It is commonplace in the UK and elsewhere for mental health service users to start working alongside mental health professionals in what is known as a ‘consumer-provider’ role. This can include a number of different skills and responsibilities such as peer support, advocacy, outreach and crisis support.
A new systematic review from the Cochrane Consumers and Communication Group has just been published that assesses the “effects of employing current or past adult consumers of mental health services as providers of statutory mental health services”. The reviewers say that this is the first rigorous assessment of the efficacy of consumer-providers in mental health care.
The usual gold standard Cochrane literature search was conducted, looking for randomised controlled trials (RCTs) of consumer-providers employed in statutory mental health services. The reviewers were interested in trials that compared either:
- Consumers versus professionals employed to do the same role within a mental health service, or
- Mental health services with and without consumer-providers as an adjunct to the service.
As you would expect with this kind of high quality review, there were two independent people who selected studies and extracted data. A random-effects model was used to pool the results of similar studies.
Eleven RCTs were included in the final analysis (a total of 2,796 patients) and these were assessed as being low-moderate quality.
- Five RCTs compared mental health professionals working in similar roles to consumer-providers and overall these studies found no difference in terms of outcomes:
- Client quality of life (mean difference (MD) -0.30, 95% confidence interval (CI) -0.80 to 0.20)
- General mental health symptoms (standardised mean difference (SMD) -0.24, 95% CI -0.52 to 0.05)
- Client satisfaction with treatment (SMD -0.22, 95% CI -0.69 to 0.25)
- Consumer-providers spent more face-to-face time with clients than mental health professionals and less time doing other things (e.g. in the office, on the phone, meeting with the clients’ friends and family or other agencies)
- Clients being cared for by consumer-providers used crisis and emergency service slightly less (SMD -0.34 (95%CI -0.60 to -0.07) than those cared for by other mental health professionals
- Six RCTs compared mental health services with consumer-providers to those without and overall found no difference in:
- Psychosocial outcomes (quality of life, empowerment, function, social relations)
- Client satisfaction with service provision (SMD 0.76, 95% CI -0.59 to 2.10) and with staff (SMD 0.18, 95% CI -0.43 to 0.79)
- Attendance rates (SMD 0.52 (95% CI -0.07 to 1.11)
- Hospital admissions and length of stay, or attrition (risk ratio 1.29, 95% CI 0.72 to 2.31)
The reviewers concluded that:
Employing past or present consumers of mental health services as providers of mental health services achieves psychosocial, mental health symptom and service use outcomes that are no better or worse than those achieved by professional staff in providing care.
The quality of the RCTs in this review was not high. The reviewers state that it was unclear how randomisation and allocation concealment occurred in many, and there was also a high risk of bias for blinded outcome assessment and selective outcome reporting.
However, despite these weaknesses in the primary research included, this review does provide encouraging results for the inclusion of consumer-providers in the mental healthcare system. Further studies should focus on confirming these positive outcomes, as well as exploring the cost effectiveness of consumer-providers and any potential adverse effects that clients may experience as a result of being cared for by a consumer-provider.
Pitt V, Lowe D, Hill S, Prictor M, Hetrick SE, Ryan R, Berends L. Consumer-providers of care for adult clients of statutory mental health services. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD004807. DOI: 10.1002/14651858.CD004807.pub2.