A Guide to Organizing Interactive Discussions 

on Mental Health Issues among Consumers, 

Providers, and Family Members 

Participatory 

Dialogues

Participatory 

Dialogues

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services
A Guide to Organizing Interactive Discussions 

on Mental Health Issues among Consumers, 

Providers, and Family Members 

Participatory 

Dialogues

Participatory 

Dialogues

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

Consumer Information Series

Volume 3

SMA 00-3472

Printed 2000
Acknowledgments

I want to especially acknowledge Marilyn Carmi, my assistant, who helped

with all aspects of the production and design of the manual, also Ed Pazicky

who helped with the final formatting.

Many supporters read the document at different stages to give me feedback:

Fred and Sharon Newman, in Florida, Betty Weathers in Atlanta, Ann

Marshall, from Alabama, Laurie Weber, a co-coordinator of several Pioneer

Dialogues, in Florida, and Jacki McKinney, in Philadelphia.

Barbara Lee, from Tampa, Florida, helped with the research summary and

bibliography; Sally Clay, in Florida, edited and proofread. Barbara Jackson,

in Florida, was also a proofreader. Final proofreading and editing were done

by Norma Wagner and Rosemary Jones. Thanks to Natalie Reatig in

Washington, D.C., and Irena Rutenberg in New York City for their support.

Many thanks to Janet Foner, who assisted with the coordination of the

Pittsburgh Dialogue, wrote a summary report, and reviewed the draft for the

manual, and to Stephen Ferrante, in Florida, who wrote sections of the

Facilitation guidelines.

Two articles were written by consumers who added a special dimension to the

manual — Darby Penney wrote “The Recovery Dialogues” that describe dialogues that were held in the State of New York. Sylvia Caras wrote Internet

Dialogues which describe how to communicate on the internet.

The assistance of all the folks involved in the two “Pilot Dialogues” was

invaluable, especially from coordinators Dr. Ken Thompson and Linda

Morrison, in Pittsburgh, and Renee Constantino and her staff at the Mental

Health Association in Palm Beach County. Thanks to J. Rock Johnson and

others, in Nebraska, for their efforts to plan a dialogue there.

Finally, I want to acknowledge and give special thanks to Paolo del Vecchio,

Risa Fox, and Iris Hyman at the Center for Mental Health Services whose

assistance was greatly appreciated.

Funding for this project was provided by the Center for Mental Health

Services (CMHS), the Substance Abuse and Mental Health Services

Administration (SAMHSA), Department of Health and Human Services

(DHHS). The opinions expressed in this document reflect the personal opinions of the authors and are not intended to represent the views, positions or

policies of CMHS, SAMHSA, DHHS or other agencies or offices of the

Federal Government.

— Gayle Bluebird

Author

Public Domain Notice

All material appearing in this

volume is in the public domain

and may be reproduced or

copied without permission

from SAMHSA.

Citation of the source 

is appreciated.

Additional copies of this

publication are available from:

National Mental Health Services

Knowledge Exchange Network

P.O. Box 42490

Washington, DC 20015

Tel: 800-789-2647

TTY: 301-443-9006

E-mail: ken@mentalhealth.org
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

What is a Dialogue? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Different Models of Dialogues . . . . . . . . . . . . . . . . . . . . . . . 3

Develop the Dialogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Organize a Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Choose a Title and Theme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Develop the Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Set up the Meeting Logistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Select a Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Select Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

The Invitation Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Plan Meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Use Volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Technical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Name Tags and Participant Packets . . . . . . . . . . . . . . . . . . . . . . . . . 19

The Evaluation Form — Don’t Forget . . . . . . . . . . . . . . . . . . . . . . . 19

Time Limits and Time Frames . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Ending Dialogues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Facilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Select the Facilitator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Use Co-Facilitators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

The Role of the Facilitator(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Start the Roundtable Dialogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Present Conduct Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Set Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Maintain Flow of Conversation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Deal with Conflict . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Stick to the Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Future Plans and Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Record the Dialogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Conclude the Dialogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

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Table of Contents Table of Contents
Conference Dialogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Selecting Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Send Letter and Brochure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Using Speakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Preparing Small Group Dialogues (Optional) . . . . . . . . . . . . . . . . . . 29

Choosing Facilitators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

The Day of the Conference Dialogue . . . . . . . . . . . . . . . . . . . . . . 30

Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Welcoming Remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Keynote Speaker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

First Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

First Dialogue Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Lunch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Second Panel and Dialogue Session . . . . . . . . . . . . . . . . . . . . . 32

Open Mike . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Ending the Conference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Attachments

Sample Brochure for Conference Dialogue . . . . . . . . . . . . . . . . . . . 33

Sample Evaluation for Conference Dialogue . . . . . . . . . . . . . . . . . . 35

Sample Agenda for Conference Dialogue . . . . . . . . . . . . . . . . . . . . 36

Appendices

Appendix A: What Happens After the Dialogue . . . . . . . . . . . . . . . 37

Appendix B: Internet Dialogues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Appendix C: The Recovery Dialogues . . . . . . . . . . . . . . . . . . . . . . . 41

Appendix D: Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Appendix E: Literature Summary . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Appendix F: Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Appendix G: Advisory Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Appendix H: List of Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

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The Center for Mental Health Services (CMHS), a part of the Substance

Abuse and Mental Health Services Administration (SAMHSA) was created

in 1992 to meet the need for an entity within the federal government that

focuses on real-world experiences, services and evaluation. CMHS works to

promote mental health and prevent the development or worsening of mental

illnesses when possible. Changes in the public mental health care system are

affecting both mental health consumers and practitioners. Mental health care

is focusing less on stabilization or custodial care, and more on rehabilitation

and recovery; part of this new focus is to involve consumers more than was

customary in the past. The widespread adoption of managed care programs

and new technologies (particularly changes involved in approaches to medication), along with the continuing problems of discrimination/stigma associated with mental illness, offer tremendous ongoing challenges to the ability to

provide high quality mental health care. Current conditions make it important

more than ever to establish partnerships — not just building one-to-one relationships, but also creating lasting, productive alliances at both the system

and policy level.

Through dialogue people can come together for a mutual exchange of ideas,

observations and experiences. Dialogues go beyond the usual interactions

between practitioners and recipients of mental health services. They provide

a safe environment in which participants may speak freely to create better

understanding and mutual trust and respect.

For the first time ever, this participatory dialogue manual, developed by mental health consumers, offers a blueprint for action. It describes the benefits of

dialogue meetings and provides easy-to-follow detailed specific action steps

on how states, local communities, providers, managed care organizations,

advocates, family members and consumers can organize meetings to develop

working partnerships to improve mental health service delivery. The goal is

to bring all stakeholders together on a level playing field and to develop the

kinds of partnerships that are needed to improve mental health services.

CMHS has successfully initiated a number of consumer/provider dialogues

using the methods outlined in the manual. After each dialogue, participants

remark about the value of the dialogue and the impetus the dialogue has

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Foreword Foreword
provided to instill changes, initiate additional programs, and examine the

insights offered.

Dialoguing, communicating, and partnering are ongoing processes. These

dialogues offer hope for a foundation of sincerity and openness that will lead

to significant improvement of mental health services because both providers

and mental health consumers are effectively communicating and discovering

the importance of such a unique collaboration.

Nelba Chavez, Ph.D. Bernard S. Arons, M.D.

Administrator Director

Substance Abuse and Center for Mental Health Services

Mental Health Substance Abuse and

Services Administration Mental Health 

Services Administration

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In July 1997, the Center for Mental Health Services convened a two-day

meeting in Arlington, Virginia, Consumers and Psychiatrists in Dialogue.

The meeting brought together twenty individuals who were equally divided

between current and former recipients of services (consumers), and psychiatrists from all over the United States. This historic meeting provided opportunities for people to explore uncharted territory through communication

exchange. The meeting was a success, measured by the reported feedback

from those who participated.

It was recommended that dialogues be replicated among other constituencies

at state and local levels, and for a written report to be distributed to a wide

mental health community. Another recommendation was to create a manual

for people to learn how to create similar dialogues. This volume is in response

to that last recommendation.

Background

Dialogue is not a new concept. Participatory Action Research, twenty years

ago, created a new paradigm for the conduct of research using dialogues

nationally and internationally.

In the mental health arena, three roundtables were convened in 1989, by the

Community Support Program, under the National Institute of Mental Health,

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Introduction Introduction

“Never doubt that a small group

of thoughtful, committed citizens

can change the world. Indeed, it’s

the only thing that ever has.”

— MARGARET MEAD
to discuss the issue of involuntary treatment. These three meetings (held first

with consumers, then psychiatrists and consumers, lastly with consumers,

psychiatrists and family members) were the inspiration for a conference

model, Pioneer Dialogues, the first of which was held in Broward County,

Florida, in 1992. The two-day dialogue conference was held at South Florida

State Hospital, bringing consumers and professionals together to discuss

basic consumer issues and strategies.

In other parts of the country, similar dialogues were being held. New York

State convened a series of Recovery Dialogues between psychiatrists and consumers. Darby Penny, New York’s Director of Recipient Affairs, describes

one of these dialogues in the manual. Dialogues were also organized between

state commissioners of mental health and mental health consumers under the

direction of Ann Loder, consumer advocate from Florida, while working with

the National Consumer Policy and Research Workgroup.

Why are Dialogues Important?

First, there is general agreement that the mental health system needs to

change. Consumers have been talking for years about what the problems are,

expressing anger about mistreatment in the name of treatment. Consumers

have received support for some of these viewpoints. Today, there are innovative programs, many of which are directed by consumers, jobs that have been

created, and new policy development that has been influenced by consumer

input. Yet, it just isn’t enough. The mental health system has had its equal

share of failures and advances. The climate of the general community is more

volatile than ever; violence on the rise is often attributed to mental patients.

Approaches are being considered that may further put consumers at risk for

increased involuntary treatment. Consumers need to talk about issues from

their different perspectives in order to develop workable solutions that will

assure consumer survival.

To Talk About Differences, 

There Must Be a Partnership

Dialogue can be a first step toward establishing partnerships between people

who agree to listen to each other. They offer opportunities for people to

exchange their beliefs with others while simultaneously having a deep, private conversation within themselves. A dialogue is a way of healing, opening

the possibility for gaining new trust and understanding. When people understand each other, they are able to work together and create partnerships.

Ultimately, however, the success of a dialogue rests with the individual whose

life has been changed.

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Pilot Dialogues

In order to determine whether the steps outlined in this manual were adequate

or complete, two pilot dialogues were held in Pittsburgh, Pennsylvania, and

in Palm Beach County, Florida, both during the Spring of 1998. Each differed

in the dialogue model that was used. Pittsburgh used the roundtable model;

Palm Beach County used the conference model.

New approaches that worked in previous dialogues have been added to the

“how-to” steps in this manual. Approaches that did not work were considered

just as valuable, because they could be used as examples of what not to do.

You will find many references to the pilot dialogues throughout the text.

Other dialogues mentioned in the text are: the Pioneer Dialogues held in

Broward County, Florida (1992–1995), a dialogue between psychiatrists and

consumers held in Arlington, VA (1997), and Recovery Dialogues held in the

state of New York. Nebraska is used as an example, several times, to illustrate

the difficulties of organizing a dialogue in a rural state.

About the Manual

Although articles and reports have been written describing the benefits of dialogues, writing about them is not the same as organizing them. The goal was

to create a practical manual with simple, concise, information that anyone

could use. Steps are included that talk about everything from location selection to how to plan meals. Two models of dialogue are presented, the conference model, and the roundtable model. Most of the steps in this manual are

applicable to both models, but specific steps for the conference dialogue have

been added. Examples in the form of vignettes have been added to most of the

steps, as well as tips that can be helpful.

