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Consumer/Survivor-Operated Self-Help Programs:
A Technical Report

Chapter Two

DESCRIPTIONS OF THE 13 DEMONSTRATION GRANT PROJECTS

Project materials from each of the CSP Consumer/Survivor-Operated Services Demonstration Projects were examined in order to provide an in-depth, cross-program examination of each individual initiative. Documents that were reviewed included: original applications, annual continuation applications, relevant correspondence from NIMH, final project reports, and evaluation findings. A variety of program elements were explored: project goals and objectives; services and supports provided; client population served; organizational structure; board development; staff size, characteristics, and training provided; reasonable accommodation practices; pro-gram materials developed; implementation issues; inter-organizational coordination; existence of other self-help programs before and after the demonstration grant; project budget; evaluation strategies and findings; and pro-gram continuation plans. These domains have been collapsed into four groupings-Project Goals and Objectives, Program Description, Implementation Issues and Problems, and Evaluation Findings-which are presented in this chapter for each of the thirteen programs which were funded.

There are limitations to this analytic strategy which may affect the objectivity of the findings. The majority of materials reviewed were self-reports created by the projects themselves. Other materials were often prepared by State mental health authority personnel, which further complicates validity, as it is possible that such staff were less familiar with a particular program's day-to-day operations than a program coordinator or director would be. The information within these documents was often incomplete, which further limits the usefulness of the documents. Other strategies (such as key informant surveys and site visits) may have been able to capture a broader spectrum of information, and perhaps enhanced the validity of the "information" or "findings" presented. However, resource constraints prevented the use of those methodologies.

The above limitations notwithstanding, these analyses do offer a valuable, albeit descriptive, examination of each demonstration site. The individual project findings indicate a variety of project approaches and successful outcomes. Although there was variation from site to site, an overall conclusion can be drawn that these efforts demonstrated efficacy in meeting consumer/survivor needs.

CALIFORNIA

Alameda County Network of Mental Health Clients

Berkeley Drop-In Center
Berkeley, CA
Oakland Independence Support Center
Oakland, CA

The grant funded the Alameda County Network of Mental Health Clients (ACNMHC) to expand the Oakland Independence Support Center (OISC) and the Berkeley Drop-In Center (BDIC). Grant funds were used to enable these programs to expand client services to better meet their service recipients' demonstrated need. This was to be accomplished via a "Coordinated Self-help System" (CSHS), which was designed to centralize shared resources, including administrative services, storage space, bookkeeping, statistics, insurance costs, and medical coverage. CSHS was also designed to enable the hiring and assignment of additional staff, develop a volunteer resource bank, and conduct coordinated outreach, evaluation, and fundraising. CSHS was conceptualized as a self-help/ mutual support approach to peers helping one another-a "self-help program for self-help programs." It was hoped that the expanded activities resulting from the grant would lead to the development of a model which could be replicated elsewhere.

PROGRAM DESCRIPTION
Services Provided

The BDIC offered direct services (a drop-in center, support groups, case advocacy, generalized advocacy, information and referral, instructional groups, free food, phone, books, magazines, transportation assistance, and clothing) and recreational activities (socialization and art activities).

The OISC offered a community drop-in center (free coffee, food, support groups, and peer counseling), independent living services and independent living skills training mailing address, bathroom and shower facilities), and information and referral (advocacy, housing search assistance, money management assistance, and outreach to other programs).

As a result of this funding effort, the pro-grams were able to increase their operating hours, increase the number of instructional groups and support groups offered, and offer additional advocacy, socialization, and sub-stance abuse counseling services. Guidelines for volunteer recruitment were developed, and a brochure and mailing list were created to assist in project outreach. Successful fundrais-ing enabled the ACNMHC to obtain a contract with the Alameda County Mental Health Department to provide tenant support services to consumers/survivors living in the Aztec Hotel, a large, nonprofit, consumer/survivor-operated, single-room occupancy hotel.

