CONSUMER/SURVIVOR-OPERATED

SELF-HELP PROGRAMS:

A Technical Report

A Retrospective Review of the 

Mental Health Consumer/Survivor Movement 

and 13 Federally Funded Consumer/Survivor-Operated 

Service Programs in the 1980s

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

CONSUMER/SURVIVOR-OPERATED

SELF-HELP PROGRAMS:

A Technical Report

A Retrospective Review of the 

Mental Health Consumer/Survivor Movement 

and 13 Federally Funded Consumer/Survivor-Operated 

Service Programs in the 1980s
ACKNOWLEDGMENTS

This publication was developed for the Substance Abuse and Mental Health

Services Administration (SAMHSA), Center for Mental Health Services

(CMHS) by Laura Van Tosh and Paolo del Vecchio under contract number

92MF059138. Significant contributors at CMHS included CMHS Community

Support Program Chief Neal Brown and Government Project Officer

Jacqueline Parrish. In addition, Patricia Deegan, Deborah Dennis, Mike

Finkle, Howard Goldman, Susan Ridgely, and Phyllis Solomon provided contributions. Finally, acknowledgment is granted to the individuals and consumer/survivor organizations that participated in the grant project. Their pioneering efforts are a testament to consumer/survivor strength and ability.

Disclaimer 

The content of this publication does not necessarily reflect the views or policies of the

Center for Mental Health Services (CMHS),

Substance Abuse and Mental Health Services

Administration (SAMHSA), or the Department

of Health and Human Services.

Note on Language 

Emerging concepts in mental health require a

vocabulary that accommodates change. The

goal of this guide is language that is flexible

and accessible to the general public.

Public Domain Notice 

All material appearing in this report is in the

public domain and may be reproduced without

permission from SAMHSA. Citation of the

source is appreciated: 

Van Tosh, L. and del Vecchio, P. ConsumerOperatied Self-Help Programs: A Technical

Report. U.S. Center for Mental Health

Serfvcices, Rockville, MD. 2000.

Access to Publication 

This publication can be accessed electronically at: http://www.mentalhealth.org. For additional copies, call: CMHS Knowledge

Exchange Network, 1-800-789-2647.

Originating Office 

Office of External Liaison

Center for Mental Health Services

Substance Abuse and Mental Health

Services Administration

5600 Fishers Lane

Room 15-99

Rockville, MD 20857

Funding has been provided by the 

Center for Mental Health Services

Substance Abuse and Mental Health 

Services Administration

U.S. Department of Health and Human 

Services

February 2001

DHHS Publication No. (SMA) 01-3510
Page

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v

Chapter 1: The Consumer/Survivor Self-help Movement: 

A Literature-Based Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Chapter 2: Description of the 13 Demonstration Grant Projects . . . . . . . . . . . . . .21

Chapter 3: Cross-Site Findings and Recommendations . . . . . . . . . . . . . . . . . . . .73

Chapter 4: Overall Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85

Appendix A: Table of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services iii

TABLE OF CONTENTS
The mental health consumer/survivor self-help movement has experienced remarkable growth

over the last two decades. The impact of this movement on mental health systems nationwide has

been dramatic. No longer are people who use these services seen simply as passive recipients

but as active participants at all levels in planning, providing, and evaluating services.

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental

Health Services (CMHS) has played a key role in supporting these important developments.

Beginning in the early 1980s, the Community Support Program (CSP), which is located within

CMHS/SAMHSA, initiated various technical assistance activities to promote self-help, peer support, and client-directed approaches. 

In 1988, CSP issued a new grant program to demonstrate and evaluate services run by and for

individuals with psychiatric disabilities. Fourteen projects were awarded funding for over $1.2 million, the first such projects to be supported by a Federal agency.

This document is a retrospective review of the mental health consumer/survivor self-help movement and, specifically, the findings and recommendations from these innovative demonstration

projects. Consumer/Survivor-Operated Self-help Programs, is the first comprehensive documentation of the experiences of consumers/survivors in designing and operating their own self-help programs. The lessons from these past efforts are invaluable in assisting us to improve mental health

services today and in the future.

Joseph Autry III, M.D. Bernard S. Arons, MD

Acting Administrator Director

Substance Abuse and Mental Health Center for Mental Health Studies

Services Administration Substance Abuse and Mental Health

Services Administration

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services v

INTRODUCTION
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 1

Chapter 1

THE CONSUMER/SURVIVOR 

SELF-HELP MOVEMENT:

A LITERATURE-BASED REVIEW

In 1987–1992, the National Institute of Mental

Health’s (and later the Center for Mental

Health Services’) Community Support Program

(CSP) launched a unique program to fund

community-based consumer/survivor demonstration grants. Through this effort, grants

totaling nearly $5 million were awarded to 

14 States to implement and evaluate an array

of services to Americans with severe mental

illness provided by mental health consumers/

survivors. The goals of this effort were to:

• Address a critical shortage in the 

number and type of self-help services

available to mental health consumers 

in the community;

• Demonstrate the feasibility and effectiveness of consumer-operated programs;

• Analyze, synthesize, and package findings from these grants so that other consumers/survivors could replicate these

services in their local communities;

• Generate a series of recommendations

useful to policymakers with responsibilities for funding community-based mental

health services; and

• Foster support for sustaining existing

programs and increasing the number of

consumer/survivor self-help initiatives so

that effective services will be available 

to those who need them.

Methodology

This document summarizes an examination 

of the findings of these innovative grant projects focusing on their accomplishments, 

implementation, operation, and evaluation. 

A cross-project analysis was used to determine similarities, differences, generalizable

observations, and recommendations for 

implementing, operating, and evaluating 

consumer/survivor-run programs.

This report is unique in that it is based on

research techniques and has been guided by

persons with an understanding of consumer/

survivor self-help issues. 

The initial method implemented was the

identification and summarization of published

and unpublished literature on self-help and

programs operated by and for consumers/

survivors. Project staff completed a literature

search with key informants in the consumer/

survivor self-help movement, self-help technical assistance centers, national consumer/

survivor organizations, self-help researchers,

CMHS documents, and other sources. In 

addition, notices were placed in national 

consumer/survivor newsletters requesting 

literature on this topic.
As a result, over 80 pieces of literature 

were located. These materials have been

reviewed while examining such issues as:

• How is “self-help” generally defined? 

What are the essential characteristics 

of “self-help”? What is the history and

rationale for its use? How has it been

instituted in different service fields?

• What is “mental health consumer/

survivor self-help”? What is its history

and the rationale for its use? What are 

its major philosophies, goals, values, 

and outcomes?

• What are consumer/survivor-operated

self-help programs? What are the topologies of services delivered? How do the

programs differ and how are they similar?

• How are consumer/survivor-operated

self-help programs organized to achieve

their aims? How are these efforts funded? How are they managed and administered? What sort of staffing patterns

exist? What is the population that is

served by these efforts? How are these

efforts governed? What is the extent of

program evaluation and research conducted with these programs? How do

they interact with traditional, professional-run organizations, each other, and the

external environment?

The second major activity focused on

review and analysis of information from each

of the CSP demonstration grant projects contained in their original proposals, progress

reports, evaluation studies, and final reports.

To accomplish this task, a detailed, qualitative, descriptive analysis was conducted 

for each project which examined the following domains:

• Project goals and objectives;

• Services provided;

• Individuals served;

• Organization and administration;

• Implementation issues and barriers;

• Successes and evaluation findings; and

• Project recommendations.

The final activity centered on conducting

analyses across the projects to determine similarities, differences, generalizable knowledge

gains, and recommendations for implementing,

operating, and evaluating consumer/survivorrun programs.

A comparative analysis of the qualitative

findings of each project enabled a synthesis of

information about the projects’ similarities as

well as differences in approaches and services, and it contrasted problems encountered

and results achieved. In so doing, a matrix

analysis was employed to complete this task.

Generalizable observations were extracted

from the information in the above domains,

and conclusions and recommendations were

then drawn from this analysis.

Limitations of Methodology

A number of factors affect the validity and 

reliability of the methodology employed. An

important issue is the age of the data. Most of

the projects reviewed were initiated approximately 6-8 years before the completion of this

report. There are a number of factors which

contributed to this, including when the grant

for the report was awarded and the time necessary to complete data analyses. While this

may, in fact, impact upon some variables 

(e.g., environmental changes), the results are

likely to be relevant and transferable to the

present time.

In reviewing literature, it is difficult to complete a comprehensive overview of all sources

in this area in that materials are published at a

rapid pace. In addition, many pieces of consumer/survivor literature are “fugitive” (e.g.,

not published in traditional, peer-reviewed professional journals). With over 80 citations,

however, this review does approach a significant overview of this field.

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Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
The qualitative analysis of the 13 projects

also brings significant limitations. These

include the examination of self-reports from

the projects themselves and the incomplete

data which these reports contain. These

issues are explored in greater detail at the

beginning of Chapter 2. This factor also

impacts upon the matrix analysis conducted to

determine cross-site findings and recommendations, because this matrix analysis was

based on the project findings themselves.

While the above do produce limitations in the

methodology, it is believed that this report does

offer a valuable—albeit descriptive—analysis of

consumer/survivor-operated programs. As

such, it should be a useful tool as consumer/

survivor-operated programs further develop.

Organization of This Report

This report presents a snapshot of the experiences of 13 of the 14 National Institute of

Mental Health/Community Support Program

(NIMH/CSP) Consumer-Operated Services

Demonstration Projects funded during 1988-

1989 (one grant was terminated due to unresolvable implementation problems).

The report opens with a brief overview of the

literature on the evolution of the consumer/survivor movement to provide a context within

which to understand the achievements of the

13 grantees. Chapter 1 continues with an

exploration of the benefits, characteristics, and

values of consumer/survivor self-help; reviews

program typologies and services; and concludes with a description of how consumer/survivor self-help programs have been organized

and administered to achieve their objectives.

Chapter 2 provides a detailed overview of

each demonstration project funded and examines: project goals and objectives; program

description; implementation issues and barriers;

and successes and evaluation findings. This will

include a review of the services provided,

clients served, and issues surrounding project

organization and implementation. Project outcomes, recommendations, and continuation

efforts are also discussed.

Chapter 3 offers overall findings based on a

cross-site analysis of the project narratives.

Specifically, this was conducted using a matrix

analysis of the key outcomes associated with

each project. Generalizable similarities and differences were extracted and are presented.

The report concludes with a set of broad 

policy recommendations for public officials,

researchers, managed care organizations,

State mental health programs, local communities, and consumers/survivors for 

implementing, operating, and evaluating 

future, community-based consumer/survivor

self-help programs.

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CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
In 1992, an estimated 4 million Americans

experience “severe mental illness”, a category

that loosely encompasses people suffering

from schizophrenia, major depression, and

bipolar disorder (Interagency Council on the

Homeless, 1992).

Historically, society has shunned, mistreated, and ignored those with serious mental

health problems, viewing them as incapable of

making decisions and thinking for themselves.

Not only have the myths and stigmas surrounding mental illness resulted in numerous

instances of discrimination in housing, employment, and education, but they have also produced a class of people who have been systematically disempowered and dependent on

what they perceive as a largely unresponsive

mental health system (Chamberlin, 1978).

Recently, however, consumers/survivors*

have begun to change their status both in their

own eyes and in those of the public. They

have become increasingly vocal and active as

participants in planning, delivering, and evaluating mental health services that better meet

their needs for appropriate treatment, respect

personal dignity, and promote independence

(Canadian Mental Health Association, 1988;

Chamberlin, Rogers, and Sneed, 1989;

Specht, 1988; Chamberlin and Rogers, 1990). 

As a result of this positive action, there is a

growing acceptance of the role of consumers/

survivors in the provision of mental health

services as well as increasing support for consumer/survivor-operated self-help services

(Interagency Council on the Homeless, 1992).

Background

Consumer/survivor-operated self-help programs are a relatively recent phenomenon,

and the paucity of information in the literature

reflects a field that is still in its infancy. 

Despite this limitation, a literature review 

was undertaken of both published and unpublished sources of information in order to

discover the basic foundations of consumer/

survivor-operated self-help programs. A computerized literature search was completed at

the University of Maryland at Baltimore; key

researchers and representatives of the consumer/survivor self-help movement were contacted to obtain materials; and notices were

placed in national consumer/survivor as well

as professional mental health journals. An

Editorial Review Committee composed of 

consumers/survivors as well as traditional

mental health researchers provided guidance

in interpreting the information contained in the

documents identified through the search. 

Definition of Self-help

Webster’s Dictionary defines self-help as 

“the act or an instance of providing for or helping oneself without dependence on others”

(Webster’s, 1974). In more general terms, 

it is the process whereby individuals who

share a common condition or interest assist

themselves rather than relying on the assistance of others.

Over the past 25 years, American society

(and the world in general) has witnessed a

revolution in the way people access and

receive help. The self-help movement has

grown so dramatically that self-help and support groups now exist for everything from

dream sharing to women’s health. Self-help

has gained such acceptance that the former

Surgeon General of the United States, Dr. C.

Everett Koop, observed that “ . . . the benefits

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Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review

SELF-HELP: A HISTORY & DESCRIPTION 

OF THE GENERAL CONCEPT

* Although a number of terms identify people who use or

have used mental health services (e.g., mental health

consumer, psychiatric survivor, ex-patient, client, inmate,

psychiatrically labeled, user, recipient), for consistency

throughout this report, the term “consumers/survivors”

will be used.
of mutual aid are experienced by millions of

people who turn to others with a similar problem to attempt to deal with their isolation, powerlessness, alienation . . .” (Katz, et al., 1992).

History of Self-help

Self-help is not a new idea. People have been

organizing to help themselves throughout history. Religious institutions have frequently

played this role by offering support for common values, meeting basic material needs,

and providing opportunities for socialization 

to their members. In the political arena, the

National Association for the Advancement 

of Colored People (NAACP), the National

Organization for Women (NOW), Mothers

Against Drunk Driving (MADD), ACT UP, and

countless others form self-help coalitions to

redress civil and social wrongs, change policy

in the public/private sectors, and promote 

education (Gartner and Riessman, 1984;

Zinman, et al., 1987).

Self-help in the traditional human services

arena, however, is a fairly recent development.

For decades, service providers have been a

highly educated and elite segment of society

(Riessman, 1989). The “professionalization” 

of social work—whereby practitioners are 

educated in university settings and licensure 

is becoming a standard requirement for

employment—is one example of this practice.

Alcoholics Anonymous

The modern self-help movement traces its

roots to Alcoholics Anonymous. Founded in

1935 by two recovering alcoholics, Alcoholics

Anonymous, or “A.A.” as it is commonly called,

is a fellowship of men and women (and, more

recently, adolescents) who share their experiences and strength with each other in a group

setting, hoping that together they can solve

their common problems (Alcoholics

Anonymous, 1994; Nace, 1992).

In A.A., alcoholism creates a profound 

bond between members, all of whom are

equal. The line between patient and doctor,

professional and amateur does not exist in

A.A. Anonymity, the primacy of both the common welfare and group unity, and the absence

of hierarchical governance are some of the

other notable hallmarks of Alcoholics

Anonymous (Nace, 1992).

While the A.A. program is deceptively simple—focusing on the “12 steps” or principles

that members follow to maintain sobriety—it

has attracted an enormous following: approximately 50,000 A.A. groups exist in North

America today.

The work and message of Bill W. and other

pioneers of A.A. were the impetus for an

entirely new philosophy that held that people

do not have to rely on “experts” in order to

improve their condition (Bufe, 1991; W., Bill,

1955). A.A.’s success has prompted, in turn, a

fundamental shift in ideas about the provision

of “help” which has resulted in the blossoming

of self-help that is seen today.

The contemporary self-help movement

exploded during the late 1960’s and 1970’s as

people began to question the status quo of traditional society and began to explore a wide

range of “alternative” ideas and behaviors from

political philosophies, to sexual mores, to

methods of assisting and empowering one

another. A.A.’s 12-step model has spawned

self-help and peer support groups for virtually

every health issue of concern to present-day

society. These include such offspring as

Narcotics Anonymous, Fundamentalists

Anonymous, and many non-12-step model

programs for people with mental retardation,

as well as those with developmental and physical disabilities (White and Madera, 1992).

Benefits of General Self-help

Millions of individuals have participated in selfhelp groups of one type or another (Mental

Health Policy Resource Center, 1991), and

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Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
numerous Statewide, national, and even international information clearinghouses on selfhelp groups have been organized in response

(White and Madera, 1992; Gartner and

Riessman, 1984). Clearly, there is something

about self-help which attracts adherents and

produces positive benefits for its members

(Stroul, 1986).

Many tangible benefits are cited by selfhelp group members as promoting their 

continued participation:

• Peer Support. The ability of group members to be empathic and compassionate

based on a common experience assists

participants in feeling better by helping

them to realize that they are not alone.

Self-help actualizes the concept of

“strength in numbers”. The sense of solidarity, encouragement, and power derived from the group imbues participants

with the sense that they can persevere.

Being a member of a group or community also instills a sense of belonging and

of being accepted for whom one is

(Riessman, 1989).

• Coping Strategies. Self-help group members share information and insights developed as a result of their own experiences

to help each other “get through tough

times” (Gartner and Riessman, 1984).

• Role Models. Self-help group members

serve a positive role models to one

another. Group members who see that

others are able to overcome problems

and conditions like their own have a

renewed sense of hope and energy 

that “if they can do it, so can I” 

(Gartner and Riessman, 1984).

• Affordability. Self-help is often free or

inexpensive, which makes it a very

attractive alternative to high-cost and 

frequently time-limited “professional”

services (Riessman, 1989; Chamberlin,

Rogers, and Sneed, 1989).

• Education. Self-help groups serve as a

valuable forum for not only exchanging

information about members’ common

concerns, but also for learning about

other resources available in the community. For example, self-help groups often

invite speakers to discuss issues of special relevance to their membership such

as the Social Security Administration’s

SSI/SSDI benefits (Rogers, J., 1988).

• Advocacy. Case and systems-change

advocacy are other attractive features of

self-help programs. Through group advocacy efforts, many group members are

able to access previously unavailable

resources. In addition, members gain

intrinsic rewards from joining together to

change systems or external environmental conditions that are negatively affecting

the self-help community (Zinman, 

et al., 1987).

• Non-Stigmatizing. Self-help avoids the

stigma and negative connotations that

are often associated with seeking traditional, professional support (i.e., those

who seek professional services are

somehow weak in mind or body). This

may be related to self-help’s emphasis

on rugged individualism and selfreliance, traits that the larger society

seems to value (Riessman, 1989).

• “Helper’s Principle”. Proponents of

self-help believe that those who are able

to provide some support or assistance to

others experience a heightened sense of

self-worth and self-esteem themselves.

This belief is known in the consumer/

survivor community as the “helper’s 

principle”, and, in various forms, is a

mainstay of the self-help movement

(Gartner and Riessman, 1984; Roberts

and Rappaport, 1989).

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Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
Characteristics and Values 

of General Self-help

In addition to the benefits attributed to selfhelp by its members, it also possesses a number of other features that distinguish it from

traditional forms of professional services:

• Non-Reliance on Professionals. While

some self-help groups take on a decidedly anti-professional stance based on negative personal experiences (i.e., one

group is entitled “Victims of Professionals”), the emphasis in the majority of

self-help groups is on the practice of selfdetermination and empowerment. In selfhelp groups, individuals are encouraged

to makethe choices and decisions that

affect their lives rather than having these

decisions made for them (Riessman,

1989; Stroul, 1986).

• Voluntary. Traditionally, self-help services are voluntary in nature. There is no

coercion or requirements that individuals

participate in the group. Most individuals

attend the self-help function based on

their choice and of their own volition

(Gartner and Riessman, 1984; Zinman,

et al., 1987).

• Equality. Self-help is egalitarian and

peer-based. The concept is rooted in a

non-hierarchical principle whereby every

member has equal status. Leadership is

often shared, and facilitation of group

discussion is rotated among the 

members (Zinman, et al., 1987).

• Non-Judgmental. Self-help is based on

peer support that is provided in a nonjudgmental atmosphere where individuals can share their feelings and thoughts

openly. Respect for a person’s confidentiality is emphasized, as well.

• Informality. Informality is generally the

norm with self-help groups (Gartner and

Riessman, 1984). Boundaries between

“professional” and “patient” do not exist,

nor do the cumbersome administrative

arrangements frequently associated with

professional services.

Use of General Self-help

Self-help programs have been instituted in a

number of different fields including substance

abuse treatment, education, housing, corrections, and physical and mental disabilities.

Alcohol and other drug abuse treatment and

recovery services are certainly the most obvious areas where self-help has prospered.

Virtually all drug and alcohol treatment programs today include or espouse participation

in some form of self-help (e.g., Alcoholics

Anonymous, Narcotics Anonymous, Cocaine

Anonymous). Recovering individuals are

employed in many treatment settings and have

been found to be highly effective counselors.

The experience of having “been there” enables

recovering substance abusers to establish a

rapport with clients that other counselors cannot. They are also able to serve as both effective role models and educators, transmitting

“reality-based” coping strategies, information,

and relapse prevention techniques that other

treatment personnel either do not know or

cannot convey in quite the same way

(Riessman, 1989).

In the field of education, peer counselors

and peer tutors have been successful in

improving the academic performance and inschool behavior of students at risk for failure

or dropping out. Informal study groups also

are routinely utilized by students at all levels

as a form of self-help (Riessman, 1989).

Self-help strategies have been particularly

effective in the area of housing development.

Self-help organizations such as the National

Union of the Homeless and its local chapters

and affiliates (including the Oakland

Independence Support Center and the

Philadelphia-based Committee for Dignity 

and Fairness for the Homeless) have operated

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Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
their own shelters for their members and have

devised a number of innovative methods for

developing and obtaining permanent housing.

Additionally, these groups have produced

employment opportunities for their members

through such business enterprises as the publication of free community newspapers

(National Association of State Mental Health

Program Directors, 1992; National Resource

Center on Homelessness and Mental Illness,

1989; Long with Van Tosh, 1988a).

Following the lead of the education field, the

correctional system has incorporated the concept of peer support into its counseling programs for young offenders. This form of selfhelp assists its members to improve their life

skills with the goal of preventing criminal

recidivism and ongoing incarceration

(Riessman, 1989).

Physical and mental disabilities are another

major area where principles of self-help have

been applied effectively (Riessman, 1989;

White and Madera, 1992). People who are

deaf or hard-of-hearing, for example, have

formed self-help support groups such as

SHHH (Self-help for the Hard-of-Hearing) and

have mobilized to initiate systems change

activities (e.g., insisting on the appointment of

an educator with a hearing impairment as

President of Gallaudet University). As another

example, during the past 20 years, consumerrun Centers for Independent Living have

developed for individuals with an array of

physical and mental disabilities through the

Independent Living movement. Services provided through these self-help oriented centers

include information on accessing resources,

locating housing, peer counseling, and advocacy services, among others. Independent

Living Centers also are opening their doors to

mental health consumers/survivors through

such programs as the National Empowerment

Center (a Federally funded consumer/survivor

self-help technical assistance effort based at

the Northeast Independent Living Center in

Lawrence, Mass.) (DeJong, 1979).

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Center for Mental Health Services

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CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
“Mental health consumer/survivor self-help” 

is the process by which mental health consumers/survivors provide assistance to one

another based, to a large extent, on the tenets

of the self-help paradigm described in the 

preceding section of this report.

