Building Bridges

Mental Health Consumers 

in Intergenerational Dialogue

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

Building Bridges

Mental Health Consumers 

in Intergenerational Dialogue

U.S. DEP U.S. DEPARTMENT OF HEAL OF HEALTH AND HUMAN SER ANDHUMAN SERVICES

Substance ubstance Abuse and Mental Health Services use and Mental Health Services Administration dministration

Center for Mental Health Services Center for Mental Health Services

www.samhsa.gov .samhsa.gov

iii

Acknowledgements

The publication was prepared for the Substance Abuse and 

Mental Health Services Administration (SAMHSA), U.S. Department 

of Health and Human Services (HHS), under contract number 

280-01-8054. Irene Saunders Goldstein wrote this monograph 

(with initial reporting by Asha-Lateef Dobbs), and Carole Schauer 

served as the Government Project Offi cer.

Disclaimers

The views, opinions, and content of this publication are those 

of the author and do not necessarily refl ect the views, opinions, 

or policies of SAMHSA or HHS.

Public Domain Notice

All material in this report is in the public domain and may be 

reproduced or copied without permission from SAMHSA. Citation 

of the source is appreciated. However, this publication may not 

be reproduced or distributed for a fee without the specifi c written 

authorization of the Offi ce of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be retrieved electronically from 

www.samhsa.gov. For additional copies of this document, 

please call SAMHSA’s National Mental Health Information 

Center at 1-800-789-2647 or 1-866-889-2647 (TDD).

Recommended Citation

Center for Mental Health Services. (2008). Building Bridges: 

Mental Health Consumers in Intergenerational Dialogue.

HHS Publication No. SMA-09-4372. Rockville, MD: Center for 

Mental Health Services, Substance Abuse and Mental Health 

Services Administration.

Originating Offi ce

Offi ce of the Associate Director for Consumer Affairs, 

Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration, 1 Choke Cherry Road, 

Rockville, MD 20857.

HHS Publication No. SMA-09-4372

Printed 2009
iv

Building Bridges: Mental Health Consumers in Intergenerational Dialogue
v

Contents

Overview .......................................................................................... 1

Mental Health Consumers: 

Similarities and Differences in the Evolving Movement ....... 4

Generational Differences ............................................................. 4

Experiences with Mental Health Services ................................... 7

Consumer Movement(s): Evolution Highlights ........................... 8

Issues and Concerns: Shared and Unique .............................. 15

Language and Labels .................................................................. 15

“Wellness” and Public Health .................................................... 17

Recovery and Resilience ............................................................ 18

Productivity: Education and Work ............................................. 19

Recording and Archiving the History 

of the Consumer Movement ...................................................... 20

Treatment Choice: Traditional and Alternative ......................... 20

Treatment Issues ......................................................................... 21

Cultural Competence ................................................................. 23

Voices and Choices .................................................................... 24

Trauma and Trauma-Informed Care .......................................... 24

Peer Support Specialists and Youth Coordinators .................... 25

Co-Optation of the Peer Support Role ...................................... 26

Lesbian, Gay, Bisexual, and Transgender Issues ...................... 27

Suicide and Suicide Prevention ................................................. 28

Poverty ........................................................................................ 29

Recommendations ........................................................................ 30

For Consumers ........................................................................... 30

For the Youth and Adult Consumer Movements ...................... 30

For the Substance Abuse and 

Mental Health Services Administration ..................................... 31

Conclusions ................................................................................... 32

Appendix: Selected Resources ................................................... 34

Intergenerational Dialogue Participants ................................ 42

References and Related Publications ....................................... 47
vi

Building Bridges: Mental Health Consumers in Intergenerational Dialogue
vii

Somewhere along the line, as a young person, I got this 

impression that the adult [consumer] movement was a bunch of 

boring old people. I had my concerns and apprehensions about 

coming here, but you all are very cool. Hearing you share your 

stories, it’s not that you just popped out as adults somewhere 

along the line. A lot of you started as consumers as young people, 

and I have so much in common with you. I can identify a lot 

with your stories. I’m interested in working with you guys now.

—Young adult participant
viii

Building Bridges: Mental Health Consumers in Intergenerational Dialogue
1

Overview

For nearly four decades, consumers of mental health services 

have advocated for improved quality and access to mental 

health services in the United States. This modern consumer 

movement is hardly the fi rst reform effort to impact mental health 

care in America. Records show that as early as the mid-1800s, 

former psychiatric patients and others had worked to improve 

the deplorable, abusive conditions rampant among the mental 

institutions of the day. 

Conditions have improved dramatically over the years, 

but advocates continue to fi ght for patients’ rights, work to 

overcome prejudice and discrimination, and promote self-help, 

peer support, and recovery. As the Surgeon General’s report on 

mental health indicated: 

The consumer movement has increased the 

involvement of individuals with mental disorders 

and their families in mutual support services, 

consumer-run services, and advocacy. They are 

powerful agents for changes in service programs 

and policy. 

The notion of recovery refl ects renewed optimism 

about the outcomes of mental illness, including that 

achieved through an individual’s own self-care 

efforts, and the opportunities open to persons with 

mental illness to participate to the full extent of 

their interests in the community of their choice. 

(U.S. Department of Health and Human Services 

[HHS], 1999)

The consumer movement’s robust impact was highlighted just 

a few years later in the call by the President’s New Freedom 

Commission on Mental Health (2003) for consumers to 

“stand at the center of systems of care and to lead the design, 

implementation, and evaluation of mental health services in the 

United States.” The Commission established the primacy of the 

consumer in its second overarching goal: mental health care is 

consumer and family driven.

Until fairly recently, the consumer movement essentially 

focused on adults’ mental health. Several major family-oriented 

advocacy organizations that organized in the 1970s and 1980s 

have since enjoyed substantial success in moving positive mental 

health policies forward for adults, children, and adolescents. 
2

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

An important fact to note is that increasing numbers of youth have 

taken seats at policy-making tables since the mid-1980s. 

Veteran consumer activists have expressed the need to share the 

history, knowledge, and skills of their movement with the younger 

generation. Likewise, many members of the younger generation 

want older consumers to be aware of their concerns and 

activities. While experiences in mental health care for both groups 

correspond in some respects, differences also have infl uenced the 

ways in which they have approached mental health in general, 

their primary issues, and their roles as advocates and leaders. 

There is an identifi ed need to bring these groups together to 

exchange views and to determine how to use the knowledge 

gleaned from their shared—and diverse—histories. 

In September 2007, the Center for Mental Health Services 

(CMHS), Substance Abuse and Mental Health Services 

Administration (SAMHSA), U.S. Department of Health and Human 

Services (HHS), hosted a 2-day roundtable meeting in Rockville, 

Maryland. Mental health consumers and advocates across multiple 

generations attended. Together with CMHS staff, a representative 

planning committee identifi ed participants, recommended 

facilitators, and developed an agenda for the dialogue. 

The intergenerational dialogue aimed to: 

develop improved mutual understanding of the participants’ 

shared history as mental health consumers;

increase communication and partnerships among mental health 

consumers to forge a common agenda to promote mental health 

recovery;

develop a set of recommendations to increase collaboration 

among consumers of all ages; and

develop strategies to promote consumer leadership and 

recovery. 
3

The dialogue brought together approximately 20 mental 

health consumers and supporters. Ranging in age from 20 to 75, 

participants included peer specialists, youth coordinators, national 

and local consumer leaders, consumer organization directors, 

trainers, mental health advocates, and others. With its emphasis on 

hearing the youth voice, which has strengthened markedly since 

2000, this dialogue meeting was an historic event, a joining of 

minds across the lifespan and a bridge across the adult and youth 

mental health consumer movements.

History of Center for Mental Health Services Dialogues

In 1997, CMHS sponsored inaugural roundtables in a series 

of formal dialogues. These meetings offer mental health 

consumers and representatives of other groups the opportunity 

to improve communication and build partnerships to infl uence 

mental health services and promote recovery. Nearly a dozen 

dialogues to date have led to concrete outcomes, including 

advances in networking, training and technical assistance, 

and valuable recommendations for CMHS and the fi eld. 

Formal dialogue reports help to disseminate these outcomes 

in printed documents and/or postings on SAMHSA’s National 

Mental Health Information Center Web site (http://nmhicstore.

samhsa.gov).

Examples of these reports include Building Bridges: Mental 

Health on Campus: Student Mental Health Leaders and College 

Administrators, Counselors, and Faculty in Dialogue (2007), 

and Building Bridges: Consumers and Representatives of the 

Mental Health and Criminal Justice Systems in Dialogue (2005). 

Additional monographs describe dialogues between consumers 

and psychiatrists, psychologists, social workers, and mental 

health/psychiatric nurses. Additional topics include the interface 

between consumers and primary health care representatives; 

consumers and representatives of faith- and community-based 

organizations; consumers and representatives of the mental 

health and criminal justice systems; and topics related to 

co-occurring disorders, consumers and service providers, 

policy makers, and researchers.
4

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Mental Health Consumers: 

Similarities and Differences in 

the Evolving Movement

We’re not two clearly defi ned groups, but I think the differences 

among our generations are important to address, because as the 

advocacy role falls onto my generation and younger, we’re not 

necessarily going to follow through the way the older generation 

would want us to. It’s important for us to learn what’s important to 

the older generation, and at the same time incorporate our views 

and what we need.

