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Articles   |    
Self-Stigma and Empowerment in Combined-CMHA and Consumer-Run Services: Two Controlled Trials
Steven P. Segal, M.S.W., Ph.D.; Carol J. Silverman, Ph.D.; Tanya L. Temkin, M.A., M.P.H.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200490
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Dr. Segal is affiliated with the School of Social Welfare, University of California, Berkeley, 120 Haviland Hall (MC 7400), Berkeley, CA 94720-7400 (e-mail: spsegal@berkeley.edu). Dr. Silverman is with the Henderson Center for Social Justice, Boalt School of Law, University of California, Berkeley. Ms. Temkin is with Kaiser Permanente of Northern California, Oakland.

Copyright © 2013 by the American Psychiatric Association

Abstract

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.

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Figure 1 Path analysis for two clinical trials showing significant paths between endogenous variables in the modelsa

aThe trials evaluated outcomes for clients assigned to receive services from either a self-help agency (SHA) or a board- and staff-run consumer-operated service program (BSR-COSP) combined with services from a community mental health agency (CMHA). The two groups receiving combined services were each compared with a group assigned to receive CMHA services only. ATPMIS, Attitudes Toward Persons With Mental Illness Scale

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Table 1Characteristics of two trials in which participants received combined services from a community mental health agency (CMHA) and a consumer-operated programa
Table Footer Note

a The consumer-operated programs were self-help agencies (SHAs) and a board- and staff-run consumer-operated service program (BSR-COSP). Participants receiving combined services were compared with those receiving CMHA services only.

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Table 2Scores of participants in two trials comparing receipt of combined services with receipt of services from a community mental health agency (CMHA) onlya
Table Footer Note

a Participants received combined services from a self-help agency (SHA) and a CMHA in one trial and from a board- and staff-run consumer-operated service program (BSR-COSP) and a CMHA in another trial. The combined-services group was compared with the CMHA-only group.

Table Footer Note

b Possible scores on the Organizationally Mediated Empowerment Scale (OMES) range from 0 to 17, with higher scores indicating increased empowerment. In the SHA-CMHA trial, a significant difference (p<.001) was found between comparison groups at follow-up.

Table Footer Note

c Possible scores on the Attitudes Toward Persons With Mental Illness Scale (ATPMIS) range from 18 to 108, with higher scores indicating more negative attitudes. In the SHA-CMHA trial, a significant difference (p=.007) was found between comparison groups at follow-up.

Table Footer Note

d Possible scores on the Self-Efficacy Scale (SES) range from 15 to 75, with higher scores indicating increased self-efficacy. In the SHA-CMHA trial, a significant difference (p<.001) was found between comparison groups at baseline, which was absent at follow-up.

Table Footer Note

*p<.01, **p<.001

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Table 3Results for path model equations for outcomes in trials in which participants received combined services from a community mental health agency (CMHA) and a consumer-operated programa
Table Footer Note

a The consumer-operated programs were self-help agencies (SHAs) and a board- and staff-run consumer-operated service program (BSR-COSP). The combined-services group was compared with the CMHA-only group. All significance tests were one-tailed: for the SHA-CMHA trial, it was the positive tail, and for the BSR-COSP–CMHA trial, it was the negative tail. The models controlled for baseline scores on the Attitudes Toward Persons With Mental Illness Scale (ATPMIS) and the Organizationally Mediated Empowerment Scale (OMES) and for age, gender, race (African American), education, marital status (never married), schizophrenia diagnosis, and presence of substance dependence. SES, Self-Efficacy Scale

Table Footer Note

b R2=.20, adjusted R2=.19; F=12.37, df=10 and 492, p<.001

Table Footer Note

c R2=.27, adjusted R2=.25; F=17.78, df=10 and 492, p<.001

Table Footer Note

d R2=.44, adjusted R2=.43; F=39.17, df=10 and 492, p<.001

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e R2=.28; adjusted R2=.22; F=4.85, df=10 and 124, p<.001

Table Footer Note

f R2=.45; adjusted R2=.41; F=11.29, df=10 and 124, p<.001

Table Footer Note

g R2=.78; adjusted R2=.76; F=43.27, df=10 and 124, p<.001

Table Footer Note

h Receipt of combined services=1.00; CMHA only=.00

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References

Achieving the Promise: Transforming Mental Health Care in America. Pub no SMA-03-3832. Rockville, Md, Department of Health and Human Services, President’s New Freedom Commission on Mental Health, 2003
 
Johnsen  M;  Teague  G;  Herr  EM:  Common ingredients as a fidelity measure; in  On Our Own, Together: Peer Programs for People With Mental Illness . Edited by Clay  S.  Nashville, Tenn,  Vanderbilt University Press, 2005
 
Mowbray  CT;  Bybee  D;  Holter  M  et al:  Validation of a fidelity rating instrument for consumer-operated services.  American Journal of Evaluation 27:9–27, 2006
[CrossRef]
 
Budd  S:  Governing structures; in  Reaching Across: Mental Health Clients Helping Each Other . Edited by Zinman  S;  Harp  HT;  Budd  S.  Riverside, California Network of Mental Health Clients, 1987
 
Chamberlin  J:  Direct democracy as a form of program governance; in  Reaching Across II: Maintaining Our Roots: The Challenge of Growth . Edited by Harp  HT;  Zinman  S.  Sacramento,  California Network of Mental Health Clients, 1994
 