History of the Consumer/

Survivor Self-help Movement

The mental health consumer/survivor self-help

movement began in its modern form approximately 25 years ago. Prior to that, a scattering

of consumer/survivor self-help efforts were initiated (Zinman, et al., 1987), including the

work of Clifford Beers—a consumer/survivor

advocate, author of A Mind That Found Itself,

and founder of the Mental Health Association.

In the late 1960’s and early 1970’s, the

increasing popularity of self-help movements 

in general, coupled with the greater awareness

of the abuses that consumers/survivors experienced (partly as a result of media exposés

and the film version of the book One Flew

Over the Cuckoo’s Nest), prompted small

groups of consumers/survivors to begin organizing in the larger East and West Coast cities

(Madness Network News Reader, 1974).

These groups were few in size and number

and took a decidedly militant viewpoint against

psychiatry and the established mental health

system. Groups with names like the “Alliance

for the Liberation of Mental Patients” and

“Project Release” met in homes and churches

and first drew their membership from the ranks

of those with first-hand knowledge of negative

experiences with the mental health system

(Madness Network News Reader, 1974).

However, they sustained their membership by

providing: peer; education about services in

the community and about the problems consumers/survivors were facing; and advocacy 

to help members access services as well 

as to change an often oppressive system

(Furlong-Norman, 1988).

Some of these groups published their own,

often impressive, newspapers and magazines

(e.g., Madness Network News, Phoenix

Rising) to provide education and information 

to their members. Others conducted advocacy

through such direct actions as protests and

pickets both at hospitals accused of being 

abusive and at conventions of the American

Psychiatric Association (Madness Network

News Reader, 1974).

Members of these East and West Coast

self-help groups met at the International

Conference on Human Rights and Against

Psychiatric Oppression and later at the

National Institute of Mental Health’s Learning

Community Conferences where they would

informally network to share information on

what they were doing in their local areas.

Over time, the numbers and types of groups

began to grow, and more moderate viewpoints

came to be represented. Groups such as

Emotions Anonymous; Recovery, Inc.; and

GROW focused more on peer support and far

less—if at all—on advocacy, while others even

welcomed the involvement of professionals in

their activities (Kaufmann and Freund, 1988;

Emerick, 1990; Roberts and Rappaport, 1989).

The publication of Judi Chamberlin’s seminal work, On Our Own, was a milestone in the

history of the movement. Consumers/survivors

and others now could read in the “mainstream”

press what it was like to have experienced the

mental health system. On Our Own also provided details about the mental health consumer/survivor self-help movement and discussed the extension of this concept into the

development of consumer/survivor-run services. For many consumers/survivors, reading

this book was the beginning of their involveU.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 9

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review

THE MENTAL HEALTH CONSUMER/

SURVIVOR MOVEMENT
ment in the consumer/survivor movement

(Chamberlin, 1978).

External Support for the

Consumer/Survivor 

Self-help Movement

In the 1980’s, the National Institute of Mental

Health (NIMH) began to support technical

assistance to further develop the self-help

model. Through its Community Support

Program (CSP), NIMH (and later, CMHS)

funded a monthly teleconference out of 

Boston University’s Center for Psychiatric

Rehabilitation (Furlong-Norman, 1988). 

During these calls, consumers/survivors 

from around the nation could talk with one

another about issues of mutual concern as

well as discuss what was happening in their

local communities. In addition, funds were 

provided for the publication of a technical

assistance manual by the California Network

of Mental Health Clients entitled Reaching

Across (Zinman, 1987). The Mental Health

Association of Southeastern Pennsylvania 

also received NIMH funds to provide information on consumer/survivor self-help

(Furlong-Norman, 1988).

In 1985, again with funding from NIMH/CSP,

the first national conference of consumers/

survivors was held in Baltimore, Maryland, to

provide technical assistance and opportunities

for networking and information exchange. This

meeting, called “Alternatives ‘85”, was attended by approximately 400 people and

proved so popular that it became an annual

event. By 1991, the “Alternatives” conference

held in Berkeley, California, drew close to

2,000 participants from virtually every State in

the Union and a number of foreign countries

(Acker, 1990; Twedt, 1990). Since that time,

the conferences have continued to be held

with similar attendance.

During this period, the number of consumer/survivor self-help groups expanded 

rapidly. Today, there are an estimated 3,000

consumer/survivor self-help organizations

functioning at the local, State, national, and

even international levels (O’Hagan, 1991;

European Client Unions Network, 1992; 

World Federation of Psychiatric Users, 

1992). Consumer/survivor self-help groups

coordinate activities and conduct advocacy 

on a Statewide level in approximately 30

States. Various national organizations—for

example, the National Alliance of Psychiatric

Survivors and the National Mental Health

Consumers’ Association—have evolved. In

1992, the World Federation of Psychiatric

Users—the first international consumer/

survivor organization—was initiated.

The NIMH/CSP also funded two research

centers to examine the phenomenon of consumer/survivor self-help. These centers, 

located in Michigan and California, have

undertaken research that is now producing

useful results (Segal, et al., 1991; Boltz,

1992). In 1992, NIMH/CSP expanded its 

support to fund two technical assistance 

centers in Massachusetts and Pennsylvania.

In addition to these Government-sponsored

initiatives, a number of national publications by

consumers/survivors, including Dendron and

NAPS News, also have provided information

about the growing consumer/survivor movement (Oaks, 1992; Unzicker, 1992).

Benefits of Consumer/

Survivor Self-help

People participate in consumer/survivor selfhelp for the same reasons that they participate

in other self-help groups; namely, for peerbased support, assistance in developing coping

strategies, exposure to relevant role models,

affordability, pertinent information about issues

and services, advocacy for systems change,

the opportunity to interact without stigma, and

the sense of well-being and self-esteem that

derives from helping others (Borck, 1983;

Fleming, 1983; Van Tosh, 1990; Roberts and

Rappaport, 1989).

10 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
In addition to these factors, consumer/

survivor self-help enjoys broad support

because it works. Studies are currently being

completed that document the value of consumer/survivor self-help as a tool in helping

people cope with and overcome their individual and collective problems as well as the 

stigma and discrimination encountered in the

external environment. Recently, CMHS has

begun planning a study examining the types 

of services provided by consumer/survivor

self-help efforts. This “inventory” will begin 

to document the significant contributions 

that these projects provide. 

Value of Consumer/

Survivor Self-help

The values and philosophies that guide consumer/survivor self-help are the driving forces

behind its development and its success. With

other self-help movements, it shares the belief

in: peer-based support and assistance; nonreliance on professionals; voluntary membership; egalitarian, non-bureaucratic, and informal

structure; affordability; confidentiality; and nonjudgmental support. However, mental health

consumer/survivor self-help also holds specific

values and beliefs.

Empowerment

The concept of “empowerment” is central to

the belief system of the consumer/survivor

self-help. For mental health consumers/

survivors, empowerment means acquiring the

ability to make those decisions that directly

affect their lives. Specifically, this translates

into the ability to make decisions about housing, jobs, and services where consumers/

survivors have typically had little input

(Zinman, 1987; Ridgway, 1988b).

Empowerment on an individual level 

also translates into control over one’s life.

Traditionally, consumers/survivors have been

falsely deemed “incapable” of playing this role.

Empowerment infuses individuals with a sense

of self-worth and belief in their capacity to “do

for themselves” (Ridgway, 1988b).

On the group level, empowerment refers 

to the capacity to impact the systems that

affect members’ lives. True representation, 

as opposed to tokenism on such decisionmaking bodies as county mental health 

services boards, is an example of a form of

empowerment that has been put into action

(Ridgway, 1988b).

Independence

The concept of independence is another 

central value of consumer/survivor self-help.

Historically, consumers/survivors have been

dependent on others (particularly in the mental

health system) to meet their basic needs and

for support. In contrast, the consumer/survivor

self-help movement stresses the importance 

of striving for independence, self-reliance, 

and the opportunity to function as productive

citizens (Zinman, 1987).

Responsibility

The consumer/survivor self-help movement

emphasizes the responsibility that individuals

must take for themselves and others (National

Mental Health Consumers’ Association,

1987a). In addition, behaving in a responsible

way with respect to one’s community is

encouraged. For example, when other consumers/survivors are discriminated against 

in housing or employment, self-help group

members are expected to respond and take

action to redress those wrongs. 

Choice

Choice in services and opportunities is also a

value of consumer/survivor self-help (Stroul,

1986; Van Tosh, 1989a). In the past, consumers/survivors had little choice in the kinds

of services and supports they received. In

some instances, such as involuntary treatment, choice was completely eliminated. 

One goal of the self-help movement is to 

create an environment in which consumers/

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CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
survivors can make informed choices about

treatment, housing, and other needed 

services (Ridgway, 1988a).

Respect and Dignity

A key value of this movement is that everyone

should be treated with respect and dignity

regardless of his or her situation, income, education, or status. The consumer/survivor selfhelp movement is committed to the idea that

all individuals are valuable and have skills and

strengths to offer society. The movement also

stresses that everyone has rights that should

be protected at all times (National Mental

Health Consumers’ Association, 1987a).

Social Action

Many segments of the consumer/survivor selfhelp movement (although not all), value social

action as a mechanism for social change.

Advocating for changes in how consumers/

survivors are treated by the mental health system and society at large is a core activity for

many in the consumer/survivor movement

(although other segments of the larger self-help

movement, particularly Alcoholics Anonymous,

take a firm non-advocacy stance). Within 

consumer/survivor self-help groups, fostering

change takes various forms from individual

advocacy (e.g., assisting individuals with

accessing benefits) to direct action and civil 

disobedience campaigns (Van Tosh, 1990;

National Mental Health Consumer Self-help

Clearinghouse, 1988b; Rogers, 1990; Andre,

1992; Zinman, 1987).

Unique Features of

Consumer/Survivor Self-help

Although they share these features in common

with other self-help groups, mental health

consumer/survivor organizations place an

extraordinary value on peer support, hope,

and recovery.

Given the history and structure of the prevailing mental health system, consumer/

survivor self-help groups view as crucial the

capacity to provide emotional support and

counseling on a peer level without the power

differentials inherent in professional treatment.

Developing a peer support network takes on a

special importance for people who have mental health problems and have become socially

isolated due to attendant stigma and discrimination (Leete, 1988).

Hope and recovery, likewise, are fervently

embraced core values. The consumer/survivor

self-help movement promotes and reaffirms

the fact that people can recover from their

often traumatic experiences. In so doing, the

movement also fosters the understanding that

when systems, communities, and individuals

dispense with stereotypes, everyone benefits.

As system changes begin to open the doors to

improving the quality of life for consumers/survivors, the movement is increasing its focus on

the values of hope and recovery and their

power to transform attitudes and behavior

(Deegan, 1988; Anthony, 1993).

Consumer/Survivor 

Self-help Classifications

While there is considerable agreement on an

acceptance of the majority of values just described, there is a diversity of philosophies in

the consumer/survivor self-help movement

relating to the professional mental health 

system. These differences enabled both

Chamberlin and Emerick to distinguish consumer/survivor self-help groups from one

another and classify them into three categories

according to their position on this issue

(Chamberlin, 1978; Emerick, 1990).

In the first category are those groups who

take an exclusively anti-psychiatric stance

towards the mental health system (which they

regard as oppressive) and refuse to work with

it. Groups in this category rarely include nonconsumers/survivors in leadership roles and

12 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
view self-help activities as an alternative

model to the mental health system. For these

groups, which some label “radical”, the selfhelp movement is a liberation struggle

(Chamberlin, 1978; Zinman et al., 1987;

Emerick, 1990).

The second category consists of those

groups that work with the system, despite

being critical of it. While these groups may

include non-consumers/survivors within their

general membership, consumers/survivors

constitute the majority and maintain leadership

positions. These groups, sometimes referred

to as “moderate”, see the system as needing

improvement. However, they also see it as

providing some benefits to others (Chamberlin,

1978; Emerick, 1990).

In the third category are those groups who

work very closely with the professional system,

involve professionals in their activities and

commonly share leadership between professionals and consumers/survivors. Self-help

groups in this category, sometimes referred to

as the “partnership” model, believe that the

mental health system is a source of positive

help for people with mental health problems

and see self-help activities as an adjunct—and

not an alternative—to the professional system

(Chamberlin, 1978; Emerick, 1990).

There is a great mix of beliefs within consumer/survivor self-help groups that cross 

the boundaries between categories; neither

groups nor individual group members fit neatly

into “little boxes”. Since a major goal of the

consumer/survivor movement is to reduce the

use of “labels” by fostering the recognition that

diversity should be respected, classification

schemes are only one approach to understanding self-help groups and should be 

interpreted cautiously.

Funding

Accepting government funding for alternative

self-help projects as well as participating in

collaborative projects with the mental health

system has been a subject of ongoing debate

within the consumer/survivor movement.

Those opposed to “taking government money”

fear being co-opted, while those accepting

funds view it as a pragmatic step that allows

their groups to implement needed services 

for consumers/survivors.

Impact of the Consumer/

Survivor Self-help Movement

The two Federally funded research centers

and a cadre of independent researchers are 

in the process of evaluating the impact of the

mental health consumer/survivor self-help

movement on both individual members and 

on the larger mental health system.

On an individual level, preliminary research

suggests that the benefits of participation in

consumer/survivor self-help include: increased

independence and self-reliance; improved selfesteem; enhanced coping skills and feelings of

personal empowerment; and increased knowledge of services/rights, housing, employment,

and other issues of special concern to mental

health consumers/survivors. In addition, as a

result of their involvement in the movement, a

growing number of consumers/survivors are

“going public” about their problems and are

speaking out against societal stigma (Roberts

and Rappaport, 1989; Borck, 1983; Leete,

1988; Van Tosh, 1990).

On a systems level, the movement has substantially contributed to the increased involvement of consumers/survivors in all aspects of

the planning, delivery, and evaluation of mental health services as well as in the protection

of individual rights. Specific examples of the

positive outcomes achieved as a result of their

involvement include: Public Law 102-321 (formerly P.L. 99-660), which established mental

health planning councils in every State, and

the development of Protection and Advocacy

agencies for patients’ rights in every State

(Chamberlin and Rogers, 1990). Both of these

laws also include a requirement for substanU.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 13

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
tive consumer/survivor involvement in planning

and implementing mandated activities.

Consumers/Survivors 

as Colleagues

The consumer/survivor self-help movement

also has had a substantial influence on

increasing the utilization of consumers/

survivors as employees in the traditional 

mental health system as well as in other areas

(Specht, 1988; U.S. Department of Education,

1990; Schlageter, 1990; Interagency Council

on the Homeless, 1991). Consumers/survivors

are being hired at all levels in the mental health

system, ranging from case manager aides 

to management positions. As consumers/

survivors enter into leadership positions, 

many leaders in the field are also disclosing

their own mental health histories (FurlongNorman, 1991 and 1988).

A significant development has been the

establishment of Offices of Consumer Affairs

(OCAs) in nearly 30 State Mental Health

Authorities. OCAs are generally staffed by

consumers/survivors to support consumer/survivor empowerment and self-help in their particular States. In 1995, CMHS hired its first

Consumer Affairs Specialist.

With the passage of the Americans with

Disabilities Act (ADA) in 1990, employment in

fields outside the mental health sphere has

become, for the first time, an achievable goal

for consumers/survivors. This landmark legislation not only makes it possible for persons

with disabilities to obtain employment, but also

it may assist people with disabilities to maintain a job. In addition, the ADA makes provisions for training consumers/survivors to use

the legislation appropriately. In the process,

employers who otherwise would not be aware

of this important legislation will also be educated about the rights of Americans with disabilities and their responsibilities as employers

to accommodate special needs in the workplace (Furlong-Norman, 1991).

14 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
One of the most significant outcomes of the

consumer/survivor self-help movement has

been the development of mental health 

consumer/survivor-operated programs.

Consumer/survivor-operated self-help 

programs are services that are planned,

delivered, and evaluated by consumers/

survivors themselves, although some programs incorporate the use of professionals 

certain areas of planning, implementation, 

and evaluation (Fleming, 1983; Stroul, 1986).

The majority of consumer/survivor-operated

self-help programs are characterized by the

values and goals delineated in the discussion

of the consumer/survivor self-help movement

and, as such, are quite different from those

ascribed to traditional professional mental

health services. As its name implies, in consumer/survivor-operated programs, the role 

of consumers/survivors is changed from 

service recipients to service providers, or 

what Frank Riessman terms “prosumers”

(Riessman, 1989).

History of Consumer/

Survivor-Operated Programs

Consumer/survivor-operated services (other

than self-help/support groups) are relatively

new. One of the earliest consumer/survivoroperated services is Fountainhouse in New

York City. Founded by a consumer/survivor 

in the 1950’s, it has become the worldrenowned leader of the “clubhouse” movement

that provides psychosocial and vocational

rehabilitation. Today, however, Fountainhouse

is no longer consumer/survivor-operated.

Although consumers/survivors are still

involved, professional staff assist the program’s “members” (Chamberlin, 1978).

Another early consumer/survivor-operated

self-help program, the Mental Patients

Association (MPA) of Vancouver, met a 

similar fate. MPA began as a drop-in center

where consumers/survivors could socialize,

participate in self-help groups, conduct 

advocacy, and obtain assistance in accessing

other services, among other activities

(Chamberlin, 1978). In consumer/survivoroperated drop-in centers, the participants plan

and administer its programs and serve as

staff. Drop-in centers frequently operate during

evening, weekend, and holiday hours when

traditional programs are closed (Long with 

Van Tosh, 1988a). 

MPA expanded its operations to include a

housing program for consumers/survivors.

Originally a decidedly “radical” organization,

over time, MPA became increasingly 

professionalized and hired professionally 

educated staff.

Not all consumer/survivor-operated self-help

programs have followed this path, however.

Some have maintained their original values

and their principles and have thrived in the

process. One of the oldest programs of this

kind is the Ruby Rogers Advocacy and DropIn Center in Cambridge, Massachusetts.

Founded in the early 1970’s, it remains a 

consumer/survivor-operated program today.

Another drop-in center, On Our Own, is a fixture among consumers/survivors in Baltimore,

Maryland, where it has been steadily providing

alternative services for more than 10 years

(Stroul, 1986).

Type of Services Offered

The range of services that consumers/

survivors are now operating is diverse and

continues to grow (Barry, 1991; FurlongNorman, 1988; Ohio Department of Mental

Health, 1990). Brief descriptions of 12 of the

most common forms of services follow.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 15

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review

EVOLUTION OF MENTAL HEALTH CONSUMER/

SURVIVOR-OPERATED SELF-HELP PROGRAMS
Drop-In Centers

Programs based on the drop-in center model

now operate in many States in a variety of settings ranging from small church basements to

over 5,000 square-foot properties. Some dropin centers operated on a “shoe string” budget.

Consumers/survivors serve as volunteer staff

and programs operate one night per week.

Others have budgets of over $150,000,

employ fulltime staff, and operate seven days

a week. Some drop-in centers are established

solely to provide opportunities for social interaction, while others offer a wide variety of different activities (Long with Van Tosh, 1988a).

Housing Programs

Housing programs are another service being

operated increasingly by consumers/survivors.

Housing options available under these programs range from various kinds of group

housing (including a low-demand residential

program) to supported independent living

arrangements. Collaborative Support

Programs of New Jersey has sponsored the

development of a unique partnership between

a nonprofit housing rehabilitation/development

corporation and a local Mental Health

Association to provide housing alternatives to

consumers/survivors (National Association of

State Mental Health Program Directors, 1992).

Counter Point in Salt Lake City, Utah, is also

collaborating with the local public housing

authority to locate housing for some of its

members, while Safe Harbor Housing of

Rhode Island is both developing and operating

housing services by and for consumers/

survivors (National Association of State 

Mental Health Program Directors, 1992).

Homeless Services

Consumers/survivors are also developing

services geared towards consumers/survivors

experiencing homelessness. Examples

include: Project Acceptance, a drop-in center

located in Lawrenceville, Kansas, that provides housing services for persons who are

homeless; Project OATS, a street outreach

and advocacy program operating in Philadelphia, Pennsylvania; and the Oakland

Independence Support Center, a multiservice

center in Oakland, California (National

Association of State Mental Health Program

Directors, 1992; Long with Van Tosh, 1988a;

Interagency Council on the Homeless, 1991).

Case Management

Consumers/survivors are now operating their

own case management programs (FurlongNorman, 1991). An NIMH CSP-funded

research demonstration project in Philadelphia

investigated the effectiveness of consumers/

survivors as intensive case managers

(Solomon, 1992). It found that consumers/survivors were as effective as non-consumers/

survivors in providing case management services. In New York, the Bronx Psychiatric

Center has incorporated consumer/survivor

peer specialists into case management teams,

while in Sacramento, California, consumer/

survivor community support services coordinators are employed to assist “clients” in accessing non-traditional case management

services (Furlong-Norman, 1991). To prepare

consumers/survivors to work as case management aides, Colorado offers a special training

program in case management for

consumers/survivors.

Crisis Response

Consumers/survivors also are operating

respite programs for those in emotional crisis

(Stroul, 1986). These programs provide a safe,

supportive, and comfortable setting where individuals can obtain some relief from their problems without the stress, coercion, and often

public shame associated with traditional, professional crisis response services. Telephone

hotlines, as well as temporary shelter during

crises, are key features of these services.

Project Acceptance has begun to provide

these services for its members, as does the

16 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
Next Step Respite Center in Ohio (Ohio

Department of Mental Health, 1990).

Benefits Acquisition

Consumer/survivor-operated benefits acquisition projects like BACUP in Los Angeles assist

their peers in accessing benefits and services

to which they are entitled (e.g., Social Security,

housing). Consumers/survivors report trusting

and feeling comfortable with peers who have

experienced problems similar to their own

(Long with Van Tosh, 1988a). Some benefits

acquisition programs also provide assistance

with case advocacy in order to protect the

rights of consumers/survivors.

Anti-Stigma Services

Consumers/survivors operate many types of

anti-stigma services including repertory companies (Project Return Players), speakers

bureaus (Project Overcome), slide presentations (PCPL), and video productions (White

Light Communications) (Rogers, S., 1988;

Lovejoy, 1988; Schlageter, 1990).

Advocacy

Many consumer/survivor-operated self-help

programs also provide advocacy services to

their members in an effort to provoke fundamental change. The Alliance of Syracuse, New

York, for example, has sponsored educational

training for consumers/survivors across the

country who wish to learn more about advocacy skills. The Alliance has also been an

ardent supporter of individual patients’ rights

and has provided support to persons in need

of advocacy (The Alliance, 1993).

Research

Consumer/survivor-operated research 

programs are a very new development.

Currently, Well-Being Programs, Inc., and 

the Consumer/Survivor Work Group on Policy

and Research have pioneered consumer/

survivor involvement in research, evaluation,

and data issues.

Technical Assistance

The consumer/survivor-operated National

Empowerment Center in Massachusetts and

the National Mental Health Consumers’ Selfhelp Clearinghouse in Pennsylvania are funded to provide technical assistance to help

other consumers/survivors implement self-help

programs and address other issues. In addition, a number of consumer/survivor-operated

organizations sponsor training workshops,

conferences, and seminars to transmit 

needed information and techniques to 

other consumers/survivors.

Employment

Consumers/survivors have also conducted

employment programs that include job training/placement efforts (the former group ACT

NOW in Pennsylvania) and job support 

groups (I CAN in Lancaster, Pennsylvania). 

In addition, there are a growing number of

consumer/survivor-operated businesses, especially in Ohio, which include such enterprises

as a jewelry cooperative (Jewelry Plus 

Craft Cooperative); a tea house (Shining

Reflections); and a landscaping business

(Your Personal Landscaping and Cleaning

Company) (Ohio Department of Mental 

Health, 1990).