—Young adult participant

Two major considerations may inform an examination of 

similarities and differences across the lifespan among mental 

health consumers, and also of the evolution of the consumer 

movement: (1) recognition of the impact of generational 

differences in the general population, and (2) the availability and 

impact of mental health treatments, services, and supports on 

the lives of consumers and on the development of the adult and 

youth consumer movements. 

Generational Differences

Psychosocial research suggests that generations share both 

commonalties and striking differences related to experience and 

values, depending on year of birth and the nature of life’s ensuing 

experiences. Table 1 presents a selection of broadly generalized 

comparisons among four current generations of Americans—

Traditionalists, Baby Boomers, Generation X, and Generation Y 

or Millenials. Participants in the intergenerational dialogue ranged 

across the four generations described.
5

Table 1. Differences Across Generations

Categories

Generations

TraditionalistsBaby 

Boomers

Generation X Generation Y:

Millenials

Birth date Before 1946 1946–1965 1965–1981 1981–2000

Numbers in 

the population

35+ million 80+ million 45–80 million 60–80 million

Family 

constellation and 

environment 







Close 

family

Mother at 

home

One marriage







Working 

mothers

Dispersed 

family

Divorced/ 

remarried









Single 

mothers

Working 

mothers

Latchkey 

kids

High 

divorce rate







Single 

mothers/ 

single 

fathers 

Looser 

family unit

Children 

increasingly 

protected 

and 

supervised 

by family 

Formative 

experiences









Great Depression

New Deal

World 

Wars I 

and II

Rationing









Civil rights

Sexual 

revolution

Cold War

Space 

travel









Fall of 

Berlin Wall

Watergate

Women’s 

liberation

Desert 

Storm











September 

11

School 

shootings

Oklahoma 

City 

bombing

Technology

Iraq War

Communication









Radio

Mimeograph

Rotary 

phones

Slide rule









TV

Photograph

Touch-tone 

phones

Calculators











Video 

games

Computers

Beepers

Cell phones

Laptop 

computers

Internet

DVD 

PDA

iPod

MySpace

YouTube

Instant 

messages

Text 

messages

(continued)
6

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Table 1. Differences Across Generations (continued)

Categories

Generations

Traditionalists

 Work hard

Team 

player

Commitment to 

work

Loyal

Baby 

Boomers

Hard work 

and loyalty equals 

career success

Seek status

Sacrifi ce 

family for 

advancement

Generation X

Work hard/

be well paid

Do not 

defer 

rewards—

cash and 

salary now

Willing to 

change jobs 

Use 

technology

Balance 

work and 

life

Generation Y:

Millenials

Expect pay 

for what 

they do, not 

time given

Boss is 

mentor/

coach

Willing to 

job hop

Work style

Characteris-  Dedication  Idealistic  Prove it  “Go do it”

tics/ and  Optimistic to me  “Can do”

values











sacrifi ce

Respect for

rules

Duty before

pleasure

Honor

Financially

conservative

Faithful to

institutions













Team

oriented

Personal

gratifi cation

Personal

growth

Believe one

can be and

do anything

Hard work

and loyalty equals

career success

Rights

focused





















Selfcentered

Skeptical of

the integrity

of institutions

Accept

diversity

Fun and

informality

Self-reliant

Pragmatic

Practical

Fend for

oneself

Adaptable

Loyalty to

team





















Diplomatic

Collaborative

Respect

diversity

Conformist

Confi dent

Achievement

oriented

Instant

gratifi cation

Respect

their ideas

Spirit of

volunteerism

Balance

between

material

goods and

spiritual

happiness

(Sources: Duke University, n.d.; Wheeler, n.d.; Dittman, 2005; 

Gaylor, 2002; Thielfoldt & Scheef, 2004; Mayo Clinic, n.d.)
7

Consensus is elusive in the literature on the generations’ inclusive 

time periods and on nicknames for the generations. Moreover, 

researchers describe generational characteristics differently. But they 

recognize universally that one’s personal experiences within the 

family, work, and community impact one’s outlook on life. 

Experiences with Mental Health Services

As might be expected, personal experiences with the mental 

health services system infl uence the way consumers view and 

advocate for mental health care. The confl uence of personal 

histories, in turn, has shaped development of both the adult and 

the youth consumer movements. Far too many adult consumers 

have shared the common experiences of institutionalization, 

forced treatment, incarceration, homelessness, poverty, poor 

mental health care, inadequate general health care, and social 

exclusion and discrimination. 

By contrast, younger consumers perhaps are less likely to have 

experienced some of the adverse conditions endured by their 

elders—although certainly prejudice and discrimination, poverty, 

and probably inadequate medical care—continue as barriers in 

their lives. Since the 1980s mental health care systems for children 

and adolescents have changed dramatically in the United States. 

Shifts have occurred in:

places where children and youth receive treatment, services, 

and supports: from hospitals and long-term residential care 

back to the community;

nature of services: for example, the introduction of mentoring 

programs, new medications, anger management strategies, and 

family supports; and

providers of the services and supports: for example, teachers, 

foster homes, child care staff, paraprofessionals, probation 

offi cers, peers, and even community volunteers. 

Younger people may take advantage of services in many locales 

within the supportive context of comprehensive, coordinated, 

community-based, and culturally competent systems of care. In establishing systems of care for children and adolescents with serious 

mental health problems and their families, many communities have 

reaped the benefi cial effects of the wraparound services they provide (CMHS, n.d.). Nevertheless, lacking those supports and services, 

many younger consumers have found themselves enmeshed in the 

juvenile justice, special education, foster care, and/or substance abuse 

treatment systems—or otherwise have fallen through society’s cracks. 
8

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Consumer Movement(s): Evolution Highlights*

As early as the mid-1800s, former psychiatric patients worked 

to change laws and public policy regarding the “insane.” In a brief 

history of the consumer/survivor movement, the National Mental 

Health Consumers’ Self-Help Clearinghouse (Clearinghouse, 

2000) explained: 

Beginning in 1868, Elizabeth Packard, founder of 

the Anti-Insane Asylum Society, published a series 

of books and pamphlets describing her experiences 

in the Illinois insane asylum to which her husband 

had had her committed. But in the nineteenth 

century, individuals fi ghting for patients’ rights, 

such as Mrs. Packard, met great opposition. Due to 

ignorance and fear—many still believed that mental 

illness was the result of demonic possession—such 

early attempts at activism were largely ignored.

A founding father of the mental health consumer movement, 

Clifford W. Beers published A Mind That Found Itself. In this 

1908 book, he described his personal challenges with mental 

illness and the harrowing treatment he received in three mental 

hospitals. His compelling narrative—together with his ability to 

enlist prominent individuals in the publication of his book and his 

subsequent reform efforts—changed the face of mental health in 

the United States (Friedman, 2002).

Throughout the 20th century, activists founded a number of 

organizations, some of which have since become familiar names 

in the mental health arena. In 1909, Beers formed the National 

Committee for Mental Hygiene, which aimed to “improve attitudes 

toward mental illness and the mentally ill; to improve services for 

the mentally ill; [and] to work for the prevention of mental illness 

and promote mental health.” Its members claimed victory for a set 

of model commitment laws enacted in several States; conducted 

infl uential studies on mental health, mental illness, and treatment; 

and convened a worldwide congress for “constructive dialogue 

about fulfi lling the mission of the Mental Health Movement.” 

Eventually the group evolved into the National Mental Health 

Association, now known as Mental Health America (Mental Health 

America, n.d.). 

* A comprehensive history of the U.S. consumer/survivor movement has 

not yet been written. 
9

In 1937, neuropsychiatrist Abraham Low founded Recovery, Inc., 

which offered a self-directed “self-help system of psychotherapy 

based on the management of fear, anger, and nervous symptoms.” 

The organization’s work continues into the present. As a 

supplement to professional treatment, participants seek to regain 

and maintain their mental health and productivity by regular 

participation in free meetings that help them learn to replace “selfdefeating and illness-promoting thoughts and impulses” with “selfendorsing thoughts and wellness-promoting actions” (Abraham A. 

Low Institute, n.d.; Recovery, Inc., n.d.). 

In the 1940s, in order to help ease for others the diffi cult 

transition from hospital to community, former psychiatric patients 

founded WANA (We Are Not Alone). In 1948, in New York City, 

the group established Fountain House, which offered psychosocial 

rehabilitation services to people leaving State mental institutions 

and fostered a community among people struggling with serious 

mental illnesses. Fountain House’s innovative “clubhouse” model 

has inspired more than 1,400 similar programs worldwide 

(Fountain House, n.d.).

Scientifi c developments in the 1950s led to the introduction as 

well as

widespread use of psychotropic . . . medications[, 

which permitted] many people—individuals who 

would once have been committed to asylums for 

life—to be released to live in the community. The 

goal of this “deinstitutionalization” movement was 

to allow people with mental illness to escape being 

warehoused in what were often terrible conditions, 

so that they could enjoy increased independence 

and opportunities. While the idea of releasing 

people from institutions was a worthy one, many 

people fell through the cracks because of the lack 

of community-based mental health services. In 

addition, many of the psychotropic drugs had 

terrible side effects. (Clearinghouse, 2000) 

In the developing civil rights movement of the late 1950s 

and early 1960s, people organized to challenge inequality and 

social injustice. By 1970, the movements for women’s, gay’s, and 

disabled people’s rights all had taken on parallel goals. Also in 

this context, 

former mental patients in several cities across the 

country began to organize groups with the 
10

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

common goals of fi ghting for patients’ rights 

and against forced treatment, eradicating stigma 

surrounding mental illness, ending economic and 

social discrimination, and creating peer-run 

services as an alternative to the traditional mental 

health system.