Dialogues are also an art form, a variation on the art of conversation, in which

listening is as important as talking. A short narrative tells you how to be a

good listener. Another form of dialogue is communication on the Internet. A

chapter explains how to use it and also lists Web sites for discussion of mental health issues.

The manual is for anyone to use. The main issue presented is mental health,

but most of the guidelines will also work for other groups. The population that

is the minority, or who has the least power, should take a lead in planning a

dialogue as much as possible. In a mental health dialogue, consumers should

take the lead. Consumers are the reason for the dialogues because consumers

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are the subject of the dialogue. Creating a forum for equal exchange is a goal,

but it should not be forgotten that one of the primary reasons for dialogues is

for professionals to learn more about consumers from consumers.

The Art of Listening

A good dialogue requires you to be a good listener. Sadly, many people do

more talking than listening. Even while listening, we are thinking about what

to say, or we are listening to what’s going on in our own head rather than 

what is being said by the other person. Many of us want to talk, but few of us

really listen.

The first step in being a good listener is to be truly interested and concerned

about the other person. Start listening from the beginning. Clear your mind

from other distractions and focus on what the other person is saying.

Listen Objectively

If you listen with the intention of taking issue with what the other person is

saying, you will not be able to understand what the person is saying under any

circumstances. Good listening requires that you suspend judgment, cut

through emotional barriers, and keep an open mind.

Listen for the Main Idea

New information requires that you understand the point the other person is

making. However, sometimes the speaker may not be clear enough to be

understood. Ask questions for clarification. Make sure you can summarize the

gist of the message when the person is finished speaking.

Listen for Details

Specifics of a message are much more difficult when they involve names,

dates, places, facts, and figures. Try to remember which details are important,

but make sure that you don’t pay so much attention to details that you lose the

overall concept of what is being said.

Listen to What is Not Being Said

Be aware of body language, tone of voice, eye contact, and gestures. It is

often what is not said that conveys the true message of what a person is saying. Your own body posture and attentiveness will influence what and how

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the person conveys information. Assume a posture of attention. Look at the

person while he is talking. It may not improve your ability to listen, but it may

have an effect on the other person.

Language Used

The generic term consumer has been used for persons who have or are currently receiving mental health services. It is used only when necessary,

because it has been the most accepted term, not because it is the most popular. Other terms such as consumer/survivor/ex-patient might have been used,

but adding words may be cumbersome. Most often, the words “people” or

“persons” are used for description.

Dialogues are being conducted all over the country, in many different ways.

They are being used as part of research and evaluation, to evaluate consumer

satisfaction, and to train staff in mental health agencies and hospitals. There

are many other possible purposes. Let this guide inspire you to create other

dialogues. How they take shape is up to you. Last word: Have fun creating

your dialogue! Have fun using the manual!

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A dialogue is a forum in which two or more groups of people are brought

together as equals to explore their differing views, experiences, and belief

systems, in this case, about mental health topics and issues. A dialogue is

structured to allow for exploration of one’s own perceptions and attitudes, as

well as to listen to other people explore their own.

All dialogues have the following common goals and objectives:

■ Create better understanding and mutual respect among consumers,

family members and professionals.

■ Allow participants to speak from their experiences and belief systems

in an atmosphere of safety.

■ Create partnership ventures through compromise and consensus.

■ Change attitudes and practices in the mental health system.

PARTICIPATORY DIALOGUES: A Guide to Organizing Interactive Discussions on Mental Health Issues among Consumers, Providers, and Family Members

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What is a Dialogue? What is a Dialogue?

“An ounce of dialogue is worth 

a pound of monologue.”

— LEONARD RAY FRANK

Dialogues Promote:

■ Listening 

■ Serious inquiry

■ Risk taking

■ Curiosity

■ Healthy conflict

■ Openness

■ Diversity inclusion

■ Consensus building

■ Empathy

■ Understanding

But Discourage:

■ Assumptions

■ Being judgmental

■ Argumentativeness

■ Divisiveness

■ Closed-mindedness

■ Hidden agendas

■ Uniformity
Roundtable Dialogue

A Roundtable Dialogue is an open discussion group with 20–25 participants.

It brings people together who have different perspectives on mental health

topics and issues. The group may consist of two or more specific groups. The

Roundtable relies on a respectful facilitator or co-facilitators who treat people

as equals and are sensitive to individual needs.

Conference Dialogue

The Conference Dialogue combines speaker presentations with small group

dialogues. The audience may include up to 125 people who gather as a group

and break up into smaller groups (up to 25) where participants interact as

equals. The Conference Dialogue may be used as an annual event to honor

our accomplishments, to educate, and to involve a particular aspect of a mental health system.

Both styles of dialogues are intended to help people to understand each other

by talking over differences and sharing similarities in life experiences. The

results are improved relationships which can help to establish partnerships

within the mental health system.

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Different Models of Dialogues Different Models of Dialogues

Both Dialogue Models

Include:

■ Participant guidelines

■ Facilitator guidelines

■ Goals and objectives

■ Participant selection

guidelines

■ Time for networking

■ Conduct guidelines

■ Plan for shared meals

■ Timekeepers

■ Time for strategies

■ Evaluation forms

■ Participant packets and

name tags

Conference Dialogue

Model Only:

■ Requires more funding

■ Planning takes longer

■ Agenda more detailed

■ Uses speakers/panelists

■ Include arts and

entertainment

■ Small pre-set dialogues

■ Uses more volunteers

■ Requires brochure

■ Location needs differ

■ “Open microphone”
Organize a Committee

■ A lead person from an agency will initiate the dialogue. This person

may later become the coordinator of the dialogue.

■ Keep small, approximately five to six people. Too many people on 

the committee will be confusing and make it harder to complete tasks

on time.

■ Include representatives of key constituency groups. Make sure

consumers are on the planning committee.

■ Always include primary consumers (direct recipients of services), as

the dialogue is intentionally established to hear their views; however,

a family member may be included, if applicable.

■ Select people who have organizing abilities, writing skills, and fundraising experience.

■ The sponsoring agency should be represented whenever possible. 

The agency should be able to provide secretarial support and other

technical assistance, including the ability to fax, send mailings, and

print copies.

Other selection criteria to be considered:

■ Enthusiasm about the dialogue.

■ Familiarity of members, i.e., do committee members know each other?

■ History of working together (because individual strengths and working

styles will already be known).

■ Commitment to meet the demands of frequent meetings and tasks.

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Develop the Dialogue Develop the Dialogue

The need for a small planning committee cannot be emphasized

enough. Sometimes people feel that it is important to be

inclusive of more representatives on the planning committee,

but it is better to keep it small to ensure that assigned tasks

are completed.
If planning a dialogue from long distance, committee members may meet by

conference calls and e-mail. Long-distance planning creates other considerations such as whether a face-to-face meeting is indicated, how to delegate

responsibilities, participant selection, etc.

Organizing a dialogue can be a long, tedious process that requires committee

members to build trust. The planning process involves ongoing and open

communication between the committee members and is often a learning experience as significant as the event itself.

The committee determines:

■ The purpose of the dialogue

■ Groups to be represented

■ Length of dialogue (one or two-day meeting)

■ Whom to invite

■ Date, location, and time

■ Type and model of dialogue (Roundtable or Conference)

■ Selection and choice of coordinator and/or co-coordinators (It is helpful to have two coordinators because they can share responsibilities

and one can take over for the other if necessary)

■ Dialogue agenda

The coordinator(s):

■ Demonstrate leadership

■ Do the majority of the work

■ Bring information to the committee for decisions

■ Set agendas and time-lines for completion of tasks

■ Keep the committee’s work on schedule

■ Serve as primary spokespersons for the event

■ Make on-the-spot decisions when necessary

The committee may want to add additional people for specific tasks, but the

nucleus group should remain intact for consistency, to make major decisions,

and to keep things running smoothly.

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It is not so important that everyone on the committee agree

on ideologies; however, it is essential that they are able to

compromise, build consensus, and work together.
The committee should allow two to four months to plan a Roundtable

Dialogue, and at least four months for a Conference Dialogue.

Choose a Title and Theme

Choose a broad theme or concept for a first dialogue, such as recovery, mental illness, partnerships, or stigma and name accordingly.

Subsequent dialogues are more specific and focus on defined issues such as

the criminal justice system, homelessness, state hospital closings, or outpatient commitment.

Keep the title short, concise, and catchy in order to grab attention.

Examples

■ The planning group in Pittsburgh, Pa. (March 1998) named their dialogue, “Talking with Each Other: For a Change.” The sub-title was a

double entendre. “Finally we are talking together instead of not communicating, AND getting together to talk, pointing out the way to

change.”

■ “Pioneer Dialogue” was the name given to the first Conference

Dialogue held in January, 1992, in Broward County, Florida. The word

“Pioneer” was chosen because, as defined in Webster’s Dictionary,

pioneer is a “group originating a new idea,” and because of a second

Webster’s Dictionary definition, of “a plant capable of establishing

itself in barren soil.” “Pioneer Dialogues” has become a common name

that other organizations are using in other parts of the country.

■ Palm Beach County, Florida (June 1997) used the “Pioneer Dialogue”

trade name with the sub-title “The Experience of Recovery.” Their second Pioneer Dialogue in 1998 dealt with more specific issues and was

called, “The Health of the Mental Health System and How it Affects

You.”

Focus Questions can be developed to yield information that is desired from

the dialogue. The committee should be careful to construct only broad questions, since the specifics of topic discussion should come directly from the

participants in the dialogue.

Example

■ Three roundtable discussions were convened in 1991–1993 by the

National Institute of Mental Health’s Community Support Program.

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PITTSBURGH, MARCH 1998

“Talking with Each Other: 

For a Change”

BROWARD COUNTY, FLORIDA, 1992

“Pioneer Discussions”

PALM BEACH COUNTY, FLORIDA,

1997

Pioneer Dialogue

“The Experience of Recovery”
The meetings focused on the subject of involuntary treatment and five

basic questions were developed prior to the meetings, as follows:

1. What are the involuntary interventions used by the mental health

system?

2. How and why do people get treated against their will?

3. How do involuntary interventions affect people who experience

them?

4. What are potential alternatives to involuntary intervention?

5. What are the implications of answers to questions 1–3 for

research, training, and program development.

Develop the Budget

A budget must be created with estimated costs for the dialogue.

Find out first if all needed funds are available or if fund-raising will be

necessary.

Determine whether a written proposal with narrative and budget is required.

Suggestions for Possible Funding

GOVERNMENT FUNDS

Government agencies are often interested in using funds for dialogues. In

fact, many of the dialogues that are discussed in this manual originated at the

state or federal government level. There may be discretionary funds at the end

of the fiscal year that agencies are eager to use.

PARTICIPATING AGENCIES

Ask participating agencies to contribute funds or in-kind support. Collaboration with participating agencies helps to insure the dialogue’s success.

PRIVATE FUNDS

Consider private funds or local foundations. Check the library for foundation

listings.

NO FUNDS

It is possible to use an agency conference room requiring no funds at all. Have

everyone chip in for a pizza or similar lunch.

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Sample Budget Items 

■ Site location

■ Meals/refreshments

■ Coordination

■ Organizer of dialogue

■ Facilitator fees

■ Travel expenses

■ Audiovisual equipment

■ Documentation fees

■ Printing

■ Mailing and postage

■ Hotel accommodations

■ Recorder fees
Two Dialogue Budgets:

(Note that the two different styles of dialogues vary in expenses.)

Funds for the above dialogue were raised through the Office of Educational

and Regional Programming in the amount of $1,000 and $500 each came

from the Pennsylvania Providers Association and the State Community

Support Program.

Commentary from Pittsburgh organizer/consumer, Linda Morrison: “We probably could have done it cheaper, but we were in the belly of the bureaucracy

and we had a good marketer. There were no strings attached to the money.”

