Office of Self-Help/TASC :: Position Papers/Reports

Self-Help and Peer Operated Services

What Are They

Client operated services are services that are totally self-governed, planned, administered and delivered by mental health clients.

The decisions about the program are made through a democratic membership process. Self-help groups are totally voluntary. Besides being based on the self-determination of the group, they are grounded in the self-determination of the individual: freedom of choice. Participation in the service is completely voluntary and clients can participate in parts of the services without being required to participate in others. Self-help groups strive to share power, responsibility and skills. They seek as much as possible a non hierarchical relationship of equals. The distinctions between staff and clients, treater and treated, are minimized or eliminated. Self-help groups, instead of seeing people as diagnosis and labels, see whole human beings with real life needs. Thus most self-help programs provide a range of social, rehabilitative, and survival services.

The underlying philosophy of peer support is that the best helpers are those who have experienced similar problems. In client-run programs, people with mental health problems see others like themselves in positions of responsibility, as role models, and thus gain confidence in themselves. By exercising control over their own lives and services, clients build capacity for self-reliance and independence.

Client-run services are of many kinds. The most popular client run model is the drop-in center, which provides an open, non threatening setting for support and socialization activities. Many drop-in centers have grown to provide advocacy services, such as housing services, vocational services, assistance with Social Security and food stamps, referral services to appropriate mental health and social services. Client-run programs can also be club houses, anti-stigma campaigns, job training classes, and patients rights advocacy programs, to name a few.

How Client-Run Services Started

Client run programs grew out of the "mental patient" civil rights movement which began in the early 1970's. In most client-run programs, this advocacy base persists Because of the persistence of many client activists, mental health policy makers began to acknowledge the need for client run groups and programs. In the early 1980's the Center for Mental Health Services (CMS) , then under the National Institute of Mental Health, began encouraging self-help programs through numerous initiatives, such as designating self-help programs as an essential component of a model mental health system, funding the first consumer run service demonstration project, supporting numerous state and national Consumer Alternatives Conferences, contracting for and conducting consultation and technical assistance, and funding two national technical assistance self-help centers, the National Mental Health Consumers Clearinghouse in Philadelphia, Pennsylvania and The National Empowerment Center in Lawrence, Mass. (There is now an additional client-run technical assistance center, Consumer Organization and Networking Technical Assistance Center (CONTAC), in West Virginia.) This federal support culminated in 1988 in a grant program to demonstrate and evaluate mental health self-help programs. 13 three-year demonstration projects were funded for a total cost of 3.5 million. "The projects demonstrated that individuals who used social and other peer supports provided by self help programs had increased social supports, decreased use of inpatient care, and improved self-confidence and decision making skills. In addition, the projects altered community attitudes toward viewing individuals with sever mental disorders as capable, responsible, productive members of the community." (CSP article) Self help and client controlled programs by the beginning of 1990's were multiplying throughout the state and country.

Client-Run Programs

Today, there are many client-run programs throughout California. Some examples are: Project Return, The Next Step, under the fiscal umbrella of the LA Mental Health Association, serves 200 clients through 102 self-help clubs in Los Angeles County. Project Return, The Next Step also operates two client run drop-in centers and a Warm Line; Sacramento Self Help Centers, a non profit client run organization that runs two drop-in centers and is the patients' rights provider in its county; Mental Health Consumer Concerns, a non profit client run agency that operates three (3) client run community centers, a self-help program in Napa County, a Warm Line, a mental health services provider training project, and is the service provider for patients' rights in three counties. In the Bay Area alone, there are sixteen (16) different self-help initiatives in ten different Counties. These range from a reach out program to hospitalized patients to rural and urban drop-in centers to community agencies that provide drop-in, advocacy, job training, and other services to an administrative self help agency that supports six (6) self-help programs.

Effectiveness of Self Help Acknowledged

The Office of the Surgeon General recognized the contributions of consumer organizations and self-help programs in the 1999 report, "Mental Health: A Report of the Surgeon General." The Report states that "Consumer organizations have had measurable impact on mental health services, legislation and research. One of the greatest contributions has been the organization and proliferation of self-help groups and their impact on the lives of thousands of consumers of mental health services." The California legislature includes "the development and use of self help groups by individuals with serious mental illnesses so that these groups will be available in all areas of the state" as part of the public mental health systems of care. (Welfare and Institutions Code Section 5600.2.(I)) Judi Chamberlin, a pioneer in the self-help movement, wrote," Self-help is not a miracle or cure-all, but it is a powerful confirmation that people, despite problems and disabilities, can achieve more than others (or they themselves) may have ever thought possible."

Challenges for the Future

Planning and policy bodies recommend the growth of self-help programs. The California Mental Health Planning Council's Master Plan recommends, "The DMH should convene a work group to evaluate the effectiveness of consumer-operated services, study the sources of funding for these services, examine the adequacy of resources for consumer-operated services, and research ways to increase funding for these services." The President's New Freedom Commission on Mental Health approved a report entitled "Shifting to a Recovery-Based Continuum of Community Care." The report promotes consumer self-determination by focusing the mental health system on recovery. It recommends that "peer support services be integrated into the continuum of community care and that public and private funding mechanisms be made sufficiently flexible to allow access to these effective support services."

However, barriers exist to growing these programs and even maintaining them.

Although there is gathering research on self-help programs, more is needed. The trend toward evidence-based research may restrict funding to innovative practices such as self-help programs that are emerging "best practices", that do not have the research amassed. Also, there is a fear that evidence based research does not look at important indicators for wellness. Dr. Jean Campbell, principal investigator of the Coordinating Center for the Consumer-Operated Services Project (COSP) Research Initiative (which is in the process of studying consumer-run services in eight states), has said, "Evidence-based research really supports the status quo because most evidence-based research looks at symptoms, recidivism, and treatment outcomes. It doesn't look at key consumer outcomes such as recovery and empowerment."

Current funding mechanisms discourage self-help programs. In Calfornia, client-run programs are paid for by realignment funding and cannot be matched for reimbursement through Medi-Cal. Thus, as stated by the Planning Council in its Master Plan, "Because of budget constraints, some counties continue to fund traditional services, such as day treatment, because it receives a 50% match with Medi-Cal funds rather than fund a peer-support program that requires 100% realignment funding." In these days of severe budget cuts, self-help programs are at risk of being decimated.

Maintaining self-help programs, which includes maintaining their integrity, should be a mental health policy priority.

Produced by the California Network of Mental Health Clients, a client-run statewide advocacy organization