consumer-operated service programs (BSR-COSPs) while led by consumer management and boards, accord less decision-making powers to their membership. This study considers the relative effectiveness of SHAs and BSR-COSPs working jointly with community mental health agencies (CMHAs) and the role of organizational empowerment in reducing self-stigma, a key to recovery.

Method: Weighted-samples of 505 and 139 new clients seeking CMHA services were randomly assigned in separate randomized control trials to one of two forms of consumer led service in addition to regular care. Respectively, the trials randomly assigned clients accepted to CMHA service to regular county-CMHA service vs. combined SHA/CMHA service, or to regular county-CMHA service vs. combined BSR-COSP/CMHA-service. Self-stigma, organizational empowerment, and self-efficacy were assessed at baseline and eight months in each RCT using the Attitudes towards the Mentally Ill Scale, the Organizationally-Mediated-Empowerment Scale, and the Self-Efficacy Scale. Outcomes were evaluated with fully-recursive path analysis models.

Results: Combined-SHA/CMHA-service-participants experienced greater positive change in self-stigma than CMHA-only participants, a result attributable to both participation in the combined condition (b =1.20; p=.016) and increased organizational empowerment (b=.27;p=.003). BSR-COSP/CMHA-service participants experienced greater negative self-stigma change than CMHA-only-participants, a result attributable to participation in the combined service (b = -4.73; p=.031). In the former trial self-efficacy change was positive in the latter it was negative.

Conclusions: Differential organizational empowerment efforts in the SHA and BSR-COSP appeared to account for the differing outcomes. Persons with mental illness experience reduced self-stigma and increases in self-efficacy when they are engaged in responsible roles with other consumers. When placed in positions implying they are less responsible, participants place more stigmas on themselves and others with similar disabilities and experience less self-efficacy.

The studies successfully demonstrate the role of meaningful participation in treatment planning as a factor in both positive and unexpectedly negative patient outcomes.

The studies provide a better understanding of the contributions that can be made by consumer-run services to improved outcomes and show the need for more discriminating endorsement of such care based on the service’s commitment, organization, and ability to empower participants in a true self-help experience.