Managed Care

With the recent development of Medicaid managed mental health care, consumers/survivors

have begun to respond by organizing and educating themselves on how this will affect their

services and their lives. A notable effort has

been the Consumer Managed Care Network

which has developed a “Platform for Action”,

indicating, from a consumer perspective, qualities of a responsive managed care system

(Consumer Managed Care Network, 1996).

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 17

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
Structure and Organization of

Consumer/Survivor-Operated

Self-help Programs

Mental health consumer/survivor-operated

self-help programs are organized in a variety

of ways to achieve their aims. While the type

of service dictates organizational specifics, the

literature suggests that there are similarities

among programs. As mentioned earlier, consumer/survivor-operated efforts are based on

the values and guiding principles of the consumer/survivor self-help movement. Thus,

egalitarianism is fostered as well as a 

non-hierarchical approach. Peer support,

empowerment, and respect for individuals 

are also promoted (Zinman, et al., 1987;

Segal, et al., 1991).

The differences come into play when these

values are operationalized. While some programs take a firm line in adhering to egalitarian and non-hierarchical values, others do not.

The question then becomes: does a consumer

/survivor-operated self-help organization cease

to exist when it no longer practices its stated

values (Zinman, et al., 1987; O’Hagan, 1991)?

The CSP Consumer/Survivor-Operated

Services Demonstration Projects described 

in Chapter 2 provide some preliminary 

information that will be useful in answering 

this question.

Funding

Funding for consumer/survivor-operated 

self-help programs originated from a mix of

sources, including: grants from Federal, State,

and local Mental Health Authorities, foundation

and corporate grants, membership dues, and

private donations. The majority of programs

receive a relatively small amount of money for

operations (Zinman, et al., 1987; National

Mental Health Consumer Self-help

Clearinghouse, 1991; Yaskin, 1992a).

Some organizations have objected to the

use of Government funds because of the

potential for co-optation. Others view them as

funds that consumers/survivors have earned

through paying taxes and to which they are

entitled. The few organizations with large

budgets (over $500,000/year) have relied primarily on governmental funding. It is clear,

however, that the majority of consumer/survivor organizations have difficulty raising the

resources necessary to accomplish their aims

due to the current economic health of the

Nation, the lack of focus on human services,

and the persistent stigma that is attached to

“mental illness” and consumers/survivors

(Furlong-Norman, 1988a).

Program Administration 

and Leadership

Although consumer/survivor self-help organizations strive to manage and administer their

programs in accordance with the values of the

movement, a number of different leadership

patterns have developed. Ideally, there would

be no formal leadership or leadership would

be shared among all the project’s members 

or staff. A few programs adhere to this strategy and also attempt to use a consensus

model, whereby everyone must agree on 

a particular course of action before it is implemented. At the other end of the spectrum are

organizations that have become hierarchical

and bureaucratic as they have grown larger. 

In these programs, leadership is clearly

defined. In the middle, where most projects

probably lie, there is a mix of leadership and

decisionmaking styles. For example, while a

program may have formally defined leaders,

democratic participatory management practices are also employed (Zinman, et al., 1987;

Emerick, 1989).

Staffing

Staffing patterns also vary greatly from organization to organization. Since most consumer/

survivor self-help programs have insufficient

18 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
funding to support paid staff, volunteers often

comprise the majority of the workforce. In

some programs, job responsibilities are shared

and staff work part-time (Zinman, et al., 1987;

Yaskin, 1992a).

It appears that the availability of support on

the job (a feature that appears to be inherent

in consumer/survivor organizations) is very

important for consumers/survivors to succeed

in the work place. In keeping with the Americans with Disabilities Act, consumer/survivoroperated services provide greater “reasonable

accommodations” (e.g., “flextime”, additional

breaks, time off for appointments) to their staff

members than more traditional organizations

do and are more sensitive to the issues their

employees face.

Populations Served

Given that research and evaluation have not

yet become standard activities for these consumer/survivor-operated programs, it is difficult

to accurately define the population that they

serve. From the literature, it appears that they

serve people who are hesitant to utilize existing traditional professional services for a number of reasons, including: the past treatment

they have received; the cost of traditional 

services; the amount of support provided at

consumer/survivor programs versus traditional

programs; and the stigma associated with

seeking professional services. Depending

upon their location, some mental health consumer/survivor-operated self-help programs

may serve only a few individuals a week, while

others in heavily populated urban areas may

serve hundreds in the same time period

(Gartner and Riessman, 1984).

Program Governance

Governance of consumer/survivor-operated

programs tends to follow the values of the

movement. In most programs, Boards of

Directors are composed entirely of consumers/

survivors. Those that depart from this practice

usually have a majority representation of consumers/survivors. Of these programs, some

deliberately offer a Board position to a highprofile community member or attorney in order

to obtain expertise in a particular area. These

consumer/survivor-operated programs believe

that this practice is permissible, as long as

consumers/survivors constitute the clear

majority on the board (Zinman, et al., 1987).

Research and Evaluation

Research and evaluation on consumer/

survivor-operated programs is sparse; the 

findings presented in this report comprise the

most comprehensive examination of its kind 

to date. However, some individual programs

(e.g., Project OATS in Philadelphia) have completed evaluation studies that demonstrate that

consumers/survivors are successful in providing services to their peers (Van Tosh, 1990).

The two Federally funded research centers

mentioned earlier are pursuing research into

the issue of consumer/survivor self-help and 

a number of independent researchers (e.g.,

Phyllis Solomon, Julian Rappaport, Caroline

Kauffman, and Athena MacLean) are also

beginning to investigate this phenomenon further. Recently, for example, Solomon released

findings indicating that consumer/survivor case

managers are as effective as non-consumer/

survivor case managers in providing services

(Solomon, 1992).

In addition, consumers/survivors have

begun conducting research themselves.

Among their initiatives are an evaluation project directed by Judi Chamberlin at the Boston

University Center for Psychiatric Rehabilitation

and the newly emerging Consumer/Survivor

Work Group on Policy and Research.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 19

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Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review
20 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 1. The Consumer/Survivor Self-help Movement: A Literature-Based Review

Interaction with 

Other Agencies

Mental health consumer/survivor-operated

self-help programs interact with the traditional

professional system in a variety of different

ways (Emerick, 1990; Boltz, 1992; National

Association of State Mental Health Program

Directors, 1989; Kaufmann and Freund.,

1988). Some self-help programs form partnerships with other agencies, while others retain

an independent stance and so do not participate in outside collaboration. The Center for

Self-help Research is investigating this area to

raise the specific issues involved in forging

interorganizational relationships (Hasenfeld

and Gidron, 1992).

Consumer/survivor organizations are 

also increasing their efforts to work with one

another. The development of national and, in

particular, Statewide organizations have played

a role in encouraging consumer/survivoroperated programs to develop linkages with

each other. However, on the national level,

political differences have created divisiveness

among different factions of the movement.

While some observers have argued that this is

the type of healthy political discourse found in

any movement, others have seen these divisions as destructive to the sense of unity 

needed to accomplish common goals. Statewide organizations, on the other hand, have

made great strides in bringing various independent consumer/survivor-operated programs

together to work collectively for positive change

and for the further development of

consumer/survivor services.

From this overview of the literature, it is

clear that there is much more to be learned

about the phenomenon of mental health consumer/survivor-operated self-help services.

The following chapters of this report examine

the results of the 13 CSP Consumer/SurvivorOperated Services Demonstration Projects as

the first step in enlarging understanding about

the consumer/survivor-operated program

model. The descriptions of all 13 individual

projects presented in Chapter 2 illuminate project similarities and differences. Chapter 3

offers a cross-site analysis as well as practical,

program-level suggestions and policy recommendations based on those findings. 
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 21

Project materials from each of the CSP

Consumer/Survivor-Operated Services

Demonstration Projects were examined in

order to provide an in-depth, cross-program

examination of each individual initiative.

Documents that were reviewed included: original applications, annual continuation applications, relevant correspondence from NIMH,

final project reports, and evaluation findings. 

A variety of program elements were explored:

project goals and objectives; services and supports provided; client population served; organizational structure; board development; staff

size, characteristics, and training provided;

reasonable accommodation practices; program materials developed; implementation

issues; inter-organizational coordination; existence of other self-help programs before and

after the demonstration grant; project budget;

evaluation strategies and findings; and program continuation plans. These domains have

been collapsed into four groupings—Project

Goals and Objectives, Program Description,

Implementation Issues and Problems, and

Evaluation Findings—which are presented in

this chapter for each of the thirteen programs

which were funded. 

There are limitations to this analytic strategy

which may affect the objectivity of the findings.

The majority of materials reviewed were selfreports created by the projects themselves.

Other materials were often prepared by State

mental health authority personnel, which further complicates validity, as it is possible that

such staff were less familiar with a particular

program’s day-to-day operations than a program coordinator or director would be. The

information within these documents was often

incomplete, which further limits the usefulness

of the documents. Other strategies (such as

key informant surveys and site visits) may

have been able to capture a broader spectrum

of information, and perhaps enhanced the

validity of the “information” or “findings” presented. However, resource constraints prevented the use of those methodologies. 

The above limitations notwithstanding, these

analyses do offer a valuable, albeit descriptive,

examination of each demonstration site. The

individual project findings indicate a variety 

of project approaches and successful outcomes. Although there was variation from 

site to site, an overall conclusion can be 

drawn that these efforts demonstrated efficacy

in meeting consumer/survivor needs.

Chapter 2

DESCRIPTIONS OF THE 13 

DEMONSTRATION GRANT PROJECTS
22 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 2. Descriptions of the 13 Demonstration Grant Projects

PROJECT GOALS 

AND OBJECTIVES

The grant funded the Alameda County

Network of Mental Health Clients (ACNMHC)

to expand the Oakland Independence Support

Center (OISC) and the Berkeley Drop-In

Center (BDIC). Grant funds were used to

enable these programs to expand client services to better meet their service recipients’

demonstrated need. This was to be accomplished via a “Coordinated Self-help System”

(CSHS), which was designed to centralize

shared resources, including administrative

services, storage space, bookkeeping, statistics, insurance costs, and medical coverage.

CSHS was also designed to enable the hiring

and assignment of additional staff, develop a

volunteer resource bank, and conduct coordinated outreach, evaluation, and fundraising.

CSHS was conceptualized as a self-help/

mutual support approach to peers helping one

another—a “self-help program for self-help

programs.” It was hoped that the expanded

activities resulting from the grant would lead to

the development of a model which could be

replicated elsewhere.

PROGRAM 

DESCRIPTION

Services Provided

The BDIC offered direct services (a drop-in

center, support groups, case advocacy, generalized advocacy, information and referral,

instructional groups, free food, phone, books,

magazines, transportation assistance, and

clothing) and recreational activities (socialization and art activities).

The OISC offered a community drop-in

center (free coffee, food, support groups, 

and peer counseling), independent living

services and independent living skills 

training mailing address, bathroom and 

shower facilities), and information and

referral (advocacy, housing search assistance, money management assistance, 

and outreach to other programs).

As a result of this funding effort, the programs were able to increase their operating

hours, increase the number of instructional

groups and support groups offered, and offer

additional advocacy, socialization, and substance abuse counseling services. Guidelines

CALIFORNIA

Alameda County Network of Mental Health Clients

Berkeley Drop-In Center

Berkeley, CA

Oakland Independence Support Center

Oakland, CA

“...Since I’ve been working here...I have felt worthwhile because

I’ve been able to help people. Knowing that I’m contributing to

society makes me feel like I’m worth something. I also feel safe

and confident to be me and work to help people in an environment of people who are like me.”

—Project staffer (OISC)
for volunteer recruitment were developed, and

a brochure and mailing list were created to

assist in project outreach. Successful fundraising enabled the ACNMHC to obtain a contract

with the Alameda County Mental Health

Department to provide tenant support services

to consumers/survivors living in the Aztec

Hotel, a large, nonprofit, consumer/survivoroperated, single-room occupancy hotel.

Individuals Served

Service recipients were defined as individuals

who had a history of psychiatric disability. The

Final Report indicated that BDIC estimated 

the total unduplicated number of individuals

served for the entire project was 1,600, while

OISC served approximately 1,900 different

individuals. Service recipients had the following characteristics: 95% were homeless or at

risk of being so; over 98% were very lowincome; the majority were African American

males; most were between the ages of 22 and

44; 26% had no high school diploma, 53%

graduated high school, 16% had some college, and 5% were college graduates; and

nearly 30% were veterans. 

Organization and

Administration

The grant was provided to the California

Department of Mental Health (DMH), which 

initially passed the funds through BerkeleyOakland Support Services (BOSS). BOSS, in

turn, provided the funding to the Alameda

County Network of Mental Health Clients

(ACNMHC), which then funded the separate

BDIC and OISC projects. Later in the grant,

both centers as well as the ACNMHC attained

nonprofit status and were able to directly

receive the grant funds.

A Coordinating Committee reported to the

ACNMHC Board and was composed of three

at-large members of the ACNMHC Board and

three members from each center, including the

Program Coordinator/Director of each. Over

time, a decision was made to eliminate the

Coordinating Committee, as its function was

duplicative of the ACNMHC Board. Both projects had a shared staff and administration.

Shared paid staff consisted of an Administrator; an Administrative Assistant; a Field

Advocate who advocated for entitlements,

housing, and rights protection; an Independent

Living Specialist who conducted skills workshops, assisted service recipients in obtaining

housing, and provided benefits counseling,

information and referral, and case advocacy;

an Activities Coordinator; and a Substance

Abuse Peer Counselor. Paid consultants were

utilized for program evaluation, fundraising,

bookkeeping, and graphics. Unpaid staff 

consisted of a Program Coordinator and an

Activities Coordinator at BDIC, and a Program

Developer, a Program Services Coordinator,

an Administrative Assistant, and Information

and Referral Specialist, a Housing Counselor,

an Independent Living Skills Trainer, an Intake

Worker, and a Peer Counselor at OISC. 

Volunteers averaged 225 hours per month

at each center to assist with structured socialization activities, food preparation, facilitating

support groups, and site maintenance. The

Final Report estimated that over 350 consumers/survivors volunteered during the 

grant period in a wide variety of tasks. 

Most staff were African American men; 

all were disabled, all were low-income when

hired; all had experienced homelessness; 

and all were consumers/survivors. The 

ACNMHC has an affirmative action plan that

emphasizes ethnic minorities, women, and 

disabled individuals in all roles within their 

programming: as participants, as staff, and

serving on governing bodies.

Employee orientation and as-needed, onthe-job training were provided. Group training

was also provided for the staff, volunteers, and

service users on such topics as peer counseling, benefits advocacy, community resources,

substance abuse, HIV/AIDS, TB and other

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 23

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 2. Descriptions of the 13 Demonstration Grant Projects
public health issues, civic involvement, defusing potentially violent situations, performing

intakes, and chairing meetings.

A number of administrative and program

materials were developed, including personnel policies, financial/accounting forms, 

and client forms. ACNMHC, BDIC, and 

OISC coordinated their activities with a wide

num-ber of other organizations and entities, 

including community service agencies, advocacy agencies, State consumer/survivor

organizations, local mental health and homelessness committees, providers of services to

the homeless, mental health providers, State

and local mental health authorities, churches,

foundations, researchers, legal centers, and

neighborhood associations. 

A total of $390,742 was spent on this 

effort over the three years of project funding.

Of this amount, $376,238 came from Federal

funds and $14,504 came from miscellaneous sources.

IMPLEMENTATION

ISSUES AND BARRIERS

Grant Startup Delays and 

Cashflow Problems

The project startup was delayed for nine

months, which affected hiring, procurement of

office space, equipment, furnishings and property insurance. This delay was due, in part, to

the 1989 San Francisco Bay Area earthquake.

State and Federal officials agreed to roll over

the first-year funds. This delay, however,

caused cashflow problems, and ACNMHC was

initially forced to borrow funds to cover payroll.

Cashflow problems also prevented the project

from conducting outreach in the South County

area, but full caseloads made outreach less 

of a priority. 

Heavy Workload and Staff Turnover

During the early phase of the grant, there was

some staff turnover. In addition to the staff

turnover, it was reported in Year 2 that the

individual projects believed that the CSHS

administrative office and staff were unable to

carry out both the functions of ACNMHC and

the functions of the two centers. Eventually,

some shared administrative support, such as

bookkeeping and statistics, was dropped.

SUCCESSES AND 

EVALUATION FINDINGS

Evaluation data were collected from a variety

of sources, including observations, interviews,

discussions, and the use of program documents, records, and quantitative data. 

The Final Report noted that the demonstration project essentially looked as planned.

ACNMHC became an effective “umbrella”

organization with shared resources, staffing,

and administrative assistance. It was agreed

that some of the administrative functions for

the two centers were not needed and would

have been logistically difficult to provide. 

Overall, it was noted that both centers succeeded in further developing their programs

(focusing on social and survival needs),

improving administration and operations (sharing of information), and improving recordkeeping and computer capacity. The local centers

were successful in gaining their own foundation grants. In Year 3, a funding consultant

was hired, resulting in successful grants 

and loans. 

Boston University conducted an outcome

evaluation that examined program participants’ self-esteem, quality of life, satisfaction

with the self-help program, service use, 

and demographics. 

24 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 2. Descriptions of the 13 Demonstration Grant Projects
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 25

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 2. Descriptions of the 13 Demonstration Grant Projects

Approximately 18% of the individuals served

were screened and intaked by CSHS staff at

both sites, with interviewers recording various

data. The services used by the most people

were: hot meals (100%), transportation assistance (100%), social/recreational activities

(93%), telephone services (88%), food referrals

(84%), peer counseling (76%), independent living skills training (60%), and peer support

groups (60%).

A correlational analysis revealed 

the following:

• Individuals who participated at a higher

level in the program had higher levels of

program satisfaction and had increased

self-esteem and quality of life.

• Findings suggested that persons with long

psychiatric histories (including frequent

and long hospitalizations) benefited at the

same levels as other participants in terms

of the program’s impact on self-esteem.

• There was no difference between members of different races or individuals with

homeless status in terms of self-help program impact on self-esteem, satisfaction,

or quality of life.

• No significant correlation was found between taking or not taking medications

and self-esteem, satisfaction, or quality

of life. However, there was a relationship

approaching significance between satisfaction with the program and taking

medications (those who do not take 

medications reported being more satisfied with the program).

The Final Report recommended that additional and more comprehensive technical

assistance and training be provided on the

topics of board development, fundraising,

recordkeeping, computer technology, and personnel policies and procedures (including laws

and regulations governing employment practices). It was also recommended that when

Federal funding is temporary, there should be

formal and concrete agreements with State

and local mental health funding agencies to

continue funds past the grant period. Lastly, it

was recommended that funds should not be

channeled through the State mental health

system, as this causes additional delays in

project startup. Funds should be provided,

instead, directly to the recipient organizations.

The Final Report suggested several interesting hypotheses for further evaluation:

• Outreach to ethnic minorities is best

accomplished when a program is 

situated in that community. 

• Both services and social activities are

needed for a viable program. 

• Programs such as these attract people

who are distrustful and resistant to 

traditional mental health services.

• An umbrella organization is essential 

for cooperation, communication, and

coordination for client-run programs 

in the same geographic area.

BDIC and OISC both obtained city funds 

to continue two positions until ACNMHC 

could obtain ongoing funds. Eventually, 

ACNMHC obtained county mental health 

funds to continue operations. 
26 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 2. Descriptions of the 13 Demonstration Grant Projects

PROJECT GOALS 

AND OBJECTIVES

The overall goal of The Phoenix Project was to

develop a consumer/survivor-controlled and 

-operated “superstructure” for the development, creation, and sustenance of nonprofit

and forprofit consumer/survivor-managed affiliate business enterprises. These affiliate enterprises would employ consumers/survivors and

would provide various direct services and

alternatives to traditionally based mental

health services to other consumers/survivors.

It was hoped that the grant would provide initial funds for startup costs and that later each

affiliate and the “superstructure” would be selfsufficient from sales and funding support from

other agencies and foundations.

Specific objectives included developing 

at least seven affiliate businesses (of which

five would provide mental health services,

such as case management, drop-in centers,

respite programs, job coaches, companion

programs, housing support staff, and vocational case management). Other suggested

business ideas included: property management and maintenance, bulletin board services, car detailing, photo finishing, messenger

service, phone marketing, wholesale handicraft and art, catering/box lunches, and 

temporary employee services. It was hoped

that these efforts would employ 50 consumers/

survivors serving 500 consumers/survivors in

the community.

The parent corporation provided initial support (startup funding), administrative and management services as needed (e.g., training,

accounting, marketing, and data processing),

and access to, and coordination of, community

resources on a cooperative model. The superstructure of the corporation provided a common job center for all affiliates, public relations, technical assistance, and fundraising.

There were also plans to disseminate project

results throughout the State and nationally.

The Final Report indicated that over time, it

became clear that the objectives were too

ambitious, so they were revised, with NIMH

approval, as follows: to develop seven businesses, of which at least three would provide

alternative mental health services. These businesses would provide alternative services to

200 consumers/survivors.

PROGRAM 

DESCRIPTION

Services Provided

After a lengthy RFP process, seven 

consumer/survivor-managed businesses 

were selected for startup funding, with six

COLORADO

The Phoenix Project

Denver, CO

“I feel [it] was a success and made a success by empowered

consumers...I can honestly say I learned to use my brain, my

knowledge, instincts, wisdom, courage, personal beliefs, 

education and experience in life...I learned the real meaning 

of team work...” 

—Project staffer 
being successfully established. These included

an auto repair service, Leopard Automotive; a

telephone help line, The Helping Ear; a desktop publishing firm, Phoenix Publishing; an

auto repair referral service, AutoMedic; a

rental management project, Phoenix Property

Management; and a benefits assistance project, Professional Benefits Assistance. 

The Helping Ear provided information and

advocacy, peer counseling, benefits acquisition assistance, and crisis intervention. Grant

funding also enabled The Phoenix Project to

provide technical assistance to consumers/

survivors. This technical assistance was

focused on specific skills such as cash register

operation; interpersonal skills such as conflict

management; and business development,

management, and other administrative skills

such as bookkeeping, purchasing, payroll,

board development, and fundraising. Lastly,

the funding enabled The Phoenix Project to

disseminate project results through presentations at international, national, Statewide, 

and local conferences, as well as through 

providing information to over 300 contacts 

and through coverage in newspaper articles

and newsletters.

Individuals Served

The project focused on serving individuals

designated as having a psychiatric disability.

The Final Report indicated that a total of 500

individuals received services from the affiliated

telephone information service, The Helping

Ear. Characteristics on the clients served by

the other affiliate businesses are unavailable.

Organization and

Administration

The grant was provided to the Colorado

Division of Mental Health, which provided the

funds to The Phoenix Project. The Phoenix

Project’s structure consisted of a Board of

Directors and a central office staff. It was originally intended that each affiliate business

would have its own Board and staff, although

further information was not reported.

Initially, a Board of Directors was to be 

composed of both consumers/survivors and

non-consumers/survivors, as well as minority

representation proportional to the State’s

makeup. After a lengthy process (which included nominations, written evaluations, and

in-person interviews), seven consumers/

survivors and four non-consumers/survivors

were chosen for the Board in late 1989. The

Final Report indicated that a total of 31 consumers/survivors and 6 non-consumers/

survivors had participated on the Board 

over the length of the project.