Funds for Pioneer Dialogue on Crisis Alternatives included approximately

$1,500 allocated by government adult mental health funds. Two local hospitals, the State Protection and Advocacy Center, and a community mental

health center provided the balance of the funds. In addition, family member

groups volunteered to serve food and provide desserts for lunch.

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Total amount spent on Pittsburgh Pilot Dialogue, March 1998: $2,200

(Roundtable Dialogue)

This was an all-day dialogue for 25 participants. 

Following is a breakdown:

■ Room rental at hotel (included breakfast and lunch) . . . . . . .$ 1,000

■ Recorder/documenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 500

■ Report duplication/mailings/postage . . . . . . . . . . . . . . . . . . .$ 500

■ Travel expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 200

Total amount spent on Pioneer Dialogue on Crisis Alternatives, 1995: $3,000

(Conference Dialogue — Fort Lauderdale)

This was an all-day dialogue for 100 participants. Following is a breakdown:

■ Unitarian Church (included six breakout rooms) . . . . . . . . . . . .$650

■ Breakfast (juice, coffee, doughnuts) . . . . . . . . . . . . . . . . . . .$ 375

■ Keynote speaker (honorarium and transportation) . . . . . . . . . .$ 600

■ Happy hour foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 500

■ Lunch (provided by Mental Health Day Treatment Program) . . . . .$ 0

■ Mailings, postage, brochure development . . . . . . . . . . . . . . . . .$250
We have provided you with only two sample budgets; however, there have

been many dialogues, each with their own variations.

Note

In Nebraska, a planning committee was formed to create a dialogue 

which never got off the ground because the funding was not in place. In retrospect, one of the planners concluded: “Funding has to be in place . . . and

only when funding is in place can you operate as a planning committee.”

Set up the Meeting Logistics

Day and Date

■ Select a day that meets the needs of most participants.

■ Consider providers’, administrators’, consumers’ preferences.

■ Consult a calendar for already scheduled conferences.

■ Note that air fares are cheaper when the weekend is included.

■ Decide on a start and finish time (consider traffic patterns during business hours and people’s family needs).

Select a Location

A Conference Dialogue requires a large central meeting room plus break-out

rooms with circular seating for small group sessions. This site must be able to

support the total number of desired participants. For example, if the total

number is 100, at least five break-out rooms are needed. Frequently, locations

are considered ideal for the conference in every respect except for adequate

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“Funding has to be 

in place . . . “

Set up:

■ Day

■ Date

■ Hours

■ Location

■ Meals

■ Breaks

■ Smoking areas

Friday is a good day, since it is easier for provider agencies

to give staff leave at the end of the week, and it is the best

day to accommodate out-of-town guests. It is also a good day

to extend social networking after the dialogue and for outof-town guests to make plans with friends over the weekend.
rooms for the dialogue sessions. At some conferences, outdoor space has been

used or rooms usually used for other purposes or a large meeting room broken into sections.

A Roundtable Dialogue requires a large meeting room with people seated at

a table in a rectangle or square. It is important that all participants can see

each other.

An ideal site has:

■ Adequate lighting (windows important)

■ Adequate rest rooms

■ Wheelchair accessibility

■ Kitchen space (optional)

■ Coffee makers available

■ Electric outlets

■ Parking

■ Transportation to and from airports

■ Good acoustics

■ Comfortable chairs

■ Public transportation accessibility

Hotel Settings

The selection of a site will be dependent on the budget. Select a hotel if there

is enough money in the budget. Hotels are desirable because they are convenient. Arrangement of meeting rooms and other details are automatically

taken care of, and meals are prepared and served.

Note

Costs vary from city to city depending on the size. Meeting rooms vary greatly in price depending on the facility. Time of year affects rates. (Areas that

attract tourists in the summer may lower rates in winter, and vice versa).

CHECK THE FOLLOWING BEFORE SELECTING A HOTEL

■ Parking space and fees — Check to see whether the hotel offers a discount or free parking for conference participants. Also make sure there

are adequate parking spaces.

■ Hidden costs for extras — It is important to ask whether there are

additional costs for microphones or other special equipment.

■ Acoustics — Make sure the rooms have adequate acoustics so that

people can hear each other.

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■ Accessibility for disabilities — Check for accessibility for wheelchairs, sign language, guides, etc.

■ Food — Be sure to check menus and costs. Most hotels will let you

sample food in advance. Some will even offer a free meal for this purpose if you ask.

■ Staff friendliness and helpfulness — Does staff take time to answer

your questions? Do they return your phone calls in a timely manner?

Do they offer suggestions? Does your intuition tell you that they will

be friendly and helpful to the participants who attend the dialogue?

■ Centralized location — Is public transportation accessible, close to

participants’ homes, and near the airport?

■ Surroundings and furnishings — Are surroundings pleasing to the

eye? Are they comfortable and inviting?

■ Directions to the hotel — If you choose a hotel make sure you ask for

written directions and a map to include with the invitation. Most hotels

have these available including directions from the airport, and to

restaurants near the hotel. Nothing is more frustrating than to have participants circling streets in a busy commercial area only to arrive at the

meeting late, totally exasperated.

LOWER COST ALTERNATIVES

■ Agency boardrooms and conference rooms

■ Colleges/educational centers

■ Training rooms in banks, companies, hospitals

■ Public libraries

■ City Hall

■ Schools (generally available only when school is not in session)

■ Churches (not usually advised if religious icons are present)

■ Community centers

■ Homes are a possibility if nothing else seems workable.

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Check to see if there are potentially loud conferences

scheduled at the same time as yours. There have been

problems with concerts, gospel sings, and rallies that can

interrupt a dialogue from an adjacent room.
Examples of site selections

■ In Palm Beach County, Florida, the Mental Health Association held

two successive conference dialogues in 1997 and 1998. The first

dialogue was held at a United Way office. The second year dialogue

was held in a hotel. The conference organizers were all in agreement

that the hotel setting was better although more expensive. Tom

Menard, one of the planners, stated: “What we lost in money, we

gained in less stress.”

■ The Pittsburgh Pilot Roundtable Dialogue planners chose a hotel.

Generally speaking, everything was ideal. However, there were two

problems. First, the planning group forgot to give instructions on how

the room should be set up. As a result, the beginning of the dialogue

was delayed. Second, this was one of the meetings during which there

was loud noise in the next room.

■ The original “Pioneer Dialogue” in Broward County, Florida, would

not meet any of the standards for comfort as have been set forth in this

manual. The conference site was situated far from where most of the

attendees lived. The chairs were straight back and uncomfortable, the

acoustics were terrible (an old air conditioner went on and off making

it almost impossible to hear) and break out rooms for the dialogue sessions were far away from the general meeting area. Despite these

drawbacks, the conference dialogue was a major success! Everyone

loved it because it set precedents for involving an entire community to

make changes in the mental health system.

■ A high school was selected for a “Pioneer Dialogue,” for which there

was no charge. All criteria were met with only one drawback. The size

of the auditorium was too large for the audience, which filled only one

fifth of the room. The problem did not become apparent until the day

of the dialogue when people spread to all areas of the auditorium, some

at the entrance, and some near the stage. The meeting was difficult to

hold together, though in many ways the site was ideal.

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Weigh the pros and cons when choosing a location. Make sure

you look at several locations and do a comparison on rates and

other features. Note that even alternative locations charge a

fee, although there are a few exceptions, so don’t rule them

out. Note also that reservations will be required far in advance

for whichever location you choose. Ask around for

recommendations. Your best bet is taking the advice of

someone who has used a particular hotel or alternative space.

They can advise you of any potential problem areas.

Sometimes you try an

alternative location, the next

year a hotel, and compare . . .

Sometimes the site appears

perfect, but gaps in planning

can disrupt . . .

Sometimes a site appears

marginal, and “it works” . . .

Sometimes a site that has 

no costs, has costs 

(if it is not working) . . .
■ One of the best site selections was for the 1996 Pioneer Dialogue,

Broward County, that was held at a Unitarian Church which offered

pretty grounds with flower gardens and trees and a large patio off the

main meeting room. Break-out rooms were adequate. Generally speaking, churches are not recommended they may be offensive to some

who are non-religious. Unitarians are a secular congregation, consequently the meeting rooms were acceptable to all participants. The

rental cost was also reasonable. All in all, this may have been one of

the nicer settings for a conference.

Select Participants

Invite people who will contribute to the dialogue and who will be affected 

by the outcome. Selected individuals should have good communication 

and listening skills, and have expressed an interest in participating in the

dialogue exchange.

A Roundtable Dialogue should be composed of no more than 25 (preferably

20) people. A 20-person dialogue should be equally divided among consumers, providers and/or family members.

A Conference Dialogue may not have equal ratios. A 30–40% consumer representation may be adequate if the goal is to educate providers. Make sure that

consumers share lead roles.

Note

Consumer and provider definitions may be interchangeable. Some consumers

are providers and vice versa. The definition of a consumer used in this manual is a person who has received direct services in the mental health system

and who openly defines himself/herself as an advocate for other consumers.

Consider the Following

■ Should only those consumers who can articulate an ideology be invited?

■ Should non-verbal consumers be invited?

■ Should consumers be invited if staff members from their agency are

participating, creating possible power imbalances?

These are issues to consider, but generally speaking, we recommend that participants should be verbal and have some opinions on issues. Occasionally

someone will make a comment, “The dialogue doesn’t represent all consumers.” Usually, when one hears the stories of dialogue participants it

becomes evident that they were not as articulate as they are now.

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And sometimes it all 

comes together.

Key Factors in 

Selecting Participants

■ Cultural backgrounds

■ Geographic representations

■ Background in leadership

■ Political perspectives

■ Employment-related

diversity

■ Gender

■ Sexual orientation

■ Age considerations

■ Physical abilities

■ Socio-economic backgrounds
In Nebraska, the planners were concerned about whether they had enough

consumers who were ready to participate in a Roundtable Dialogue. J. Rock

Johnson, a consumer advocate, made the following observation: “It becomes

obvious to me that dialogues are not designed and may not be suitable for

‘bootstrap’ situations such as ours. The expectation is that there is an existing pool of consumers who are self-assured, articulate, and can be at ease

with authority figures. My thinking was that we could use this vehicle to help

find persons with potential and help develop them. That is still our intention.”

DIVERSITY

It is important to reach out and include as many people as possible from different racial and cultural backgrounds. Perspectives on mental health differ

greatly, and people of color have been discriminated against, not only in society, but in the mental health system as well. Sometimes they are added as an

afterthought. Jacki McKinney, consumer advocate (PA) states: “Most of the

time, no matter how large or small the meeting, there’s only one or two people of color present. I am excited, as I see that dialogues can be used as a positive tool to correct this.”

In Arlington, Virginia, a dialogue between psychiatrists and consumers, in

1997, included a diverse group of people who were Asian, Polynesian,

African American, as well as people with differing sexual orientations, religious and age backgrounds. Janet Foner, consumer advocate from

Pennsylvania, stated: “The inclusion of persons with so many different backgrounds made it a truly rich experience.”

OTHER CONSIDERATIONS

Consider whether to invite an individual who has a history of grandstanding

or being hostile or disruptive at meetings. While it is important to be inclusive of all viewpoints, it is also important to ensure as much as possible that

participants are not going to be disruptive. Talk to an individual before inviting him/her, define the problem, ask for cooperation, and ask for an

agreement to follow guidelines. If the person agrees, fine; if not, reconsider

the invitation.

Example

■ The planning group from Pittsburgh was worried that a potential invitee might not be able to be objective at the meeting and decided to discuss it with the individual ahead of time to express their concerns. The

person agreed to follow the guidelines, was invited, and only had to be

reminded once that “a dialogue is not a debate, and every person’s

opinion is valid.”

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“. . . dialogues are not

designed and may not be

suitable for ‘bootstrap’

situations such as ours.”

“. . . no matter how large 

or small the meeting, 

there’s only one or two 

people of color present . . .