Unlike professional mental health services . . . 

based on the medical model, peer-run services 

were based on the principle that individuals who 

have shared similar experiences can help 

themselves and each other through self-help and 

mutual support. (Clearinghouse, 2000)

Many early organizers adopted a more militant view of mental 

health systems. Their groups took on names such as Insane 

Liberation Front and the Network Against Psychiatric Assault 

(Chamberlin, 1978), and their members viewed the mental health 

system as destructive and disempowering. But by 1980, another 

approach was coming into vogue:

Individuals who considered themselves consumers 

of mental health services had begun to organize 

self-help/advocacy groups and peer-run services. 

While sharing some of the goals of the earlier 

movement groups, consumer groups did not seek 

to abolish the traditional mental health system, 

which they believed was necessary. Instead, they 

wanted to reform it. Consumer groups encouraged 

their members to learn as much as possible about 

the mental health system so that they could gain 

access to the best services and treatments available. 

(Clearinghouse, 2000)

The psychiatric rehabilitation movement of the 1970s and 

especially the 1980s promoted such community-based services 

as group homes and apartments, employment supports, and 

case management services. Upon passage of legislation in 1975 

supporting the creation of community mental health centers, the 

National Institute of Mental Health (NIMH) actively promoted 

community-based services (National Institutes of Health, 1998). 

In her groundbreaking 1978 book On Our Own, consumer 

activist Judi Chamberlin described living with a mental illness, and 

she introduced readers to the emerging mental health consumer/

survivor self-help movement. During the next decade, NIMH 

began to fund technical assistance efforts to expand the self-help 
11

model across the Nation. Also with NIMH support, the fi rst in 

a series of annual Alternatives Conferences took place in 1985. 

This national conference, organized by and for mental health 

consumers and survivors (and more recently funded by SAMHSA 

and other partner organizations), provides consumers from 

across the country with opportunities to network and exchange 

information (SAMHSA, n.d.; Van Tosh & del Vecchio, 2001; 

National Empowerment Center, n.d.a). 

Independent support groups for parents of adults with serious 

mental illnesses formed and eventually merged (National Alliance 

on Mental Illness/NAMI Southwest, n.d.; Frese & Davis, 1997). The 

Federation of Families for Children’s Mental Health organized in 

1989 to promote a family- and youth-driven approach to enable 

children and youth with emotional, behavioral, and mental health 

challenges and their families to obtain the services and supports 

they need to enable children to grow up healthy and able to 

maximize their potential (Federation of Families for Children’s 

Mental Health, n.d.). 

Since the creation of SAMHSA in 1992, CMHS has championed 

consumers’ strengthening voice in policy making and in the 

development, implementation, and evaluation of mental health 

services and supports, especially through its Offi ce of the 

Associate Director for Consumer Affairs. 

In 1999, two major events signaled a major new direction in 

the U.S. Government’s approach to people with mental health 

challenges. The Supreme Court’s Olmstead v. L.C. decision 

extended deinstitutionalization into “historically unprecedented 

mandates to integrate people with disabilities into communities 

of their choice” (Deegan, 2003). And Mental Health: A Report 

of the Surgeon General recognized the “emergence of powerful 

consumer and family movements” as a “defi ning trend in the 

mental health fi eld” over the previous quarter century (HHS, 1999, 

pp. xii-xiii). In recent decades, 

self-help and peer support groups emerged to 

empower people to be proactively engaged in their 

own mental health, and to advocate for change 

within the mental health system as a whole. . . . 

[Consumers have come to be] accepted as valued 

service providers and participants in mental health 

policy and treatment planning. (Clearinghouse, n.d.) 

Peer services include, among others, crisis prevention and 

respite care, drop-in centers that provide recreational and social 
12

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

activities plus links to services, safe and affordable housing, peer 

companions, and peer support and counseling.

Since 1999, when the Surgeon General pointed to the “changing 

role of consumers and families, with attention to informal support 

services (i.e., unpaid services)” [emphasis added] (HHS, 1999, 

p. xiii), consumers’ roles have changed dramatically. By 2001, 

Georgia had certifi ed the Nation’s fi rst class of current and 

former mental health consumers who were newly trained as 

peer specialists. These “paid employees of our public and private 

providers . . . neatly transition ownership of the program into 

the hands of the consumers seeking services in peer support 

programs” (Georgia Certifi ed Peer Specialist Project, 2008). 

Other States and the Department of Veterans Affairs have since 

incorporated peer specialists into their own mental health and 

primary care systems in a wide variety of support roles.

In setting out a blueprint for transformed mental health systems 

nationwide, the President’s New Freedom Commission on Mental 

Health (2003) highlighted the critical role of consumers (and 

families) in its second goal: “Mental health care is consumer and 

family driven” (p. 27). The Commission offered a snapshot of a 

consumer- and family-driven system of care: 

Consumers choose their own programs and the 

providers that will help them most. Their needs and 

preferences drive the policy and fi nancing decisions 

that affect them. Care is consumer-centered, with 

providers working in full partnership with the 

consumers they serve to develop individualized 

plans of care. Individualized plans of care help 

overcome the problems that result from fragmented 

or uncoordinated services and [mental health care] 

systems. (p. 28)

Since its founding in 2006, and guided by its vision of selfdirected recovery, the National Coalition of Mental Health 

Consumer/Survivor Organizations (2008) has added a unifi ed 

consumer/survivor voice to advocacy efforts to transform the 

nation’s mental health services. 

In recent years, with support from CMHS, consumers have 

directed or played other signifi cant roles in the following 

initiatives, among many others:
13

establishment of a Subcommittee on Consumer/Survivor Issues 

to serve as a fact-fi nding body for the CMHS National Advisory 

Council;

Consumer-Operated Services Program to evaluate the 

“effectiveness of consumer-run services in improving the 

outcomes of adults with serious mental illnesses when used 

as an adjunct to traditional mental health services” (Missouri 

Institute of Mental Health, n.d.);

technical assistance to improve the outcomes and operations of 

consumer-run and -operated services;

Statewide Consumer Network Grants to “enhance State capacity 

and infrastructure to be consumer-centered and targeted toward 

recovery and resiliency, and consumer-driven by promoting 

the use of consumers as agents of transformation” (SAMHSA, 

2006a), and Statewide Family Network Grants to “enhance State 

capacity and infrastructure to be more oriented to the needs of 

children and adolescents with serious emotional disturbances 

and their families” (SAMHSA, 2006b);

project to chronicle the history of consumer/survivors in U.S. 

mental health systems. Articles on South Dakota’s Hiawatha 

Asylum for Insane Indians (Yellow Bird, 2000) and the African 

American experience of oppression, survival, and recovery 

in mental health systems (Jackson, 2000) emerged from this 

initiative; 

support for the restoration of abandoned and neglected State 

hospital cemeteries, where markers identifi ed deceased patients 

by number rather than by name; and

multiple initiatives to eliminate prejudice and discrimination and 

to promote social inclusion. 

Although many are still active in the consumer movement, 

activists of the late 20th century have matured, and a new, 

independent generation of leaders and advocates has come 

forward. Youth and young adults with mental health challenges, 

along with a cadre of allies and supporters, currently are creating 

their own history and a distinctive movement for change. 

Built on the groundwork and leadership of CMHS, the 

Federation of Families, and other organizations and individuals 

since the 1980s, young people have increased their participation 

in and infl uence on local and State mental health systems. The 

youth viewpoint took center stage in 2000, during the pioneering 

Surgeon General’s Conference on Child Mental Health, where 
14

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

young people had joined with families and professionals to 

discuss children’s mental health needs in the United States. 

However, because they felt “unwelcome and tokenized,” at the 

conference, youth participants did not return on the second day 

until they had prepared a list of specifi c requests, asking to be 

treated with respect and dignity. At that moment the conference 

became more youth friendly (Matarese, McGinnis, & Mora, 2005). 

The Surgeon General’s report of that conference acknowledged 

young people’s importance as it expressed gratitude to “especially 

the youth whose input reminded us of the critical need to listen to 

their perspectives” (U.S. Public Health Service, 2000).

Following that watershed event, the youth movement in mental 

health has gained momentum. With the emergence of a variety of 

independent youth advocacy organizations (several are listed in 

the appendix, along with other selected resources), young people 

are working to amplify their voices and to infl uence mental health 

policy more actively. To unite young people’s perspectives and 

causes, a national organization was formed, Youth Motivating 

Others through Voices of Experience (Youth MOVE), now a 

subsidiary of the Federation of Families for Children’s Mental 

Health. As a diverse collective, Youth MOVE’s members “advocate 

for youth rights and voice in mental health and other systems 

that serve them, in the process of empowering youth to be equal 

partners in the process of change” (Youth Move, 2008). They act 

as consultants to youth, professionals, families, and other adults; 

develop training tools, guides, and other documents; and provide 

a voice in the development of mental health policies and services 

(Matarese et al., 2005). 

The focus of our movement isn’t just mental health services. Young 

people are in juvenile justice facilities, and conditions there are 

despicable. Imagine being a young person with a mental health 

issue in the juvenile justice system or a young person with a mental 

health issue in the child welfare system. We try to unite those voices. 

—Young adult participant

A history of the fl edgling youth movement remains to be 

chronicled.
15

Issues and Concerns: 

Shared and Unique

Pearls of wisdom: It’s the irritation of the sand that creates the 

pearl. Don’t think that agitation, irritation, and all those things 

that make us uncomfortable are not necessary. Sometimes, they’re 

very necessary to get things done.

