In addition to working in a variety of provider roles, consumers make other important contributions to the field of psychiatric rehabilitation. In recent years, more consumers are being asked to participate in governing roles such as membership on agency boards of directors or administrative positions in state mental health departments. Consumers also participate actively in PsyR professional organizations such as USPRA and its state chapters. Increasingly, consumers are also contributing in meaningful ways to program evaluation and research studies. These roles allow consumers to have an impact on practice and policy issues, both on the individual agency level and on the state and national level. However, this can only occur if consumers are allowed to hold real power. As with their provider roles, it is important that the perspective of consumers in these influential positions is used and that they are not simply functioning as tokens to satisfy agency requirements or to help an organization appear progressive.
Activists in the ex-patient/consumer/survivor movement have had a meaningful impact on local, state, and national policy issues that relate to the concerns of people identified as mental health consumers. Typically, they achieve their goals by working outside of the mental health system. But to change a system that many people who have severe mental illnesses are dissatisfied with, the consumer perspective needs to be heard inside of the mental health system as well. In terms of statewide mental health systems, this has been achieved through the establishment of Offices of Consumer Affairs, which now exist within most state mental health authorities (Van Tosh et al., 2000). For example, South Carolina has a director of consumer affairs position. This position is held by an individual who has a mental illness and who reports directly to the state mental health director. Part of this individual's responsibility is to hire consumer affairs coordinators for each of the community mental health centers located throughout the state. The positions are earmarked for self-identified consumers and are funded through the state's mental health plan. The main thrust of this innovative plan is to make consumer satisfaction with mental health services the system's number one goal (Bevilacqua, Gettys, & Cousins, 1997).
Progress has been made on the national level as well. In 1995 SAMHSA's Center for Mental Health Services created the position of consumer affairs specialist. Other examples of consumer involvement on the national level included the appointment of activist Daniel Fisher to the President's New Freedom Commission on Mental Health, which issued its final report, Achieving the Promise: Transforming Mental Health Care in America, in 2003.
Consumer involvement on local mental health and PsyR agency boards is essential to the planning and implementation of consumer-centered services. A board of directors that has a substantial percentage of consumers filling meaningful roles is an excellent example of empowerment. It is important to realize that nonprofit agency administrators must answer to their board of directors. The board has the power to hire and fire administrators, develop and refine the agency's mission and goals, and create policies that govern day-to-day service provision. Consumers serving on these boards also have a chance to combat stigma by serving as role models in their communities. For example, residential programs often have to deal with resistant community members when opening new group homes or apartments. Board representatives who are also self-identified consumers can help ease fears and misconceptions by speaking to neighbors and community representatives.
PsyR professional organizations are another place where consumer involvement is essential. Consumer participation on the boards and subcommittees of these organizations provides an excellent opportunity for collaboration between consumers and professionals that can positively influence both local and national service systems. Consumer involvement at local and national professional conferences, as both presenters and attendees, is another way in which consumers can share their perspective with PsyR and mental health professionals. In the 1970s, when PsyR professional associations began to emerge, these conferences were opportunities for professionals to talk with each other about their work with persons with psychiatric disabilities. Now, many of these conferences provide opportunities for professionals, peer providers, consumers, and family members to share concerns and strategies for improving services, with consumers often assuming important roles such as keynote speaker.
Finally, program evaluation and research are areas where consumers are making important contributions. Increased collaboration between providers and consumers in evaluating individual program outcomes is increasingly evident. In terms of more rigorous studies, not only do consumers act as subjects and survey respondents but also as active partners in research projects and even as independent researchers (Campbell, 2002; Van Tosh et al., 2000). Activist Daniel Fisher (1994b) recommends "basing total quality improvement of mental health services on outcome measures designed by survivors and consumers" (p. 915). He cites the formation of the Consumer/Survivor Research and Policy Work Group, an entity that has been supported by SAMHSA's Center for Mental Health Services, as an important example of this goal. Thus, persons who have severe mental illnesses are helping to enhance both our knowledge of best practices and our understanding of recovery through their involvement in planning, designing, conducting, and reporting on important research studies (Van Tosh et al., 2000).
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