Self-stigma and empowerment in combined-CMHA and consumer-run services: two controlled trials.

OBJECTIVE: Self-help agencies (SHAs) are consumer-operated service organizations managed as participatory democracies involving members in all management tasks. Hierarchically organized board- and staff-run consumer-operated service programs (BSR-COSPs) are consumer managed, but they afford members less decision-making power. This study considered the relative effectiveness of SHAs and BSR-COSPs working jointly with community mental health agencies (CMHAs) and the role of organizational empowerment in reducing self-stigma. METHODS: Clients seeking CMHA services were assigned in separate randomized controlled trials to a trial of combined SHA and CMHA services versus regular CMHA services (N=505) or to a trial of combined BSR-COSP and CMHA services versus regular CMHA services (N=139). Self-stigma, organizational empowerment, and self-efficacy were assessed at baseline and eight months with the Attitudes Toward Persons With Mental Illness Scale, the Organizationally Mediated Empowerment Scale, and the Self-Efficacy Scale. Outcomes were evaluated with fully recursive path analysis models. RESULTS: SHA-CMHA participants experienced greater positive change in self-stigma than CMHA-only participants, a result attributable to participation in the combined condition (b=1.20, p=.016) and increased organizational empowerment (b=.27, p=.003). BSR-COSP-CMHA participants experienced greater negative change in self-stigma than CMHA-only participants, a result attributable to participation in the combined service (b=-4.73, p=.031). In the SHA-CMHA trial, participants showed positive change in self-efficacy, whereas the change among BSR-COSP-CMHA participants was negative. CONCLUSIONS: Differential organizational empowerment efforts in the SHA and BSR-COSP appeared to account for the differing outcomes. Members experienced reduced self-stigma and increases in self-efficacy when they were engaged in responsible roles.

Outcomes from consumer-operated and community mental health services: a randomized controlled trial.

OBJECTIVE: Hierarchically organized board-and-staff-run consumer-operated service programs (COSPs) are viewed as organizations that promote recovery while working in concert with community mental health agencies (CMHAs). This study's objective was to determine the effectiveness of such combined services for people with serious mental illness. METHODS: A board-and-staff-run consumer-operated drop-in center and colocated CMHA provided the context for the randomized clinical trial. In a weighted sample, 139 new clients seeking help from the CMHA were randomly assigned to agency-only service or to a combination of COSP and CMHA services. Client-members were assessed at baseline and eight months on a measure of symptom severity and on four recovery-focused outcome measures: personal empowerment, self-efficacy, independent social integration, and hopelessness. All scales used have high reliability and well-established validity. Differences in outcome by service condition were evaluated with multivariate analysis of covariance via dummy variable regression. Change scores on the five outcomes were the dependent variables. The covariates for the multivariate analysis included baseline status on each outcome measure and service condition between-group demographic differences. RESULTS: Results indicated that significant changes in three recovery-focused outcomes were associated with service condition across time: social integration (p<.001), personal empowerment (p<.006), and self-efficacy (p<.001). All changes favored the CMHA-only condition. Neither symptomology nor hopelessness differed by service condition across time. CONCLUSIONS: Hierarchically organized board-and-staff-run COSPs combined with CMHA service may be less helpful than CMHA service alone.

Self-help and community mental health agency outcomes: a recovery-focused randomized controlled trial.

OBJECTIVE: Self-help agencies (SHAs) are consumer-operated service organizations managed as participatory democracies. Members are involved in all aspects of organizational management, because a premise of SHAs is that organizationally empowered individuals become more empowered in their own lives, which promotes recovery. The study sought to determine the effectiveness of combined SHA and community mental health agency (CMHA) services in assisting recovery for persons with serious mental illness. METHODS: A weighted sample of new clients seeking CMHA services was randomly assigned to regular CMHA services or to combined SHA-CMHA services at five proximally located pairs of SHA drop-in centers and county CMHAs. Member-clients (N=505) were assessed at baseline and at one, three, and eight months on five recovery-focused outcome measures: personal empowerment, self-efficacy, social integration, hope, and psychological functioning. Scales had high levels of reliability and independently established validity. Outcomes were evaluated with a repeated-measures multivariate analysis of covariance. RESULTS: Overall results indicated that combined SHA-CMHA services were significantly better able to promote recovery of client-members than CMHA services alone. The sample with combined services showed greater improvements in personal empowerment (F=3.99, df=3 and 491, p<.008), self-efficacy (F=11.20, df=3 and 491, p<.001), and independent social integration (F=12.13, df=3 and 491, p<.001). Hopelessness (F=4.36, df=3 and 491, p<.005) and symptoms (F=4.49, df=3 and 491, p<.004) dissipated more quickly and to a greater extent in the combined condition than in the CMHA-only condition. CONCLUSIONS: Member-empowering SHAs run as participatory democracies in combination with CMHA services produced more positive recovery-focused results than CMHA services alone.

When the Neighbors Complain: Correlates of Neighborhood Opposition to Sheltered Care Facilities.

Neighborhood resistance to unwanted land uses is a much heralded but insufficiently investigated feature of recent decades. This paper investigates local opposition to sheltered care for a people with mental disabilities. Using data gathered in a 12 year follow-up of a probability sample of sheltered care facilities in California, the study looks at changes over time in local opposition and at correlates of local reaction. It concludes that opposition is not related to typically proposed factors such as social class, inner-city location, or neighborhood cohesion but instead to the amount of disability of the residents, the ties of the operator to the neighborhood and location in an outer suburb.

Who Belongs?: An Analysis of Ex-Mental Patients' Subjective Involvement in the Neighborhood.

What causes people with psychiatric disabilities to feel they belong in their neighborhood? This article examines predictors of belonging for a sample of former psychiatric patients in community settings. The authors consider what differentiates ex-patients who feel they belong in their neighborhoods from those who do not. For the sample as a whole, belonging primarily results from satisfaction with the dwelling. It depends neither on reception by neighbors nor on whether they live in sheltered care. Furthermore, there is nothing about sheltered care (i.e., a supervised residence) that makes people feel less belonging. For long-term sheltered care residents, belonging depends on neighbor relations and ease of arranging activities with house residents.

The Survival of Sheltered Care Homes: Facility and Neighborhood Contributions.

We use data from a representative probability sample of all 1973 California Sheltered Care facilities for ex-mental patients. Facilities were recontacted between 1983 and 1985. Based on several literatures, we hypothesized variables that might contribute to facility survival over this period including: neighborhood factors such as community reaction and gentrification and organizational and institutional characteristics such as profit motivation and legitimacy. Contrary to expectations, age of facility, appreciation in housing values, vacancy rates, neighborhood antagonism, gentrification and conservatism were not related to closure. Instead, the facilities were more likely to stay open when they possessed a steady income stream and when they were more businesslike and licensed. They were also likely to stay open when they were located in very poor and mixed use neighborhoods.