 —Adult participant

In an animated discussion of factors that have hindered or 

promoted wellness and recovery from their mental health 

challenges, dialogue participants identifi ed a number of important 

themes. As might be expected, on some issues they expressed 

views unique to their generation(s); on others they differed 

regardless of generation; and on some issues participants shared 

views across the board. After having established strong group 

rapport, and in reviewing their conversations at the close of 

the dialogue, participants expressed surprise that their views so 

closely resembled each others’ across generations. 

This section presents an overview of the general themes that 

emerged in the dialogue; participants’ comments illustrate the 

range of perspectives on each theme. Topics include the power 

of language and labels; “wellness” and public health; recovery 

and resilience; education and work; recording and archiving the 

history of the consumer movement; treatment choice; treatment 

issues; cultural competence; voices and choices; trauma and 

trauma-informed care; peer support specialists and youth 

coordinators; co-optation of the peer support role; lesbian, gay, 

bisexual, and transgender issues; suicide and suicide prevention; 

and poverty. Organization of the themes does not necessarily 

refl ect priorities attributed by individual participants.

Language and Labels

From the outset of the dialogue, the use of specifi c terms arose 

as points of intergenerational divergence. Participants recognized 

that terminology sometimes can lead to misunderstandings and 

sometimes to negative feelings, even when they may be used in a 

neutral or positive sense. Mental Health: A Report of the Surgeon 

General set the context for this tension nearly a decade before the 

dialogue took place: 
16

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

The lexicon is complicated by objections to the 

term “consumer.” To some, being a consumer 

erroneously signifi es that [mental health] service 

users have the power to choose services most 

suitable to their needs. Those who object contend 

that consumers have neither choices, leverage, nor 

power to select services. Instead, some consumers 

refer to themselves as “survivors” or “ex-patients” 

to denote that they have survived what they 

experienced as oppression by the mental 

health system (Chamberlin & Rogers, 1990). 

This distinction can best be understood in its 

historical context. (HHS, 1999)

Many younger dialogue participants expressed discomfort with 

the term “consumer” because of personal experience, political 

implications they attribute to the term, or for other reasons. By 

contrast, several more senior members at the table explained 

the usefulness and history of the term from their experience and 

perspective. 

“. . . consumer?” I thought. “That’s language that’s going to make 

me feel empowered?!” Then I realized that there was a history, and 

that this was a victory, trying to reframe the way people feel about 

mental illness.

—Young adult participant 

. . . To us it was a very empowering word. We were “the customer.” 

It meant quality. “Is what I’m selling you good? How can I 

improve it?” 

—Adult participant 

. . . We like the term “client.” I can be a client. The client hires the 

therapist. That means you work for me, and I should be able to 

have some say in my treatment.

—Young adult participant

Discussion of “consumer” continued throughout the dialogue. 

Nevertheless, across the generations, participants expressed their 

belief that “no perfect language” exists. Several other terms about 

which participants expressed strong feelings are discussed in the 

sections below.
17

“Wellness” and Public Health

Dialogue participants observed that use of the term “mental 

wellness” avoids the prejudice and bias often associated 

with other terms related to mental health issues. Across the 

generations, they uniformly and emphatically discouraged use 

of the term “mental illness.” They shared the general view that 

mental wellness is a public health issue that must be addressed as 

such by mental health systems, schools of public health and social 

work, and institutions of higher education in other disciplines 

that educate the next generation of service providers. A focus on 

mental wellness, they pointed out, encourages a holistic approach 

and better facilitates the integration of alternative treatment and 

support options into the portfolio of traditional mental health 

services and approaches. 

. . . One thing I’d like to see is no use of the term “mentally ill.” 

That’s my “n-word.” Don’t call me mentally ill! 

—Adult participant

. . . The label of mental illness is damaging. When I got that label, 

I was told I could never amount to anything, could never work, 

could never go to school, never have children. It took me a while to 

get through that. I want to be a person. I don’t want to be 

the illness.

—Adult participant

. . . I like to use the term “mental health diagnosis,” because not 

everyone believes that they have a mental illness. There’s no perfect 

language, but we’re trying to be inclusive.

—Adult participant

. . . Look at the growth of the international literature on mental 

wellness. It says that we all have mental health, we all have minds. 

—Young adult participant

The National Association of State Mental Health Program 

Directors’ report Morbidity and Mortality in People with Serious 

Mental Illness, which revealed that people with serious mental 

illnesses die an average of 25 years earlier than the general 

population, adopts the American Heritage Dictionary defi nition 

of wellness as the “condition of good physical and mental 

health, especially when maintained by proper diet, exercise, 

and habits.” In describing the population designated by the 

Federal Government as adults with serious mental illness, the 

report asserts that “wellness is one of the ultimate goals of, and 

an integral part of, recovery, and that recovery principles and 
18

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

approaches are necessary to achieve wellness” (Parks, Svendsen, 

Singer, & Foti, 2006, p. 30). Participants discussed the trauma of 

consumers’ lives lost so early to ill health.

. . . The side effects of many of the medications that we take, in 

addition to smoking and the lack of access to general health care, 

have had a dramatic impact on our life expectancy. 

—Adult participant

. . . I think about the loss of the contributions that we could have 

made to our communities—and how the trauma felt by the next 

generation continues in our society.

—Adult participant

Recovery and Resilience

The term “recovery” had gained currency in mental health circles 

by the mid-1990s. About a decade later, not long after issuance of 

the 2003 New Freedom Commission’s report, SAMHSA convened 

more than 100 diverse stakeholders to develop a consensus 

statement on mental health recovery. Its participants determined 

that: “Mental health recovery is a journey of healing and 

transformation enabling a person with a mental health problem to 

live a meaningful life in a community of his or her choice while 

striving to achieve his or her full potential” (SAMHSA, 2004). 

The consensus group agreed that the fundamental components 

of recovery include self-direction, individualized and person 

centered, empowerment, holistic, nonlinear, strengths based, peer 

support, respect, responsibility, and hope. 

But some advocates assert that recovery does not address 

certain issues that apply especially to children and that “mental 

health services and supports . . . need to focus on using and 

developing the strengths of the young person and the family so 

as to build a full life.” After all, young children with mental health 

challenges could not be expected to “recover” a life they had 

never experienced. They were children and they had to move 

ahead developmentally. These advocates looked to the concept 

of resilience to close the linguistic and practical gap. “Resilience 

brings attention to the strengths of the child as protective factors 

and as assets for the process of positive development. A focus on 

resilience also draws attention to the family as the most important 

asset a child can have” (Walker, 2005, p. 25). Dialogue participants 

weighed in on the issue.
19

. . . I don’t like “recovery.” You have to have recovered from 

something. I like to look at it as “resiliency.” Things happen in life. 

Can you bounce back?

—Young adult participant 

. . . Resiliency and recovery are the same thing.

—Adult participant

Productivity: Education and Work

Participants universally identifi ed the critical need for access to, 

and accommodations for, education, employment, and meaningful 

activity. Some had been encouraged in their early years to pursue 

an education, but many participants recounted painful personal 

stories of having been taunted and/or their educational needs 

neglected as school-age children. 

. . . Many people with mental illnesses don’t have access to 

education, don’t realize that they have access through disability 

services, and don’t have to drop out of college and live in poverty.

—Young adult participant 

. . . The sixth grade was the last grade that I completed, so they 

call me a drop-out. But I self-identify as: I pushed out of school. . . . 

I have no education, but I can learn stuff to survive in this world.

—Adult participant

. . . I had to go through a lot of hurtful things in the mental health 

system and the educational system.

—Young adult participant 

Adult and young adult participants both asserted the importance 

of securing steady employment that accommodates their need 

for fl exibility in diffi cult times and for maintaining their wellness. 

Training and supports that permit self-employment typically are 

unavailable to mental health consumers. (See also the section 

on poverty.)

. . . Employment—many people might not fi t in the 9-to-5 mold. 

—Young adult participant 

. . . [Consumers] get into jobs where they basically have to fi t in, 

where there’s no reasonable accommodation to go to doctors’ 

appointments and so forth.

—Adult participant
20

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Recording and Archiving the History of the 

Consumer Movement

Dialogue participants observed that, like the civil rights 

movement, various aspects of the consumer movement have 

developed over time. They articulated unanimously the need to 

share and record the consumer movements’ histories, experiences, 

and wisdom in order to educate future consumers and advocates, 

strengthen the movement, and promote understanding. They 

especially endorsed efforts to fi nd a suitable institution to archive 

the documents and artifacts of the mental health consumer 

movement(s).

. . . An archives and our history are important, because there is 

common ground. The young people’s stories were not unfamiliar 

today. They were my story, and then I got older.

—Adult participant

. . . There are two different movements, and I think it’s important 

to bring their issues to the table. 

—Young adult participant 

. . . “Where is the university with an archive for our movement?” 

[a pioneer advocate asked]. “Where do my ten fi le cabinets of 

movement history go when I die?”

—Adult participant

. . . That’s an intergenerational concern. When people are coming 

up, they’ll get to see history [and learn about the] different people 

who were doing things in our movement.

—Adult participant

Treatment Choice: Traditional and Alternative

The consumer movement has promoted the choice of a 

therapeutic approach as an important value, as embodied 

in the recovery principle of self-direction. Traditional mental 

health services have included talking therapy and medications. 

In addition to, or instead of, these traditional strategies, many 

consumers have embraced one or more alternative approaches. 

