Growing numbers of PsyR and mental health agencies purposefully employ individuals who have experienced a severe and persistent mental illness (Davidson et al., 1999; Moxley & Mowbray, 1997; Salzer et al., 2002; Solomon, 2004). Some of these individuals act as service providers in peer-operated initiatives and peer partnerships. They are also hired to provide a wide range of psychiatric rehabilitation and mental health services in the traditional mental health delivery system. Mowbray and colleagues (1996) examined this trend toward consumers working as service providers. Their work identified four principal reasons for this trend:
1. Consistent with a rehabilitation philosophy, productive and important work is made available and accessible to consumers.
2. Inclusion of consumers as mental health workers can increase the sensitivity of programs and services about recipients.
3. [Consumers] can serve as effective role models for clients.
4. The inclusion of consumers is an expression of affirmative action and is consistent with contemporary civil and disability rights policies. (Mowbray et al., 1996, p. 48)
There is a great deal of variation in the level of professionalism attached to the peer employee or consumer/provider role. There are many individuals who identify themselves as having a mental illness working as professionals on staff teams. Some rehabilitation counselors, social workers, nurses, psychologists, psychiatrists, and other credentialed PsyR and mental health service providers are also consumers of mental health services.
On the other hand, some agencies have designated peer employee positions that are meant to be an adjunct to professionally provided services. For example, an assertive community treatment team that consists primarily of professionals with degrees and credentials may include two peer employees who serve as community resource aides. Positions that are specifically developed for peer providers have been given a number of labels including peer counselor, peer advocate, peer specialist, and consumer case manager (Solomon, 2004). Peer employees have been referred to at times as "prosumers." Manos (1993) stated that:
Prosumers are former mental patients, graduates of various forms of living hell, transformed into consumers and now activated toward a wide variety of work roles to help others who are still in the first stages of defining their selves and their beings. (p. 117)
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