I see that dialogues 

can . . . correct this.”

“. . . different backgrounds

made it a truly rich

experience.”

PITTSBURGH

“. . . a dialogue is not a

debate, and every person’s

opinion is valid.”
Finally, the Pittsburgh dialogue raised the question regarding the presence of

observers. It was clarified that all participants should be full participants,

not observers.

The Invitation Letter

An invitation should be sent well in advance of the dialogue.

For a Roundtable Dialogue, the letter is sent to individuals who have 

been pre-selected by the committee. The letter should specify pertinent

information.

■ Who — The name of the sponsoring organization

■ What — The event (title of the dialogue)

■ Where — Location of the event, including, address, phone number,

fax, and e-mail, if possible

■ When — Day, date, and time

■ Why — Objectives, specific goals for the meeting

Make sure to mention if there are any costs involved and whether meals 

are included. Request that casual clothes be worn. Also, ask if there are 

any special needs requiring accommodation. After all the pertinent details 

of the event are given, an RSVP should be requested with an expected date 

of return.

For a Conference Dialogue, an initial notice should be sent to mental health

agencies, selected individuals, and other facilities to alert them about the

upcoming dialogue. Later correspondence will include a brochure that provides more detailed information (See illustration of a brochure in the conference section).

Plan Meals

Meals are an important part of the dialogue. Plan meals

that keep the group together so that people can socialize with each other and network to exchange information. Participants should be told in advance that meals

are part of the dialogue.

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Invitation Letter:

■ Who

■ What

■ Where

■ When

■ Why
Selecting Foods

CONTINENTAL BREAKFAST

Coffee, juice, muffins or sweet rolls. Make sure there are selections with little or no sugar such as fresh fruit. Set a cutoff time for coffee in order to minimize distractions during the dialogue.

BUFFET STYLE LUNCH

Simple foods such as sandwich ingredients, cut-up vegetables, finger foods,

and salads are good choices. Make sure that vegetarians and people with special diets are accommodated, including persons with religious restrictions. A

choice of beverages may include iced tea or lemonade.

Food Preparation

Food can be prepared at the dialogue if the site includes kitchen facilities.

However, make sure that participation in the dialogue is not compromised by

persons who are involved in food preparation, and that the kitchen is far

enough away from the dialogue to avoid distractions. A special committee

may be appointed to take care of the food and all of the tasks involved.

Another option is to have food prepared in advance and delivered.

Use Volunteers

Recruit volunteers from the invited participants to perform a variety of tasks.

This maximizes participation and helps to make participants feel like they are

an important part of the planning process. Volunteers can help prepare food,

design a brochure, set-up rooms, greet, video or audiotape the conference,

keep time, etc.

Note

Use consumers as volunteers whenever possible. Try to pay stipends for performing a variety of tasks. Be creative . . . use volunteers as photographers,

“taxi drivers,” ushers, etc. We call stipend volunteers “paid volunteers.”

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Serve food attractively. Extras, such as flowers on the table, 

are nice additions to make the occasion memorable. Have 

bag lunches made (even a hotel will make them) with a

sandwich, potato chips, piece of fruit, and a lollipop. 

(Lollipops were added to one of the “Pioneer Dialogue” 

lunches and were a hit!)
Technical Considerations

Flip Charts

■ Write in bold capital letters

■ Use dark colored ink

■ Number each page for reference

■ Use colors for highlighting

■ Keep one idea heading per page

■ Post on walls for easy reference

■ Pre-cut masking tape and put tape on sides,

not top, to remove it easily

Video/Audiotape: “To Tape Or

Not To Tape”

ROUNDTABLE DIALOGUE

Videotaping and audio-taping is discouraged in 

a Roundtable Dialogue because participants may 

not be as open or honest in their discussions.

However, a Roundtable Dialogue may be audio-taped

only for the purpose of documenting minutes for a

summary report.

CONFERENCE DIALOGUE

Videotapes or audio-tapes may be made of speakers and panelists at a

Conference Dialogue, but the small group dialogues should never be

taped. Assign someone to keep track of when to change the tape and to make

sure the tape player is near the microphone. Give the task to someone who has

experience with the audiovisual equipment.

Note

Be sure to have signed consent forms for anyone video or audio-taped.

Example

■ Dialogues were videotaped in the state of New York between psychiatrists and consumers and they were used as effective training tools.

However, a key organizer, Darby Penney, New York State Director of

Recipient Affairs, stated: “ . . . the discussion may have been freer and

deeper had they not been taped. There was one of our six sessions that

was not taped, and my sense is that conversation was much more

intense and dealt with more difficult topics than the others.”

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“ . . . the discussion may have

been freer and deeper had

they not been taped.”
Name Tags and Participant Packets

Hand out name tags at the beginning of the dialogue. Name tags can be

purchased or made by hand with an artistic design. Cardboard place cards 

are also important at a Roundtable Dialogue. Place cards can be labeled 

with names and placed ahead of time in order to diversify seating 

arrangements. Participant packets can provide all participants with information pertinent to the dialogue, such as dialogue guidelines, agenda and a 

list of participants.

The Evaluation Form

. . . Don’t Forget!

Reasons for evaluating the dialogue:

■ To determine whether the dialogue was helpful

■ To identify areas of improvement

■ To assess the effectiveness and whether to continue

Design a one-page form that is user-friendly and simple with carefully constructed questions for the information needed. (See samples in “Attachments”)

Establish a rating system, with five choices (1–5) that designates excellent 

to poor.

Include open-ended questions with adequate space for comments and suggestions.

Ask questions like: What did you like best about the dialogue? What did you

like least? What suggestions do you have for improvement?

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Be sure to include brochures and newsletters of consumer-run

services in the packets. Current articles with new approaches to

treatment are always enjoyed.

Participant Packets 

May Include:

■ Dialogue guidelines

■ Agenda

■ Blank paper

■ Pen

■ Acknowledgments

■ Resource articles

■ Brochures of local programs

■ Names and addresses of all

participants

Rate the Following:

■ Overall presentation

■ Facility/location

■ Food and service

■ Facilitators and speakers

■ Topic relevance

■ Pacing

■ Start and finish time
Give attendees the option of not revealing their names and addresses. This

option encourages candid responses since people write comments more freely

if they do so anonymously.

Collect forms at the end of the day.

Note

Do not give people the option of sending forms back since they rarely do. In

order to ensure that evaluation forms are completed, announce their importance at opportune times during the day and request that people return them

before leaving.

Time Limits and Time Frame

In a Roundtable Dialogue, set specific time limits for the introduction and

for the closing session.

A Conference Dialogue must have carefully planned time frames for each

section of the day and for speakers and panelists.

Designate someone to be the timekeeper who will use a stop watch or timer.

The timekeeper will need to present information such as, “We have about two

minutes for each person. When you hear the bell or see the signal that your

time is up, please try to finish your thought quickly, so that everyone has a

chance to speak.” If presented correctly, even those people who dislike time

limits may like the challenge. Individuals may get a chance to laugh at themselves if they start to go over the time. The group can laugh with them.

Ending Dialogues

Both dialogues should end with spontaneous comments from participants.

In a Roundtable Dialogue it is called “Round Robin,” for which an hour is

allowed for final comments.

A Conference Dialogue ends with “Open Mike” (microphone). Both of these

methods are explained in more detail in their respective sections.

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Select the Facilitator

Dialogues are interactive and participatory events. They rely on effective

facilitation to promote participation, stimulate interaction, and summarize

information. A skillful facilitator, therefore, is a major player in the success

of a dialogue.

Choose a facilitator with the following qualities:

■ Energetic, enthusiastic

■ Good active listening skills

■ Able to be neutral on sensitive issues

■ Previous experience

■ Preferably a consumer

Consider the Following

■ Whether to use a person on the planning committee or someone outside of the planning process.

■ Whether to choose a person not associated with your mental health

system to ensure total neutrality.

■ Whether or not to select a consumer or professional. One possibility

would be to utilize a facilitator and a co-facilitator — one a professional, and the other one a consumer.

Use Co-Facilitators

Two facilitators can share roles and responsibilities. However, one person

should take the lead. A co-facilitator can take over if the lead facilitator gets

stuck, or if the group becomes stagnant. A co-facilitator can also add information or clarify points being made. Another role may be to record suggestions on a flip chart, serve as timekeeper, and be available for any unanticipated situations that may arise.

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Facilitation Facilitation
The Role of the Facilitator(s)

The facilitator(s) role involves each of the following tasks:

■ To create a safe, open, trusting and supportive environment for all

group members.

■ To guide the group activity and discussion.

■ To keep the channels of communication open.

■ To sense moods and feelings within the group.

■ To keep the group focused.

Directive, Participatory or 

Non-directive Facilitator(s):

A Directive Facilitator — Asks prepared questions and keeps the discussion

focused on those questions.

A Participatory Facilitator — Starts the discussion by reminding the group

of the goals and objectives of the dialogue, then invites suggestions on how

to proceed as a group, as well as on the specifics of what will be discussed.

A Non-Directive Facilitator — Declares the discussion open, sometimes

acting as a “gatekeeper” like the participatory facilitator. He/she will only be

involved directly in the discussion when it gets too heated or if there is more

than one person talking at the same time.

A good facilitator uses all three styles at different times, and will know when

to apply each one. The group that is tightly reined will be less creative, and if

too unstructured may lose focus and will not be cohesive. The facilitator who

is most effective is eclectic and intuitive to group needs.

A factor in facilitation style may be determined by the particular group and

the goals of the dialogue. It may be appropriate for the facilitator to interact

as a group member if it is decided the group will benefit.

The facilitator’s primary role, however, is to manage process and time. While

doing so, the facilitator should allow the group to direct itself as much as

possible, and only introduce new topics to keep the discussion flowing in a

positive direction.

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Facilitator Top 10 Tips:

1. Greet participants when

they enter the room.

2. Acknowledge suggestions.

3. Use names of participants

as often as possible.

4. Watch out for your own

biases.

5. Avoid interrupting.

6. Allow the group to solve

problems.

7. Maintain eye contact.

8. Give positive

reinforcement.

9. Recognize sponsors.

10. Remember, this is their

show, not yours!

Facilitator Pitfalls:

■ Not managing

monopolizers.

■ Talking down to the group.

■ Not finishing on time.

■ Telling a flat joke!

■ Using sexist language.
Start the Roundtable Dialogue

Welcome Everyone

■ Tell a joke or anecdotal story.

■ Brief group members on the purpose and objectives of the dialogue.

■ Acknowledge individuals who planned the dialogue.

■ Give recognition to sponsors and underwriters.

■ Review housekeeping information, including location of rest rooms

smoking areas, time for lunch, and ending time of dialogue.

Introductions

The facilitator should start the introductions so that participants will feel

comfortable with him/her and serve as a model for others when it is their turn

to introduce themselves.

Information requested may include whether the person is a consumer, 

family member or provider, job title or employment, advocacy affiliation,

whether they are a parent, or grandparent, and where they live, or other pertinent information.

Set time limits for participant introductions (three minutes each for a 20-

person dialogue).

Present Conduct Guidelines

The following guidelines should be observed:

■ Be considerate.

■ Be able to consider new ideas.

■ Avoid professional jargon.

■ Feel free to ask any questions.

■ Have fun!

Ask the group if they have any other guidelines to add.

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The facilitator may use an ice breaker such as: 

“Please tell us the most embarrassing thing that happened to

you this month,” or “Talk about what you like to do for fun,”

or “What is your favorite hobby?”
Set Agenda

Pre-selected topics or focus questions should be presented to dialogue participants for their approval or modification. The group should approve the focus

questions, make minor changes, but not alter them entirely.

■ Allow a limited amount of time for modifications.

■ Usually the initial topic is first-person stories and narratives.

■ Set approximate time frames for all topics.

■ Make sure to allow time for future planning and closing.