SAMHSA advises that an “alternative approach to mental health 

care . . . emphasizes the interrelationship [among] mind, body, 

and spirit” (SAMHSA, April 2004). In parallel with traditional 

approaches, some alternative approaches have enjoyed a long 

history while others remain controversial. The National Center 

for Complementary and Alternative Medicine at the National 
21

Institutes of Health helps to evaluate alternative methods of 

treatment and to foster integration of effective practices into 

mainstream health care practice. Examples of alternative treatment 

approaches include self-help and peer support, diet and nutrition, 

exercise, prayer and meditation, animal-assisted therapies, 

expressive therapies (such as art, dance/movement, and music 

therapies), culture-based healing arts, relaxation and stressreduction techniques, and such technology-based applications as 

telemedicine, telephone counseling, electronic communications, 

and radio psychiatry.

Dialogue participants expressed a range of similar views 

supporting treatment choice, including one young person 

who had anticipated a sharp divide “between radicals and 

mainstream”—that disagreements would crop up between those 

who supported the use of traditional treatments, including 

medications, and those who supported the use solely of 

alternatives. One young adult explained that receiving a diagnosis 

and effective medications set the foundation for her recovery. 

Although many participants strongly advocated for the use of 

alternative and nontraditional treatments—and for affordable 

access to them—one young adult expressed excitement “that I’ve 

learned today that we’re all on the same team.” Participants agreed 

that choice was paramount, including the choice to take, or not 

take, medications. 

. . . We don’t have a manual on how to live. What works for me 

is naming it, claiming it, and taming it. I take the meds and fi nd 

they help me to balance.

—Adult participant

. . . I think it’s so sad that we have millions of people who die by 

suicide or who are toxic because our system does not give access to 

choices in treatment.

—Young adult participant

. . . Medicines change the brain, but so do the ancient Asian 

ways, such as meditation and qigong. 

—Adult participant

Treatment Issues

Participants discussed several issues at the center of ongoing 

controversy. Some expressed impassioned concern about 

the practice of prescribing psychiatric drugs for very young 

children. Some participants emphasized the need to promote 

public awareness of alternatives to psychiatric drugs and of the 
22

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

possibility to make informed—pro-drug or anti-drug—choices as 

they direct their own or their children’s treatment. (See the Report 

of the Surgeon General’s Conference on Children’s Mental Health

[U.S. Public Health Service, 2000] for background on these issues.)

. . . I was a canary in the coal mine. What happened with me 

[as a youth in a psychiatric hospital where drugs were forcibly 

administered] now affects millions. When I started this work 

[decades] ago, this was about the back wards. Now it’s about your 

next door neighbor and the school down the street. 

—Adult participant

. . . When you’re forcibly given a chemical that shrinks the 

brain, it’s an emergency. There’s an emergency of human rights 

violations against youth in the mental health system. 

—Adult participant

. . . We’re pro-choice to choose psychiatric drugs or not.

—Young adult participant

In the AIDS world, we bless the pharmaceuticals. Give us more 

drugs, keep us alive. In the mental health world, it’s the complete 

opposite. How do we balance that attitude?

—Adult participant

Through the years, recipients of electroconvulsive therapy 

(ECT) often have complained of persistent amnesia and defi cits 

in cognitive abilities as a result of the procedure, and advocates 

(including several dialogue participants) have protested its use. 

The foremost ECT researcher during the past quarter-decade has 

reversed his position on the safety of the procedure in publishing 

fi ndings that these adverse effects in fact persist for an extended 

period (Sackheim, 2007). 

The use of seclusion and restraint, in institutional and 

community-based settings, on persons with mental health and/

or addictive disorders has resulted in deaths and serious physical 

injury and psychological trauma—at the rate of about 150 

mortalities annually (SAMHSA, 2003).  

Some participants described their personal and advocacy 

experiences with involuntary treatment, including ECT and 

seclusion and restraint. 

. . . I’m a trauma survivor. I took all kinds of medications and 

ECT. Now I’m going back to my roots of believing in mind-bodyspirit. Spirit is the lead in healing ourselves.

—Adult participant
23

. . . People who are diagnosed in youth are told that they don’t 

have insight into their condition. That’s how they validate 

forced treatment.

—Young adult participant

. . . Anytime you say “restraints” in our fi eld, you should 

say “physical and chemical restraints.” [Folks may be] on the 

bandwagon to oppose physical restraint, but the amount of forced 

chemicals goes up. 

—Adult participant

. . . It’s important that we promote safe, humane treatment choices.

—Young adult participant

Cultural Competence

Dialogue participants universally expressed the need for cultural 

competence. Practitioners must be trained to understand and 

address the unique needs of individuals from divergent ethnic 

and cultural backgrounds. Participants particularly observed that 

mental health service providers must understand the different 

lenses through which nonmajority consumers view the mental 

health system.

Mental illness means different things in different cultures, and 

culture applies to more than race. In fact, observed one participant, 

special cultural competence is warranted to support and respond 

to individuals whom the psychiatric system has traumatized and to 

those who do not speak English. In addition, participants noted the 

need to avoid “tokenism” in bringing members of ethnic and racial 

minority groups to decision-making tables. 

. . . We have a right to culturally competent services—a wide 

array of services, including spiritual components.

—Young adult participant

. . . A culturally competent workforce is an issue. How are we 

engaging and recruiting individuals into the workforce to help 

our communities?

—Adult participant 

. . . We had [Asian American/Pacifi c Islander] people in mental 

health systems from across the United States [at a conference]. We 

had Mandarin and Cantonese and Korean and Filipino—we had 

19 different ethnicities with their translators. Some of our cultures’ 

languages did not even have a word for “mental illness.”

—Adult participant 
24

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Voices and Choices

Participants across generations echoed the theme “voices and 

choices” throughout the dialogue, underscoring their recognition 

that advocacy must continue to promote alternatives to the status 

quo. Several participants, both younger and older adults, cited 

what has now become a mantra for the consumer movement: 

“Nothing about us without us.” 

. . . We need to all be equal members at the table, even if we are 

under 18.

—Young adult participant

. . . We have to have a voice at all levels of decision making—not 

only heard but understood.

—Adult participant

. . . Some might advocate for adults’ voices for choices, but with 

youth, it’s “oh, they’re children, and they need someone to take 

care of them.” 

—Young adult participant

. . . The underlying issue is that you don’t have the same rights as 

the rest of society once you have that diagnosis.

—Young adult participant

Trauma and Trauma-Informed Care

A number of participants disclosed that though traumatic events 

had led to their own involvement in the mental health system, 

treatment typically had not addressed—or even acknowledged—

their trauma issues. Their comments called attention to the need 

for providers who understand the role that trauma may play 

in triggering and sustaining mental health problems. They also 

highlighted the need to use treatment techniques that address the 

roots of the problem and avoid retraumatization. 

. . . I’m an immigrant. No one really considered the impact of 

trauma. They fi gured, “She’s white, and she speaks English, and 

she’ll be fi ne.” I wasn’t. 

—Young adult participant

. . . None of my trauma was ever dealt with, just meds and talk 

therapy that didn’t deal with the trauma. And I was made to feel 

like it was my fault. 

—Young adult participant
25

. . . I was marched into the psychiatrist’s offi ce, who was chain 

smoking and showing me inkblots and asking about my day at 

school. But it was unrecognized trauma.

—Young adult participant

. . . When we think of trauma, we never think about men 

suffering trauma.

—Adult participant

Peer Support Specialists and 

Youth Coordinators

The value of peer support transcended generations among the 

dialogue participants. Most told stories of the vital role that peers 

have played in their recovery from mental health challenges. 

. . . Through the peer support group, I was able to feel like I wasn’t 

alone anymore.

—Young adult participant

. . . Hearing others’ recovery stories is what saved my life—

and also telling my stories.

—Adult participant

. . . Peers need to feel empowered that they can give back 

something on the lived experience, and I think that’s what youth 

wants to do. It’s something we need to work on together.

—Adult participant

Recognizing the power of peer support in creating the hope and 

reality of recovery, consumer activists have launched advocacy 

efforts to incorporate mental health consumers into mainstream 

care systems. Over the past two decades, increasing numbers 

of States have hired and/or certifi ed peer support specialists. 

The goal is to leverage their personal experience with mental 

health systems to facilitate consumers’ recovery. In addition, 

within the last decade, the Federal Child Mental Health Initiative 

has supported development of a cadre of youth peer support 

facilitators, called youth coordinators. Under a variety of models, 

persons with both job descriptions draw on their lived experience 

to promote wellness and recovery among others who contend 

with mental health struggles. 

Peer support specialists work around the Nation, in both the 

public and private sectors, in a variety of roles and settings, 

including inpatient, outpatient, and hospital emergency rooms. 
26

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Some adult dialogue participants helped to develop and 

implement early peer support specialist models. 

The development of a peer support model among young people 

has evolved along an independent path from the adult consumer 

movement. Since 2002 the Child Mental Health Initiative has 

required State grant recipients to hire local youth coordinators. 

At every level within communities’ systems of care, these youth 

coordinators foster “youth development and involvement within 

their own group as well as throughout the community.” Based on 

the understanding that the “power of youth participation helps to 

rebuild the community, fosters resiliency, and combats [negative 

attitudes] around mental illness, youth coordinators serve as 

coaches for youth with mental health issues.” They help establish 

youth-run groups to create social change, to “raise awareness [in 

the community] of the importance of valuing youth voice and 

incorporating the youth voice into policy development and service 

delivery” (Matarese et al., 2005, viii, pp. 5, 15, 25).