Individuals Served

Service recipients were defined as individuals who had a history of psychiatric disability. The Final Report indicated that BDIC estimated the total unduplicated number of individuals served for the entire project was 1,600, while OISC served approximately 1,900 different individuals. Service recipients had the follow-ing characteristics: 95% were homeless or at risk of being so; over 98% were very low-income; the majority were African American males; most were between the ages of 22 and 44; 26% had no high school diploma, 53% graduated high school, 16% had some col-lege, and 5% were college graduates; and nearly 30% were veterans.

Organization and Administration

The grant was provided to the California Department of Mental Health (DMH), which initially passed the funds through Berkeley-Oakland Support Services (BOSS). BOSS, in turn, provided the funding to the Alameda County Network of Mental Health Clients (ACNMHC), which then funded the separate BDIC and OISC projects. Later in the grant, both centers as well as the ACNMHC attained nonprofit status and were able to directly receive the grant funds.

A Coordinating Committee reported to the ACNMHC Board and was composed of three at-large members of the ACNMHC Board and three members from each center, including the Program Coordinator/Director of each. Over time, a decision was made to eliminate the Coordinating Committee, as its function was duplicative of the ACNMHC Board. Both proj-ects had a shared staff and administration .

Shared paid staff consisted of an Adminis-trator; an Administrative Assistant; a Field Advocate who advocated for entitlements, housing, and rights protection; an Independent Living Specialist who conducted skills work-shops, assisted service recipients in obtaining housing, and provided benefits counseling, information and referral, and case advocacy; an Activities Coordinator; and a Substance Abuse Peer Counselor. Paid consultants were utilized for program evaluation, fundraising, bookkeeping, and graphics. Unpaid staff consisted of a Program Coordinator and an Activities Coordinator at BDIC, and a Program Developer, a Program Services Coordinator, an Administrative Assistant, and Information and Referral Specialist, a Housing Counselor, an Independent Living Skills Trainer, an Intake Worker, and a Peer Counselor at OISC.

Volunteers averaged 225 hours per month at each center to assist with structured social-ization activities, food preparation, facilitating support groups, and site maintenance. The Final Report estimated that over 350 consumers/survivors volunteered during thegrant period in a wide variety of tasks.

Most staff were African American men; all were disabled, all were low-income when hired; all had experienced homelessness; and all were consumers/survivors. The ACNMHC has an affirmative action plan that emphasizes ethnic minorities, women, and disabled individuals in all roles within their programming: as participants, as staff, and serving on governing bodies.

Employee orientation and as-needed, on-the-job training were provided. Group training was also provided for the staff, volunteers, and service users on such topics as peer counsel-ing, benefits advocacy, community resources, substance abuse, HIV/AIDS, TB and other public health issues, civic involvement, defusing potentially violent situations, performing intakes, and chairing meetings.

A number of administrative and program materials were developed, including personnel policies, financial/accounting forms, and client forms. ACNMHC, BDIC, and OISC coordinated their activities with a wide number of other organizations and entities, including community service agencies, advocacy agencies, State consumer/survivor organizations, local mental health and homelessness committees, providers of services to the homeless, mental health providers, State and local mental health authorities, churches, foundations, researchers, legal centers, and neighborhood associations.

A total of $390,742 was spent on this effort over the three years of project funding. Of this amount, $376,238 came from Federal funds and $14,504 came from miscellaneous sources.

The project startup was delayed for nine months, which affected hiring, procurement of office space, equipment, furnishings and property insurance. This delay was due, in part, to the 1989 San Francisco Bay Area earthquake. State and Federal officials agreed to roll over the first-year funds. This delay, however, caused cash flow problems, and ACNMHC was initially forced to borrow funds to cover payroll. Cash flow problems also prevented the project from conducting outreach in the South County area, but full caseloads made outreach less of a priority.