Harp  H;  Zinman  S:  Maintaining our roots, the challenge for self-help development; in  Reaching Across II: Maintaining Our Roots: The Challenge of Growth . Edited by Harp  HT;  Zinman  S.  Sacramento,  California Network of Mental Health Clients, 1994
 
Zinman  S:  Issues of power; in  Reaching Across: Mental Health Clients Helping Each Other . Edited by Zinman  S;  Harp  HT;  Budd  S.  Riverside, California Network of Mental Health Clients, 1987
 
Segal  SP;  Silverman  C;  Temkin  T:  Are all consumer-operated programs empowering self-help agencies? Social Work in Mental Health 11:1–15, 2013
[CrossRef]
 
Goldstrom  I;  Campbell  J;  Rogers  J  et al:  National estimates for mental health mutual support groups, self-help organizations, and consumer-operated services.  Administration and Policy in Mental Health and Mental Health Services Research 33:92–103, 2006
[CrossRef] | [PubMed]
 
Segal  SP;  Silverman  CJ;  Temkin  TL:  Self-help and community mental health agency outcomes: a recovery-focused randomized controlled trial.  Psychiatric Services 61:905–910, 2010
[CrossRef] | [PubMed]
 
Segal  SP;  Silverman  CJ;  Temkin  TL:  Outcomes from consumer-operated and community mental health services: a randomized controlled trial.  Psychiatric Services 62:915–921, 2011
[CrossRef] | [PubMed]
 
Cooley  CH:  Human Nature and the Social Order .  New York,  Scribner, 1902
 
Link  BG:  Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection.  American Sociological Review 52:96–112, 1987
[CrossRef]
 
Watson  AC;  Corrigan  P;  Larson  JE  et al:  Self-stigma in people with mental illness.  Schizophrenia Bulletin 33:1312–1318, 2007
[CrossRef] | [PubMed]
 
Rüsch  N;  Corrigan  PW;  Wassel  A  et al:  Self-stigma, group identification, perceived legitimacy of discrimination and mental health service use.  British Journal of Psychiatry 195:551–552, 2009
[CrossRef] | [PubMed]
 
Davidson  L;  Chinman  M;  Kloos  B  et al:  Peer support among individuals with severe mental illness.  Clinical Psychology: Science and Practice 6:165–187, 1999
[CrossRef]
 
Kyrouz  EM;  Humphreys  K:  Do psychiatrically disabled people benefit from participation in self-help/mutual aid organizations? A research review.  Community Psychologist 29:21–25, 1996
 
Rogers  ES;  Teague  GB;  Lichenstein  C  et al:  Effects of participation in consumer-operated service programs on both personal and organizationally mediated empowerment: results of multisite study.  Journal of Rehabilitation Research and Development 44:785–799, 2007
[CrossRef] | [PubMed]
 
Verhaeghe  M;  Bracke  P;  Bruynooghe  K:  Stigmatization and self-esteem of persons in recovery from mental illness: the role of peer support.  International Journal of Social Psychiatry 54:206–218, 2008
[CrossRef] | [PubMed]
 
Robins LN, Cottler LB, Bucholz KK, et al: Diagnostic Interview Schedule for the DSM-IV (DIS-IV). St Louis, Washington University Press, 1999
 
Segal  SP;  Silverman  C;  Temkin  T:  Characteristics and service use of long-term members of self-help agencies for mental health clients.  Psychiatric Services 46:269–274, 1995
[PubMed]
 
Link  B;  Cullen  FT;  Frank  J  et al:  The social rejection of former mental patients: Understanding why labels matter.  American Journal of Sociology 92:1461–1500, 1987
[CrossRef]
 
Peterson  NA;  Zimmerman  MA:  Beyond the individual: toward a nomological network of organizational empowerment.  American Journal of Community Psychology 34:129–145, 2004
[CrossRef] | [PubMed]
 
Segal  SP;  Silverman  C;  Temkin  T:  Measuring empowerment in client-run self-help agencies.  Community Mental Health Journal 31:215–227, 1995
[CrossRef] | [PubMed]
 
Bandura  A:  Self-efficacy: toward a unifying theory of behavioral change.  Psychological Review 84:191–215, 1977
[CrossRef] | [PubMed]
 
Segal  SP;  Kotler  PL;  Holschuh  J:  Attitudes of sheltered care residents toward others with mental illness.  Hospital and Community Psychiatry 42:1138–1143, 1991
[PubMed]
 
Cohen  J:  Statistical Power Analysis .  Hillsdale, NJ,  Erlbaum, 1988
 
Pallant  JF:  SPSS Survival Manual: A Step by Step Guide to Data Analysis Using SPSS .  New York,  Allen & Unwin, 2007
 
Silton  NR;  Flannelly  KJ;  Milstein  G  et al:  Stigma in America: has anything changed? Impact of perceptions of mental illness and dangerousness on the desire for social distance: 1996 and 2006.  Journal of Nervous and Mental Disease 199:361–366, 2011
[CrossRef] | [PubMed]
 
Segal  SP:  Attitudes toward the mentally ill: a review.  Social Work 23:211–217, 1978
[PubMed]
 
Heise  DR:  Problems in path analysis and causal inference; in  Sociological Methodology . Edited by Borgatta  EF;  Borestedt  GW.  San Francisco,  Jossey-Bass, 1969
 
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