Consumer-providers of care for adult clients of statutory mental health services
The consumer participation and self-help movements have driven increased levels of user involvement in health services generally, including mental health services, since at least the 1970s. Involving adults who use mental health services as providers of mental health services to others is known as the ‘consumer-provider’ model. People working in this role may provide peer support, coaching, or advocacy; engage in specialist or peer interviews; or undertake case management or outreach. They may serve as crisis workers, assertive community treatment workers, or providers of social support programmes.
Despite the widespread application of this model, the effects of employing ‘consumer-providers’ within or alongside tradition mental health services, to support adult mental health service users have not previously been assessed systematically. Involving consumers in mental health service provision has the potential to produce both benefits and harms. Mechanisms of involving consumer-providers need to be carefully considered, and practice needs to be guided by evidence on effectiveness.
A team of Cochrane authors, based in Australia and working with the Consumers and Communication Review Group, set out to answer the question of whether the practice of employing past or present users of mental health services as providers is effective in improving quality of life and clinical outcomes. The review team evaluated 11 randomised controlled trials involving 2796 participants. Of these, five trials, involving 581 people, compared mental health professionals to consumer-providers working in similar roles; the other six, involving 2215 people, compared mental health services with or without the addition of consumer-providers.
None of the included studies found differences in the outcomes measured, including quality of life and general mental health symptoms. No studies in either comparison group reported data on adverse outcomes for clients, or information on the financial costs of service provision. The authors classified the evidence from the included studies as of ‘moderate to low quality’, and concluded that ‘involving consumer-providers in mental health teams results in psychosocial, mental health symptom and service use outcomes for clients that were no better or worse than those achieved by professionals employed in similar roles, particularly for case management services.’
In evaluating the implications for future research indicated by the findings of this review, the Cochrane author team points out that, while there is no definite benefit identified from the use of consumer-providers in mental health services, neither is there any indication of harm. “Future research in this area should focus on cost effectiveness and benefits and harms to consumer-providers themselves,” suggested Dianne Lowe, a researcher at LaTrobe University’s Centre for Health Communication and Participation, and the contact author for the review. “A more rigorous assessment of client outcomes, using standardised mental health measures, would also be useful.”