During the early phase of the grant, there was some staff turnover. In addition to the staff turnover, it was reported in Year 2 that the individual projects believed that the CSHS administrative office and staff were unable to carry out both the functions of ACNMHC and the functions of the two centers. Eventually, some shared administrative support, such as bookkeeping and statistics, was dropped.

Evaluation data were collected from a variety of sources, including observations, interviews, discussions, and the use of program documents, records, and quantitative data.

The Final Report noted that the demonstration project essentially looked as planned. ACNMHC became an effective "umbrella" organization with shared resources, staffing, and administrative assistance. It was agreed that some of the administrative functions for the two centers were not needed and would have been logistically difficult to provide.

Overall, it was noted that both centers succeeded in further developing their programs (focusing on social and survival needs), improving administration and operations (sharing of information), and improving record keeping and computer capacity. The local centers were successful in gaining their own foundation grants. In Year 3, a funding consultant was hired, resulting in successful grants and loans.

Boston University conducted an outcome evaluation that examined program participants' self-esteem, quality of life, satisfaction with the self-help program, service use, and demographics.

Approximately 18% of the individuals served were screened and intaked by CSHS staff at both sites, with interviewers recording various data. The services used by the most people were: hot meals (100%), transportation assistance (100%), social/recreational activities (93%), telephone services (88%), food referrals (84%), peer counseling (76%), independent living skills training (60%), and peer support groups (60%).

A correlational analysis revealedthe following:

• Individuals who participated at a higher level in the program had higher levels of program satisfaction and had increased self-esteem and quality of life.
• Findings suggested that persons with long psychiatric histories (including frequent and long hospitalizations) benefited at the same levels as other participants in terms of the program's impact on self-esteem.
• There was no difference between members of different races or individuals with homeless status in terms of self-help program impact on self-esteem, satisfaction, or quality of life.
• No significant correlation was found between taking or not taking medications and self-esteem, satisfaction, or quality of life. However, there was a relationship approaching significance between satisfaction with the program and taking medications (those who do not take medications reported being more satisfied with the program).

The Final Report recommended that additional and more comprehensive technical assistance and training be provided on the topics of board development, fundraising, record keeping, computer technology, and personnel policies and procedures (including laws and regulations governing employment practices). It was also recommended that when Federal funding is temporary, there should be formal and concrete agreements with State and local mental health funding agencies to continue funds past the grant period. Lastly, it was recommended that funds should not be channeled through the State mental health system, as this causes additional delays in project startup. Funds should be provided, instead, directly to the recipient organizations.

The Final Report suggested several interesting hypotheses for further evaluation:

• Outreach to ethnic minorities is best accomplished when a program is situated in that community.
• Both services and social activities are needed for a viable program.
• Programs such as these attract people who are distrustful and resistant to traditional mental health services.
• An umbrella organization is essential for cooperation, communication, and coordination for client-run programs in the same geographic area.

BDIC and OISC both obtained city funds to continue two positions until ACNMHC could obtain ongoing funds. Eventually, ACNMHC obtained county mental health funds to continue operations.

COLORADO

The Phoenix Project
Denver, CO

The overall goal of The Phoenix Project was to develop a consumer/survivor-controlled and -operated "superstructure" for the development,creation, and sustenance of nonprofit and for profit consumer/survivor-managed affiliate business enterprises. These affiliate enterprises would employ consumers/survivors and would provide various direct services and alternatives to traditionally based mental health services to other consumers/survivors. It was hoped that the grant would provide initial funds for startup costs and that later each affiliate and the "superstructure" would be self-sufficient from sales and funding support from other agencies and foundations.

Specific objectives included developing at least seven affiliate businesses (of which five would provide mental health services, such as case management, drop-in centers, respite programs, job coaches, companion programs, housing support staff, and vocational case management). Other suggested business ideas included: property management and maintenance, bulletin board services, car detailing, photo finishing, messenger service, phone marketing, wholesale handicraft and art, catering/box lunches, and temporary employee services. It was hoped that these efforts would employ 50 consumers/survivors serving 500 consumers/survivors in the community.