Co-Optation of the Peer Support Role

The issue of co-optation of both peer support specialists and 

youth coordinators elicited strong reactions among all generations 

taking part in the dialogue. Some experts describe co-optation 

as a situation in which “consumers begin to identify less with the 

consumers they represent and more with [the organization that 

engages them to] serve” (National Mental Health Consumers’ SelfHelp Clearinghouse, 2006). 

Some young adult participants described the tug of coming 

to terms with their own presence at the government-funded 

dialogue. Some participants described problems with the way 

systems use the services of peer specialists. Some questioned 

whether earning a livelihood in a peer support role is consonant 

with consumers’ interests—or whether the employment 

arrangement inherently represents co-optation. Some pondered 

whether co-optation hampers their ability to advocate for change, 

and other participants, mostly veteran activists, asserted the 

usefulness of their offi cial peer support role and resources to 

advance both their clients’ recovery and the consumer movement.

. . . Peer support is a natural function of the human condition. 

That is how we have been helping each other for generations, 

without anyone getting paid for it.

—Young adult participant
27

. . . When peers get these jobs, they’re trying to be role models, to 

talk about their lived experience, to share that with the peers they’re 

working with. Sometimes that’s missing, because the provider 

agency has its own agenda. The agency wants to make peers into 

mini-case managers, doing casework and not the kinds of peer 

support that they’re supposed to be doing.

—Adult participant

. . . I don’t consider ourselves co-opted because we’re not pushing 

their agenda in the traditional sense of pushing the government 

agenda with government money. They knowingly give us money to 

do this work that has to be done, and I think that’s the attitude that 

we must have on this. We cannot be scared to act. 

—Young adult participant

. . . I hesitate for us to think that there’s any one way of our doing 

things, that anything else means co-optation. Many of us need to 

work in many ways.

—Adult participant

The conversation appeared to raise consciousness about the 

potential for other types of co-optation.

. . . The youth movement . . . is where it’s at, and we need to get 

on their team. We don’t need to bring them into the room. People 

ask how we can get children and youth more involved, but that’s 

co-opting them. I think they should come in and talk to us about 

how we can get more involved. We should be the people they are 

using to further their agenda. 

—Adult participant

Lesbian, Gay, Bisexual, and Transgender Issues

Until 1973, homosexuality was considered a mental illness. 

Only after a successful advocacy campaign by gay and lesbian 

psychiatrists and leaders did the medical designation change.

Dialogue participants described several concerns about the 

lesbian, gay, bisexual, and transgender (LGBT) population in 

their discussions of both cultural competence and suicide (see 

also those sections). Some participants highlighted the effects of 

prejudice and discrimination. Others pointed to the diffi culty of 

LGBT persons, especially those who also cope with mental health 

challenges, in accepting and adjusting to the awareness of their 

sexual and gender identities. Other participants highlighted the 

outreach model the LGBT movement has adopted. 
28

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

. . . Homosexuality is not a mental illness. When it was taken out 

of the [Diagnostic and Statistical Manual of Mental Disorders], we 

called that our “day of instant cure.”

—Adult participant

. . . I’ve come up with an acronym that works in my life, with all 

the “isms” that I’m working with and trying to dispel the myths. I 

consider myself a “MESSS.” My MESSS has three S’s: I have Medical, 

Emotional, Social, Spiritual, and Sexual needs. But I’m HIVpositive, so my last S is silent!

—Adult participant

. . . The LGBT movement folks have it down. I think we have a 

lot to learn about their organizing tactics, because they’re the 

ones who are doing the most inspiring, powerful work on college 

campuses. They’re basically fi nding kids who show up at college, 

always the ones who feel like outcasts and don’t fi t in, saying, “Hey, 

look! You should be proud of who you are.”

—Young adult participant

Suicide and Suicide Prevention

Dialogue participants included survivors of suicide attempts, 

survivors of the suicide deaths of people to whom they were 

close, and active advocates for suicide prevention efforts. Some 

participants represented more than one category, and suicide 

prevention emerged as a universal concern. Studies have shown 

that suicide and injury account for more than 30 percent of early 

deaths that affect persons in the U.S. public mental health system 

(Parks et al., 2006, p. 11).

. . . I learned from others that thoughts and feelings are just 

thoughts and feelings, and you don’t have to commit suicide.

—Young adult participant

. . . We’re [LGBT] an invisible culture with suicide rates up to six times 

higher, as kids explore their sexual and gender identities. It amazes 

me that LGBT is not considered in developing data on suicide rates. 

—Adult participant

. . . Suicide prevention should include access to peer support.

—Adult participant

. . . My medications and my therapy have helped save my life, 

keep me from being suicidal. Now I’m living as a functioning 

member of society. I’m a wife and have a job that I love.

—Young adult participant
29

Poverty

Recent studies show that poverty, unemployment, inability 

to afford housing, and lack of health insurance represent risk 

factors for developing a mental illness, including depression 

(Hudson, 2005; Mauksch et al., 2001). In addition, mental illnesses 

link indirectly with the stressful, adverse economic conditions 

experienced among lower income groups (Hudson, 2005). 

Participants expressed their opinions about the intersection of 

poverty and mental health challenges.

. . . Our government and our society don’t want to take 

responsibility for the cause of mental health problems. It’s easier to 

blame individuals: “You’re the one who’s sick. Let’s try to fi x you.” 

Instead, we should look at it the other way around: “This person is 

responding to a horrible environmental situation.”

—Young adult participant

. . . I’m a person in recovery from a lot of things that happened in 

my life, alcoholism, depression, and poverty—

mostly poverty in my family.

—Adult participant 

. . . Part of being human is having access to wellness, including 

medical insurance and the other benefi ts that come with 

employment. The other is economic empowerment—otherwise we 

live in poverty.

—Adult participant 
30

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Recommendations

If we took different paths at times, experienced frustration, 

maybe different ways of communicating, maybe some struggles, a 

bit of tension once in a while during this dialogue, is that a part 

of our intergenerational coming together? Clearly, we probably do 

some things differently. Some of that may be personal, but maybe 

that’s what we need to consider as we move forward, working 

together in partnership. 

—Adult participant 

Dialogue participants developed a short, focused set of 

recommended actions to promote increased collaboration among 

consumers of all ages. They envisioned activities to be undertaken 

by consumers, by the multiple movements that advocate on 

mental health issues, and by SAMHSA. 

For Consumers 

 1. Advocate through the media to reduce (and eliminate) 

prejudice and discrimination—specifi cally in such quality-oflife arenas as employment and housing—at the national, State, 

and local levels.

2. Serve as public health advisors and health educators to foster 

understanding of the importance of overall wellness, which 

includes both mental and physical health. 

3. Use the arts as an engagement and empowerment strategy 

to raise awareness and advocate for consumer services and 

supports. 

For the Youth and Adult Consumer Movements 

1. Work together, while maintaining the values of each 

movement. Learn from each others’ experiences, and 

collaborate on common issues and goals. 

 2. Create a history of the adult and young adult movements that 

chronicles multiple aspects of the saga, including attention to 

injustices, civil disobedience, and the unique experiences of 

people of color.

 3. Organize to create a permanent archive for documentation and 

artifacts of mental health consumer movements.

 4. Work together to foster access to alternative, as well as 

traditional, services and supports.
31

 5. Ensure the availability of educational and employment 

supports for youth and adults.

 6. Develop leadership within the movement(s) to facilitate 

promotion of mental health recovery.

7. Offer cross-movement mentoring services to promote greater 

knowledge and understanding of the issues, as well as skills 

for advocacy.

For the Substance Abuse and Mental Health 

Services Administration

8. Reframe the issue of “mental illness” as “mental wellness,” part 

of overall wellness and a public health approach.

 9. Continue to promote the understanding that mental health 

affects everyone and is essential to overall health.

10. Learn from consumers at SAMHSA-sponsored events about 

their activities that foster—or would lend themselves to—

intergenerational collaboration.

11. Promote intergenerational dialogues at the local level. Supports 

would include, for example, funding, training, and technical 

assistance for facilitators.

12. Provide fi nancial support for youth to attend conferences, such 

as the Alternatives Conference, to learn about the consumer 

movement and mental health services delivery issues, and to 

share their perspectives and experiences. In addition, offer 

opportunities for virtual training and distance learning. 

13. Provide support to compile and publicize the history of 

the mental health consumer movements, covering, among 

other topics, human injustices, civil disobedience, and crossgenerational issues. 

14. Assist with the identifi cation and engagement of an 

appropriate institution to serve as steward of the documents 

and other artifacts of mental health consumer movements, in 

order to preserve the history and to promote scholarship and 

public awareness.
32

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Conclusions

At the close of the intergenerational consumer dialogue, 

participants were invited to identify which generations had made 

the following statements. 

“We need to work in partnership.”

“Some of us believe we don’t have a voice.”

“We want to live, learn, and work.”

“We are not always listened to.”

“We must consider our strengths.”

“We need to become empowered.”

“Let’s recognize the value of our lived experience.”

“We need to know more about your movement.”

“We need to express all our voices.”

“We need alternatives to make our choices.”

In fact, these statements were made by individuals across the 

generations, highlighting the reality that participants’ viewpoints 

converged more than they differed. 

Dialogue participants spent a long day sharing personal 

stories and discussing the array of issues that consumers face in 

recovering from their mental health challenges. As they learned 

about each other and broadened their views of the multi-pronged 

consumer movement, they also developed heightened levels of 

trust within and across the generations. 

On the fi nal day of the dialogue, the participants distilled their 

ideas and observations down to selected areas of shared concern. 