■ Set times for breaks and lunch, and ending time.

Maintain Flow of Conversation

While the dialogue group session is taking place, it is the job of the facilitator to maintain the flow of communication within the group. In order to do

this, the facilitator should use the following techniques:

■ Building/Crediting — Add to others’ ideas or suggestions. It can

include picking out from what everyone says and adding additional

clarification.

■ Encouraging — The facilitator should be friendly and responsive to

members and their contributions and make positive, genuine, reinforcing statements about participants’ input.

■ Harmonizing — Encourage people to explore their differences and

appreciate each other’s point of view.

■ Clarifying — Clarify vague statements, as well as offer facts or relevant information about issues being discussed. This technique can

include answering questions, interpreting or reflecting ideas and suggestions, or giving and seeking information to clear up confusion. At

the same time, the facilitator should avoid interrupting or speaking too

long. Interruptions may be necessary only when a person has talked

too long or has strayed from the subject.

■ Summarizing — Summarize statements made by members of the

group. These summaries generally recap what has been said or covered; pull together ideas that are related, and identify areas of agreePARTICIPATORY DIALOGUES: A Guide to Organizing Interactive Discussions on Mental Health Issues among Consumers, Providers, and Family Members

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Energy levels are lowest after lunch. Keep lunch light 

to avoid afternoon drowsiness. Start the afternoon 

session with something stimulating.
ment. A summary can also restate suggestions after the group has discussed them.

■ Motivating — The facilitator is expected to keep the discussion

process flowing. If the group becomes stagnant, he/she can change the

direction of the dialogue, suggest a break, or ask the group where it

wants to go next. The facilitator can also introduce a new topic. It may

be necessary to restate the goal or purpose of the discussion session. If

the group reaches a consensus, acknowledge it, and move forward.

Deal with Conflict

As group members interact, it is likely that their perspectives will clash or

contradict. This contradiction can create conflict within the group session. It

is the job of the facilitator to evaluate this conflict and determine if any intervention is necessary.

When assessing conflict, the facilitator should consider these key points:

■ Allow a reasonable amount of subject-related conflict. Such conflict is

healthy for the group.

■ Encourage the group to thoroughly weigh, explore and examine topics

and issues, including conflict.

■ Do not retreat from tension-filled situations.

■ Minimize conflict among members on unrelated topics.

■ Keep the group focused on ideas, not personalities.

■ Remain neutral during disagreements. Avoid taking sides.

■ Avoid being heavy-handed or too controlling.

Note

Recognize that controversy can spark creativity, promote growth, and build

allies. Do not feel compelled to discourage or stop conflict immediately.

Remember that feelings, emotions and conflict are legitimate factors in 

the dialogue process. It is important for the facilitator to recognize this from

the start.

Stick to the Agenda

Stick to the planned agenda as much as possible. When you see that participants are ready to move on, go to the next agenda item. Sometimes the dialogue will take on a life of its own, but the facilitator should remind the group

that there are topics still to be discussed.

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Future Plans and Strategies

The last portion of the dialogue should be used for creating strategies and initiatives and making future plans:

■ Take all suggestions and place on the flip charts.

■ Allocate at least one hour for strategizing.

■ End with a challenge.

■ Ask everyone to commit to a task.

■ Prioritize suggestions.

■ Write participants’ suggestions on the flip chart.

■ Make plans for reconvening if the group decides to do so.

Record the Dialogue

Designate a person to record minutes of the dialogue which later become the

summary report and/or documentation of the meeting. It is important that the

draft of the report be read and approved by all of the participants before being

put into final form. When recording:

■ Respect confidentiality when taking notes.

■ Do not tag responses with participants’ names.

■ Do not feel compelled to note everything.

■ Be concise, brief, and summarize.

■ If a consensus is reached on a topic or suggestion, record the item.

Conclude the Dialogue

The Round Robin is the final portion of the Roundtable Dialogue. Allow an

hour at the end of the dialogue for last-minute comments, suggestions and

expressions. Instruct each person to take a turn around the group to provide

input, but make sure to state that people can pass.

Timekeeping is particularly important during Round Robin. First determine

the total amount of time remaining in the dialogue. Then divide that time by

the number of participants so that each person receives an equal amount of

time. A timekeeper will keep close tabs on each person.

After the Round Robin, show appreciation for everyone’s participation. The

closing remarks are sometimes very personal and reinforce connections

between people, making the day a memorable one. 

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This section describes the particular steps that need to be added to organize a

Conference Dialogue.

Selecting Participants

■ Approximately 50–150 people.

■ Use the same criteria as for a Roundtable to select participants.

■ Ask mental health agencies to select participants after receiving a letter and brochure that includes the number of slots allotted.

■ Send individual family members, consumers, and advocates separate

invitations.

■ Invite public officials and dignitaries.

Note

VIP guests should be full participants but may not be able to stay for the entire

conference.

Planning

■ Planning takes at least four months.

■ The core planning group may add special subcommittees for tasks.

■ Early in the planning stages inform mental health constituents about

the conference for their information and involvement in planning.

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Conference Dialogue Conference Dialogue

Dialogue as Training

Day (Inservice):

Make sure to inform mental

health agencies well in

advance of the dialogue to

ensure their cooperation and

participation in giving

employees a day for

“inservice” training.

A Conference Dialogue may be scheduled for two days.
Send Letter and Brochure

Two months before the Conference, send the first letter of invitation to mental health agencies, organizations, and individuals. The letter should be written on agency stationery and signed by the executive director.

The letter assigns a specific number of registration openings for each agency

proportionate to its size. Request that mental health consumers be included,

as well as persons with different cultural backgrounds and other diversities.

The Brochure

A brochure should be enclosed in a second letter to be sent to all invitees one

month before the Conference. The brochure should include all of the factual

material. It may include art work and illustrations that are appropriate to the

theme of the conference.

Include a registration form in the brochure that will be returned in order to

pre-register all participants. For expediency, agencies may fax or e-mail back

the names and titles of the participants. Individuals can mail their registration

forms or could also fax or e-mail them. When all names are in, compile in categories in order to prepare the dialogue sessions in advance. (Please note that

advance preparation of the dialogue sessions is optional).

For an example brochure, see “Attachments.”

Using Speakers

A Conference Dialogue includes a keynote speaker and two sets of panelists

(for a one-day conference). A keynote speaker talks for no more than 30 minutes, panelists are given 15 minutes each for a panel of four.

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Proof the brochure carefully! Don’t forget the phone number,

e-mail and fax number. Believe it or not, there have been

brochures entirely without a phone number, and some with

the wrong number, or the date and time have been wrong.

Brochure Should

Include:

■ Title and theme

■ Date, time and location

■ Purpose/philosophy

■ Information about the

conference

■ Goals and objectives

■ Cost, if any

■ Conference coordinators

and guest speakers

■ Conference agenda

■ Who will attend

■ Registration form

■ Sponsors and funding

agents

■ Names of planning

committee

■ Phone contact for

additional information
Steer away from long introductions and formal recognitions that distinguish

speakers from other participants in the audience Treat all participants as equals.

Preparing the Small Group 

Dialogues (Optional)

Allow two hours to organize the small group dialogues. This can be accomplished by a small sub-committee. The committee members must be familiar

with the local mental health community professionals and consumers in order

to pre-set the small groups.

Assign approximately 20–25 (preferably 20) participants to each group. More

than 20 individuals is difficult to manage, however you need to allow for people who leave or do not appear. It is essential to know, in advance, how many

breakout rooms are available in order to determine the size of the groups.

Gather all of the names of pre-registered participants. Although there will be

people who do not register in advance, it is essential to know most of the

attendees’ names and affiliations in order to create a balanced group of participants for the dialogue sessions.

Sort participants’ names and arrange them according to status, providers,

administrators, family members, therapists, psychiatrists, etc. Be sure to

include people at all levels of work experience, i.e., front line staff, volunteers, etc. Ideal groups include diverse participants who have different perspectives on mental health issues.

Designate a different color or symbol for each group. A designated symbol or color is attached to the participants’ name tag the day of the dialogue.

Participants will be given instructions on the location of their group session

corresponding to the symbol or color.

Make a plan for the break-out groups. It is recommended that people stay

with the same group for each dialogue session.

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It is important to know the total projected number of

participants in order to set up the dialogue sessions. Be sure to

calculate extra spaces in each group for persons who register at

the door.
Choosing Facilitators

A facilitator and co-facilitator should be selected for each small group

dialogue.

Ask the panelists to serve as facilitators of the small group dialogues in order

to provide continuity and expansion of ideas that were presented. Panelists

generally have the necessary skills, but be sure to offer them the facilitator

guidelines.

Persons chosen to be co-facilitators should include a mixture of consumers,

professionals, and family members.

Guidelines for facilitators should be developed and enclosed in their packets.

It is desirable to offer facilitator training prior to the Conference Dialogue.

Skills should include active listening, dealing with conflict, redirecting, and

leading the group toward consensus. Role playing situations can be helpful.

The Day of the Conference 

Dialogue

Registration

Registration materials, cash drawer (if applicable), name tags, participant

packets, etc. should be assembled, and ready for distribution at the earliest

registration time. Allow at least one half hour for registration prior to opening ceremonies.

Registrars should be well informed in order to answer questions.

Assign one registrar for persons who come to the conference without preregistering.

Serve refreshments during time of registration in an area that will not interfere with the conference. Make sure to establish a cut off time.

Welcoming Remarks

The conference coordinator should welcome all participants, state the theme

of the dialogue, review participant guidelines, and set the agenda for the day.

The coordinator usually introduces the keynote speaker.

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Documentation

Be sure to make a plan to

document the conference

with a report, photographs,

and/or videotape. When

designating the writer,

videographer or

photographer, it is preferable

to use professionals or

persons who have skills and

experience. Documentations

can be circulated to

participants and other parties

who wish to replicate the

effort. Note that release

forms are necessary for

persons photographed or

videotaped. Finally, if you use

a professional documenter,

he/she will charge a fee,

which will need to be

included in your budget.
Keynote Speaker

It is desirable that a consumer be the keynote speaker whenever possible, either

an out-of-town guest, or a recognized individual from the local community.

First Panel

The first panel takes place after the keynote speaker.

Typically the first panel includes first person narratives and stories from the

perspective of consumers, family members, and providers. All panelists must

be given careful time limits (10 to15 minutes each for a panel of four). It is

essential that the panel not exceed an hour in order for the dialogue sessions

to have enough time.

First Dialogue Session

All participants go to their assigned room. The facilitators start the group with

first name introductions and present the subject matter which relates to what

was discussed by the first panel. The small group dialogue is conducted in the

same manner as a Roundtable Dialogue. However, discussion will be limited

by time constraints, therefore limiting the scope of discussion.

Flip charts should be used to place suggestions and other feedback. At the 

end of the session, one of the facilitators will be responsible for 

transcribing flip chart information to a report sheet which is given to the

conference coordinator.

Lunch

Time allotted for lunch should be long enough to allow time for networking.

An art exhibit and/or book display table would add another dimension to 

the conference. It may even be desirable to have entertainment presented by

local consumers.

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Pay consumers a stipend for work whenever possible.

Get media coverage for the event. Having connections 

with newspaper writers, television newscasters, or radio

announcers helps.
Second Panel and Dialogue Session

Timing is important. The conference coordinator should pull everyone together for the second panel discussion. The second panel usually focuses on problems, barriers, and solutions to current mental health issues.

Open Mike

The Open Mike session for a Conference Dialogue is a final feedback session

conducted with the entire group.

A pre-appointed emcee moves about the audience with a microphone and

encourages people to get involved. A good emcee will know how to encourage people to come up and speak in front of an audience.

Participants should be told they only have one-to-two minutes to speak. The

emcee will inspire the audience to express themselves spontaneously with comments ranging from serious to humorous. Subject matter could include thoughts

about the conference, suggestions, personal anecdotes, jokes, poetry, songs, etc.