Paid staff consisted of an Executive

Director, an Assistant Director, a Consumer

Project Coordinator, an Administrative

Assistant, and a Bookkeeper. The State also

provided inkind staff support through a

Community Support Program Director and a

Human Resources Development Assistant.

The Final Report indicated that other part-time

staff and consultants were hired to assist with

administrative tasks including help from a

Business Manager and an Operations

Manager. The Report also indicated that 100

consumers/survivors over the entire project

period participated as staff, consultants, board

members, or volunteers. Nearly all paid staff

were consumers/survivors; consultants were

generally non-consumers/survivors.

Staff were provided with training on nonprofit organization development, business

management, specific employment-related

skills, and interpersonal skills. In Year 2, the

project determined that it would encourage its

affiliate businesses to offer low-stress, flexible,

supportive above-minimum-wage jobs (with

time off for doctors’ appointments, if needed),

career advancement, and assistance to staff 

in achieving financial independence. It also

decided to offer case management to those

who were transitioning back to work and 

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
regular support groups for employees to see 

if their needs were being met.

A number of pertinent materials were developed as a result of this effort, including a personnel handbook, a Request for Proposals,

and Board application forms. The project was

coordinated with a number of organizations

and entities, including retired business executives, training centers, mental health providers,

and colleges. In terms of the project’s impact

on the region, prior to the grant, there was a

consumer case management program in

Denver and a few self-help groups in the area.

After the effort, The Helping Ear and the

Statewide consumer/survivor organization

Survivors and Consumers of Colorado

Organized for Rights and Empowerment

(SCCORE) had been developed.

The Final Report indicated that the total

Federal funding for the project was $450,000.

IMPLEMENTATION

ISSUES AND BARRIERS

Several issues were encountered in the implementation of this initiative. Delays in startup

occurred, due to some State-level staff

turnover; as a result, a project extension was

granted. Turnover in the Executive Director

position and Board members also contributed

some difficulties. Tensions over control developed on the Board between consumers/

survivors and those who were not consumers/

survivors. Eventually, at the end of the project,

the Board was composed of all consumers/

survivors, except for one member. The amount

of resources needed to accomplish the original

goals was underestimated, and limited financial resources hindered the program’s success. Superstructure delays in providing subgrants to the affiliate businesses resulted in

the State threatening to withhold funds for 

the entire project.

Board and staff members both felt that there

was a lack of expertise in marketing approaches, financial management knowledge,

technical assistance, priority setting, and overall direction, which was ultimately detrimental.

The affiliate businesses were initiated in an

artificial environment. The Board and staff had

to train others on how to develop a Board and

organization at the same time they were learning to do it themselves, and this contributed to

the difficulties. It was recommended that more

time should have been allocated to these

organizational development tasks. Additional

problems mentioned were expediency of decision making (too many decisions were made

in times of crisis), and the isolation of Board

members from one another.

SUCCESSES AND 

EVALUATION FINDINGS

The project evaluation was originally conducted by an independent consultant; this was

later contracted to the Center for Technical

Assistance and Training at the University of

Northern Colorado. Project document analyses

and key informant surveys were the principal

sources of data.

The Final Report stated that Board members experienced positive impacts, including:

more knowledge of services available, knowledge of consumer/survivor needs, knowledge

of business and legal issues, and a growing

sense of empowerment.

Overall, it was found that the number 

of consumers/survivors employed was 

considerably lower than that expected and

that self-supporting businesses are a difficult

undertaking under even the best circumstances. The project did appear to enable 

people to develop skills to seek employment

elsewhere. Some comments provided by the

Board and the staff: “. . . Consumers were

motivated to consider themselves as positive

members of society . . .”, and “. . . It was 

highly successful in empowering the consumer

participants and in providing them with a 

variety of interpersonal, leadership, and

employment-related skills.”

28 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
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Some overall recommendations were

offered by the evaluation: 

• Ongoing training should be provided 

for staff on mission, policy and procedures, orientation, team building, communication, best business practices, 

and management issues, and for the

Board on such areas as communication,

problem solving, decision making, and

leadership development; 

• Effective communication needs to be

improved between the Board and staff; 

• Minority representation needs to be

increased throughout the program; 

• A business advisory committee should

be established to direct and advise the

businesses proposed; 

• The search for additional funding to

maintain the project’s financial viability

should be continued; 

• Career planning for consumers/survivors

for long-term employment goals should

be implemented; 

• Ongoing outreach to consumers/

survivors who might not be a part of 

he formal mental health system should

be continued; 

• Realistic expectations regarding the project should have been established so that

participating consumers/survivors were

not set up for disappointment; 

• Longer-term funding should be secured

(e.g., a five-year grant, which would

allow for greater success, given that

most startup businesses take three to

five years to establish themselves); 

• The necessity of being proactive and taking a planned, systematic approach to

completing the project should be emphasized; and 

• There is a need for effective team 

decision making, values clarification,

community linkages, and sound 

management philosophy.

Additional recommendations were made

regarding rewards and incentives. The 

project should:

• Find ways to concretely celebrate each

success, no matter how small (thankyou notes, extra break times, congratulation phone calls);

• Recognize work done well (employeeof-the-month, newsletter mention, letters

of recognition);

• Develop incentive programs based 

upon employee choice and personal 

values; and

• Treat people with unconditional respect

and use rewards strategically but often.

After the grant, attempts were made to

locate ongoing funding, but these were ultimately unsuccessful. The Phoenix Project

ceased operation in April, 1993.
30 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

PROJECT GOALS 

AND OBJECTIVES

The overall mission of this effort, as stated in

the original application, was to empower consumers/survivors by creating opportunities to

increase self-esteem, self-reliance, and independence through strengthening support networks and advocacy efforts. Specifically, this

was to be accomplished by developing and

setting up an Office of Consumer Affairs

(OCA) within the Indiana Department of

Mental Health, via the Mental Health Association of Indiana. The OCA would establish

links with consumers/survivors, family members, providers, and others. It was proposed

that this effort would develop a telephone tree

for legislative alerts, distribute monthly bulletins, publish a quarterly newsletter, and

sponsor quarterly meetings of State and

regional councils. 

Additionally, the project would work towards

developing a structure for the consumer/survivor movement and provide training on starting self-help projects. One component of this

training was to develop a model for self-help

groups known as KEY (Knowledge Empowers

You) groups. The project also hoped to develop a mailing list of consumers/survivors.

A training package for use in public speaking was to be developed as part of a speakers

bureau. Other plans included organizing a

Statewide conference, information dissemination, assisting in developing a coalition of consumers, family members, and providers, promoting consumer/survivor representation on

boards, and organizing an improvisational theater group and a media anti-stigma campaign.

PROGRAM 

DESCRIPTION

Services Provided

Grant funding enabled the project to provide

the following services:

• Organizational Development. The project established the KEY Consumer

Organization, a Statewide consumer/

survivor organization. A Statewide

Consumer Advisory Council and two

regional Councils were also developed.

A development professional was hired to

initiate fundraising activities, and preparations were made for writing several

grant proposals.

• Technical Assistance. Onsite technical

assistance was provided throughout the

State. Eight KEY self-help groups were

developed, and a leadership training

retreat was held. Training was organized

on serving on boards and committees,

peer support group leadership and facilitation, and communication skills. A peer

counseling training program was started,

INDIANA

Knowledge Empowers You

Indianapolis, IN

“KEY has helped me to be more motivated and more independent and also it has made me think of myself as a useful person

for a change, and not just someone with an illness...”

—Project participant
which provided 28 hours of initial training

for those interested in being case aides.

The Statewide network was expanded to

over 750 consumers/survivors. Two

Statewide conferences for consumers/

survivors were held. Scholarships were

provided to over 80 consumers/survivors

to attend conferences and meetings.

• Advocacy. Various advocacy efforts

were conducted around the State, including obtaining consumer/survivor representation on patients’ rights committees,

holding sessions for the purpose of

meeting legislators, and holding meetings to discuss consumer/survivor rights. 

• Information Dissemination.

KEYNOTES, a newsletter, was published

and disseminated to over 1,000 individuals. A speakers bureau was organized

and provided over 125 educational presentations and workshops. A toll-free

hotline was established and provided

information and referral services to 

consumers/survivors. Improvisational

theater groups were established, and

these conducted a number of educational performances.

Individuals Served

The following criteria were designated 

for individuals who were to be served by 

the program:

• Persons with a psychiatric disability;

• Former or current patients or service

recipients of the mental health treatment

system; or 

• “Concerned others” who want help or

referrals for mental health or consumer/

survivor services.

No specific client characteristics were

reported, but the following general characteristics were observed: service recipients? ages

ranged from 15 to 80; more women were

served than men; service recipients were

mostly low-income; and there was an increase

in minority service recipients being served,

over time.

Organization and

Administration

The grant was provided to the Indiana

Department of Mental Health, which provided

the funding to the Mental Health Association

(MHA) of Indiana. Initially, a Consumer Advisory Council (CAC) was established and composed of representatives from across the

State. During the second year of the project,

an all-consumer/survivor Board of Directors

was formed, formal bylaws were established,

and the project was formally incorporated. By

the project’s end, the KEY Consumer Organization was directly receiving the grant from

the State.

Paid staff consisted of a Consumer Affairs

Director, an Assistant Director, an Administrative Assistant, an Evaluator Assistant, and 

a Newsletter and Filing Assistant. Paid staff

were primarily Caucasian, middle-aged women.

Over 100 volunteers assisted in many different

areas. Staff training was provided on computer

technology, sign language, and newsletter

development. “Flextime” was provided to staff.

A large number of service-related program

and administrative materials were developed

during the course of the project, including legislative training information and a support

group model description. This project interacted with a number of public and private

groups, including family groups, other consumer/survivor groups, mental health providers, vocational rehabilitation offices, and

protection and advocacy agencies.

The reported total costs for this effort were

$166,198, with approximately $161,000 in

Federal funding.

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

IMPLEMENTATION

ISSUES AND BARRIERS

Reorganization of Fiscal Agent

In Year 2, the KEY Consumer Organization

was established as a nonprofit with bylaws,

etc. It was felt that some of the problems

experienced by the project were related to the

original fiscal agent’s lack of understanding

regarding the autonomy of KEY. KEY subsequently moved out of the agent’s offices and

opened an independent office that was provided by the State at no cost.

Regional Councils Were 

Not Developed

It was originally planned that regional advisory

councils would be developed throughout the

State. These councils were ultimately not

developed due to support groups not being

stable and geographic distance. 

Obtaining Representation on 

Patient Advocacy Committees 

in State Hospitals

Delays were experienced in realizing this

objective due to the lengthy processes State

hospitals used in appointing representatives to

these committees. 

Lack of Involvement of People 

of Color

Staff reported that “. . . members of KEY feel

they have tried and failed at attracting the

minority populations and they are unsure 

of what else to do . . .”.

Other Issues

Staff noted that the most critical problem, by

far, has been the lack of money. Other problems included limited staff resources and 

interpersonal conflicts among staff.

SUCCESSES AND 

EVALUATION FINDINGS

Although formal program evaluations were not

completed (according to the Final Report), an

informal evaluation was conducted with recipients of KEY services. Results were 

generally positive. Some of the comments

included: “KEY has created a greater awareness of consumer needs and issues especially

in the provider community...the main success

of KEY has been the empowerment of the consumers . . . ,” “. . . The KEY Consumer Organization has been a blessing to many people

who suffer from mental illness. People who

have been empowered by KEY have gone on

to live very productive lives.”; “Thanks to KEY I

can stand up for my rights and do many other

things I never could before I came to be

involved with them . . . I now have confidence

and can do much better than I ever have

before.”; and “It’s made a difference in my life.”

During the project period, a new Department of Mental Health Commissioner was

appointed. He was considered progressive

and supportive of consumer/survivor initiatives

and mandated more consumer/survivor

involvement. It was reported that KEY received a portion of an NIMH/CMHS Services

System Improvement Grant to provide continued services to consumers/survivors.
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PROJECT GOALS 

AND OBJECTIVES

The goals of this effort were “...to empower

and enable persons who are psychiatrically

labeled to help themselves and other psychiatrically labeled persons [and] to enable consumers to assume and maintain equal status

as partners in the mental health system.”

Specific objectives included funding the

Portland Coalition for the Psychiatrically

Labeled (PCPL) to: develop the necessary

infrastructure and breadth of competency to

operate effectively; refocus PCPL on in-house

member activities; turn volunteer service into

paid employment; and create a model for consumer/survivor-operated peer support, advocacy, education, and training services.

PROGRAM 

DESCRIPTION

Services Provided

Grant funding enabled PCPL to provide the

following services:

• Administration. The project developed

an in-house financial system, conducted

fundraising, developed a Board, and

wrote bylaws and personnel policies.

• Drop-In Center. The Drop-In Center provided social and informational activities

to benefit members, developed a membership list, held monthly membership

meetings, and distributed a monthly

update of activities.

• Peer Support. The project held frequent

and regular peer support meetings, conducted outreach and peer support for

individuals in nursing homes and

schools, offered informal support to

those discharged after long-term institutionalization, provided one-on-one counseling for support on independent living

skills, and conducted specialized peer

support groups for alcoholism, homelessness, and posttraumatic stress disorder.

• Respite/Crisis Assistance. PCPL provided assistance on a limited basis by

referring individuals to other services 

and working with staff of a crisis stabilization project to monitor and evaluate

their program.

• Empowerment. The project empowered

consumers/survivors through greatly

increasing the membership and enabling

PCPL to conduct special outreach to

minority groups.

MAINE

Portland Coalition for the Psychiatrically Labeled

Portland, ME

“...We are on the cutting edge of the mental health system—

being a consumer organization. We’re working together 

to make it fly. We have something we can prove. We can 

make a difference.”

—Project staffer
• Independent Living Programs. The

project established a stipend program

which assisted individuals in developing

job skills and provided information and

referral services.

• Public Education. PCPL published a

newsletter three times per year and 

distributed it to over 1,500 people and

produced a slide show on stigma.

• Advocacy. The project conducted regular monitoring visits to institutions, testified to State legislators, and filed a class

action lawsuit against the Augusta Mental Health Institute regarding patient

deaths. PCPL members participated on

various mental health committees and

task forces Statewide.

Individuals Served 

All individuals who were psychiatrically labeled

or psychiatrically disabled were eligible to

receive project services. It was reported that

PCPL experienced a fourfold increase in the

number of individuals served during the grant

period. Little data were provided on characteristics of service recipients who used services.

A drop-in center evaluation found: a slight

majority of the participants were male; their

ages ranged from 32 to 55; all were psychiatrically labeled; all were living in the community, and a slight majority lived alone; 

the vast majority were currently receiving 

mental health services; and all had been 

previously hospitalized. 

Organization and

Administration

The grant was awarded to the Maine

Department of Mental Health, Office of

Community Support Systems. The State then

provided the funding to the Portland Coalition

for the Psychiatrically Labeled (PCPL). 

The PCPL administrative structure was

composed of a Board of Directors, staff, and

members. The PCPL Board existed prior to

the grant and was composed entirely of consumers/survivors. The Board was elected

annually and was provided with training. Paid

staff included an Executive Director, an

Assistant Executive Director, a Consultant/

Planner, an Office/Work Skills Manager, a

Peer Support Program Coordinator, a House

Advocate, a Clerical Supervisor, and Stipend

Workers. The State also provided three inkind

positions, serving in the roles of Community

Support Program Director, Mental Health

Program Coordinator, and Management

Analyst II. PCPL staff characteristics were not

provided in detail, but it was noted that all

were consumers/survivors.

It was reported that staff attended training

sessions in management skills and desktop

publishing. In addition, stipend workers

received group and individual training, and

advocacy training was provided to members

and staff. “Flextime” was available to staff by

prior agreement with the Executive Director.

Leaves of absence due to illness could be

granted for up to six months.

A number of materials were developed over

the course of the project, including newsletters, a poetry book, a Board training notebook,

a monthly update, bylaws, personnel policies,

and job descriptions. It was noted that the use

of documentation (e.g., memos, bimonthly

update reports) helped to alleviate personnel

issues and stabilized the organization.

PCPL collaborated with a wide array of

other organizations in achieving its goals and

objectives, including: other disability groups,

the State protection and advocacy agency,

mental health providers, nonprofit management consultants, advocacy groups, and 

family groups, and universities.

34 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
During the grant period, a total of $540,500

was expended for this effort. Of this amount,

approximately $469,500 was Federal funding,

$66,000 was State funding and $5,000 was

local funding.

IMPLEMENTATION

ISSUES AND BARRIERS

Listed below are the issues which developed

during the project’s implementation. A retreat

at the start of Year 3 developed a strategic

plan for improving internal communication in

order to solicit input from all members, staff,

and Board regarding these issues and other

internal and external affairs of PCPL.

Delay in Project Startup

It was reported that this was due to the

Executive Director resigning and the time

needed to hire a replacement. A reorganization occurred after the change in Executive

Director, including other personnel changes

and a revision of the bylaws, personnel policies, and job descriptions. The hiring process

for several staffers took longer than anticipated, and there was ongoing staff turnover.

Cancellation of Statewide Expansion

A decision was made not to attempt to expand

within Maine (as originally planned) and

instead to focus programming locally on the

Portland area.

Lack of Equipment

A lack of typewriters, word processors, and

other equipment hampered the job training

stipend program.

Personal Conflicts and Tension

The reports indicated that interpersonal conflicts developed between staff and members.

This was a major problem encountered during

the project. It affected the entire staff and

membership. This resulted because some

members obtained employment, while 

others did not.

Unclear Priorities

This resulted in problems of resource allocation and staff burnout, and was due to a lack

of organizational planning.

SUCCESSES AND 

EVALUATION FINDINGS

A descriptive, summary evaluation of PCPL’s

drop-in center was completed and was based

on interviews with members who used the

drop-in center and observation of drop-in center activities. This evaluation found that a

majority of participants reported that the center

has helped them stay out of the hospital; a

majority felt more confident since coming to

the center; almost all would recommend the

center to others; and a majority said that coming to the center has helped them cope better

with their problems. 

The overall evaluation focused on the need

for continued development of PCPL organizational features, and the following recommendations were offered by the evaluators:

• PCPL should do planning with an expert

facilitator to clarify priorities, specify

objectives, create an action plan, and

build cohesiveness.

• Training on conflict resolution should 

be provided to Board, staff, and membership to defuse the tensions that

developed during organizational 

change and growth and employment 

of certain members.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 35

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

• Experts in group process and team building should be used to provide training to

staff and Board and serve as facilitators

during Board meetings.

• Board training should be provided 

annually, along with a packet of 

written materials.

• Board terms should be overlapping, and

provisions should be made for alternates. 

• Leadership training should be provided

to members.

• Training and technical assistance should

be provided to the Board and Executive

Director on hiring practices to address

staff turnover as well as on strengthening

interpersonal relations.

• PCPL should clarify and enforce policies

and procedures, including preparing upto-date policy manuals and offering training to groups and individuals on policy

implementation.

A final comment within the evaluation

indicated the overall success of this effort:

“. . . the project has demonstrated, without a

doubt, that consumers can plan and run 

their own organization . . .” 

PCPL was successful in obtaining funding

for continued operations.
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 37

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 2. Descriptions of the 13 Demonstration Grant Projects

PROJECT GOALS 

AND OBJECTIVES

This project developed The Self-help Center, a

drop-in center in Kirkwood, MO, for self-help

and advocacy services. Specifically, the

Center was set up to offer self-help group

meetings, peer case management, a drop-in

center (offering recreational activities, socialization, respite care for families, a game room,

and a reading room), and a self-help and

advocacy clearinghouse (providing hotline

services, information on advocacy, legislature

visits, position paper development, and publication of a rights information pamphlet).

PROGRAM 

DESCRIPTION 

Services Provided

Grant funding enabled The Self-help Center to

offer the following services:

• Advocacy. The center assisted in filing a

lawsuit on patients’ rights, obtained representation on various boards and committees, collected information on consumer/

survivor grievances, and advocated that

all publicly contracted agencies be required to have consumers/survivors 

on their Boards of Directors.

• Dissemination and Public Education.

The center presented at various conferences, published newsletters, distributed

1,000 pamphlets, and developed a clearinghouse library.

• Drop-In Center. The center operated 30

hours per week, with 20 people served

per day. Weekly membership meetings,

exercise classes, and biweekly volunteer

training meetings were held.

• Support Groups. The center sponsored

support group meetings of national

model self-help programs such as

Recovery, Inc., Project SHARE,

Overeaters Anonymous, and the

Missouri Mental Health Consumer

Network, among others. 

Individuals Served 

All individuals with a psychiatric disability were

eligible for services. A total of 220 members

were served, of whom 125 had frequent contact. The average attendance was 16 persons

per day. Most of those served were Caucasian

and under age 50.

Organization and

Administration

Initially, the grant was provided to the Missouri

Department of Mental Health, which then 

provided the funding to the Mental Health

Association (MHA) of St. Louis. The MHA

served as the fiduciary agent for The SelfMISSOURI

The Self-help Center

Kirkwood, MO

“Overall, The Self-help Center stands out as a quite 

successful program.”

—Project participant
help Center. The Center’s members elected

representatives to a Board of Directors, as

well as officers who functioned in a member/

staff role in running the center. The day-today decisions were made by a majority vote 

of the participants at weekly membership

meetings. The project eventually received its

incorporation and no longer worked through

the MHA, as it was able to provide its own

accounting services.

The Board consisted of six consumers/

survivors, a family member, and one additional

interested individual. Factionalism within the

Board presented some obstacles, as did 

ongoing struggles between the Board and 

the Director.

Paid staff included an Executive Director, an

Assistant Director, a Drop-In Center Manager,

two Clerical Workers, a Homeless Coordinator,

a Benefits Acquisition Specialist, a Case

Management Supervisor, a Clearinghouse

Manager/Director of Advocacy, a Maintenance

Worker, and a Technical Advisor (from the

MHA). These positions were primarily parttime positions. All staff were current or former

consumers/survivors, with the exception of the

Technical Advisor. Attempts were made to use

a Transitional Employment worker from a

nearby psychosocial program to fill some of

the clerical positions. Some members were

also provided with stipends ($75 per month) to

work approximately one day per week performing various tasks (outreach, recreation,

food services). These workers were elected 

by the membership to fulfill these roles.

The staff were mostly Caucasian; there was

an equal balance between men and women;

and there was one physically disabled individual and five former SSI/SSDI recipients. A

number of volunteers assisted, including five

parents. Training was provided to staff on

counseling skills and orientation to case management. Staff were initially permitted to

attend self-help group meetings during paid

time for their own mental health. 

A variety of program and administrative

materials were developed, including: drop-in

center rules and regulations, weekly drop-in

center attendance summary, monthly financial

reports, and financial procedures. The project

interacted with a number of organizations and

entities, including advocacy groups, family

groups, mental health providers, State and

local mental health authorities, and other 

consumer/survivor self-help projects. 

The project documents reported that a total

of $490,239 was spent on this effort, of which

$461,116 was Federal funding and $29,123

was from other sources.

IMPLEMENTATION

ISSUES AND BARRIERS

The following issues were encountered during

the implementation of this project:

• Staff Turnover and Other Personnel

Matters. A major problem was staff

instability, as four employees left.

Another problem was the lack of affordable health insurance coverage. Staff

were provided with $100 per month for

this purpose, but it did not cover this

cost. Another problem identified was the

difficulty that members had in setting

boundaries in staff and member relationships. The two way nature of these relationships (sharing problems as well as

listening to service recipients and being

“advice givers”) made this difficult. A

great deal of time was spent in staff

meetings on these issues.