As prescribed in the overarching goals of the dialogue, they 

then compiled a list of recommendations for actions to increase 

collaboration among consumers of all ages to promote mental 

health recovery.
33

But this group did not stop there. As the dialogue came to a 

close, participants concretely demonstrated their commitment to 

further the cause of mental wellness and to promote consumer 

leadership and recovery. Virtually every consumer, leader, and 

supporter articulated a specifi c plan, some in concert with others 

at the table, to collaborate on cross-generational advocacy efforts. 

Some commitments that were made are the following:

Find out whether their States have a youth movement and to 

“network to fi nd the commonality”;

Develop training for people to facilitate their own mindfulness 

groups that translate to youth or any age and teach techniques 

of breath awareness, body awareness, and being grounded in 

the present;

Use the dialogue experience with “my peers and people in the 

mental health fi eld. Our strength is not in this room, but out 

there, walking on the streets, with the general public”;

Try locally to connect both movements and form a local 

action plan;

Listen to and promote “youth voices for choices through 

surveys, forums, and dialogues”;

Address the “emergency of overuse of psychiatric drugging, 

while affi rming those who choose to use a medical approach”;

Write a paper about “youth in the mental health system, then 

and now; he’s going to do the now, I’m going to do the then”;

Build a Web site for “people of color, including youth as part of 

our voices”; and

Initiate local dialogues, “including a dialogue with the foster 

care alumni movement. We share a common experience and 

have some common goals.”

The biggest thing we need to change is attitudes.

—Young adult participant
34

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Appendix

Selected Resources*

Center for Mental Health Services

Substance Abuse and Mental Health Services Administration

U.S. Department of Health and Human Services

The Center for Mental Health Services (CMHS) leads the national 

system that delivers mental health services in order to provide 

the treatment and support services needed by adults with mental 

disorders and children with serious emotional problems. CMHS 

supports the meaningful participation of mental health consumer/

survivors in all aspects of the mental health system, including 

the planning, design, implementation, policy formulation, and 

evaluation of mental health services. To accomplish this goal, 

CMHS sponsors a variety of consumer affairs activities, such as 

scholarships to attend national conferences, meetings to address 

the needs of consumer/survivors, regional consumer meetings, 

programs to promote social inclusion and acceptance of persons 

with mental illnesses and other issues related to mental illness, 

the development and dissemination of educational materials, and 

much more.

Web sites: www.samhsa.gov and www.mentalhealth.samhsa.gov

Address: 1 Choke Cherry Road, Rockville, MD 20857

Telephone: 1-877-SAMHSA-7 (toll free) or 1-877-726-4727 (toll free)

E-news Alert: www.mentalhealth.samhsa.gov/consumersurvivor

Funding opportunities: www.grants.gov

Active Minds, Inc. 

Active Minds is a national organization that develops and 

supports student-run mental health awareness, education, and 

advocacy organizations on college campuses. Each peer group 

works to increase students’ awareness of mental health issues, 

* This report provides contact addresses and Web sites for information 

created and maintained by other public and private organizations. 

This information is provided for the reader’s convenience. SAMHSA 

does not control or guarantee the accuracy, relevance, timeliness, or 

completeness of this outside information. Furthermore, the inclusion 

of information or addresses or Web sites for particular items does not 

refl ect their importance and is not intended to endorse any views 

expressed or products or services offered.
35

provides information and resources regarding mental health and 

mental illness, encourages students to seek help as soon as it is 

needed, and serves as a liaison between students and the mental 

health community. By planning campus-wide events that promote 

awareness and education, Active Minds aims to change the negative 

attitudes that surround mental illness and create a comfortable 

environment for open discussion of mental health issues. 

Web site: www.activeminds.org

Address: 1875 Connecticut Avenue, NW, Suite 418, 

Washington, DC 20009

Telephone: (202) 719-1177

E-mail: info@activeminds.org

Federation of Families for Children’s Mental Health

This national family-run organization is dedicated exclusively 

to helping children with mental health needs and their families 

achieve a better quality of life. The Federation of Families for 

Children’s Mental Health provides leadership to develop and 

sustain a nationwide network of family-run organizations, focuses 

the passion and cultural diversity of its membership to be a 

potent force for changing how systems respond to children with 

mental health needs and their families, and helps policy makers, 

agencies, and providers become more effective in delivering 

services and supports that foster healthy emotional development 

for all children. 

Web site: www.ffcmh.org

Address: 9605 Medical Center Drive, Suite 280, Rockville, MD 20850

Telephone: (240) 403-1901

E-mail: ffcmh@ffcmh.org

Icarus Project

The Icarus Project envisions a new culture and language 

that resonates with our actual experiences of extreme states 

of consciousness rather than trying to fi t our lives into a 

conventional framework. We are a network of people living 

with the dangerous gifts that are commonly labeled as bipolar 

or related “mental illness.” The Icarus Project is a collaborative, 

participatory adventure fueled by inspiration and mutual aid. 

We bring the Icarus vision to reality through a national staff 

collective and a grassroots network of autonomous local support 

groups across the United States and beyond. The Icarus staff 

serves and nourishes local groups by facilitating a Web site 
36

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

community, distributing publications, educating the public, 

offering tools, sharing skills, creating art, engaging in advocacy, 

enhancing community capacities, offering technical assistance, 

providing inspiration and solidarity, and taking care of national 

housekeeping tasks. The grassroots network of local groups 

gathers people locally for listening, education, support, mutual 

aid, art, activism, access to alternatives, and any creative ventures 

they can dream up.

Web site: www.theicarusproject.net

Address: The Icarus Project, c/o Fountain House, 

425 West 47th Street, New York, NY 10036

Telephone: 1-877-787-5883 (toll free)

E-mail: info@theicarusproject.net

Jed Foundation

The Jed Foundation is a nonprofi t, public charitable organization 

committed to reducing the suicide rate among college and 

university students nationwide. Its programs target the full range 

of audiences that can infl uence college mental health, including 

students, educational institutions, politicians, mental health 

professionals, and parents. The Jed Foundation’s work fosters 

greater public awareness of the extent of college-age suicides; 

collaborates with colleges and universities to strengthen mental 

health services on campus; creates linkages between the academic 

research community that works on suicide prevention and the 

higher-education professionals who work directly with students; 

and produces innovative, Internet-based intervention systems for 

college students. 

Web site: www.jedfoundation.org

Address: 583 Broadway, Suite 8B, New York, NY 10012

Telephone: (212) 647-7544

E-mail: emailus@jedfoundation.org 

Mental Health America

Mental Health America (formerly known as the National Mental 

Health Association) is a national nonprofi t organization dedicated 

to helping all people live mentally healthier lives. With its more 

than 320 affi liates nationwide, Mental Health America represents 

a growing movement of Americans who promote mental 

wellness for the health and well-being of the Nation. Mental 

Health America educates the public about ways to preserve and 

strengthen its mental health; fi ghts for access to effective care and 
37

an end to discrimination against people with mental and addictive 

disorders; fosters innovation in research, practice, services, 

and policy; and provides support to the more than 60 million 

individuals and families living with mental health and substance 

use problems. 

Web site: www.mentalhealthamerica.net

Address: 2000 North Beauregard Street, 6th Floor, 

Alexandria, VA 22311

Telephone: 1-800-969-6642 (toll free); (703) 684-7722

E-mail: infoctr@nmha.org

National Alliance on Mental Illness (NAMI) 

NAMI is a national grassroots organization for people with 

mental illness and their families. Founded in 1979, NAMI has 

affi liates in every State and in more than 1,100 local communities 

across the country. NAMI is dedicated to the improvement of 

the quality of life for persons of all ages who are affected by 

mental illnesses. NAMI’s activities include public education and 

information, peer education and support, raising awareness and 

fi ghting prejudice, and State and Federal advocacy. (See also STAR 

Center below.)

Web site: www.nami.org

Address: 2107 Wilson Boulevard, Suite 300, 

Arlington, VA 22201-3042 

Telephone: (703) 524-7600; toll free information helpline, 

1-800-950-NAMI (6264)

National Coalition of Mental Health Consumer/

Survivor Organizations

The National Coalition of Mental Health Consumer/Survivor 

Organizations works to ensure that consumer/survivors have a 

major voice in the development and implementation of health 

care, mental health, and social policies at the State and national 

levels, empowering people to recover and lead a full life in the 

community.

Web site: www.ncmhcso.org

Address: 1300 L Street, Suite 1000, Washington, DC 20005

Telephone: 1-877-246-9058 (toll free)

E-mail: info@ncmhcso.org
38

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

National Consumer Supporter Technical Assistance Center 

(NCSTAC)

NCSTAC works to strengthen consumer organizations 

by providing technical assistance in the form of research, 

informational materials, and fi nancial aid. 

Web site: www.ncstac.org

Address: 2000 North Beauregard Street, 6th Floor, 

Alexandria, VA 22311

Telephone: 1-800-969-6642 (toll free)

E-mail: ConsumerTA@mentalhealthamerica.net

National Empowerment Center

The National Empowerment Center, a SAMHSA-funded national 

technical assistance center, carries a message of recovery, 

empowerment, hope, and healing to people who have been 

labeled with mental illness. Run by consumer/survivor/expatients, each staff member lives a personal journey of recovery 

and empowerment. The National Empowerment Center provides 

information and referrals; networking services; conference 

planning services; lectures, workshops, and consultation; 

publishing and media services; education and advocacy on policy 

issues; representation on national boards; research; development 

of educational resources; and development of self-help resources. 