It is always nice to end Open Mike with an inspirational thought or song.

Ending the Conference

End the Conference Dialogue with an expression of appreciation and final

acknowledgments.

Collect evaluation forms. In Palm Beach County, Pioneer Dialogue, 1999, the

coordinator announced at different times during the day, “We have certificates of attendance for everyone to receive, but you will only receive one if

you fill out the evaluation form.” Everyone did.

Certificates of attendance are a nice reward and can be given out as participants leave the conference.

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Document the conference. The document can later be

circulated to the participants as well as people in other parts

of the country who may want to replicate the effort.

Involving university mental health research departments can

be helpful in providing technical assistance.
Sample Brochure for Conference

Dialogue

This sample is of a tri-fold brochure printed on two sides.

front side

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Attachments Attachments 
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back side
Sample Evaluation for Conference

Dialogue

This sample is of a one-page evaluation, printed on one side.

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Sample Agenda for Conference

Dialogue

This sample is of a one-page agenda, printed on one side.

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One way to measure the success of dialogues is to note

what happens afterward. A good dialogue is one that

results in concrete plans for the future, incorporating the

suggestions received from the dialogue participants. All

of the suggestions should be reviewed and prioritized in

order to develop action plans. Each community’s needs

are different. Recommendations may include requests

for more dialogues on special issues or with different

groups, or plans for new program development.

SOME RESULTS FROM PILOT DIALOGUES

In Pittsburgh, participants’ suggestions included plans to

hold all-day dialogues in ten other counties in Western

Pennsylvania, as well as follow-up dialogues on topics

such as managed care. Participants at the 1998 Dialogue

requested that family members be invited to future dialogues, as well as a broader group of consumers. Other

goals focused on the need for consumer sensitivity training in professional educational programs, particularly

for medical residents. It was suggested that consumerrun drop-in centers be used for visitation and on-the-job

training. It was also recommended that a set of “best

practices”, describing quality programs and consumer

groups be catalogued for professional use. A written

report of their first dialogue was sent to major stakeholders in their county system. Proposed plans will be

implemented in the next year. In the meantime, people

still talk about the dialogue they attended.

Palm Beach County made plans for dialogues and trainings (some of them related to legislative issues) as a

result of their conference dialogue. Letter writing campaigns were underway during an election year and a

training session was held for consumers to inform them

about candidate’s issues and ways to respond. It was

decided that “Pioneer Dialogue” would become an annual conference each year to focus on a different aspect of

their mental health system. Other recommendations

included the need for increased consumer involvement in

district planning and enhancement of their drop-in center,

“Peer Place.” Participants who attended Pioneer

Dialogue from nearby districts took an interest in the

conference, and are making plans to organize their own.

At the national level, dialogues are being held between

consumers and different professional groups, i.e., psychologists and nurses. A dialogue with children is being

considered, with special regard for confidentiality

issues. This Manual is one of the outcomes from a recommendation made at the 1997 dialogue between psychiatrists and consumers. Other recommendations were

to establish possibilities for more communication and

shared endeavors between psychiatrists and consumers,

to replicate dialogues at the state and federal level, and

to improve access for consumers in different parts of

government and managed care. Some of these issues are

being worked on and are at various stages of readiness.

As one participant at the national dialogue said:

“Success is a journey, not a destination.”

WHAT ABOUT PARTNERSHIPS?

One of the goals for dialogues is for partnerships to be

created between diverse groups to develop and conduct

dialogues. The question is whether partnerships after the

dialogue are sustaining.

Depending on what is meant by partnerships, too high

expectations may not be realistic. Differences that existed prior to the dialogue do not automatically disappear.

People’s attitudes will hopefully shift to some degree,

but it must be considered that persons with different

perspectives usually have different work and life experiences. Consumers who are developing new self-run

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Appendix A

What Happens After the Dialogue? What Happens After the Dialogue?
programs rely more on life experience than professional

degrees. Providers, on the other hand, are required to

hold licenses that dictate mode of treatment which limits flexibility. Both groups have certain vulnerabilities.

While professional providers are concerned with risk

factors and liabilities, consumers worry about being coopted into adapting to medical model practices.

Positive partnerships then, might be defined as learning

partnerships in which both groups agree to continue the

dialogue and plan activities that are mutually beneficial.

This may include working on strategies to follow up on

recommendations or training on subjects that are helpful

to both groups. Informal gatherings that bring people

together socially will also help to break down barriers.

Full partnerships will occur because people want them to

and when they are ready. Full partnerships are like any

other relationship. They are chosen. They are trusting.

They treat each other as equals. In the mental health

arena, this will take time and work. Dialogues are a good

way to start the process.

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INTERNET DIALOGUES

Computer-mediated communication is a new dialogue

technology. Electronic mail — e-mail — is less formal

than usual written exchanges and less textured than inperson dialogue. E-mail is forgiving of punctuation and

spelling errors and typos. E-mail is intolerant of affectation and tends to ignore pedigree. E-mail substitutes for

nonverbal communication, not usually with literary

expression of mood and affect, but more often with

icons: for instance :) for smile, or <grin>. Those who

like to use voice and presence and non-verbals to communicate are not always comfortable.

Computer-mediated communication generally takes

place on a neutral and level field. Feedback is quick;

gratification is frequent. People Who have-not can use

free e-mail from their public library on equal footing

with e-mail from a mental health program director. Rural

areas without even cheap local phone service can 

use wireless, satellite links and Web TV. Third world

countries, newly wired, are installing state-of-the-art

infrastructures.

People Who experience mood swings, fear, voices and

visions (People Who) have found each other on the

Internet through news groups, Web pages, and mailing

lists. They have found support, mutuality, and advocacy

for system change. They have found relief from the loneliness associated with seeming different, cutting edge

medical information, and quick error correction of bad

data. They have found a range of views about psychiatric

disabilities, from iatrogenic to disease.

People Who have also found the mental health professionals online. There are a large number of professionally oriented mailing lists — for instance about forensics,

psychopharmacology, managed care, outcomes; some

welcome People Who as a valued resource, some open

the lists only to professionals.

Exchange with a mental health professional by e-mail

has a different tone from in-person exchange. The territory is neutral — one's own computer screen rather than

a therapist's private office or a mental health director's

conference room. The Person Who can take whatever

space and time is needed to express a point of view, can

set the context of the response by excerpting from a

previous message, can readily provide supporting ideas

and evidence that the professional might not have considered. Those in conversation are not limited by having

to share a fixed amount of time, are not limited by having to stay focused on the topic, are not limited by the

inherent power imbalance between professional and

Person Who.

People Who dialogue with peers about work opportunities, and advocacy and rights issues, and about managing the situations that earned them a psychiatric label.

People Who dialogue with professionals about advocacy

and rights issues, especially forced treatment; and about

DSM diagnoses, prognoses, and psychotropic medications, and especially new treatments.

People Who read news groups like alt.society.mentalhealth, sci.med.psychobiology, alt.support.depression,

alt.support.anxiety-panic, alt.support.loneliness, and

soc.support.depression.family. Moderated news group

discussions stay focused. Many unmoderated people like

to post to unmoderated news groups, and opinions are

apt to be polarized.

People Who visit the many mental health information

Web sites. Generally this is a one way exchange — the

visitor reads what is provided, perhaps makes a

comment to the Web master. Some Web sites provide

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Appendix B

Other Dialogues Other Dialogues
chats and have some interaction. Some Web sites are

actually run on bulletin board software and have more

interactivity.

People Who use Internet Relay Chat and other chat software and situations to join in synchronous exchanges

with each other and with professionals.

Managed care companies and public health providers are

beginning to use modem technology to provide patient

management and support.

And then there are lists. There are lists for moods —

Walkers (melancholy), Pendulum (mood swings); for

voices and visions — Schizoph; for advocacy — ActMad; for safe support — ClubMad; for spirituality —

MadSpirit; for working as a consumer mental health professional — TwoHats; for state-specific issues —

MHCONSUMERS-OR. The exchanges are international, asynchronous, and vigorous. Some lists generate

upwards of 100 e-mail messages a day. Content varies

from humor, to dismay about psychiatric labels and public images, to reviews of newly released DSM's, to

newspaper articles. Some participants post a reply to

almost every message they read; some only read.

Internet lists help to realize the slogan of the South

African anti-Apartheid movement: "Nothing about me

without me."

The MADNESS list states, "We bear witness each to our

own experience with madness, to how we have been

treated, and to the social consequences we have felt. We

bear witness to the common vision and aspirations 

of People Who experience mood swings, fear, voices 

and visions.”

Lists are effective organizing tools. SAMHSA/Center

for Mental Health Service organized a Walk the Walk:

With Lives Touched by Mental Illness in May 1998. A

hundred Internet users planned ways to participate on a

list devoted to the Walk. Australia and Canada planned

parallel events, as did some other United States cities.

Posters and symbols were devised and posted on the

Web, the message People Who desired to communicate

was hotly debated and finally agreed, and press releases

were drafted and distributed. Now it seems there is 

new momentum among those consumer/survivors wanting to make improvements especially in public mental

health systems.

People Who are politically active have found 

support for resistance to involuntary treatment and

resistance to unconsented electro-shock, as well as

encouragement for Advance Directives, support for

including independent grievance procedures in managed 

care contracts.

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In 1992, the New York State Office of Mental Health

(OMH) began an innovative project which brought

together nine consumers/survivors/ex-patients (c/s/x)

with seven psychiatrists for a series of structured

dialogues about the concept of recovery. During a twoyear period, this group met on five different occasions,

four of which were videotaped. Two training videotapes were produced using footage from the first two

dialogue meetings.

The goal of the project was to create shared understandings between the two groups about the process of recovery from a diagnosis of "mental illness," resulting in recommendations for the public mental health system on

how these understandings could be used to promote

recovery. There was a sense that the consumer/survivor/ex-patient movement had valuable experiential

knowledge on this issue that wasn't being adequately

heard by clinicians and administrators, and the dialogues

were seen as a tool to build consensus on the importance

of system reform. 

On the face of it, the dialogue process seems like an

ideal way to bring together two groups of people with

disparate positions in order to converse on difficult topics. As envisioned by the project organizers, dialogues

bring "groups together as equals and provide a structured opportunity for people to explore and reflect on

their own experience and their own belief systems.. . .

They allow the integration of diverse perspectives,

resulting in a more complex understanding . . . [and]

result in a shared vision rather than a vision imposed

from the outside."

The dialogue process was painstakingly planned to

reduce barriers to communication due to power imbalances between psychiatrists and c/s/x. For example, the

c/s/x outnumbered the psychiatrists, and the particular

c/s/x participants were selected because they were seen

as strong, articulate individuals who would not be easily

intimidated. Skilled, neutral facilitators used a carefully

sequenced series of focus questions to guide the discussion. People used first names, not titles; we were seated

in the round and the two groups were interspersed; informal time for socializing was built into the schedule.

Over the course of the five meetings, we covered a wide

variety of sometimes controversial topics in a fairly collegial manner. After an initial period of polite tenseness,

we were able to speak frankly and freely among ourselves. As we got to know the psychiatrists as individuals, some of the distance created by our very different

statuses were narrowed. While much of what the c/s/x

had to say about our treatment in the system was difficult for the psychiatrists to hear and acknowledge, many

of them clearly struggled to understand views that were

foreign to them. There was a shared sense that what we

were doing was important and valuable. And, yet.

And yet something really didn't feel quite right. While

the experience of speaking truth to power was liberating

at first, I felt a surprising undercurrent of unease and

even resentment associated with the process. Naturally,

as a good ex-patient, I blamed myself: somehow, I wasn't feeling the "right" emotions in this process. Here I

was with a group of my peers, having the opportunity to

explain our views to people who could have an impact,

and instead of feeling pleased and excited, I felt very

uncomfortable.

