The idea of people with mental illness providing services to their peers is not a new concept. Stemming from historical roots that began in the early part of this century, peer-based services increased in visibility as a result of the ex-patient movement of the 1970s and subsequently developed as alternatives to traditional community mental health (CMH) programs and psychiatric institutions. A widening of consumer involvement in federal community support services programs occurred in the 1980s, with increased consumer presence in advocacy systems, national conferences, and protest literature. Consumerism is now emphasized through psychosocial rehabilitation programs, policies such as person-centered planning and legislative initiatives for rights protection and advocacy. (Since the 1970s various terms have been used to describe individuals with a mental illness, for example, consumers, recipients, survivors, ex-patients, clients, and so forth. We recognize and respect the terms these individuals use to descr ibe themselves. However, for brevity, "consumer" is used in this article.)
Authors, researchers, consumers, providers, and advocates have articulated the value of consumer-operated services. The most often-stated aspects of consumer-operated services are increasing a sense of personal control and empowerment (Salem, 1990), which counteracts typical feelings of powerlessness (Chamberlin & Rogers, 1990); offering choices (Connelly, Keels, Kleinbeck, Schneider, & Cobb, 1993); promoting independence and competence, providing social support, and individualizing services (Chamberlin, 1984); providing support that is more empathic, concrete, and relevant (Mowbray, 1997); offering role models, organizational involvement (through a flattened administrative hierarchy), and group empowerment (Segal, Silverman, & Temkin, 1993); and working for social justice and social change on behalf of individuals with serious mental illness (Chamberlin & Rogers; Segal et al.).
The range of consumer-operated programs described in the literature includes drop-in centers, housing and homeless support services, advocacy, case management services, respite care, and businesses (Chamberlin, Rogers, & Ellison, 1995; Conrad, 1993; Mead, 1997; Meek, 1994; Miller & Miller, 1997; Mowbray, Moxley, Jasper, & Howell, 1997; Mowbray, Wellwood, & Chamberlain, 1988; Trainor, Shepherd, Boydell, Leff, & Crawford, 1997). The services offered usually include mutual support, cultural activities, advocacy (including assistance with legal problems), knowledge development and skills training, public and professional education, and economic development (Chamberlin et al.; Trainor et al.).
CONSUMER DROP-IN CENTERS
The most frequently described of consumer-operated mental health services models is the drop-in center (Kaufmann, Ward-Colassante, & Farmer, 1993; Mowbray et al., 1997; Mowbray & Tan, 1992, 1993). The historical origins of consumer drop-in centers have not been documented. However, the first consumer-operated program was probably the WANA Society (later Fountain House, which provided a psychosocial support system for its members leaving state institutions; Moxley & Mowbray, 1997). In 1961 the report of the Joint Commission on Mental Illness and Health identified four types of ex-patient alternatives. Consumer drop-in centers appear similar to their "social clubs," which were organized to provide ex-patients with support, recreation, and social interaction.
Consumer drop-in centers provide a wide range of services to consumers (Van Tosh & del Vecchio, 1998). At their most basic, they offer a place that is accepting, safe, supportive, and normalizing; where consumers can feel needed and grow in self-worth, dignity, and self respect; and where they can learn about community support (Meek, 1994; Mowbray & Tan, 1992). …