The parent corporation provided initial support (startup funding), administrative and management services as needed (e.g., training, accounting, marketing, and data processing), and access to, and coordination of, community resources on a cooperative model. The super-structure of the corporation provided a common job center for all affiliates, public relations, technical assistance, and fundraising. There were also plans to disseminate project results throughout the State and nationally.

The Final Report indicated that over time, it became clear that the objectives were too ambitious, so they were revised, with NIMH approval, as follows: to develop seven businesses, of which at least three would provide alternative mental health services. These businesses would provide alternative services to 200 consumers/survivors.

After a lengthy RFP process, seven consumer/survivor-managed businesses were selected for startup funding, with six being successfully established. These included an auto repair service, Leopard Automotive; a telephone help line, The Helping Ear; a desk-top publishing firm, Phoenix Publishing; an auto repair referral service, AutoMedic; a rental management project, Phoenix Property Management; and a benefits assistance project, Professional Benefits Assistance.

The Helping Ear provided information and advocacy, peer counseling, benefits acquisition assistance, and crisis intervention. Grant funding also enabled The Phoenix Project to provide technical assistance to consumers/survivors. This technical assistance was focused on specific skills such as cash register operation; interpersonal skills such as conflict management; and business development, management, and other administrative skills such as bookkeeping, purchasing, payroll, board development, and fundraising. Lastly, the funding enabled The Phoenix Project to disseminate project results through presentations at international, national, Statewide, and local conferences, as well as through providing information to over 300 contacts and through coverage in newspaper articles and newsletters.

The project focused on serving individuals designated as having a psychiatric disability. The Final Report indicated that a total of 500 individuals received services from the affiliated telephone information service, The Helping Ear. Characteristics on the clients served by the other affiliate businesses are unavailable.

The grant was provided to the Colorado Division of Mental Health, which provided the funds to The Phoenix Project. The Phoenix Project’s structure consisted of a Board of Directors and a central office staff. It was originally intended that each affiliate business would have its own Board and staff, although further information was not reported.

Initially, a Board of Directors was to be composed of both consumers/survivors and non-consumers/survivors, as well as minority representation proportional to the State’s makeup. After a lengthy process (which in-cluded nominations, written evaluations, and in-person interviews), seven consumers/survivors and four non-consumers/survivors were chosen for the Board in late 1989. The Final Report indicated that a total of 31 con-sumers/survivors and 6 non-consumers/survivors had participated on the Board over the length of the project.

Paid staff consisted of an Executive Director, an Assistant Director, a Consumer Project Coordinator, an Administrative Assistant, and a Bookkeeper. The State also provided inkind staff support through a Community Support Program Director and a Human Resources Development Assistant. The Final Report indicated that other part-time staff and consultants were hired to assist with administrative tasks including help from a Business Manager and an Operations Manager. The Report also indicated that 100 consumers/survivors over the entire project period participated as staff, consultants, board members, or volunteers. Nearly all paid staff were consumers/survivors; consultants were generally non-consumers/survivors.

Staff were provided with training on non-profit organization development, business management, specific employment-related skills, and interpersonal skills. In Year 2, the project determined that it would encourage its affiliate businesses to offer low-stress, flexible, supportive above-minimum-wage jobs (with time off for doctors’ appointments, if needed), career advancement, and assistance to staff in achieving financial independence. It also decided to offer case management to those who were transitioning back to work and regular support groups for employees to see if their needs were being met.

A number of pertinent materials were developed as a result of this effort, including a personnel handbook, a Request for Proposals, and Board application forms. The project was coordinated with a number of organizations and entities, including retired business executives, training centers, mental health providers, and colleges. In terms of the project's impact on the region, prior to the grant, there was a consumer case management program in Denver and a few self-help groups in the area. After the effort, The Helping Ear and the Statewide consumer/survivor organization Survivors and Consumers of Colorado Organized for Rights and Empowerment (SCCORE) had been developed.

