Table 1.

Involving current or former users of mental health services as providers in mental health services

Study	Involvement of	No of users involved and inclusion criteria	Study design (n=No of clients)	Measures of client* outcomes or service delivery patterns	Differences between groups
Solomon and Draine, 1994-6, USA†7 17 19	Case managers in community mental health service	4 in team (population changed over time); recent use of psychiatric services	Randomised controlled trial; 2 case management team conditions: employing users (n=48) and employing non-users (n=48)	Delivery: dates, locations, and manner of contact with clients	User employees: more face to face, fewer telephone or office based contacts
				Outcomes: income, level of functioning, quality of life, attitude to drugs compliance, social contacts, symptoms, inpatient days, treatment satisfaction	1 year: clients of user employees less satisfied with treatment, less family contact; 2 years: none
Paulson et al, 1997-2000, USA†8 18	Case managers in assertive community treatment programme	5 in team (population changed over time)	Randomised controlled trial; 3 conditions: assertive community treatment employing users (n=58), employing non-users (n=59), and usual care (n=61)	Delivery: time spent on categories of case manager activities	User employees (compared with non-user ACT employees): longer in supervision, more flexible scheduling
				Outcomes: time until first hospitalisation, arrest, emergency hospital care, or homelessness	Clients of user employees: longer before hospital admission, fewer hospitalised, or had emergency care
O'Donnell et al, 1998-9, Australia5 23	Client advocates attached to case management service	Number not stated	Randomised controlled trial; 3 case management conditions: clients focused with advocacy (n=45), clients focused (n=39), and standard care (n=35)	Outcomes: satisfaction with service, quality of life, functioning, family burden, inpatient days, use of crisis services	Family burden lower for client focused (2 groups combined) than for standard case management
Klein et al, 1998, USA10	Peer counsellors alongside case management service	Number not stated; recovering from addiction	Comparative study; 2 case management conditions: with peer support (n=10) and standard (n=51)	Outcomes: hospital admissions, crisis events, social support, functioning, quality of life, drug use, satisfaction with service	Clients of peer support: fewer inpatient days, better social functioning, some quality of life improvements
Felton et al, 1995, USA11	Peer specialists on case management teams	3	Comparative study; 3 case management conditions: additional employees who were users (n=125), additional non-user employees (n=118), and no additional employees (n=68)	Outcomes: self esteem, engagement in programme, attitude to recovery, social support, quality of life, inpatient days, life problems, symptoms	Clients of user employees (compared with other 2 groups combined): more satisfied with living situations and finances, fewer reported life problems, less decline in contact with case managers
Chinman et al, 2000, USA12	Case managers in outreach service	Number not stated; prior psychiatric treatment	Descriptive study; case management service sites separated into 2 conditions: sites with ⩾10 clients of user employees (n=113) and sites with all or most services from non-user employees (n=630)	Outcomes: symptoms, quality of life, days of homelessness, social support, employment, relationship between client and case manager	None
Chinman et al, 2001, USA13	Service providers in community outreach service	3 in team (population changed over time)	Comparative study; 2 conditions: programme with user employees (n=92) and matched sample of clients receiving usual care (n=79)	Outcomes: number of readmissions to hospital, inpatient days	None
Lyons et al, 1996, USA14	Users as service providers in mobile crisis assessment service	8; prior psychiatric hospitalisation and medication or prior outpatient treatment	Descriptive study; compared working pairs in which: 1 or both of the pair had history of hospitalisation and neither user employee had a history of hospitalisation	Delivery: time spent on categories of duties, pattern of hospitalising clients	Working pairs in which at least 1 user employee had previous hospitalisation: more mobile outreach, fewer emergency responses, more hospitalising of clients involuntarily during routine dispatch

^*Clients are recipients of services in which users are employed. 

^†These studies are also described in other publications cited elsewhere.²⁰