• Heavy Paperwork Load. The Executive

Director reported being overwhelmed

with paperwork and accounting.

• Site Selection/Renovations. A site 

was selected, renovations were completed four months later, and donated

office equipment was received. However, delays occurred when the Fire

38 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
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CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 2. Descriptions of the 13 Demonstration Grant Projects

Marshal required extensive modifications, and during a long negotiation 

with the State regarding day program

licensure requirements.

• Community Resistance.

Implementation was difficult because 

of the “NIMBY” (“Not In My Back Yard”)

phenomenon during site selection 

and development.

SUCCESSES AND 

EVALUATION FINDINGS

Overall evaluation findings indicated that the

project met most of its stated objectives. A

large majority of participants reported that

“People who come here are learning to

depend on themselves more,” and “People are

encouraged to make their own decisions.” A

majority of participants felt more confident

about making their own decisions, and many

agreed with the statement “everyone pitches

in.” An impressive 90% said that people are

proud of the drop-in center. All staff and Board

said their work has made them more confident

to help others.

Other findings included: a majority considered the center a good place to “be yourself”

and a place to talk about hopes and dreams; 

a majority stated that “it’s true that it’s a 

place to share feelings without being put

down”. A large majority said that they felt

accepted at the center and that they now 

have more friends.

Respondents’ impressions regarding what

contributes to the longevity and success of a

self-help program such as this one were also

reported, including:

• Operational effectiveness;

• Member satisfaction;

• The attractiveness of the self-help philosophy, with its emphasis on empowerment and experiential knowledge;

• Strong organizational leadership;

• Strong administrative backing from 

the Department of Mental Health 

and NIMH; and

• Interpersonal interaction and 

social support.

Despite repeated and varied attempts, 

the project was unsuccessful in obtaining 

continuation funding and ultimately had to

cease operations.
40 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 2. Descriptions of the 13 Demonstration Grant Projects

PROJECT GOALS 

AND OBJECTIVES

The overall project goal was to enhance 

consumer/survivor involvement in service 

planning, service provision, and evaluation in

order to overcome obstacles presented by

geographic isolation and to address the need

for more opportunities for consumers/survivors

to actively participate in providing peer selfhelp, social and educational opportunities,

education and information dissemination 

activities, and community support services.

Two projects were proposed and are

described below. A special effort was made 

to increase minority participation and to

emphasize services for individuals experiencing homelessness, substance abuse 

problems, and developmental disabilities.

A Way to Better Living, Inc. (AWBL) of

Manchester, NH, sought to provide peer support for consumers/survivors released from 

NH State Hospital and others in re-integrating

into mainstream society. The program would

accomplish this by demonstrating how peers

might reach their best potential and helping 

to lessen stigma.

The Merrimack County Drop-In Center in

Concord, NH (later named the Do Drop-In

Center), developed a drop-in center and a

telephone support line to address socialization

and support.

PROGRAM 

DESCRIPTION

Services Provided

AWBL provided the following services:

• Outreach. Friendly Companions, an outreach program, used peer volunteers to

help facilitate delivery of communitybased services.

• Information Dissemination. A Speakers

Bureau provided monthly talks to increase

consumer/survivor knowledge and skills.

A newsletter was created and distributed

monthly, and a manual of information on

community services, laws, regulations,

rights and responsibilities was developed. 

• Financial Assistance and Food

Services. A revolving se curity deposit

loan fund provided limited loans for

peers to acquire independent, private

housing and a food bank assisted in 

providing food supplies.

The Do Drop-In Center provided a

drop-in center in the lower level of a clubhouse

program which operated 5:00 p.m.–9:30 p.m.

weekdays and 10:00 a.m.–9:30 p.m on weekends. The program offered an organized 

activity each night, support groups two nights

NEW HAMPSHIRE

A Way to Better Living

Manchester, NH

Do Drop-In Center

Concord, NH

“I would like to add that I am grateful for these services, for

without them, I would no longer live.”

—Project participant
per week, and a telephone support line staffed

by volunteers.

Individuals Served

A total of 230 individuals were served by the

two programs, 140 at AWBL and 90 at the Do

Drop-In Center. The largest proportion of service recipients lived in group homes, subsidized

housing, and supervised apartments. A minority lived in individual homes or with family.

At AWBL, the majority of service recipients

were female, Caucasian, and age 30-40.

Unemployment and psychiatric history data

were not reported.

At the Do Drop-In Center, the majority of

service recipients were male, Caucasian, and

age 36-45. Sixty-one percent were unemployed, and only seven percent had full-time

employment. 

Organization and

Administration

Funds were provided to the NH Division of

Mental Health, which then provided funds to

the two programs. AWBL eventually obtained

independent, nonprofit status. Each project

had its own Board of Directors, Project

Directors, and staff. The overall project had 

a Statewide Advisory Council of consumers/

survivors and family members which met regularly with the Director of the NH Division of

Mental Health. AWBL requested a local church

to act as its Board of Directors and provided

its services through the church, prior to gaining independent nonprofit status. The Do

Drop-In Center elected its own Board of 

consumers/survivors.

Paid staff at AWBL included a Project

Director, a Project Manager, a Secretary, and

a Treasurer. Volunteers at AWBL, called

“Friendly Companions” provided peer support

services. Paid staff at the Do Drop-In Center

included a Program Director, an Activities

Coordinator, an Outreach Coordinator, a

Program Manager, an Operation Supervisor,

and Administrative Assistants. Most of the

positions at the Do Drop-In Center were parttime, in order to allow flexibility in hiring (based

on differing project needs and skills of individuals) and to allow for flexible accommodation

of the needs of consumers/survivors. The

State provided additional inkind staff support.

AWBL reported that all paid staff were

female consumers/survivors, and most were

ages 50-60. The Do Drop-In Center reported

that all staff were consumers/survivors from

the local county.

The Friendly Companions at AWBL were

given specialized training. At the Do Drop-In

Center, training was provided to 

telephone support line volunteers in listening

skills, dealing with threats of harm to self or

others, and accessing available resources.

Project Directors provided additional training 

to staff depending upon need, and State

Division of Mental Health staff provided 

ongoing consultation.

Program materials developed by the two

projects included newsletters, organizational

bylaws, job descriptions, and an information

sheet for Food Bank recipients at AWBL, and

a telephone log sheet to record hotline information at the Do Drop-In Center. 

The two projects coordinated their activities

with several other groups, including: community service agencies, mental health providers,

family groups, hospitals, churches, and mental

health providers.

Prior to this project, at least three self-help

projects were known to exist in New Hampshire. After the initiative, it was reported that at

least 12 new self-help efforts had been developed, including: a satellite program out of the

Do Drop-In Center, a social club established at

AWBL, a Statewide consumer/survivor council,

a Statewide network of regional councils, and

consumer/survivor-operated services in six

regions of the State. Two of the services which

were developed were a consumer/survivoroperated discount retail store and the Wyman

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
Way Co-op (a consumer/survivor-run consortium of businesses).

The total budget for the three years of the

demonstration project was $254,666, of which

$229,250 was Federal funding and $25,416

was State funding.

IMPLEMENTATION

ISSUES AND BARRIERS

The following issues were encountered during

the implementation of this project:

• Startup Delays. Delays in passing funds

to the projects (which were caused, in

part, by State funding regulations and

grantee inexperience) caused some

service delivery delays at AWBL and

resulted in an initial lowering of consumer/survivor interest in the project at

the Do Drop-In Center.

• Transportation. AWBL was unable to

provide transportation services to service

recipients due to insurance constraints.

• Lack of Organized Activities. A lack of

organized activities in the first year at the

Do Drop-In Center was later addressed,

and the Center began to offer food,

dances, bowling trips, field trips and a

pool table.

SUCCESSES AND 

EVALUATION FINDINGS

A limited process evaluation was conducted

on both programs, using questionnaires to 

collect data on participant demographics and

ratings of services. 

AWBL’s “Friendly Visitor” outreach program

served five to ten service recipients per month;

the Speakers Bureau conducted approximately

10 engagements per month; and 400 copies of

the newsletter were distributed each month.

The food service was the most popular service, particularly at the end of the month, due to

economic conditions in New Hampshire. The

evaluator stated: “Many consumers told us

that they depended on the food supplies to

make it through the month, that without this

service, they would go hungry.”

The Evaluator also found that AWBL was

“...blessed with an incredibly devoted staff,

with a very low rate of turnover . . . [The] program offers a comprehensive, varied approach

to consumer needs . . . which work together to 

provide consumers with economic, educational, and emotional support when they 

need it most.”

The Evaluator found the Do Drop-In Center

was most successful, as it had “. . . grown

from a rather small, underutilized social club to

a popular, well attended social center for area

consumers . . . [it] provides a safe place...[and]

fulfills an important role. ...Social bonds are

created, maintained and strengthened. As

consumers’ social networks expand, demand

on emergency services and mental health supports [drops]. . . . [Participants] had a place to

call their own.” For those employed by the Do

Drop-In Center, it provided an “. . . important

stepping stone to further employment opportunities [and] provided consumers with an opportunity to prove that they can handle the

responsibilities of a job.”

Recommendations, based upon the 

evaluation, included: 

• All key persons and organizations should

be involved from the beginning to build a

constituency, generate support, clarify

expectations, and enhance the capacity

of the system to support these projects.

• Future projects should focus on assisting

consumers/survivors in developing natural

support systems. This will require a sufficient level of funding for adequate service

and meaningful evaluation research.

• Future evaluations should focus on the

most effective methods of increasing

rates of employment for consumers/

survivors and assisting them in obtaining

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

high school diplomas or GED’s. This will

also require a sufficient level of funding. 

• While the continuation status of these

programs was not reported, the following

quote was taken from the Final Report:

“...[the] Division [is] exploring [the] financial viability of continuation with general

fund dollars [at a] time of financial uncertainty in New Hampshire; nonetheless,

the Division is committed to continuing

the funding of these projects.”
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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

PROJECT GOALS 

AND OBJECTIVES

The overall goal of this effort, which was titled

Friends of the Homeless and later renamed

Share Your Bounty/Friends of the Homeless

(SYB), was to expand the activities of a consumer/survivor-operated food bank and outreach program which had been in operation

since 1984, serving people who were experiencing homelessness, primarily in the Bronx

and Manhattan. The project’s activities included raising food donations from local 

suppliers and distributing them directly to

homeless persons on the streets, in shelters,

or through other community agencies.

Specific objectives for this initiative were:

establishing an independent organizational

base in order to assure consumer/survivor

control (by obtaining office space and nonprofit

status); expanding and diversifying the project’s workforce; and increasing the project’s

efficiency, number of shelters reached, and

number of clients served (by purchasing a van

and driver to pick up and deliver food). The

project also planned to offer job placement

assistance through a vocational rehabilitation

counselor; to disseminate results through presentations at conferences and at meetings of

national consumer/survivor organizations; and

to meet with consumer/survivor groups at all

adult State hospitals to develop interest in

replicating the project, including holding a

Statewide conference and providing technical

assistance to those interested. The project

also hoped to develop additional funding

resources by creating relationships with the

New York State Office of Mental Health,

municipal agencies serving homeless 

individuals, and corporate donors. 

PROGRAM 

DESCRIPTION

Services/Supports Provided

Funding enabled Share Your Bounty/

Friends of the Homeless to provide the 

following services:

• Sandwich Delivery and Basic Food

Supplies. Until new policies forced

homeless individuals out of the building,

SYB provided sandwich delivery to this

population at Grand Central Station. SYB

also provided basic food supply to shelters and other delivery points in the city.

• Technical Assistance and Training.

SYB conducted workshops throughout

the State, which contributed to the development of four other consumer/survivorrun projects, including a consumer/

survivor-operated food bank called

“Harlem Dollar Stretchers,” an outreach

NEW YORK

Share Your Bounty/Friends of the Homeless

New York, NY

“...There is also a tremendous increase in self-esteem 

that comes with going from being a hospital patient who 

is dependent to working independently and doing 

something important.”

—Project staffer 
effort to homebound elderly persons in

the Bronx, an “adopt-a-family” donation

effort at a hospital, an “adopt-a-shelter”

program, and a consumer/survivor-run

coffee stand at several mental health

residences. Consumer/survivor staff

input also directly stimulated the development of a consumer/survivor-run case

management program.

• Committee Work and Housing

Advocacy. Staff served on various task

forces, committees, and workshops. Staff

assisted the New York City Department of

Mental Health in initiating an Integrated

Neighborhood Housing Project (INHP).

INHP was an effort to promote community

acceptance of people with mental illness

living in the community in various New

York City neighborhoods.

• Information Dissemination. A videotape of SYB was developed and distributed widely and shown on White Light

Communications (a consumer/survivorrun video production project in Vermont,

discussed elsewhere in this chapter),

and several articles were accepted for

publication in Hospital & Community

Psychiatry and the monthly bulletin of the

New York State Office of Mental Health.

• Other Services. SYB acted as fiduciary

for a Consumer/Survivor Resource and

Information Center at Bronx Psychiatric

Center. In the last year of the project, as

an increasingly larger number of people

in need of help came to the project’s

offices, SYB began to offer crisis intervention, referral to social services, and

peer support.

Individuals Served

Little specific information was reported on the

consumers/survivors who were served by the

project. It was estimated that approximately

100 homeless individuals per day were receiving food at Grand Central Station, during the

period when the project provided street food

distribution. Most of these individuals were

African American and Latino males, ages 

18 to 40.

Organization and

Administration

Initially, the grant was provided to the New

York State Office of Mental Health, which provided the funds to the Bronx Psychiatric

Center. Bronx Psychiatric Center acted as the

fiscal agent for SYB until the project attained

independent nonprofit status. It was proposed

that if a conflict developed between the project

workers and the hospital, the issue would be

sent to an outside committee composed of two

consumer/survivor consultants, a provider, and

staff of the State Office of Mental Health.

During its first year of operation, SYB

became a separate organization. SYB developed a management team composed of the

Executive Director, Treasurer/Secretary,

Resource Manager, Outreach Manager, and

Operations Manager. A bookkeeper, business

accountant, project evaluator, and a consumer/survivor evaluator were later added to

the team. Three employees served as the

Board of Directors. An Advisory Council of

providers was also developed. This organizational model was described as a “supportive to

separatist” self-help project (see description of

Chamberlin’s and Emerick’s typologies in the

literature review in Chapter 1). Professional

involvement diminished as the program handled its own financial matters and retained its

own lawyer.

Paid staff consisted of: an Executive Director,

a Treasurer/Secretary, an Outreach Manager, a

Resource Manager, an Operations Manager,

Food Distributors, Drivers, an Office Manager, a

Senior Research Assistant/Field Trainer,

Consumer Consultants, a Consumer Evaluator,

and a Business Accountant. In-kind staff, 

funded elsewhere, included: an Assistant

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Director, Project Workers, a Custodian, a

Bookkeeper, a Secretary, a Research

Supervisor, Bronx Psychiatric Center

Consultants, a Principal Consultant, and 

a Senior Research Advisor. 

The Project Workers were all

consumers/survivors from the Bronx

Psychiatric Center. One-half were formerly

homeless, 72% were African American or

Latino, 18% were Caucasian. Some were still

hospitalized, and some had extensive work

histories. Education levels ranged from ninth

grade to law school graduate; the majority had

a high school diploma. Two of the staff had

previous self-help movement experience. A

total of 46 people participated as paid staff

during the life of the project. 

Staff attended and presented at various 

conferences and trainings. Some staff received training on organizational management

and fiscal accounting. The Office Manager and

the Bookkeeper obtained training in computerized bookkeeping.

At the start of the project, it was determined

that there would be no staff stratification based

on level of disability. Staff could decide to

reduce work activities or take temporary leave,

if needed. By Year 2, the Office Manager had

been providing peer counseling to staff, and

there was interest in developing a drop-in center at the SYB offices. In the following year, all

staff including the Executive and Assistant

Directors rotated jobs so that all staffers would

have familiarity with all positions and so that

staff could trade jobs if they disliked what 

they were doing.

The project collaborated with a number of

organizations, including: hospitals, research

organizations, homeless service providers,

advocacy organizations, food banks, universities, supermarkets, churches, soup kitchens,

and State and local mental health authorities.

Total Federal funding for the project 

was $378,420.

IMPLEMENTATION

ISSUES AND BARRIERS

The following issues were encountered during

the implementation of this effort:

• Office Space. Originally, the project 

was established at a temporary space 

at the Bronx Psychiatric Center. The 

project later obtained its own space,

which greatly facilitated a sense 

of independence.

• Delay in Receiving Project Funding.

It was reported that this was due to

delays in achieving nonprofit status. 

• New Homeless Policy at Grand

Central Station. SYB was forced to 

stop food distribution at Grand Central

Station, due to a new policy against food

distribution and against homeless people

congregating at the station.

• Leadership Gaps. The resignation of

the Executive Director and the unexpected death of a board member left 

a gap in leadership.

• Provider vs. Consumer/Survivor

Issues. Differing perceptions by consumers/survivors and professionals

regarding what direction the organization

should be taking created friction and 

distrust. These problems were exacerbated at the end of the grant, when 

non-consumer/survivor outsiders’ ideas

regarding how SYB could be continued

resulted in tense communications. 

• Decisionmaking Hierarchy. The Final

Report indicated that the board and the

management team were often the sole

individuals involved in decision making.

This hierarchical structure prevented

some participants from learning to take

responsibility and learning how the

organization functioned.

46 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
• Drug Abuse Among the Homeless.

This contributed to the decision to stop

street food distribution, as some SYB

members felt at-risk as a result of their

own substance abuse histories.

SUCCESSES AND 

EVALUATION FINDINGS

The evaluation consisted of a qualitative 

study, using participant-observation, individual

interviews, focus groups, and documentation

of activities. 

Overall findings indicated that the project,

by becoming consumer/survivor-run, had “selfdeinstitutionalized” itself and its members.

SYB members felt they had learned much

about the work world from their positions,

learned work skills transferrable to other 

jobs, took great pride in helping others, and

found their work to be flexible, enjoyable, 

and meaningful.

Statements from the staff included: 

• “Now I’ve realized how we need people,

others need me and I need others.”

• “[At SYB],...no one judges you.”

• “. . . [The] program has contributed to the

emotional, spiritual and financial transition from the hospital.”

Members stated that they learned to get

along with one another, problem solve together, air out their feelings, and encourage

one another. Members supported one another

to be drug-free and to act responsibly. They

developed a sense of independence, autonomy, and self-confidence that many said they

had not felt before. One participant stated:

“What’s empowering for us is to do our 

own thing now.”

It was noted that staff provided peer support/self-help to one another and to other

peers. SYB had become a “. . . family center

where members socialized, played music, and

discussed their problems with one another . . .

birthdays were celebrated . . . [it] took on the

aspect of a ‘home’ . . . members referred to 

each other as ‘family’. Members provided 

crisis management for one another. At 

least five members were hospitalized briefly;

members would visit and phone regularly, 

and sometimes people got day passes to

come to work. All returned to work after 

their hospitalizations.” 

According to the evaluation, one of the 

principal benefits of the project was that it 

“. . . demonstrated that consumers can form

an autonomous organization which aided them

in transition from [a] long-term, institutionalized

[setting] to successful community integration;

[it] demonstrated that such an organization

can provide its members with a number of

essential functions (i.e., socialization) without

professional service providers; [and it] demonstrated that SYB members remained committed to [the task] for the duration of the grant,

despite occasional setbacks.”

The impact was also felt on the community,

where “former mental patients were seen as

capable and motivated to provide much-needed

outreach and goods to those who are even

more destitute. SYB contributed to a destigmatization of formerly institutionalized people,

[and] a considerable number of empowerment

efforts across the State were begun in the 

wake of SYB.” 

Many professionals, administrators, and

State officials, in informal conversation,

expressed positive changes in attitudes

towards consumers as a result of their contact

with SYB. It should also be noted that SYB

received Honorable Mention for the 1989

Hospital & Community Psychiatry Achievement Award, presented by the American

Psychiatric Association.

Some concerns were raised that the grant’s

implementation imposed “structural and

bureaucratic constraints” on SYB. The quick

and large growth of the organization was a

positive in terms of the organization’s ability to

disseminate information, but it also produced

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self-management growing pains, along with 

a lack of appropriate technical assistance 

and education. The “use of outside professionals [rather than consumers] made SYB

members wary and uncomfortable with the

‘outside’ world of non-consumers.” This 

highlighted some differences between participating members and professionals and 

contributed to tensions. 

A series of recommendations were offered,

based on the evaluation:

• The State Office of Mental Health 

should develop technical assistance 

programs to help consumer/survivor-run

programs develop or expand in the areas

of incorporation, bylaw development,

organizational structure, legal consultation, budgeting, grants management,

reporting requirements, and payroll.

Wherever possible, this assistance

should be provided by other

consumers/survivors.

• The New York State Office of Mental

Health and the New York City Department of Mental Health should develop a

policy concerning the support and development of consumer/survivor initiatives,

and this policy should be linked to

longer-term planning for financing consumer/survivor initiatives. They should

identify staff points of contact and funding sources and mechanisms.

• Staff should include at least one 

bilingual individual.

• Consumer/survivor organizations 

may want to develop a “Friends of . . .”

group, consisting of non-consumers/

survivors or consumers/survivors who

are not members, for the purpose of 

networking and fundraising.

Attempts were made to secure continued

State funding, city homeless funding, and corporate support, but these efforts to continue the

program’s funding were ultimately unsuccessful.
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PROJECT GOALS 

AND OBJECTIVES

The purpose of this effort was to establish, 

via Mind Empowered, Incorporated (MEI), in

Portland, Oregon, outreach services to help

consumers/survivors achieve coping and community living skills and a better quality of life

and to provide an array of services which

assist, support, and empower psychiatrically

disabled persons. Activities were organized

around three main program elements: training,

which focused on developing a cadre of peer

outreach counselors, support services which

utilized peer counselors and volunteers, and

public education/advocacy, which worked to

combat stigma through public education and

policy advocacy efforts. Specific goals included: developing an existing nonprofit consumer/survivor-operated corporation into a

well-organized entity based on sound operating principles; establishing a curriculum and

training peer outreach counselors on a quarterly basis; providing stipend-supported and

volunteer placements; establishing effective

peer support and advocacy services; and pursuing public education and advocacy efforts 

to combat the stigma of mental illness.

The Final Report indicated that the project

had been renamed SEEDS (Spreading

Empowerment, Enlightenment, and Dignity).

PROGRAM 

DESCRIPTION

Services Provided

Funding enabled MEI to provide the 

following services:

• Training. Core trainings were organized

and held weekly on topics such as: mental illness, medication and side effects,

accessing community resources, psychosocial rehabilitation, dual diagnosis

assessment and referral, personality disorders, suicide intervention, and violence.

• Public Education, Advocacy, and

Information Dissemination. A clearinghouse was developed, numerous public

information and interagency presentations

were made by project staff, and members

participated on a variety of committees.

• Drop-In Center and Support Groups. A

drop-in center, open Monday–Saturday,

10 a.m.–7 p.m., was started. Holiday 

dinners were prepared and served on

Thanksgiving and Christmas, and 

monthly dances and cookouts were held.

Three time-limited peer support groups

met weekly on a variety of issues.

• Outreach Services. Outreach was 

conducted at a homeless shelter and 

a State hospital. 

OREGON

Mind Empowered, Inc./Spreading Empowerment, Enlightenment, and Dignity

Portland, OR

“MEI [Mind Empowered, Inc.] has made a big difference in my

life . . . I don’t know what would have happened to me without

these people . . .”