During a break, I learned that I wasn't the only c/s/x in

the group feeling ill at ease. As we talked among ourselves, several themes emerged that seemed connected

to our ambivalent reactions. First, there was a sense that

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Appendix C

The Recovery Dialogues The Recovery Dialogues

A Personal Reflection and a Cautionary Note
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we were putting out a tremendous amount of emotional

energy, talking about difficult personal experiences in

the hope of making important points about what was

wrong with the mental health system and what would be

preferable. Our emotional efforts (and the resulting vulnerability we felt) were not being reciprocated by the

psychiatrists. Despite all the steps taken to reduce the

power imbalances and to create a level playing field, the

process did not feel "equal."

There was a feeling that, while we were finally being listened to, it wasn't really in the spirit of mutuality. Rather,

we were being used as teaching tools for the professionals, and in the end, they got much more benefit from the

experience than we did. While we spoke from the heart

about experiences that had defined our lives and our

sense of ourselves, they were still able to listen from

their "doctor" roles. They learned some new ideas,

rejected others that made them uneasy, and went away

with their professional roles intact. We, on the other

hand, felt emotionally spent, slightly patronized, and

decidedly unfulfilled by the experience.

For me, the emotional strain of the process reached a

crescendo at what turned out to the last structured dialogue between the two groups. During the discussions, it

came out that all eight of the c/s/x’s around the table that

day were trauma survivors. This was a startling revelation to the c/s/x, as we had never discussed this among

ourselves, and we were eager to pursue the subject in the

context of discussing recovery. The psychiatrists, to a

person, almost immediately shut down, and the discussion was quickly steered to a less threatening topic. At

that moment, it finally became crystal clear to me that

this was not a process of exploring beliefs and experiences in search of a shared vision. Even in this structured

process which worked so hard to be egalitarian, the psychiatrists continued to define reality for us. It brought

back all those old feelings of being subordinated, of having one's life discounted, of being seen as "less than." It

didn't feel equal, it didn't feel like progress, and it sure as

hell didn't feel safe.

In February 1998, more than four years after our last

meeting with the psychiatrists, eight of the original 

nine c/s/x came together again to talk about trauma

issues. This time, we did not invite the psychiatrists. 

We came together to have a dialogue among ourselves, to

learn from each other, and to share our experiential

knowledge in a safe place. It felt remarkably productive,

and we came away with consensus on a number of steps

that could be taken to make the mental health system less

re-traumatizing for people, as well as hours of videotape

with which to make training tapes from our perspectives.

If I learned one important thing during this long, multistage process called the Recovery Dialogues, it is this:

Communication is only possible between equals.
Collaborate — To work with others. In area of mental

health, collaboration may refer to interaction

between mental health consumers, families and professionals in order to effect change.

Dialogue — A dialogue is a forum in which two or more

groups are brought together as equals to explore

their differing views, experiences, and belief systems. A dialogue is structured to allow for self

exploration of one's own behavior and attitudes as

well as to listen to other people explore their own.

Empowerment — "Becoming connected and integrated

into a community that is mutually respectful and

being able to fully participate in the decisions affecting your life” (Fisher). "When people are transformed from their roles as passive objects to historical self-reflective subjects capable of acting to

transform their own conditions” (Rose and Black).

Facilitator — Conductor of a meeting who remains

neutral and respectful of all participants. Maintains

power balance in the group, ensures that all

participants have an equal opportunity to speak 

and keeps the group focused and within established

time frames. Sets guidelines for all participants to

follow. Recognizes when the group reaches consensus on issues.

Focus Group — An interview style of collecting data

designed for small groups. Researchers strive to

learn through discussion about conscious, semiconscious, and unconscious psychological and sociological characteristics and processes among various

groups. It is an attempt to learn about the biographies and life structures of group participants. To be

more specific, focus group interviews are either

guided or unguided discussions addressing a particular topic of interest or relevance to the group and

the researchers.

Moderator — A person who presides over a discussion

or meeting differentiated from a facilitator who

remains neutral. A moderator may be much more

directive and involved in a meeting.

Paradigm — A word used often in current research to

define a shift in values, thinking, or ways of conducting treatment. Treatment of mental illness used

to be thought of as long-term and non-reversible.

People would never get better. Today thinking has

changed to include the possibility that full recovery

may take place. This is one example of a paradigm

shift.

Participatory — Means that all who wish to can make

a difference through their participation. The difference can be positive or neutral but not negative. No

one need fear that their participation will harm others. Each person's contribution will either contribute

to the group's potential for increased learning or it

will result in not much difference in whether the

group moves forward or stays at the same place.

Participatory Action Research — Defined as a study

in which people being studied participate actively

with the professional researcher throughout the

research process, from the initial design to the final

presentation of the results and discussion of their

action implications. (E. Sally Rogers)

Recovery — Is best understood as a process, not an outcome. A key element in recovery is the presence of

people who offer hope, understanding, and support;

who encourage self-determination; and who promote self-actualization. (Frese and Davis)

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Appendix D

Glossary of Terms Glossary of Terms
Self-help — Self-help groups include people who 

have a common bond, and who voluntarily come

together to share experiences, reach out and learn

from each other in a trusting, supportive and open

environment. The common bond is defined as both

a) the collective experience related to being

diagnosed as having a mental illness and receiving

services from the mental health system and b) the

individual experience(s) associated with having

survived the process. Self help is based on the principle of helping both one's self and others at the

same time.

Transformation — A complete change as of appearance or personality.

Working Group — Similar to focus group in regards

to size and makeup of group, however, a working

group has an action agenda and may include formulation of policies and development of tasks 

to accomplish.

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At first glance there appeared to be very little literature

on the subject of dialogues. Manuals and books are written about focus groups and how to do them. Articles on

Participatory Action Research talk about the need for

dialogue. There are many articles written about self-help

and empowerment, including research studies using

focus groups as the means to collect data. 

What began as a frustrating task became enjoyable as

people around the nation responded to my request on the

Internet. Many people shared information with me by email as well as sending me names of individuals to contact. The library also became a great resource when the

words "Communication Building," "Community

Dialogues," "Participatory Action," and other terms were

used to find related materials. Suddenly, a picture began

to emerge of what should be read in order to develop and

create a dialogue. There were many examples of dialogues. I suspected I only began to scratch the surface.

Particularly exciting were examples of dialogues, town

meetings, study circles, etc., held not only in this country,

but in other countries as well. In many cases, these dialogues served to create better communication between

disadvantaged groups and under-served populations.

The Experience of Stigma and Dis-empowerment —

It became clear that it is necessary to understand underlying principles and values guiding the consumer/survivor movement. Many articles on self-help, empowerment, and partnerships were reviewed. The ones chosen

for this research summary are ones I enjoyed the most,

because they are interesting and easy to read. Other articles are cited in a supplementary bibliography for additional insight and reference.

A good place to start is Priscilla Ridgway's, "The Voice

of Consumers in Mental Health Systems: A Call for

Change" (1988). Esso Leete's quote begins the narrative:

"I can talk, but I may not be heard. I can make suggestions, but they may not be taken seriously. I can voice my

thoughts, but they may be seen as delusions. I can recite

experiences, but they may be interpreted as fantasies. To

be a patient or even an ex-client is to be discounted."

Ridgway believes that the most important reason for

professionals discounting the consumer voice is the idea,

"that providers know best." She explores client selfdetermination in its raw beginnings, and reports that one

of the responses of the consumer movement to this

entrenched idea was to develop self-help alternatives,

and to focus on the importance of empowerment.

Reidy (1993) did a study on stigma in which 46 people

gave personal testimony about their own experiences

with stigma, including ones involving employment,

including employment in the mental health system.

Empowerment and Self-help Alternatives —

Chamberlin (1997) defines empowerment in a research

project in which 12 consumers, who are also service

providers, agreed on 15 statements, in which they

attempted to describe the qualities of empowerment. The

statements show that empowerment is a complex

process, not an event, in which the power to make decisions, and to have choices from a range of options, are

the most important elements. Self-help alternatives and

consumer-provided mental health services provide the

most favorable situation for these elements to exist.

Zinman, Harp, and Budd (1997) describe these in selfhelp efforts among consumers. Knight and Carpinello

(1991) also found these same important elements in a

qualitative study of the perceptions of self-help group

processes and outcomes.

The Need for Consumer Involvement in Research —

Anyone interested in knowing more about consumer 

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Appendix E

Literature Summary Literature Summary
mental health research will want to read the works of Jean

Campbell. She has written extensively on the subject and

was largely responsible for a Quality of Life Study by

The Well Being Project, California (1989). The study was

conducted by consumers for consumers and asked questions previously not asked. It was the feeling of 56% of

mental health consumers that mental health professionals

do not really listen to them, and 47% of the participants

stated they avoided mental health services for fear of

involuntary commitment. Jonikas and Bamberger (1998)

also found important differences in women's perceptions

of their own needs, compared to professionals.

Campbell, Ralph, and Glover (1993) presented the subject of consumer/survivor involvement in research at the

Fourth Annual National Conference on State Mental

Health Agency Services Research and Program

Evaluation. Campbell reviewed the history of consumer/survivor involvement in research, and Glover

reported that 36 of 50 states fund consumer-operated

services, suggesting there is enough consumer leadership to support full integration into research projects.

Ralph provides an interesting summary of research models in which consumers are either lab rats (passive

objects) at one extreme, or independent researchers at

the other end, planning and writing grants, collecting

data, and analyzing and interpreting results. 

In an article "Behavioral Healthcare Tomorrow"

(May/June 1995) Campbell and Johnson talk about

beliefs and attitudes viewed differently by consumers

and professionals. Discussed is the need for research

partnerships. The original Pioneer Dialogues is mentioned as having brought consumers and state mental

health administrators together to discuss system reform

(1994).They state in the conclusion of the article, "Now

is a rare moment, a clearing horizon of historic opportunity for individuals and communities to enter into dialogue about values and goals and to proceed thoughtfully into all areas where health quality and consumer

choice are assured and policy decisions are made.”

Dialogues: Developing the Potential for Partnership

between consumers and Professionals — Since about

1990, there has been growing interest in the use of dialogues as a way to bridge the differences between consumers and professionals, or consumers and providers.

Also, many writers, including Deegan (1991), Johnson

(1996), Frese (1997), and others have published important work recommending training of professionals to

increase sensitivity to, and partnership with, consumers.

Caras (1995) states the potential of the information

superhighway in the Internet Report at HSRI. She discusses the Internet as a means for dialogue between people and groups who "experience mood swings, fear,

voices, and visions." Caras summarizes the value of

Internet discussion groups and dialogues in just 26

words: "Someone listens. Usually someone replies. I

hear. When I'm heard, I feel appreciated. I feel worthy. I

feel understood. I feel respected. I feel affirmed."

Dialogues: the Practice and the Results — The early

Roundtable discussions and dialogues were often on the

issue of involuntary treatment. The participants were

able to come to surprising levels of consensus, given the

initial differences in perspective. Dialogues documented

between consumers and providers, state commissioners,

and psychiatrists, all seemed to have been quite successful in raising consciousness, influencing some changes

in policies, and establishing the value of true collaboration among the participants.

Much of the literature on conducting focus groups is

useful to help teach people how to do dialogues. Also,

Knight (1998) provides some guidelines for developing

dialogues which stress the importance of participant

selection, and other specifics of organizing a quality dialogue. Bluebird (1992) outlines steps for replication in

the Pioneer Dialogue Recipe.

Bassman (1989) writes an article describing dialogues in

which he makes the plea to psychologists and other professionals "to come forward, to blast open the doors to

legitimate inquiry, to separate control and management

from treatment services, to question all the so-called truths

about mental illness, and to stand up for people's rights."