The Final Report indicated that the total Federal funding for the project was $450,000.

Several issues were encountered in the implementation of this initiative. Delays in startup occurred, due to some State-level staff turnover; as a result, a project extension was granted. Turnover in the Executive Director position and Board members also contributed some difficulties. Tensions over control developed on the Board between consumers/survivors and those who were not consumers/survivors. Eventually, at the end of the project, the Board was composed of all consumers/survivors, except for one member. The amount of resources needed to accomplish the original goals was underestimated, and limited financial resources hindered the program's success. Superstructure delays in providing sub-grants to the affiliate businesses resulted in the State threatening to withhold funds for the entire project.

Board and staff members both felt that there was a lack of expertise in marketing approaches, financial management knowledge, technical assistance, priority setting, and over-all direction, which was ultimately detrimental. The affiliate businesses were initiated in an artificial environment. The Board and staff had to train others on how to develop a Board and organization at the same time they were learning to do it themselves, and this contributed to the difficulties. It was recommended that more time should have been allocated to these organizational development tasks. Additional problems mentioned were expediency of decision making (too many decisions were made in times of crisis), and the isolation of Board members from one another.

The project evaluation was originally con-ducted by an independent consultant; this was later contracted to the Center for Technical Assistance and Training at the University of Northern Colorado. Project document analyses and key informant surveys were the principal sources of data.

The Final Report stated that Board members experienced positive impacts, including: more knowledge of services available, knowledge of consumer/survivor needs, knowledge of business and legal issues, and a growing sense of empowerment.

Overall, it was found that the number of consumers/survivors employed was considerably lower than that expected and that self-supporting businesses are a difficult undertaking under even the best circum-stances. The project did appear to enable people to develop skills to seek employment elsewhere. Some comments provided by the Board and the staff: ". . . Consumers were motivated to consider themselves as positive members of society . . .", and ". . . It was highly successful in empowering the consumer participants and in providing them with a variety of interpersonal, leadership, and employment-related skills."

Some overall recommendations were offered by the evaluation:

• Ongoing training should be provided for staff on mission, policy and procedures, orientation, team building, communication, best business practices, and management issues, and for the Board on such areas as communication, problem solving, decision making, and leadership development;
• Effective communication needs to be improved between the Board and staff;
• Minority representation needs to be increased throughout the program;
• A business advisory committee should be established to direct and advise the businesses proposed;
• The search for additional funding to maintain the project's financial viability should be continued;
• Career planning for consumers/survivors for long-term employment goals should be implemented;
• Ongoing outreach to consumers/survivors who might not be a part of he formal mental health system should be continued;
• Realistic expectations regarding the project should have been established so that participating consumers/survivors were not set up for disappointment;
• Longer-term funding should be secured (e.g., a five-year grant, which would allow for greater success, given that most startup businesses take three to five years to establish themselves);
• The necessity of being proactive and taking a planned, systematic approach to completing the project should be emphasized; and
• There is a need for effective team decision making, values clarification, community linkages, and sound management philosophy.

Additional recommendations were made regarding rewards and incentives. The project should:

• Find ways to concretely celebrate each success, no matter how small (thank-you notes, extra break times, congratulation phone calls);
• Recognize work done well (employee-of-the-month, newsletter mention, letters of recognition);
• Develop incentive programs based upon employee choice and personal values; and
• Treat people with unconditional respect and use rewards strategically but often.