—Project participant
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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

Individuals Served

Services were open to individuals, 18 years 

of age and older, who had a psychiatric disability. The program further targeted: people

who were in hospitals preparing for discharge,

who cannot access mental health services due

to long waiting lists; those homeless or at-risk

of becoming so; those labeled “hard-to-treat”,

who don’t want to be identified with the formal

system; and those who wished to supplement

their involvement with professional mental

health service providers. Recipients of 

services were primarily male, age 30–50, 

and Caucasian.

Organization and

Administration

The grant was provided to the Oregon Mental

Health Division (MHD), which provided the

funding to MEI. Initially, MEI used the Mental

Health Association of Oregon as its fiscal

agent until it attained nonprofit status and

became sufficiently established to do its own

fiscal books and payroll.

The Board of Directors already existed at

the time of the grant application. It required a

majority of its membership to be consumers/

survivors. Paid staff included an Executive

Director, an Outreach Manager, a Socialization

Team Leader/Coffee House Manager, a Skill

Trainer, an Information and Referral Team

Leader, a Volunteer Team Leader, a

Secretarial Team Leader, and several Stipend

Positions. The State provided several inkind

positions, including: a Manager of Community

Programs, a Coordinator of Community

Programs, and several Consultants.

MEI policy required that a majority of staff

have a history of serious mental illness as well

as the capability to perform duties. Where

qualified consumers/survivors could not be

found for positions requiring an essential type

of expertise, non consumers/survivors could

be employed, but in such cases they were to

be screened carefully to insure compatible values and a commitment and understanding of

consumer/survivor empowerment. Efforts were

also made to recruit minority individuals. The

Final Report stated that all paid staff were 

consumers/survivors, and the total number

employed throughout the project was 22.

The project’s personnel policies specifically

addressed the issue of providing reasonable

accommodations. This included paid time off,

at the discretion of the Executive Director, to

permit stabilization of acute illness and reallocation of duties when necessary. 

A number of materials were developed over

the course of the project, including: a program

flyer; job descriptions; a client intake form; a

daily contact log; member’s weekly contacts; a

daily time record for staff; an expense summary

form; an employment application; an evaluation

intake form; progress notes; a goal setting form;

an informed consent form; and policies regarding personnel, the drop-in center, outreach, and

information and referral services.

The project coordinated its efforts with a

number of other organizations, including: mental health providers, hospitals, the National

Association for Rights, Protection, and

Advocacy, universities, County Commissioners,

Social Security offices, homeless service

providers, Parks Department special programs,

churches, and Oregon Public Radio. 

A total of $480,353 was spent on this effort,

of which $399,196 were Federal funds and

$81,157 were State funds.

IMPLEMENTATION

ISSUES AND BARRIERS

The following issues were encountered during

the implementation of this project:

• Systems Change. Oregon’s mental

health system experienced broad operational and philosophical changes which

impacted upon this project, including the
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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

implementation of Public Law 99-660.

This legislation mandated consumer/

survivor involvement in State mental

health planning councils. As a result, consumers/survivors were more accepted

and included as valued participants.

• Staff Turnover. There were reports 

that staff turnover created some 

delays in the implementation of 

certain project activities.

• Funding. A ten percent reduction in

funding by NIMH across all projects

resulted in the project needing to cancel

publication of the MEI newsletter.

SUCCESSES AND 

EVALUATION FINDINGS

A member satisfaction survey revealed that a

majority felt that the center was a major factor

in providing them with socialization opportunities and money management skills. Participants valued it as a place to learn about mental illness, low-cost housing, and employment

opportunities and many stated the project

played a central role in their social lives. Other

findings included: a majority felt they had

found help for their problems at the center (primarily housing, Social Security, or other practical information); and that the center was a

place where hopes and dreams could be discussed. Most said they were encouraged to

make their own decisions and that a lot of dayto-day problems were solved through involvement with the center. Overall conclusions

found that: members value MEI in the community; many would feel an extreme loss if the

center were to close; and MEI assists individuals in linking with community services which

enable them to live independently.

An analysis of staff contact logs revealed

that housing was the most requested service,

followed by money management assistance

and interagency referrals.

A process evaluation noted that the greatest

strengths and successes of the effort were

that consumers/survivors can develop an

organization, overcome difficulties, make 

contact with other consumers/survivors, and

deliver needed services. MEI maintained a

continuity of vision and philosophy and developed extraordinarily helpful and beneficial relations with other grassroots and consumer/

survivor empowerment interests. MEI demonstrated that consumers/survivors can move

through the stages of interest, opportunity,

learning, and service to others.

Some unanticipated benefits were reported,

as well. The project provided a training and

proving ground for consumers/survivors’

efforts in mental health work, as a number are

now working with other agencies. The relationship between the State and the project was

especially important during the application 

and preparation process. 

Several recommendations resulted from 

this evaluation:

• Training sessions should offer a mix of

exploration and problem solving.

• The evaluation would have been more

successful if a State/project cooperative

system of recordkeeping that reported

more useful program information had

been created. With appropriate opportunities for incorporating feedback, such

information would have contributed

greatly to decision making, clarifying

focus, and documenting changes. 

• The theory and practice of self-help and

its impact on staff learning, development,

and self-esteem should be examined.

There is a need for further examination

of the model of “becoming interested,

volunteering, learning, and moving into

staff positions.”

It was noted that in 1991, MEI received the

Small Employer (of handicapped individuals)

of the Year Award by the Oregon Disabilities
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Commission and the Excellence Award by 

the Oregon Division of Mental Health and

Developmental Disability Services.

The State Division of Mental Health and

Developmental Disability Services remained

committed to ongoing funding of this project.

Continued State funding for SEEDS and for a

new program entitled CSP, the Community

Survival Program, was awarded.
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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

PROJECT GOALS 

AND OBJECTIVES

The overall objective of this project was to

develop and operate a drop-in center and

related services, called Friends Helping

Friends, to meet the socialization and support

needs of consumers/survivors in Nashville,

Tennessee. The goals of the project were: to

empower consumers/survivors by helping

them to gain control over their lives and the

services they receive (by developing selfconfidence and self-esteem and by rotating

leadership positions and responsibilities); to

provide emotional support to consumers/

survivors (through a support group, friendship

networks, and drop-in activities); to combat

stigma (through a speakers bureau); and to

promote consumer/survivor independence

through consumer/survivor-run services (a

housing loan program, a crisis intervention/

respite care program, job placement services,

and roommate matching services).

PROGRAM 

DESCRIPTION

Services Provided

Grant funding enabled the project to provide

the following services and supports:

• Drop-In Center. The center offered 

crisis intervention, peer counseling, 

hospital visits, an information bureau,

referral services, recreation and socialization activities, meals, and holiday

gatherings. The center was open seven

days per week, including holidays and

evening hours.

• Speakers Bureau. Ten consumers/survivors were trained and then sent out to

speak to groups on a variety of topics,

ranging from housing to advocacy to

blood pressure to first aid. Consumers/

survivors gave an average of four presentations per month. 

• Job Placement Service. Staff located

employers who had temporary jobs and

matched consumers/survivors with available jobs. Park Center (a psychosocial

program which served as this project’s

fiscal agent) provided an onsite Job

Coach daily. 

• Roommate Matching Service. The project provided assistance with locating

apartments, moving, and followup visits.

• Crisis Intervention/Housing Respite.

This service was created to offer an

alternative to hospitalization, when

appropriate. The service was coordiTENNESSEE

Friends Helping Friends

Nashville, TN

“Through participating in Friends Helping Friends, members

achieve greater confidence in decision making, are better 

able to cope with their problems, have more friends, participate in healthier activities, and are better able to avoid psychiatric hospitalization.”

—Project evaluator
nated by Park Center, which placed an

onsite Housing Specialist at Friends

Helping Friends.

• Newsletter. The project published a

bimonthly newsletter, which included a

schedule of events, creative submissions, information on pending legislation,

drop-in center statistics, and consumer/

survivor concerns. The newsletter was

distributed to over 400 people. 

• Self-help Group. The project sponsored

a weekly group which focused on support, education, and advocacy regarding

physical abuse, overmedication, and

boarding home abuses.

• Loan Fund. A fund which made small,

interest-free loans for housing and

employment needs was set up. The maximum loan was $25, and a committee

reviewed all requests, which included

security deposits, furniture, eyeglasses,

and car repairs.

Individuals Served

Criteria for membership stated that individuals

served must have a major “mental illness”, be

able to travel independently, and abuse no

substances at the drop-in center. The definition was later broadened to include former

consumers/survivors and homeless consumers/survivors. The definition was broadened in order to respond to concerns that 

people in need would be denied services. 

A total of 300 individuals were served by the

project. Fifty individuals, mostly homeless,

were referred to other programs. A majority of

service recipients were Caucasian males; the

average age was 52. Thirty-six percent were

African American, 60% had a high school education, 93% had been previously hospitalized,

and 98% had previously used community

mental health services.

Organization and

Administration

The grant was awarded to the Tennessee

Department of Mental Health/Mental

Retardation, which provided the funds to a

psychosocial program, House of Friendship/

Park Center Association. Park Center acted as

the project’s fiscal agent. Initially, a Planning

Group composed of consumers/survivors and

providers was formed to help direct the program. This Planning Group later became more

formalized, and members held elections for a

President, Vice President, and Secretary. By

Year Two, this Board had hired a Director,

who, in turn, hired staff. Paid staff included the

Director, two Peer Counselors, a Secretary,

and an additional On-Call Peer Counselor.

A total of $237,000 was spent on this effort,

of which $234,000 were Federal funds and

$3,000 were individual donations.

IMPLEMENTATION

ISSUES AND BARRIERS

The following issues were encountered during

the implementation of this effort:

• Project Development. Initially, it was

planned that two support groups would

form the Nashville Consumer

Consortium, which would then become

incorporated and develop a board. This

would enable them to contract directly for

services. This apparently never happened, although the reasons are unclear

from project materials. 

• Project Location. The drop-in center

was ultimately located within Park

Center, as three other independent sites

which were explored were deemed

unsuitable due to high rent or crime. 

• Project Autonomy. There were indications that the project did not have a

sense of being consumer-run, due to its

close affiliation with the Park Center.

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
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Sharing space and staff with this program contributed to this concern. In 

addition, with Park Center being the fiscal agent, this furthered the impression

of excessive professional involvement

with this project.

SUCCESSES AND 

EVALUATION FINDINGS

The project evaluation was conducted by 

the State Department of Mental Health and

|Mental Retardation. Program aspects to be

examined included the number served in 

various project activities vs. projections 

and member satisfaction.

Respondents reported that they were proud

of the center, and reported that they felt that

the center: encouraged people to make their

own decisions, helped people learn about

resources, and encouraged people to share

feelings without being put down. During the

grant period, a Statewide consumer/survivor

group, the Tennessee Mental Health

Consumers’ Association, was formed.

The evaluation found that a sizeable number of people thought that the center was

owned by Park Center, and as a result, an

interim recommendation was made that the

drop-in center try to obtain its own space. The

evaluators also recommended more social

activities, more outreach to mental health centers, staff training and recognition within the

mental health community, a new location for

the drop-in center, and efforts to increase

minority participation and enhance the cohesion of consumers/survivors, family members,

and professionals.

The Final Report indicated that the project

received $90,000 per year in continuation

funding from the Tennessee Department of

Mental Health/Mental Retardation.
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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

PROJECT GOALS 

AND OBJECTIVES

The original objective of this effort, called White

Light Communications, was to use a portable

satellite uplink vehicle for transmission of live

public education productions to remote regions

of Vermont. The project was originally set up to

be financially self-sufficient by making its

portable uplink available for rental fees to commercial users. Productions were distributed

live, via satellite, on a weekly basis to 60,000

cable television subscribers in VT, and included

public affairs items, public-interest stories, and

entertainment produced by, and featuring, consumers/survivors. This effort provided opportunities for consumers/survivors to communicate

directly to the public about their experience of

being a psychiatric patient.

Project goals consisted of: public education

to change attitudes and misinformation about

mental illness; outreach to organize consumers/

survivors by conducting State, regional, and

national networking; and development of 

professional employment opportunities for 

consumers/survivors, including technical 

and managerial roles not usually available 

to such individuals.

The project focus was later changed from

satellite uplink to direct video production, due

to the price of purchasing equipment. The

project developed several broadcast-quality

productions for distribution on national cable

systems; duplicated and sold videos of its productions; and worked on co-producing, directing, and staffing two interactive, live, national

satellite broadcasts of consumer/survivor panels discussing major issues.

PROGRAM 

DESCRIPTION

Services Provided

The following services were provided:

• Weekly Productions. Half-hour weekly

productions were distributed via cable

networks in VT’s three largest cities and

in Syracuse, NY. Throughout the project,

nearly 80 half-hour productions on a variety of consumer/survivor issues were

made for a monthly cable show.

• Broadcast-Quality Productions. Three

documentaries on consumer/survivor

activities and perspectives were produced for national distribution during 

the project.

• Consumer/Survivor Involvement.

Representation was obtained on several

mental health boards and committees at

the State and local levels.

• Networking. A relationship was established with a major video production and

distribution company, and contacts were

begun with national cable channels for

broadcasting a production on Alternatives

VERMONT

White Light Communications

Burlington, VT

“. . . [It has] opened up a whole new avenue for communication,

for building support networks for fostering empowerment, and

for developing a sense of belonging among consumers.”

—Project staffer
‘90, the fifth annual national mental health

consumer/survivor conference, sponsored by NIMH and held in Pittsburgh.

• Interactive Satellite Conferencing. A

concept for a national, interactive, live

satellite television network production

was developed and implemented, and

the first broadcast of “Self-help Live” took

place in 1991. This broadcast focused 

on highlighting a number of consumer/

survivor leaders.

• Videotape Marketing. A list of 35 available educational videotapes, all produced

by the project, was compiled. The project

distributed copies of these tapes. The

videotapes were used to promote consumer/survivor education and provide professionals with education and training

regarding consumers/survivors and their

issues. The best productions were duplicated and a marketing brochure was

developed and mailed to 15,000 potential

customers. Sales of videos accounted for

a percentage of the project’s 1992 budget.

Individuals Served

It was estimated that the project reached an

estimated 1.6 million homes in the Boston,

Seattle, New York City, upstate New York, and

Vermont areas via public access cable television stations. A total of 38 states participated

in the broadcast of “Self-help Live”, with nearly

200 viewing sites.

Organization and

Administration

The grant was awarded to the Vermont

Department of Mental Health, which provided

the funds to the Vermont Liberation

Organization to operate the project.

Initially, the Vermont Liberation Organization

(VLO) had an existing board which included

eight consumers/survivors, one family member

and two mental health professionals. The

Board expanded to include business and communications experts, and periodically other

constituent group representatives (i.e., other

consumer/survivor groups, family groups, etc.)

were asked to attend meetings to provide suggestions and feedback.

The staff of the project consisted of an

Executive Director, an Office Manager, a

Production Coordinator, and 30 part-time production assistants over the life of the project.

Several communications professionals and

business consultants assisted the project in

creating a business plan, bookkeeping, project

evaluation, and technical aspects of television

production. All staff received two months of

training at Adelphia Cable in Burlington.

All staff were consumers/survivors. The staff

was all Caucasian, mostly New Englanders,

2/3 were female, and their ages ranged from

30–43. All staff were college graduates, and

the mean income was $21,250.

Materials that were developed during the

project included job descriptions, a brochure,

videotapes and television productions, and a

listing of videotapes available. The project

interacted with several other entities, including

local, state, and national cable and video production organizations, mental health technical

assistance agencies, state mental health

authorities, and universities.

A total of $529,475 was spent on this effort,

of which $517,475 came from Federal funding.

IMPLEMENTATION

ISSUES AND BARRIERS

The following issues were encountered during

the implementation of this project:

• Purchase of Equipment Not Feasible.

The original plan to purchase a portable

satellite uplink and to lease it in order to

generate revenues was not feasible due

to cost. The project instead decided to

establish a television production busiU.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 57

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ness and to distribute productions

through existing networks.

• Struggles Regarding Commercial vs.

Nonprofit Status. Originally, the project

was set up to evolve into a viable commercial enterprise. The advisory committee urged it to maintain its nonprofit status

and to maintain its focus on promoting the

consumer/survivor movement.

SUCCESSES AND 

EVALUATION FINDINGS

A staff survey was conducted, which found

that all staff had high job satisfaction throughout the three years of the project. This survey

also found that a wide array of employment

activities were offered for participants, there

was a high level of acquisition of job skills,

staff communication/relationship satisfaction

was good, and employees felt high levels of

social competence.

Four focus groups were organized, and a

process evaluation of two television productions was completed. Findings indicated that

the issues and problems portrayed in the productions were important and relevant, but they

found that the informational content of the program could be enhanced by through the use of

greater visual stimulation and narrative explanation of the content and background of people presented in the show.

Other evaluation activities included a survey

of the cable audience, a telephone survey to

study the impact and effectiveness of marketing the videotapes, an evaluation of the satellite teleconference broadcast, and a content

analysis of the videotapes.

The telephone survey of the cable production audience revealed that, of those who

watched the program, they liked it and found 

it easy to understand and informative about

mental health issues. It also revealed that public attitudes towards individuals who are mentally disabled were not very positive; however,

those who viewed the show had more positive

attitudes about the mentally disabled on each

dimension as compared to non-viewers.

The telephone survey studying the impact 

of the marketing of video productions revealed

that videotape customers represented a broad

range of audience groups, with the largest percentage consisting of mental health professionals in private practice and individuals

associated with self-help agencies. 

A survey of “Self-help Live”, the satellite teleconference broadcast, collected data from a

total of 977 respondents. Findings included:

85% of respondents were satisfied with the 

production; 89% learned something new; 

participants were 72% Caucasian, 13% Native

American, 12% African American, 2% Asian,

and 1% Latino. Topics suggested for future

broadcasts were: employment (42%), housing/

homelessness (35%), and abuse of consumers/

survivors (27%).

The content analysis of the productions

revealed that 86% of the interviewees on the

tapes were consumers/survivors, and 63% of

the tapes examined involuntary treatment and

hospitalization as a major informational focus.

The evaluation report stated: “Clearly, the

results indicate that involuntary treatment and

hospitalization appear to be important issues

from the perspective of ex-patients, consumers

and mental health consumer advocates.” A total

of 83% of the tapes had information on public

education, and 7% had information on women’s

issues in the mental health system. The report

went on to indicate that, with respect to the latter finding, women’s issues were not explored

in a significant way.

Overall conclusions, based on the above

results, were as follows:

• Broadcast of the weekly program 

should be continued. The evaluation

report stated: “It is evident that the 

availability of free public access cable

channels provides an excellent medium

that consumer groups . . . can utilize to 

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
promote consumer education and 

support networks.”

• There is a strong market for materials

produced by consumer/survivor-operated

video production organizations. If the

production quality and visual content are

able to be improved, then the market is

likely to grow.

• Employees were able to attain a wide

range of job experiences and skills.

However, turnover and other satisfaction

ratings suggest the need to provide training, orientation, and job enrichment

experiences for all employees, in order to

foster personal and professional growth.

The final report also stated that the project’s

greatest strengths were its “ability to stay

focused and maintain its clear vision as a

communication source for the movement.

Using many of the principles of the consumer

and ex-patient movement, in the workplace,

the staff was able to work [out] its difficulties,

support one another, and work toward a common goal...The opportunity of having a nonstigmatized image in the business world

played a major role in providing true community integration for mental health consumers and former patients...It affords a

bridge across which people from both sides

can work together as equals.” 

Overall recommendations based on this

project included:

• Support for consumer/survivor public

education efforts should be continued at

the State and Federal levels. It is important for funding support to be provided

for consumer-run business demonstration projects in order to promote community integration.

• Participation of State agencies and 

consumer/survivor service organizations

in using the potential of satellite-interactive telecasts should be encouraged 

and increased.

• Preventive measures should be taken to

foster personal and professional growth

in the workplace (i.e., building a human

environment in the workplace that is supportive and enhances communication,

trust, self-esteem, and empowerment

among the employees).

• Live video teleconference broadcasts

should be continued by asking for State

subscriptions. Participation in live teleconferences should be studied, including

differences (if any) between levels of participation by consumers/survivors and

non-consumers/survivors and the reasons people choose to participate or 

not participate.

• Research is needed to investigate the

impact of teleconference broadcast 

programs such as “Self-help Live” on 

the consumer/survivor movement, networking, and State consumer/survivor

services in subscribing vs. non-subscribing States.

• There is a critical need to conduct

process and outcome research on the

use and application of communication

technology in promoting public education, consumer/survivor networking, 

and prevention.

Though it had initially been hoped that the

project could continue via the rental of uplink

equipment, purchase costs prevented this from

being a viable option. The project found that it

was able to generate significant revenues

through sales of tapes, and with a successful

marketing campaign, it planned to generate a

significant part of its future funding through tape

sales and national commercial broadcasts.

There were plans to continue the project after

Federal funds expired; a number of contracts

for production of public education materials

were bid upon, and grant support was applied

for from the van Ameringen Foundation and 

|the John D. and Catherine T. MacArthur

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

Foundation. The project also reported that it

had obtained subscriptions from 18 states for

“Self-help Live”. Ultimately, however, White

Light was unable to generate confirmed funding

and was forced to cease operations.
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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

PROJECT GOALS 

AND OBJECTIVES

The overall goal of this effort was to develop a

consumer/survivor designed, managed, and

operated clubhouse program with a majority of

consumers/survivors on the Board of Directors.

The Clubhouse, named Capital Clubhouse,

was situated in Olympia, Washington, and

served a two-county area, with transportation

provided to members.

Objectives included: starting three prevocational day programs; publishing a newsletter; providing social and recreational activities for participants; and starting a transitional

employment program (TEP).

PROGRAM 

DESCRIPTION

Services/Supports Provided

The following services were provided by the

project: two slots in the Transitional Employment Program; a clerical unit, including production of a newsletter; a kitchen unit, called Capital Cafe; and an outreach unit. Other activities

included transportation, advocacy, drop-in center functions, and social/recreational activities.

The Final Report indicated that other indirect

services were offered, including information/

referral, conference coordination, meal catering, provision of meeting space, anti-stigma

programs, and dissemination of information

about the project via speaking engagements

and news and video releases.

Individuals Served

The original eligibility requirements for service

recipients were restricted to those deemed as

having a serious mental illness. This was

relaxed somewhat in later years, with an

emphasis on those not receiving other services. 

The project designated three categories of

membership: “Regular Participation” (periodic

attendance); “Daily Attendance”; and

“Applications for Membership on File” (participant initiated contact and completed membership form, but participated very infrequently 

or not at all). The process for becoming a

member included attending an initial meeting,

participating in orientation, engaging in an

interview with advocacy staff, and submitting 

a completed application form.

The Final Report indicated that the project

served 101 participants. Characteristics included: 64% were female; almost all were

Caucasian; and the average age was 40. Fiftyseven percent were single, 11% were married,

and 32% were divorced; 57% lived alone, and

40% lived with a roommate or family. Eighty-two

percent were unemployed and 14% had parttime work; 22% had less than a high school

education, 21% had a high school diploma,

21% were college graduates, and 11% had

completed postgraduate work. Ninety-three 

percent had prior hospitalizations and had a

wide variety of diagnoses.

WASHINGTON

Capital Clubhouse

Olympia, WA

“. . . [It was] unique, enjoyable and effective.”

—Project participant
Organization and

Administration

The grant was awarded to the Washington

Division of Mental Health, which provided the

funds to the Thurston-Mason County Regional

Support Network. The Network then provided

the funds to the Capital Clubhouse, which

obtained its nonprofit status and began receiving funding directly from the State during the

course of the project.