In summary, the published literature is a rich source of

materials to enrich planners' understanding of power

dynamics and how to overcome them in the conduct of

dialogues. Those briefly mentioned above, and others,

suggested that all meetings for planning and conducting

dialogues must operate in a way that is sensitive to the

stigma and dis-empowerment that may be felt by the

consumer participants. Care must be taken to ensure an

atmosphere of safety to express conflicting perspectives.

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Bassman, R. (1989). “The Mental Health System:

Experiences from Both Sides of the Locked Doors.”

Professional Psychology-Research and Practice,

Vol. 5 Foc 28, No.3. New York State Office of

Mental Health.

Blanch, A., Fisher, D., Tucker, W., and Chassman, J.

(1993). “Consumer Practitioners and Psychiatrists

Share Insights About Recovery and Coping.”

Disability Studies Quarterly, 13 (2), 17–20.

Bluebird, G. (1992). “The Story of Pioneer Dialogue.” (a

report).

Brown, Cherie R., and Mazza, George J. (1997).

“Healing Into Action: A Leadership Guide for

Creating Diverse Communities.” Washington, D.C.,

National Coalition Building Institute, (a manual).

Campbell, J. (1992). “The Well-Being Project Mental

Health Clients Speak for Themselves.” In Third

Annual Conference Proceedings in State Mental

Health Agency Research, Alexandria, VA: National

Association for State Mental Health Program

Directors Research Institute.

Campbell, J. (Fall,1996). “Toward Collaborative Mental

Health Outcomes Systems.” New Directions for

Mental Health Services, No. 71, Jossey-Bass

Publishers, 69–76. 

Campbell, J., and Johnson, J. (1995). “Struggling to

Reach Common Ground.” Behavioral Healthcare

Tomorrow, 4 (3), 40, 45–46.

Carr, W., and Kemmis, S. (1983). Becoming Critical:

Knowledge Through Action Research. Victoria,

Australia: Deakin University Press.

Chamberlin, J. (1978). On Our Own: Patient-Controlled

Alternatives to the Mental Health System.

Hawthorne Books, NY.

Curtis, Laurie C., and Shore, Samuel E. (1997).

Managing Workplace Conflict: A skills training

workbook for mental health consumers and supervisors. National Research and Training Center on

Psychiatric Disability, University of Illinois at

Chicago, IL.

Chester, M. (1991). “Participatory Action Research with

Self-help Groups: An Alternative Paradigm for

Inquiry and Action.” American Journal of

Community Psychology, 19 (5), 757–768.

Doyle, M.,and Strauss, D. (1976). How to Make

Meetings Work. Jove Books, NY.

Fals-Borda, O. (1984). “Participatory Action Research.”

Development: Seeds of Change, 2, 18–20.

Fisher, R., Ury, W., and Bruce Patton of the Harvard

Negotiation Project (1991). Getting to Yes:

Negotiating Agreement Without Giving In. Second

Edition, Penguin Books, NY.

Fisher, B. Tucker & Chasman (1993). “Consumer

Practitioners and Psychiatrists Share Insights about

Recovery and Coping.” Disability Studies

Quarterly, 13:2.

Foner, J. “Leadership Exchange Listening.” A brochure

and leadership materials.

Jonikas, J.A., Bamberger, E. (1997). “Needs Assessment

Survey Project: Women Speaking for Themselves.”

(A report.) The National Research and Training

Center on Psychiatric Disability, Chicago, IL.

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Appendix F

Bibliography Bibliography
Jonikas, J A.., Solomon, M L., Cook, J A., and Kerouac,

J. (1998). Positive Partnerships: How Consumers

and Non-Consumers Can Work Together as Service

Providers. National Research and Training Center

on Psychiatric Disability, Chicago, IL.

Knight, E. (1992). “A Dialogue on Recovery: Tips 

for Structuring a Recipients Dialogue.” Report 

done for the office of Mental Health, New 

York State.

Knight, E., and Carpinello, S. (1991). “A Report of 

the Qualitative Study of the Perceptions of the

Meaning of Self-help.” Self-help Group Processes 

and Outcomes, Presentation at Consumer 

Advocacy Training Program, Batavia, NY,

November 21.

Loder, A., and Glover, R. (1992). New Frontiers:

Pioneer Dialogue Between Consumers/Survivors

and Commissioners. MHSIP Updates, Nov.

pp.13–14. 

Park, P., Brydon-Miller, M., Hall, B., and Jackson, T.

(1988). Voices of Change: Participatory Research in

the United States and Canada. Bergin & Garvey,

Westport, CN. London: UK.

Penny, Darby. “A Dialogue on Recovery: Tips for

Structuring a Recipient Dialogue.” Albany, 

NY: New York State Office of Mental Health,

undated brochure.

Reidy, D. (1993). “Stigma is Social Death, Mental

Health Consumers/Survivors Talk About Stigma in

Their Lives.” Education for Community Initiation,

February.

Ridgway, P. (1988). The Voice of Consumers in Mental

Health Systems: A Call for Change. South

Burlington, VT.: Center for Community Change

Through Housing and Support.

Rogers, E. S., and Palmer, V. (1994). “Participatory

Action Research: Implications for Research and

Evaluation in Psychiatric Rehabilitation.”

Psychosocial Rehabilitation Journal, October,

Vol.18, No.2

Shea, S., and Herold, N.H. (1995). “Evaluating Internet

Mental Health Applications: A Roundtable Report.”

The Evaluation Center @ HSRI. 

Susko, M. (Ed.), (1991). Cry of the Invisible: Writings

from the Homeless and Survivors of Psychiatric

Hospitals. Baltimore Conservatory Press.

Tyman, A.C. & Dryton (1984) “Conducting Focus

Groups: A Guide for First Time Users. “ In T.J.Hayes

and C.B. Tatum Focus Group Interviews — A Reader.

Zinman, S., Harp, H., and Budd, S. (1987). “Reaching

Across: Mental Health Clients Helping Each Other.”

Riverside: California Network of Mental Health

Clients, (a manual).

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Advisors to the project participated in a teleconference to review the outline of the dialogue in order to make suggestions

and recommendations. In addition, there were numerous phone calls, e-mails, and meetings with individuals in the group.

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Appendix G

Advisory Group Advisory Group

Gayle Bluebird

110 SW 8th Avenue

Fort Lauderdale, FL 33312

(954) 467-1431

Sally Clay

220 Moonglow Avenue

Lake Placid, FL 33852

(941) 465-8150

Fred Frese

283 Hartford Drive

Hudson, OH 44236

(216) 650-2864

fax: (216) 650-6748

Janet Foner

920 Brandt Avenue

New Cumberland, PA 17070

(717) 774-6465

Larry Fricks

Director of Consumer Relations

Georgia Division of Mental Health

2 Peachtree Street, Ste. 3-22

Atlanta, GA 30303

(404) 657-2172

fax: (404) 657-2187

Hikmah Gardiner

6517 N. Sixth Street

Philadelphia, PA 19126

(215) 844-2540

John Gates, Ph.D., Director

Director of Programs

Collaborative Center for Child

Well-Being

750 Commerce Drive, Suite 400

Decatur, GA 30030

(404) 592-1404

Ed Knight, Ph.D.

Colorado Health Network

201 N 8th Street, Ste. 380

Pueblo, CO 81003

1-800-804-5040

fax: (719) 583-7636

Barbara Lee, Ph.D.

Florida Mental Health Institute

The University of South Florida

13301 Bruce B. Downs Blvd.,

MHC6-238

Tampa, FL 33612-3899

(813) 974-4699

fax: (813) 974-4406

Warren Liang, M.D., Director

Psychiatric Residency 

The University of Cincinnati

P.O. Box 670559

Cincinnati, OH 45267-0559

(513) 558-5190 

fax: (513) 558-3477

Ann Marshall

Alabama Disabilities Advocacy

Program

P.O. Box 870395

Tuscaloosa, AL 35487-0395

(205) 348-4928

fax: (205) 348-3909

Jacki McKinney

5124 New Hall Street

Philadelphia, PA 19144

(215) 844-2540

Frederick L Newman, Ph.D.

Florida International University

North

145 NE 94th St.

Miami Shores, FL 33181

(305) 919-5802

Kenneth Thompson, M.D.,

Director

Institute for Public Health and

Psychiatry

Western Psychiatric Institute and

Clinic

3811 O'Hara Street

Pittsburgh, PA 15213 

(412) 383-9805

fax (412) 383-9843 
Bazelon Center for Mental Health Law

1101 15th Street, NW, Ste. 1212

Washington, D.C. 20005

phone: (202) 467-5730

fax: (202) 223-0409

www.bazelon.org

Carter Center Mental Health Program

One Copenhill

Atlanta, GA 30307

phone: (404) 420-5165

fax: (404) 420-5158

The Center for Community Changer, Institute for

Program Development

Trinity College of Vermont

208 Colchester Avenue

Burlington, VT 054011-1496

phone: (802) 658-0000

fax: (802) 863-6110

e-mail: cc@courage.trinityvt.edu

Consumer Organization and Networking Technical

Assistance Center (CONTAC)

1036 Quarrier Street

Charleston, WV 25301

phone: (888) 825-TECH (8324)

fax: (304) 346-9992

www.contac.org

Substance Abuse and Mental Health Services

Administration

Center for Mental Health Services

Knowledge Exchange Network, National Mental

Health Services

P.O. Box 42490

Washington, D.C. 20015

phone: 1-800-789-CMHS (2647)

fax: (301) 984-8796

tdd: (301) 443-9006

e-mail: ken@mentalhealth.org

www.mentalhealth.org

The Evaluation Center@HSRI

2336 Massachusetts Avenue

Cambridge, MA 02140

phone: (617) 876-0426

fax: (617) 492-7401

e-mail: tecenter@hsri.org

www.hsri.org

National Alliance for the Mentally Ill

2101 Wilson Boulevard, Ste. 302

Arlington, VA 22201

phone: (703) 524-7600 or 1-800-950-NAMI

fax: (703) 524-9094

www.nami.org

National Association of Protection and Advocacy

Systems 

900 2nd Street NE, Ste. 211

Washington, D.C. 20002

phone: (202) 408-9514

fax: (202) 408-9520

www.protectionandadvocacy.com

PARTICIPATORY DIALOGUES: A Guide to Organizing Interactive Discussions on Mental Health Issues among Consumers, Providers, and Family Members

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services

51

Appendix H

List of Resources List of Resources
National Depressive and Manic Depressive Association 

730 N Franklin, Ste. 501

Chicago, IL 60610

phone: (312) 642-0049 or 1-800-826-3632

fax: (312) 642-7243

www.ndmda.org

National Empowerment Center

599 Canal Street, 5 East

Lawrence, MA 01840

phone: 1-800-POWER2U

tty: (800) TTY-POWER

fax: (978) 681-6426

www.nec.org

National Mental Health Association 

1021 Prince Street

Alexandria, VA 22314-2971

phone: (703) 684-7722 or 1-800-969-NMHA

fax: (703) 684-5968

www.nmha.org

National Mental Health Consumers Self-help

Clearinghouse

1211 Chestnut Street, Ste. 1207

Philadelphia, PA 19107

phone: (215) 735-6082 or 1-800-553-4539

fax: (215) 636-6312

tdd: (215) 751-9655

www.mhselfhelp.org

National Research and Training Center on Psychiatric

Disability

104 S Michigan Avenue

Chicago, IL 60603

phone: (312) 422-8180

fax: (312) 422-0706

National Technical Assistance Center for State Mental

Health Planning

66 Canal Center Plaza, Ste. 302

Alexandria, VA 22314

phone: (730) 739-9333

fax: (703) 548-9517

www.nasmhpd.org/ntac

PARTICIPATORY DIALOGUES: A Guide to Organizing Interactive Discussions on Mental Health Issues among Consumers, Providers, and Family Members

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services

52
Consumer Information Series

Volume 3

SMA 00-3472

Printed 2000