After the grant, attempts were made to locate ongoing funding, but these were ultimately unsuccessful. The Phoenix Project ceased operation in April, 1993

INDIANA

Knowledge Empowers You
Indianapolis, IN

The overall mission of this effort, as stated in the original application, was to empower consumers/survivors by creating opportunities to increase self-esteem, self-reliance, and independence through strengthening support net-works and advocacy efforts. Specifically, this was to be accomplished by developing and setting up an Office of Consumer Affairs (OCA) within the Indiana Department of Mental Health, via the Mental Health Association of Indiana. The OCA would establish links with consumers/survivors, family members, providers, and others. It was proposed that this effort would develop a telephone tree for legislative alerts, distribute monthly bulletins, publish a quarterly newsletter, and sponsor quarterly meetings of State and regional councils.

Additionally, the project would work towards developing a structure for the consumer/survivor movement and provide training on starting self-help projects. One component of this training was to develop a model for self-help groups known as KEY (Knowledge Empowers You) groups. The project also hoped to develop a mailing list of consumers/survivors.

A training package for use in public speaking was to be developed as part of a speakers bureau. Other plans included organizing a Statewide conference, information dissemination, assisting in developing a coalition of consumers, family members, and providers, promoting consumer/survivor representation on boards, and organizing an improvisational theater group and a media anti-stigma campaign.

Grant funding enabled the project to provide the following services:

• Organizational Development. The project established the KEY Consumer Organization, a Statewide consumer/survivor organization. A Statewide Consumer Advisory Council and two regional Councils were also developed. A development professional was hired to initiate fundraising activities, and preparations were made for writing several grant proposals.
• Technical Assistance. Onsite technical assistance was provided throughout the State. Eight KEY self-help groups were developed, and a leadership training retreat was held. Training was organized on serving on boards and committees, peer support group leadership and facilitation, and communication skills. A peer counseling training program was started, which provided 28 hours of initial training for those interested in being case aides. The Statewide network was expanded to over 750 consumers/survivors. Two Statewide conferences for consumers/survivors were held. Scholarships were provided to over 80 consumers/survivors to attend conferences and meetings.
• Advocacy. Various advocacy efforts were conducted around the State, including obtaining consumer/survivor representation on patients' rights committees, holding sessions for the purpose of meeting legislators, and holding meetings to discuss consumer/survivor rights.
• Information Dissemination. KEYNOTES, a newsletter, was published and disseminated to over 1,000 individuals. A speakers bureau was organized and provided over 125 educational presentations and workshops. A toll-free hotline was established and provided information and referral services to consumers/survivors. Improvisational theater groups were established, and these conducted a number of educational performances.

The following criteria were designated for individuals who were to be served by the program:

• Persons with a psychiatric disability;
• Former or current patients or service recipients of the mental health treatment system; or
• "Concerned others" who want help or referrals for mental health or consumer/survivor services.

No specific client characteristics were reported, but the following general characteristics were observed: service recipients? ages ranged from 15 to 80; more women were served than men; service recipients were mostly low-income; and there was an increase in minority service recipients being served, over time.

The grant was provided to the Indiana Department of Mental Health, which provided the funding to the Mental Health Association (MHA) of Indiana. Initially, a Consumer Advisory Council (CAC) was established and com-posed of representatives from across the State. During the second year of the project, an all-consumer/survivor Board of Directors was formed, formal bylaws were established, and the project was formally incorporated. By the project's end, the KEY Consumer Organization was directly receiving the grant from the State.

Paid staff consisted of a Consumer Affairs Director, an Assistant Director, an Administrative Assistant, an Evaluator Assistant, and a Newsletter and Filing Assistant. Paid staff were primarily Caucasian, middle-aged women. Over 100 volunteers assisted in many different areas. Staff training was provided on computer technology, sign language, and newsletter development. "Flextime" was provided to staff.

A large number of service-related program and administrative materials were developed during the course of the project, including legislative training information and a support group model description. This project interacted with a number of public and private groups, including family groups, other consumer/survivor groups, mental health providers, vocational rehabilitation offices, and protection and advocacy agencies. The reported total costs for this effort were $166,198, with approximately $161,000 in Federal funding.