A Mental Health Consumers’ Coalition

(MHCC), composed of different area consumers/survivors, helped to develop a Board.

The MHCC Board hired the Clubhouse staff

and developed job descriptions for Board

member duties and expectations. During Year

Two, the Clubhouse developed its own tenmember Board. Eighty percent of the members were consumers/survivors. The Board

met monthly, and had five committees:

finance, fundraising/public relations, program,

personnel, and nominations. Over time, an ad

hoc Advisory Group was formed to assist the

Clubhouse Director. This group was composed

of the State Community Support Programs

Director, the MHCC Board Chair, a local mental health center manager, and the County

Mental Health Coordinator.

Paid staff included an Executive Director, 

a Clubhouse Manager, two Consumer 

Clubhouse Staff Workers, and a Social/

Recreational Program Staffer.

The Final Report indicated that there was

some staff turnover experienced, including the

Executive Director’s position. Staff characteristics were not provided in detail, although it was

noted that all were consumers/survivors.

Training occurred “on the job”, and staff met

together weekly for peer support and training.

Training was also provided for volunteer

recruitment, food handling, the Transitional

Employment Program, and general organizational development topics, including: marketing

a nonprofit, applying for nonprofit status, team

building, board training, and Clubhouse orientation. Staff participated in Alternatives

conferences, the Western Regional Clubhouse conference, and other consumer/

survivor conferences. 

The total reported expenditures for this project were $316,074, of which $277,073 were

Federal funds.

IMPLEMENTATION

ISSUES AND BARRIERS

The following issues were encountered during

the implementation of this effort:

• Delay in Receiving Funds. Some

delays in the distribution of grant funds

were experienced, due to changes in the

State Community Support Programs

Director and because the county wanted

the State to contract directly with the

Clubhouse rather than through the 

county. Eventually, the State did accept

this change.

• Lack of Advance Planning. It was

reported that the decision to open the

Clubhouse immediately was detrimental

in the short run, as policies and procedures were not yet in place.

• Peer/Member/Staff Tensions and

Internal Conflicts. It was reported that

there was a period of time during which

staff and members experienced prolonged conflict. Staff development grew

into a priority, with a wide range of issues

being discussed, including: role clarification (peer vs. paid staff); how does a

member complete the transition into

becoming a staffer; how does the program justify paying some members who

are staffers, when all members in the

program volunteer; staff training on being

proactive vs. responding to immediate

needs; what kind of “special accommodations” can be made for consumers/survivors; the risks and benefits of getting

62 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
off of SSI/SSDI; operating in an equal,

non-hierarchical fashion; how can the

program integrate into the current mental

health system as an alternative to traditional modes of treatment; and how can

staffers justify gaining expertise and

training when so few consumers/

survivors have had the opportunity to 

do so. It was reported that some of the

struggles and tensions arising from 

these issues resulted in resignations 

and terminations of staff.

SUCCESSES AND 

EVALUATION FINDINGS

A process evaluation, which was conducted by

an outside evaluator, focused on membership

characteristics, demographics, changes in 

status with respect to membership and community adjustment, and quality of life. Data

were collected through surveys of staff and

members, participant observation, and group

and individual interviews. The interviews

focused on who were the members, what did

they like or not like about the program, and in

what other mental health services did they

participate. Interviews had 189 questions and

each respondent was paid for participating.

Interviews revealed the following findings:

39% reported being hospitalized since joining;

85% were involved in more than two other

mental heath services; more than 67% said

that they had insufficient funds for social activities and transportation; and 30% had been victims of nonviolent crimes over the past year.

Other findings indicated that: nearly half

reported moderate or serious problems in

maintaining an adequate diet; 54% said they

stayed at home prior to going to club; 54%

said they stayed at home when not at the

Clubhouse; and time spent in day treatment

fell from 25% to 7% after participants began

going to the Clubhouse. Still other findings

indicated that: 57% heard about the

Clubhouse from a professional; 25% from

friend or family; 64% liked the friendship, people, support, and good atmosphere of the club;

and 43% liked the lack of stigma and acceptance. While 30% said they would like the

Clubhouse to conduct more community

involvement/outreach activities, 93% were

generally very satisfied with the Clubhouse;

68% said they had more friends since coming

to the Club; 93% said they would recommend

it to their friends; and 88% of the respondents

said that coming to the Clubhouse helped

them cope better with their problems.

Recommendations based on this demonstration project were as follows:

• The purpose of the Clubhouse should be

clearly defined (e.g., work-ordered day

participation vs. drop-in, etc.);

• The service population should be clearly

defined, and policy should state who is

and is not a candidate for membership; 

• Objectives should be stated in measurable terms and reviewed periodically;

• A local project steering/oversight committee should be developed for startup

activities, composed of members: who

are willing to make a three-year commitment; who understand consumer/survivor

empowerment and psychosocial rehabilitation (PSR); and who understand the

personal contribution necessary to participate in one’s own recovery.

• The Board should be in place prior to 

hiring an Executive Director, Board 

members should have expertise in 

many areas, and the majority should 

be consumers/survivors;

• Clubhouse activities should include food,

clerical, advocacy and outreach services; 

• Funding should be sought from additional sources by the Board and the Director; 

• Clear personnel policies should be developed, including job descriptions, hiring

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procedures, reasonable accommodations,

performance evaluation procedures, termination policies, and ethical standards

regarding staff/member relationships; 

• Staff should create functional job 

descriptions, be paid the same as 

non-consumers for the same work, 

possess the ability to work with peers 

and other professionals, and model

desired behaviors; 

• Staff grievance procedures need to 

be developed with specific time frames

for responses; 

• The Clubhouse Director should be the

sole staff supervisor, staff should be told

of expectations upon hiring, and should

be placed upon probationary status followed by an evaluation;

• Staff should be trained on the Clubhouse

model, meeting facilitation, food handling,

the Americans with Disabilities Act, diversity issues, crisis intervention, emergency

management, sexual harassment and

safe sex, conducting meetings, public

speaking, Board membership, continuous

quality improvement and accountability

practices, working with “difficult” people,

stress management, and setting personal limits;

• The Clubhouse Program Manager

should be onsite at all times, should be

conversant with all units, and should be

able to work with many different types 

of people; and 

• Ethnic/cultural minority outreach and

involvement should continue to be 

a goal. 

The Final Report indicated that the Capital

Clubhouse received continued grant funding

from the Thurston-Mason County Regional

Support Network. 
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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

PROJECT GOALS 

AND OBJECTIVES

The overall objective of this project was to

establish a Consumer/Survivor Affairs Office

within the West Virginia Department of Health,

Office of Behavioral Health Services. 

Specific goals included:

• Empowering consumers/survivors so that

they may have an impact on mental

health services development, by developing an Office of Consumer Affairs, working

with the West Virginia Mental Health

Consumers’ Association (WVMHCA),

becoming involved in policy and planning,

developing a consumer/survivor review of

mental health services, training staff,

reviewing and responding to service grievances and complaints, and developing a

consumer/survivor-oriented plan for supportive residential services;

• Improving the communications and interactive networks of consumers/survivors

throughout the State by providing assistance to WVMHCA and other consumer/

survivor groups, developing Statewide

teleconferencing and/or bulletin board

services to facilitate communication, 

and assisting WVMHCA in production 

of a newsletter;

• Reducing stigma by developing a speakers bureau, developing and distributing

informational brochures, and implementing an advertising campaign; and

• Demonstrating that mental health programs can be run effectively and efficiently by and for consumers/survivors,

by employing and training consumers/

survivors to conduct peer counseling

focused on crisis stabilization and by

establishing three locally based peer

counseling/support services.

Other planned activities included monitoring

and disseminating information about State and

Federal legislation; facilitating communication

and coordinated efforts between all organizations and individuals involved in mental health

planning and service; disseminating project

information via articles and papers in newsletters, in journals, and at conferences, publishing

a consumer/survivor peer counseling resource

directory and handbook, and coordinating training opportunities for Board members.

PROGRAM 

DESCRIPTION

Services Provided

Grant funding enabled the following services

to be provided:

WEST VIRGINIA

West Virginia Office of Consumer Affairs

Huntington, WV

“Now for the first time, consumers have a forum in which to

voice their opinions, and an organization to provide the support

to make that voice heard.”

—Project participant
• Education and Training. Twenty consumers/survivors attended Alternatives

‘89 and thirteen attended Alternatives

‘90; two issues of a newsletter were published and distributed Statewide to over

500 individuals; the project started operation of an electronic bulletin board;

planning and operation of the speakers

bureau began; project staff participated

in staff orientations for the State Department of Health; a training curriculum 

was developed for use with Community

Coordinating Councils; and consumers/

survivors received training on public

speaking from Department staff.

• Support Groups. A training and organizing curriculum for peer counseling group

development was created. Eight Prescriptive Peer Counseling (PPC) groups

were active on a weekly basis, with an

average of 50 consumers/survivors participating weekly, and a PPC Handbook was

published. A Community Coordinating

Council was developed in each local area

(consisting of a Peer Counseling Coordinator, a representative of a local Community Behavioral Health Center, a

Consumer Affairs Board member, and 

a local consumer/survivor) to address

issues of support group site location,

transportation, child care, and referral. A

trained volunteer at each site served as

advisor and attended meetings. Groups

elected a chairperson, who submitted

monthly reports on attendance and activities to the State Consumer Affairs Office

and maintained contact at least once a

month with the Peer Counselor Coordinator. The Peer Counselor Coordinator

conducted monitoring and periodic 

visits. Two hundred copies of the Peer

Counseling Resource Directory and

Handbook were published and given to

each member of the groups as well as 

to mental health staff, as requested.

• WVMHCA Support. The project worked

to expand membership in WVMHCA and

to strengthen relationships between

WVMHCA and community mental health

center boards of directors and professional associations. During the course of

the project, membership in WVMHCA

tripled and ten chapters were organized.

• Advocacy. Consumers/survivors were

active in various advocacy efforts (including mental health boards and committees), and the Executive Director

addressed the State Legislature.

• Information and Referral Helpline. A

helpline was established and received 

an average of 19 calls per month.

• Information Dissemination. Staff spoke

at three Alternatives conferences, presented at the International Association 

of Psycho-Social Rehabilitation Services

(IAPSRS) conference, trained the Milwaukee Planning Council on conducting a

housing preference survey, presented 

at the Statewide consumer/survivor 

conference in South Carolina, conducted

a six-hour consumer empowerment training workshop for the South Carolina

Mental Health Association, and wrote 

an article for Community Support Network News on grassroots organization 

of consumers/survivors.

• Fighting Stigma. The project participated twice yearly in mental health fairs,

and utilized 13 hours of free airtime on

public television during May—Mental

Health Month.

Individuals Served

The project originally planned to serve adults

with severe mental illness. It was estimated

that there were 29,000 people in West Virginia

who met this criterion. The criteria were later

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
revised to include all persons who have

received any form of mental health treatment.

The “Prescriptive Peer Counseling” groups

had members with the following characteristics:

each had a severe mental illness; the average

age was 40 years; 68% were female; 19% were

married, 23% were divorced, 41% were single,

and 17% were widowed; 87% were Caucasian,

5% were Native American, and 9% were

African American; all were living in the community; 18% were meaningfully employed; 67%

received governmental assistance; and the

average annual income was $5,000.

Organization and

Administration

The grant was awarded to the West Virginia

Department of Health, Office of Behavioral

Health Services. The project funds were provided to WVMHCA, which administered the

grant activities. No Board information was

reported for this effort. 

Paid staff included the Project Coordinator/

Executive Director, a Clerical Staffer, a Consultant, and a Peer Counseling Program

Coordinator. The State provided, inkind, the

Mental Health/Community Support Program

Director, the Behavioral Health Coordinator,

and a Project Evaluator/Consultant.

All staff were required to be consumers/

survivors. Staff were interviewed by a committee of State behavioral health services staff

and consumers/survivors from WVMHCA.

Attempts were also made to recruit minority

candidates and individuals who knew

American Sign Language.

Staff were primarily female and Caucasian.

Volunteers provided over 150 hours per month

of service, including leading peer counseling

groups and newsletter production. Volunteer

contributions were estimated at $20,000 per

year. Staff were provided with training on implementing a housing preference survey, on public

speaking, and on creating a speakers bureau.

A number of materials were developed during the course of the project, including newsletters, the PPC Handbook, a housing preference

survey, and a training curriculum. The project

interacted with a number of other organizations

including local mental health providers, family

groups, advocacy organizations, hospitals, and

other consumer/survivor organizations.

The total expenditure of Federal funds for

this effort was $214,057.

IMPLEMENTATION

ISSUES AND BARRIERS

The following issues were encountered during

the implementation of this effort:

• Autonomy. The office was moved 

during the second year from the State 

to rented office space elsewhere, as 

staff wanted this for privacy, autonomy,

and self-empowerment.

• Bulletin Board System. This was never

fully realized due to the inability of consumers/survivors across the State to

access this technology.

SUCCESSES AND 

EVALUATION FINDINGS

The evaluation focused on objectives achieved

and recipient characteristics and empowerment. It was reported that staff contributed to

the development of data collection instruments. Data on empowerment were collected

on four sets of empowerment descriptors (personal, emotional, social, and political). The

process evaluation was conducted by the

WVMHCA Board by reviewing project results

on an objective-by-objective basis. 

Findings revealed that the project engaged

in a wide variety of activities including: recipient involvement on local mental health boards;

advocacy for expanded residential services via

the housing preference survey; establishment

of 10 new chapters of WVMHCA; and increasU.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 67

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

ing membership from 45 to 200 individuals. It

was found that Community Behavioral Health

Center staff were aware of WVMHCA chapters, but were slow to make referrals.

The outcome evaluation surveyed 50 consumers/survivors (who were members of four

peer counseling groups) twice over a two year

period. The following findings were revealed:

85% of respondents had been hospitalized, and

40% had voluntary admissions. Attendance on

boards of community programs showed an

increase. The number of consumers/survivors

who openly voiced opinions on mental health

issues showed the greatest increase.

Conclusions indicated that project members

were more empowered by becoming more

involved; the majority of project members had

been in the system all of their adult lives; and

change comes slowly with knowledge, training

and support. 

Recommendations as a result of the 

project included:

• It was suggested that training on selfhelp and empowerment should be conducted first, and then training on the

organization of the Peer Counseling

Groups at selected locales, rather than

the reverse (which had been the case).

• Grassroots organization is the most costeffective method of effecting change.

• Mental health consumers/survivors’ natural support systems are each other.

The Final Report stated that the project did

continue with West Virginia State funding.
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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

PROJECT GOALS 

AND OBJECTIVES

The objective of this project was to strengthen

and formalize the State’s fledgling consumer/

survivor movement by hiring a consumer specialist within the State Office of Mental Health,

establishing a Statewide consumer/survivor

Steering Committee to link and support local

groups, developing and supporting local consumer/survivor-run programs, and developing

the Wisconsin Network of Mental Health

Consumers (WINMHC). The Specialist identified and helped communities organize local

self-help groups, provided technical assistance,

and helped to fight stigma through public education. In addition, the project provided funding

for ongoing evaluation which compared different self-help models and for obtaining training

and technical assistance via consultation with

other States and consumer/survivor attendance

at State and national conferences.

PROGRAM 

DESCRIPTION

Services Provided

Grant funding enabled this project to provide: 

• Technical Assistance. Thirteen self-help

groups, as well as a telephone network of

groups throughout the State, were established, and the project maintained a collection of resource materials. Technical

assistance was also provided in State

consumer/survivor conference organizing.

• Newsletter. The project published and

distributed the WINMHC newsletter to

over 1,000 individuals.

• Advocacy. The project obtained consumer/survivor representation on approximately ten committees. Staff spoke at

Alternatives conferences, the National

Association for Rights, Protection, and

Advocacy (NARPA) conference, and 

various State conferences.

• Training. Training was provided to staff

on mental health issues, advocacy, leadership training, psychotropic medications,

and fundraising strategies. Scholarships

were provided to 27 consumers/survivors

to attend State and national conferences. 

• Mini-Grant Funding. Sixteen groups

received a total of $65,000 for self-help

groups, drop-in centers, peer counseling,

and video production in eleven counties.

Technical assistance meetings were held

with all grantees, and grants ranged from

$500 to $6,000.

Individuals Served

Recipients of services were all current consumers/survivors or those with a history of

severe and persistent mental illness or emotional disorders. No information was provided

regarding client characteristics.

WISCONSIN

Wisconsin Network of Mental Health Consumers

Madison, WI

“. . . Both State and local groups have benefitted from the struggle and learning, and both have flourished.”

—Project participant
Organization and

Administration

In Year 1, grant funds were awarded to the

Wisconsin Department of Mental Health. In

Year 2, this was changed and funds were

awarded from the State to the Wisconsin

Coalition for Advocacy (a protection and advocacy agency), which acted as an umbrella for

funding and project administration. In Year 3,

the grant was directly awarded from the State

to WINMHC, which administered and coordinated the grant activities directly.

Initially, a Steering Committee was developed with representatives from six regions of

the State. Meetings were held on a periodic

basis. In 1991, the Steering Committee

merged with the WINMHC Board. 

Paid project staff included an Administrative

Project Specialist and a Technical Assistance

Project Specialist. In-kind staff provided by the

State included the Office of Mental Health

Director and the State Community Support

Program Director. 

A number of program materials were 

developed over the course of the project,

including job descriptions, a technical assistance request form, written roles and responsibilities of committee members and staff, 

and a Request for Proposals. The project 

collaborated with a number of organizations

and entities, including advocacy organizations,

the media, family groups, national consumer/

survivor groups, NARPA, and the local Mental

Health Association.

A total of $364,359 was expended 

during the grant period, with $327,882 

in Federal funding.

IMPLEMENTATION

ISSUES AND BARRIERS

The following issues were being experienced

during the implementation of the grant: 

• Initial Administrative Change. During

Year 2, the State decided to operate the

project through the Wisconsin Coalition

for Advocacy (WCA), as it was claimed

that they had the administrative capability and the flexibility necessary to complete tasks more quickly than a State

agency. It was also stated that this was

done to reduce perceptions of disempowerment. However, this new project

plan unfortunately resulted in fewer funds

being available for local initiatives, due to

new operational costs that were previously provided on an inkind basis by 

the State.

• WINMHC Development. The grant was

transferred in order to increase consumer/survivor control over operations

and expenditures. During Year 3, it was

proposed to transfer the grant to WINMHC in order to increase the autonomy

and decisionmaking power of the consumer/survivor staff. Major problems

were experienced in this transition as 

a result of the lack of infrastructure at

WINMHC and poor communication

between OMH and WINMHC. 

• Delay in Mini-Grant Payments. This

was a significant problem, and it was felt

that it was caused by bureaucracy and

overregulation. Local projects felt that

their efforts were put in serious jeopardy.

SUCCESSES AND 

EVALUATION FINDINGS

The Final Report highlighted the following benefits of the mini-grants that were distributed:

• The consumer/survivor movement 

was strengthened on the local and 

State levels;

• Education and information 

were provided; 

• New self-help groups and projects 

were initiated; 

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Chapter 2. Descriptions of the 13 Demonstration Grant Projects
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Chapter 2. Descriptions of the 13 Demonstration Grant Projects

• People became motivated; 

• There was a reduction of stigma because

people “came out” of the closet regarding

their diagnosis; 

• Administrative tasks were learned; and

• The importance of communication, negotiation, and democratic decision making

were learned.

The Final Report indicated that the administration of the project had problems in terms of

growing pains, structure, administration, and

accountability: “WINMHC [experienced] growing

pains . . . [WINMHC and the] consumer movement [were] not mature enough to carry a unified agenda and consequently [were] too ambitious given the time frame of the grant . . . [they

also] needed more grassroots support . . .”

An outside evaluator added the following

comments: “Many local projects were remarkably successful in assisting people towards

empowerment . . . much of the administrative 

difficulties resulted from an externally 

imposed bureaucratic structure.”

The evaluator’s major recommendations were:

• Organizations funded with State or federal dollars should have a clear mission,

philosophy, and organizational structure

in place; and 

• Levels of financial, policy, and administrative structure should be minimized,

perhaps through a direct RFP process,

rather than through State governments.

WINMHC received continued support from a

CMHS Service Systems Improvement Grant.

Many local groups continued with the support

of county mental health funds, Mental Health

Association funds, United Way agencies, and

private grants. An increase in the CMHS mental health block grant allocation for Wisconsin

provided additional funds for ongoing consumer and family initiatives at the State and

local levels.
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 73

An overall cross-site analysis was conducted

with the findings from the qualitative analysis

of the thirteen demonstration projects. In completing this task, a matrix was developed to

compare and contrast the significant findings

between each site in each of the seven

domains examined (see Appendix A). The 

significant similarities and differences in the

following domains are presented below: 

• Project Goals and Objectives;

• Services Provided;

• Individuals Served;

• Organization and Administration;

• Implementation Issues and Barriers;

• Successes and Evaluation Findings; and 

• Recommendations. 

It is important to note that there are methodological weaknesses with this approach. As

different service models were developed in

vastly different environments, there is the

potential for many extraneous variables which

could impact upon the site—and, therefore,

cross-site—findings. Also, as discussed previously, the data are limited in their comprehensiveness and validity. Nonetheless, given that

this is a “natural” laboratory, these findings do

offer impressions and indications associated

with and across these sites.

The last section consists of overall suggestions and recommendations based on the

cross-site findings. It is hoped that these will

offer guidance for consumers/survivors, State

and local mental health authorities, policy

makers, managed care organizations, and others involved in the planning, policy development, operation, and evaluation of consumer/

survivor-operated services. 

Chapter 3

CROSS-SITE FINDINGS 

AND RECOMMENDATIONS

PROJECT GOALS AND OBJECTIVES

“[It] appears that these efforts focus 

on priority needs as identified by consumers/survivors which are often not

addressed by traditional mental health 

service providers.”

In examining the findings from the individual

projects, a number of similar themes, goals,

and objectives were apparent and are discussed below. Please note that goals stated in

project materials may differ from the operational goals that actually existed. 

Mutual Support

In keeping with a major tenet of the consumer/survivor self-help movement, over 75%

of the sites indicated that the provision of

mutual or peer support was a major goal.

This ranged from drop-in center programs in

New Hampshire to the shared resource system in California. An array of needs was

addressed through the provision of mutual

support, including socialization, limited

resources, employment, and peer counseling.
Basic Human Needs

The provision of direct services to meet critical

human needs was also cited by 85% of the

projects. The needs included housing, employment, food, independent living skills, protection

against discrimination, access to services,

socialization, crisis respite care, and outreach.

Research has shown that these needs are

often cited as priorities by consumers/survivors

across the Nation (Ridgeway, 1988b).

Empowerment

Over 50% of the projects noted the general

goal of empowering consumers/survivors

as a major focus. Again, this is a major 

philosophical tenet of the consumer/survivor

self-help movement. This took the form of

increasing both personal as well as collective

empowerment via leadership development

training, community organizing, technical

assistance, and obtaining representation 

on boards and committees.

Public Education

The most frequently cited goal (over 90% of the

sites) was public education and information

dissemination. This ranged from speakers

bureaus, to publishing newsletters, to presenting at conferences. Two major foci seemed to

be addressing stigma/discrimination and disseminating information about the projects.

Rights Protection

Over 75% of the sites noted that rights protection was a project goal. This included both individual case advocacy and systems advocacy

and ranged from helping people to access services, to coalition building, to effect needed

change. Sites participated in legal and legislative advocacy, as well as hospital monitoring

and developing policy and planning initiatives.