Web site: www.power2u.org

Address: 599 Canal Street, Lawrence, MA 01840

Telephone: 1-800-power2u (1-800-769-3728) (toll free information 

and referral); (978) 685-1494

National Mental Health Consumers’ Self-Help Clearinghouse

The nation’s fi rst national consumer technical assistance 

center played a major role in the development of the mental 

health consumer movement. The Clearinghouse works to foster 

consumer empowerment through its Web site, up-to-date news 

and information announcements, a directory of consumer-driven 

services, electronic and printed publications, training packages, 

and individual and onsite consultation. The Clearinghouse helps 

consumers organize coalitions, establish self-help groups and 

other consumer-driven services, advocate for mental health 

reform, and fi ght the prejudice and discrimination associated 

with mental illnesses. The organization also strives to help 

the movement grow by supporting consumer involvement in 
39

planning and evaluating mental health services, and encouraging 

traditional providers and other societal groups to accept people 

with psychiatric disabilities as equals and full partners in treatment 

and in society. The Clearinghouse maintains an extensive 

library of information on topics important to consumer groups 

interested in self-help and advocacy, including peer counseling, 

deinstitutionalization, fund raising, involuntary treatment, patient 

rights, using the media, and many others. The Clearinghouse 

provides targeted technical assistance to individual consumers, 

self-help and advocacy organizations, and consumer coalitions. 

Web site: www.mhselfhelp.org

Address: 1211 Chestnut Street, Suite 1207, Philadelphia, PA 19107

Telephone: 1-800-553-4539 (toll free); (215) 751-1810

E-mail: info@mhselfhelp.org

Consumer-Driven Services Directory: www.cdsdirectory.org

Peers Helping Peers

The Depression and Bipolar Support Alliance (DBSA) Technical 

Assistance Center fosters strengthened consumer organizations 

and leadership in States (primarily Wisconsin and Arkansas), skills 

development for consumers, consumer participation in policy 

development, and recognition of recovery among mental health 

providers. The technical assistance center assists consumers 

with online/media-supported training, peer leadership coaching 

programs, peer specialist training, consumer organization 

assistance, and focus group development, knowledge exchange, 

and skill-building activities.

Web site: www.dbsalliance.org/site/PageServer?pagename=home

Address: 730 North Franklin Street, Suite 501, Chicago, IL 60610 

Telephone: 1-800-826-3632 (toll free); (312) 642-0049
40

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Recovery, Inc. 

In existence for more than a half century, the nonprofi t, 

nonsectarian, and member-operated Recovery, Inc. offers free 

training in a self-help method to regain and maintain mental health. 

The comprehensive system incorporates concepts embedded in 

the more recently developed techniques of cognitive therapy and 

behavior modifi cation. Participants attend local or phone meetings 

held weekly throughout the United States and abroad. 

Web site: www.recovery-inc.com

Address: 802 North Dearborn Street, Chicago, IL 60610

Telephone: 1-866-221-0302 (toll free); (312) 337-5661

E-mail: inquiries@recovery-inc.org 

STAR Center

The STAR Center provides Support, Technical Assistance, and 

Resources to assist consumer-operated and consumer-helper 

programs meet the needs of underserved populations. The STAR 

Center offers a broad array of technical assistance to consumeroperated and peer-run programs, leadership trainings, national 

teleconferences, consumer scholarships for attendance at the 

annual Alternatives Conference, national identifi cation of culturally 

competent consumer-operated programs as part of its ConsumerOperated Service Identifi er (COSI) project, and an online Cultural 

Resource Directory. 

Web site: www.consumerstar.org

Address: 2107 Wilson Boulevard, Suite 300, 

Arlington, VA 22201-3042 

Telephone: 1-866-537-STAR (7827) (toll free)

E-mail: star@nami.org

Technical Assistance Partnership for Child and Family 

Mental Health

The Technical Assistance Partnership for Child and Family 

Mental Health (TA Partnership) provides technical assistance to 

systems of care communities funded by SAMHSA’s Comprehensive 

Community Mental Health Services for Children and Their 

Families Program. The TA Partnership is a collaboration between 

the American Institutes for Research, which is committed to 

improvement in the lives of families and communities through 

the translation of research into best practice and policy, and 

the Federation of Families for Children’s Mental Health, an 
41

organization dedicated to effective family leadership and advocacy 

to improve the quality of life of children with mental health needs 

and their families. 

Web site: www.tapartnership.org 

Address: 1000 Thomas Jefferson Street, NW, Suite 400, 

Washington, DC 20007 

Telephone: (202) 403-6827 

E-mail: tapartnership@air.org

Youth MOVE

Youth MOVE, an organization to empower youth to be equal 

partners in the process of change, is made up of a diverse 

group of youth coordinators and young people from systems 

of care communities and Partnerships in Youth Transition sites. 

The organization unites the voices and causes of youth; offers 

consultation to youth, professionals, families, and other adults; 

and advocates for youth rights and voice in mental health and 

the other systems that service them. Youth MOVE assists in 

developing the Youth Leadership Program at meetings, creating 

youth movement principles and policies, and developing training 

tools, guides, and other documents. 

Web site: www.youthmovenational.org

Address: Youth M.O.V.E. National c/o National Federation of 

Families for Children’s Mental Health , 9605 Medical Center Drive, 

Suite 280, Rockville, MD 20850

Telephone: (240) 403-1901

E-mail: c.yonder@youthmove.us
42

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Intergenerational Dialogue 

Participants

Planning Committee

Alison Malmon

Founder and Executive Director

Active Minds, Inc.

Leah Harris

Consultant

Jacki McKinney

Consultant

Lauren Spiro

Director of Public Policy

National Coalition of Mental Health Consumer/Survivor 

Organizations

Participants 

Marvin Alexander, M.S.W.

Youth MOVE National

North Miami Beach, Florida

Kinike Bermudez-Walker

Consumer Projects Coordinator

National Asian American Pacifi c Islander Mental Health 

Association (NAAPIMHA)

Garland, Texas

Gayle Bluebird, R.N.

Bluebird Consultants

Gainesville, Florida

Celia Brown

Recipients Affairs

New York State Offi ce of Mental Health

New York, New York
43

Mark Davis

LGBT Liaison, Philadelphia Department of Behavorial Health

Pennsylvania Mental Health Consumers’ Association 

Philadelphia, Pennsylvania

Sascha Altman DuBrul

Co-founder and Collective Member

The Icarus Project

Germantown, New York

Becca Frazee

Chapters Coordinator

Active Minds, Inc.

Washington, District of Columbia

Leah Harris

Consultant

Washington, District of Columbia

Alison Malmon

Founder and Executive Director

Active Minds, Inc.

Washington, District of Columbia

Jacki McKinney

Consultant

Phildelphia, Pennsylvania

David W. Oaks

Director

MindFreedom International

Eugene, Oregon

Gilberto Romero

Public Health Advocate

De Sol a Sol

Santa Cruz, New Mexico 

Dally Sanchez

Families Together New York State, Inc.

Albany, New York
44

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Lauren Spiro

Director of Public Policy

National Coalition of Mental Health Consumer/Survivor 

Organizations

Washington, District of Columbia

Can Truong

Director

Center for Education Empowerment

Kettering, Ohio

Amy Upham

Action for Mental Health

Kenmore, New York

Facilitators

Samantha Jo Broderick

Treasurer/Youth Advocate

Youth MOVE

Columbus, New Jersey

Kathy Muscari

Director

Consumer Organization and Networking Technical Assistance 

Center (CONTAC)

Charleston, West Virginia

Federal Staff

Paolo del Vecchio, M.S.W.

Associate Director for Consumer Affairs

Center for Mental Health Services

Substance Abuse and Mental Health 

Services Administration

Rockville, Maryland 

Carole Schauer, R.N., M.S.

Senior Consumer Affairs Specialist

Center for Mental Health Services

Substance Abuse and Mental Health 

Services Administration

Rockville, Maryland 
45

Writer

Irene Saunders Goldstein

Arlington, Virginia 

Reporter 

Asha-Lateef Dobbs, M.Ed. 

College Park, Maryland

Observers

Mattie Curry Cheek, Ph.D., M.Ed.

Public Health Advisor/Project Offi cer

Center for Mental Health Services

Substance Abuse and Mental Health 

Services Administration

Rockville, Maryland

Kim Pawley Helfgott

Child Welfare Resource Specialist

Technical Assistance Partnership

American Institutes for Research

Washington, District of Columbia

Stacey Lesko, M.S.W.

Consumer Affairs Specialist

Center for Mental Health Services

Substance Abuse and Mental Health 

Services Administration

U.S. Public Health Service

Rockville, Maryland

Chris Marshall

Consumer Affairs Specialist

Center for Mental Health Services

Substance Abuse and Mental Health 

Services Administration

Rockville, Maryland

Bethanie Parrish

Commissioned Corps Program Offi cer

U.S. Public Health Service

Rockville, Maryland
46

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

Lisa Rubenstein

Public Health Advisor

Center for Mental Health Services

Substance Abuse and Mental Health 

Services Administration

Rockville, Maryland

Diane L. Sondheimer

Deputy Branch Chief

Child, Adolescent, and Family Branch

Center for Mental Health Services

Substance Abuse and Mental Health 

Services Administration

Rockville, Maryland
47

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Center for Mental Health Services. (n.d.). Systems of Care: 

A Promising Solution for Children with Serious Emotional 

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imply endorsement by SAMHSA.
48

Building Bridges: Mental Health Consumers in Intergenerational Dialogue

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