Summary

Approximately 70% of the sites indicated similar goals. Four of the sites indicated—in one

form or another—all of the above five goals

within their stated goals or objectives, with five

additional sites indicating four of the goals. 

Three sites that were unique in their approach were California (with a focus on shared

administration and resources among different

self-help initiatives), Colorado (developing a

“superstructure” to develop businesses), and

Vermont (focusing on video production and 

distribution). While their approaches may have

differed from the other alternative service providers, they did share a number of similar goals

(e.g., public education, basic needs) with the

other sites.

In reviewing the five significant goals/objectives (mutual support, basic human needs,

empowerment, public education, and rights protection), it does seem apparent that the philosophy and values of the consumer/survivor selfhelp movement have a significant impact upon

the focus of these projects. In addition, it

appears that these efforts focus on priority

needs (as identified by consumers/survivors)

which are often not addressed by traditional

mental health service providers with a focus on

professionally driven mental health treatment.

Consumer/survivor-operated services are

addressing and striving to meet the critical, selfidentified concerns of consumers/survivors that

are often overlooked in other models.

Services Provided

“It is clear that consumers/survivors 

can provide a broad and diverse range 

of services.”

A range of services were provided via the 

projects. Documented below are the major 

categories of services that were provided 

by these efforts.

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Chapter 3. Cross-Site Findings and Recommendations
Drop-In Centers

More than half of the projects operated dropin center programs that provided socialization/

recreation and other services. This is a model

that has gained great popularity as an effective consumer/survivor-operated program.

Since the implementation of these projects,

drop-in centers have continued to flourish with

the development of this model in most States

across the Nation.

Support Groups

Over 75% of the projects organized support

groups or peer counseling efforts for consumers/survivors. This is indicative of the 

origins and basis for the consumer/survivor

self-help movement—grass-roots self-help

groups. A few of the projects were specifically

designed to assist in the organizing of local

support groups in their region or State. These

models help to address the needs for peer

support, socialization, and recovery-based

approaches that emphasize self-determination,

consumer/survivor strengths, encouragement,

and hope.

Information and Referral

About 40% of the sites provided information

and referral services to consumers/survivors

to address human and social service needs.

These services help consumers/survivors to

understand and access services and benefits

which may be available to them.

Information Dissemination

All of the sites indicated that they provided

information and education to the public

about their projects, mental health issues, etc.

A number indicated that they focused on

addressing the topic of stigma. One project

(Vermont), focused exclusively on public information/education and communications through

video production and dissemination.

Advocacy

As mentioned above, advocacy for rights

protection and service access was a significant activity by over 75% of the sites. While a

variety of advocacy strategies were employed,

the facilitation of consumer/survivor representation on boards and committees was a major

accomplishment of many of the projects.

Outreach

Outreach activities were conducted by

approximately 40% of the sites. This included

outreach to individuals in hospitals, in-home

outreach to provide support services to people

released from such settings, and street and

shelter outreach to consumers/survivors experiencing homelessness.

Technical Assistance and Training

Nearly half of the sites provided technical

assistance and training activities to other

consumers/survivors. This ranged from providing training on medication issues to providing

technical assistance in other communities to

help them replicate these projects.

Independent Living

Direct services to assist persons in independent living were offered by almost 50% of

the projects. This ranged from shower facilities,

to roommate matching services, to small loan

funds for housing or employment expenses.

Employment

A complementary, yet significant, finding 

was that all of the projects employed 

consumers/survivors in various capacities 

in their activities. This employment provided

valuable experience for the individuals involved. Often, it enabled individuals to cease

receiving Social Security and other benefits

and become fully employed, tax-paying citizens. It was noted that some of the staff used

these positions as “stepping stones” to obtain

other employment. Many other individuals participated in non-paid, volunteer employment

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Chapter 3. Cross-Site Findings and Recommendations
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Chapter 3. Cross-Site Findings and Recommendations

positions. While the data were incomplete,

sites that reported findings indicated that over

260 consumers/survivors participated in

employment capacities within these projects. 

Summary

All of the projects offered multiple services.

Five of the sites offered seven of the service

categories mentioned above. An additional

four sites provided services in six of the categories. Therefore, approximately 70% of the

projects provided a minimum of six different

services. It is clear that consumers/survivors

can provide a broad and diverse range of

services. Two of the projects were unique in

their focus on select activities: the development of consumer-run businesses and a video

production enterprise (Colorado and Vermont). 

Individuals Served

“Consumer/survivor-operated projects can

serve large numbers of low- income individuals with significant mental health concerns who have diverse backgrounds.”

The total number of service recipients reported

was 5,701 individuals. This does not include

the projected 1.6 million homes that were

reached via cable television broadcasts by one

of the sites. The number of persons served

was probably higher as some of the sites did

not provide detailed information on the number

or characteristics of those persons who were

served. Excluding the video project, the number of reported persons served by individual

sites ranged from 101 to 3,500.

Demographic findings across the sites are

discussed below.

Persons With Psychiatric Disabilities

All of the projects indicated that they served

individuals with psychiatric disabilities. Interestingly, some had initially developed fairly detailed

criteria of who was to be served. Over time, this

was found to be cumbersome and broader criteria were employed. As a whole, all of the projects indicated that they served persons with

serious mental health problems including persons in hospitals or recently discharged.

Impoverished

Projects that reported the income of participants served (over 30%) indicated that they

served persons who were in poverty, including

individuals experiencing homelessness. One

site indicated that 82% of those served were

unemployed, and another reported that the

average annual income of service recipients

was $5,000 per year.

Gender Balance

It seems that both genders were attracted to

this service model. Four (4) sites reported the

majority of members served were men, while

three (3) sites reported a higher percentage of

members were women. 

Cultural Diversity

The reported racial characteristics of members

were diverse—however, of those reporting,

70% indicated that a majority of service recipients was Caucasian. Two sites which indicated that a majority of people of color were

served were also in highly urbanized areas:

the California Bay Area and New York City. 

A number of projects specifically targeted 

outreach to people of color communities 

with varying results.

Young- to Middle-Aged Adults

The range of ages served was from 15 to 80

years old. The average age range seemed to

be between 18 and 55 years old, with over

80% of the sites indicating this range.
Veterans

The one site that reported on this characteristic (CA) indicated that approximately 30% of

its recipients were military veterans.

Summary

The above data indicate that consumer/

survivor-operated projects can serve large

numbers of low-income individuals with 

significant mental health concerns who 

have diverse backgrounds.

ORGANIZATION AND

ADMINISTRATION

“Consumers/survivors can develop service

organizations with moderate costs that 

are autonomous and, yet, collaborate 

with a myriad of different sectors to meet

consumer/survivor needs.”

Project organization and administration were

significant factors that impacted upon the development, operation, and ultimately, outcomes of

these initiatives. Only two of the projects operated as bona fide non-profit organizations upon

receipt of their funding. Many of the projects

learned (and at times struggled) to successfully

manage such a structure. Some of the findings

in this area are discussed below.

Autonomy

Over the life of the projects, over 90% of the

initiatives obtained autonomous non-profit

status with Boards of Directors. Initially, most

of the sites operated via a “pass-through” nonprofit organization for administrative supports

and services, such as financial management.

By the end of these grants, almost all had

developed the capacity to conduct these 

functions on their own.

Training and Technical Assistance

It was reported that over 60% of the sites

received some training and technical assistance in organizational and staff development.

This ranged from training on marketing, to

peer counseling skills, to bookkeeping. There

was, however, a lack of a coordinated

approach to training and technical assistance

as is now generally provided in CMHS-funded

multisite evaluation demonstration projects.

Project Materials

Over 75% of the sites reported that they developed project materials to assist with the

administration of their organization. This

included personnel policies, financial accounting forms, job descriptions, informed consent

forms, intake materials, and others. The development of these materials depicts the growth

of these organizations.

Increased Collaboration

Approximately 85% of the sites reported

increased collaboration with other organizations in the course of their activities.

Collaboration to address consumer/survivor

needs occurred with many different entities,

including: mental health providers, advocates,

social services, churches, businesses, 

universities, and governmental entities.

Funding

The total costs for all thirteen projects for 

their grant years totaled $4.81 million. The

amount of funding for project activities (as 

$167,000 to $540,000 in total costs, with a

mean of $370,000 per site for the average

three-year period of these efforts. This large

variation significantly impacts upon the comparability of these projects. In general, however, each project had a very modest average

budget of approximately $124,000 per year. 

As will be noted later, access to adequate

resources was reported as a crucial element 

in project success.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 77

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 3. Cross-Site Findings and Recommendations
Summary

In reviewing the above, it is apparent that consumers/survivors can develop service organizations with moderate costs that are autonomous

and yet collaborate with a myriad of different

sectors to meet consumer/survivor needs. In

addition, training and technical assistance,

along with adequate resources, appear to be

key factors in the successful organization and

administration of these efforts.

IMPLEMENTATION

ISSUES AND BARRIERS

“To avoid these pitfalls, consumers/

survivors need adequate resources, 

training, and development as well as 

mutually respectful collaborations 

with public and private sectors.”

Some of the best lessons are realized by 

the problems we encounter. These demonstration projects experienced implementation

issues and barriers which offer useful learning

experiences for those who are replicating 

such models.

Startup Delays

More than half of the projects reported 

delays in project implementation which

were primarily due to the length of time it 

took funding to move from the Federal

Government to State Governments and, 

finally, to the projects. As mentioned earlier, 

in the early phase of most of these efforts,

there were additional organizations which

acted as fiduciary agents for the consumer/

survivor projects which created another layer

of bureaucracy affecting funds transfer. In

some cases, the startup delays resulted in

lowered consumer/survivor interest and participation as well as increased potential for alienation from State and Federal bureaucracies. 

Limited Resources

Almost 50% of the sites reported that a lack of

resources impeded their ability to adequately

carry out their activities. In a number of the projects, consumer/survivor need outpaced the

available funds to address them. This resulted

in fewer personnel, as well as a lack of necessary equipment for some sites (e.g., typewriters, computers, and video equipment). Many

projects believed that more could have been

accomplished, given adequate resources.

Staff Turnover

Changes in personnel were reported by

almost half of the sites. This was due to a

number of factors, including individuals seeking other employment, lack of training, interpersonal conflicts, and health reasons. A number of sites actively pursued staff development

training, formal personnel policies, and reasonable accommodation practices to address

these issues.

Lack of Organizational Expertise

Approximately one-third of the sites indicated

that a lack of necessary training on organizational issues (e.g., financial management)

was a significant barrier. As indicated elsewhere, most of the organizations undertaking

these ventures were new themselves and

experienced rapid growth. The vast majority of

staff had limited knowledge or expertise in

nonprofit organizational management issues.

The training that was offered on management

skills was reported to be helpful, but comprehensive and coordinated training was missing.

Working with Bureaucracies

Approximately 30% of the projects reported

difficulties working with State bureaucracies due primarily to value differences

between consumer/survivor efforts and State

systems. This resulted in issues surrounding

paperwork, evaluation requirements, etc. 

78 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 3. Cross-Site Findings and Recommendations
Interpersonal Conflict

Conflicts between consumer staff and/or

board members were reported as barriers by

about one-third of the sites. These took the

nature of political and philosophical differences, personality and ego clashes, jealousies, and power struggles. These conflicts

are not unique to these specific projects, nor

are they unique to consumers/survivors. One

confounding factor may be the principle of

egalitarianism in the consumer/survivor movement, which can be compromised with the

introduction of paid staff into such projects.

Unclear Focus

In several of the sites, it was noted that the

project lacked a clearly articulated series of

priorities or foci. This was due, in part, to a

lack of experience in strategic planning and 

is related to the organizational expertise 

mentioned above.

Autonomy

Approximately one-third of the sites also indicated that consumers operating their own programs created tensions with professionals.

In a few projects, this took the form of issues

of control, paternalism, and “turfism”, as professionals were uncertain in their dealings or

responded in traditional fashion with these

new models, and, at the same time, consumers/survivors, in pursuit of empowerment

and self-determination, resisted these

responses.

Summary

While the above issues will be explored in

greater detail in the final part of this chapter, it

can be stated in summary that in order to

avoid these pitfalls, consumers/survivors need

adequate resources, training and development, and mutually respectful collaborations

with public and private sectors.

It is also interesting to note that a few of the

sites had unique issues which they confronted.

This included State geographic distances,

community resistance to program location,

transportation issues, and philosophical

debates over having a commercial enterprise

orientation versus maintaining an advocacybased, non-profit status. 

SUCCESSES AND 

EVALUATION FINDINGS

“Consumer/survivor-operated services 

are successful in increasing the overall

quality of life, independence, employment, social supports, and education 

of consumers/survivors.”

There were wide and varied successes 

documented within the evaluations of these

projects. Overall, the hypothesis that consumers/survivors can successfully develop

and operate autonomous service organization was validated.

Perhaps the greatest measure of success is

that over 70% of these initiatives were continued with the assistance of other funding

sources. These projects demonstrated that

they were successful in capturing ongoing

financial support. Other significant, cross-site

findings, with a focus on person-centered outcome measures, are discussed below.

Increased Recipient Self-Efficacy

All of the projects reported that as a result of

these initiatives, consumers/survivors had

achieved greater levels of independence,

empowerment, and self-esteem. Individuals

had an improved sense that they could make

their own decisions, solve problems, and help

others. This helped people to become more

confident and to cope better.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 79

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 3. Cross-Site Findings and Recommendations
80 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 3. Cross-Site Findings and Recommendations

All of the projects reported that consumer/

survivor quality of life was increased in 

various aspects. This included better income,

housing, and friendships. For some individuals, it meant better knowledge of rights and

services. These efforts helped people to stay

out of hospital settings and contribute positively to their communities.

Increased Social Supports

The development of social supports was a

key success reported by over 60% of the projects. People felt more accepted and had

greater numbers of friends. For some individuals, these efforts played a central role in their

social lives. These social supports and acceptance helped people to combat the social

ostracism and loneliness which often accompanies mental health problems.

Enhanced Employment

As mentioned elsewhere, all of the projects

recorded an increase in employment skills

and experience among those consumers/survivors participating in these efforts. As poverty

and unemployment are other major factors in

the lives of consumers/survivors, this success

cannot be overlooked.

Expanded Education and Knowledge

More than half of the projects reported success in increasing the knowledge of consumers/survivors in various areas such as

rights, available services, communication,

negotiations, working in a team, and organizational operations. These efforts also played

an important role in educating the community

about the positive abilities of consumers/

survivors, to counter the often negative, 

stigmatizing portrayals.

Based on these results, it can be said that

consumer/survivor-operated services are successful in increasing the overall quality of life,

independence, employment, social supports,

and education of consumers/survivors.

Other successes cited include that 

consumers/survivors can be extremely 

devoted staff members to assist their peers,

and that consumers/survivors can overcome

difficulties to deliver needed services.
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 81

“Efforts to develop consumer/survivoroperated services should include adequate

technical assistance, strategic planning,

funding, and cooperation with a need to

increase people of color participation.”

Many of the individual projects offered recommendations on how to improve these efforts.

The following represents overall recommendations that were mentioned by the greatest

number of sites.

Increased Technical Assistance 

and Training

Approximately 70% of the sites indicated that

more training and technical assistance

would have contributed to increased successes. This training was needed in organizational development as well as staff development.

Participants revealed that they felt hindered by

this lack of knowledge and that coordinated,

comprehensive approaches to meeting 

technical assistance needs would have 

been of benefit. 

Better Planning

More than one-third of the projects reported

that they needed better preparation and

planning prior to starting these initiatives. This

includes the development of a clear mission,

philosophy, and operational structure before

implementation. There was a need for a more

“proactive” strategic approach to planning.

Adequate Funding and Continuation

About 40% of the sites indicated a need for

increased resources to adequately accomplish project activities, as well as firm assurances of continuation funding. Regarding

the latter, this was a source of substantial 

distress for a number of the projects in their

last grant years, resulting in distractions 

from project activities.

Enhanced Cooperation

Approximately one-third of the projects reported the need for improved cooperation

with governmental entities, providers, family

members, and advocates. In addition, there

was a need for increased cooperation

amongst consumers as well.

Expanded People of Color

Representation

Approximately one-third of the projects reported the need for expanded representation

of people of color in consumer/survivor selfhelp activities. Greater outreach to these communities was cited as a need.

More Research

Approximately 40% also indicated the need 

for more research into consumer/survivoroperated services. This included enhanced

research into who is attracted to self-help, as

well as rigorous process and outcome evaluations of these ventures.

Fund Projects Directly

As a result of the startup delays mentioned

earlier, about 20% of the sites suggested that

future funding for these initiatives be provided directly to the recipient organization,

rather than via State Mental Health Authorities.

Summary

The above findings indicate that efforts to

develop consumer/survivor-operated services

Chapter 4

OVERALL RECOMMENDATIONS
should include adequate technical assistance,

strategic planning, funding, and cooperation,

with a need to increase participation by people

of color. Future research is needed to examine

the process as well as the outcomes associated with this model.

It is important to note that since the implementation of these projects, a large number of

additional consumer/survivor-operated services

have been developed, including: case management, housing, employment assistance, “hitech” computer networks, a pharmacy, higher

education assistance, commercial enterprises,

and many others. Also, these and other initiatives have demonstrated similar findings,

including the ability to reach large numbers of

diverse individuals. One example is an organization in a southeastern State that provides

leadership training and development at annual

conferences with over 1,500 consumers/

survivors at each gathering.

Finally, in addition to the above projectbased recommendations, the following 

overall recommendations are offered:

• Research. There is a clearly defined

need for more rigorous research of 

consumer/survivor-operated services.

Suggested research designs include a

multisite, multiyear effort with common

data collection and measures. A coordination center should be established to

assist with data collection and related

technical assistance matters. The determination of the research design and specific measures and methodology to be

employed should be directed by consumers/survivors. Consumers/survivors

should be meaningfully involved in every

stage of this process from conceptualization to data analysis to publication. 

Specific outcomes and other measures that

could be examined include: 

• Cost/benefit analyses; 

• Independence (including eliminating 

people’s need for Social Security and

welfare benefits);

• The impact of self-help on specific subpopulations (e.g., racial and ethnic

minorities and women);

• Recipient satisfaction with services; 

• Empowerment; and 

• Examining whether these programs

serve those whose needs would not 

otherwise be met.

Training and Technical Assistance

There is an ongoing need for targeted training

and technical assistance in the development of

consumer/survivor-operated services. This

should be focused on all areas of non-profit

organization management, including board

development, fiscal management, staff supervision, conflict resolution, strategic planning,

fundraising, managed care, and cultural diversity/competency. Training and technical assistance also needs to be given to States and

providers to demonstrate how they can support consumers/survivors developing their own

service programs. Efforts to provide training

and technical assistance should use continuous quality improvement strategies to adapt

the training to the needs of consumer/survivoroperated services.

Funding

Financial support for the operation of consumer/survivor-run services should expand and

originate from a variety of sources: State governments (possibly through a setaside of block

grant funds), managed care organizations, private foundations, and other Federal entities

(e.g., HCFA, HRSA, NIMH, RSA, SAMHSA).

Also, other financing mechanisms, such as feefor-service and capitation within managed care

arrangements, should be explored.

82 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 4. Overall Recommendations
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 83

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

Chapter 4. Overall Recommendations

Public Education

The benefits of consumer/survivor-operated

services also need to be marketed. This

should be targeted to specific audiences—

including funding entities and other policydetermining bodies. This could entail the use

of traditional dissemination strategies (e.g.,

journal articles, conference presentations) as

well as other marketing tools (e.g., direct mail,

print ads, Internet, and other technologies).

Managed Care

The development of managed care for publicly

financed mental health services may drastically

alter the landscape for consumer/survivoroperated services. Managed care organizations

need to become better educated on these models. There also is the need to integrate consumer/survivor-operated services within managed care settings, through the development of: 

• Practice guidelines; 

• Best practices;

• Staff competency evaluation and 

credentialing; and

• Staff training curricula. 

These should be developed with the direct

and meaningful involvement of consumers/survivors. In addition, draft “boilerplate” language

needs to be developed for States to insert in

bidding and contracting processes which mandate consumer/survivor services in benefit

plans and service system designs.

The future of consumer/survivor self-help

services appears to be bright. As the benefits

of this model—both on individual and systems

levels—become better known throughout the

Nation, the growth of self-help efforts will

hopefully continue, unabated.
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 85

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Yaskin, J. (Ed.). (1992a, February). Nuts and Bolts. Philadelphia, PA: National Mental Health

Consumer Self-help Clearinghouse/Project SHARE.

Yaskin, J. (Ed.). (1992b, Spring-Summer). VISION 4(2).

Zinman, S., Harp, H.T., and Budd, S. (1987). Reaching Across. Sacramento, CA: California Network

of Mental Health Clients.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 89

CONSUMER/SURVIVOR-OPERATED SELF HELP PROGRAMS: A TECHNICAL REPORT

References
Empowerment

CA

CO

IN

ME

MO

NH

NY

OR

TN

VT

WAWV

WI

Total

%

•••••••••••••

7

54

••

•••

•

•••••••

1077

••

•

••••••

•

•••

11

77

•

••••••••••••

1292

••

•

••••••••••

7

54

•••••••••••••

1077

••

•

•

•

••••••••

5

38

•••••••••••••

13

100

•••••••••••••

1077

•

•

•

•

•

••••••••

5

38

•

••

••

••••••••

6

46

•••••••••••••

13

100

•••••••••••••

13

100

•••••••••••••

4

31

•••••••••••••

2

15

•••••••••••••

3

23

•••••••••••••

9

69

•••••••••••••

18

•••••••••••••

1292

•••••••••••••

8

62

•••••••••••••

1077

•••••••••••••

11

85

•••••••••••••

7

54-

•••••••••••••

6

46-

•••••••••••••

4

31

•••••••••••••

4

31

•••••••••••••

4

31

•••••••••••••

4

31

•••••••••••••

6

48

•••••••••••••

4

31

•••••••••••••

4

31

•••••••••••••

13

100

•••••••••••••

9

69

•••••••••••••

13

100

•••••••••••••

7

54

•••••••••••••

8

62

•••••••••••••

9

69

•••••••••••••

4

41

•••••••••••••

2

15

•••••••••••••

5

36

•••••••••••••

3

•

•

••••

•

••

•

•••

1077

Self-help or Mutual Support

Rights Protection

Basic Needs

Public Education

Drop-in Centers

Support Groups

Information and Referral

Information Dissemination

Advocacy

Outreach

Technical Assistance and Training

Employment

Primarily Persons with Psychiatric Disabilities

Primarily Impoverished Persons

Significant Number of People of Color

Majority of Women

Age Range 1855

Veterans

Autonomy

Training

Project Materials

Increased Collaboration

Start-up Delays

Limited Resources

Interpersonal Conflicts

Lack of Organizatinoal Expertise

Unclear Focus

Staff Turnover

Autonomy

Working wi th Bureaucracies

Increased Self-efficacy

Project Continuation

Enhanced Quality of Life

Expanded Knowledge and Education

Increased Social Supports

Enhanced Employment

Increased Technical Assistance and 

More Research

Fund Programs D

Expande

States

Project Goals and

Objectives Services Provided Who Was Served Organization/ Administration Implementation Issues and Barriers Successes and Evaluation Findings 

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, Center for Mental Health Services 91
Consumer Information Series

Volume 1

SMA 01-3510

www.samhsa.gov Printed 2001