In Year 2, the KEY Consumer Organization was established as a nonprofit with bylaws, etc. It was felt that some of the problems experienced by the project were related to the original fiscal agent's lack of understanding regarding the autonomy of KEY. KEY subse-quently moved out of the agent's offices and opened an independent office that was pro-vided by the State at no cost.

It was originally planned that regional advisory councils would be developed throughout the State. These councils were ultimately not developed due to support groups not being stable and geographic distance.

Delays were experienced in realizing this objective due to the lengthy processes State hospitals used in appointing representatives to these committees.

Staff reported that ". . . members of KEY feel they have tried and failed at attracting the minority populations and they are unsure of what else to do . . .".

Staff noted that the most critical problem, by far, has been the lack of money. Other prob-lems included limited staff resources and interpersonal conflicts among staff.

Although formal program evaluations were not completed (according to the Final Report), an informal evaluation was conducted with recipi-ents of KEY services. Results were generally positive. Some of the comments included: "KEY has created a greater aware-ness of consumer needs and issues especially in the provider community...the main success of KEY has been the empowerment of the con-sumers . . . ," ". . . The KEY Consumer Organi-zation has been a blessing to many people who suffer from mental illness. People who have been empowered by KEY have gone on to live very productive lives."; "Thanks to KEY I can stand up for my rights and do many other things I never could before I came to be involved with them . . . I now have confidence and can do much better than I ever have before."; and "It's made a difference in my life."

During the project period, a new Depart-ment of Mental Health Commissioner was appointed. He was considered progressive and supportive of consumer/survivor initiatives and mandated more consumer/survivor involvement. It was reported that KEY re-ceived a portion of an NIMH/CMHS Services System Improvement Grant to provide contin-ued services to consumers/survivors.

MAINE

Portland Coalition for the Psychiatrically Labeled
Portland, ME

The goals of this effort were “...to empower and enable persons who are psychiatrically labeled to help themselves and other psychi-atrically labeled persons [and] to enable con-sumers to assume and maintain equal status as partners in the mental health system.” Specific objectives included funding the Portland Coalition for the Psychiatrically Labeled (PCPL) to: develop the necessary infrastructure and breadth of competency to operate effectively; refocus PCPL on in-house member activities; turn volunteer service into paid employment; and create a model for con-sumer/survivor-operated peer support, advo-cacy, education, and training services.

Grant funding enabled PCPL to provide the following services:

• Administration. The project developed an in-house financial system, conducted fundraising, developed a Board, and wrote bylaws and personnel policies.
• Drop-In Center. The Drop-In Center pro-vided social and informational activities to benefit members, developed a mem-bership list, held monthly membership meetings, and distributed a monthly update of activities.
• Peer Support.The project held frequent and regular peer support meetings, con-ducted outreach and peer support for individuals in nursing homes and schools, offered informal support to those discharged after long-term institu-tionalization, provided one-on-one coun-seling for support on independent living skills, and conducted specialized peer support groups for alcoholism, homeless-ness, and posttraumatic stress disorder.
• Respite/Crisis Assistance. PCPL pro-vided assistance on a limited basis by referring individuals to other services and working with staff of a crisis stabi-lization project to monitor and evaluate their program.
• Empowerment. The project empowered consumers/survivors through greatly increasing the membership and enabling PCPL to conduct special outreach to minority groups.
• Independent Living Programs. The project established a stipend program which assisted individuals in developing job skills and provided information and referral services.
• Public Education. PCPL published a newsletter three times per year and distributed it to over 1,500 people and produced a slide show on stigma.
• Advocacy. The project conducted regular monitoring visits to institutions, testified to State legislators, and filed a class action lawsuit against the Augusta Mental Health Institute regarding patient deaths. PCPL members participated on various mental health committees and task forces Statewide.

All individuals who were psychiatrically labeled or psychiatrically disabled were eligible to receive project services. It was reported that PCPL experienced a fourfold increase in the number of individuals served during the grant period. Little data were provided on characteristics of service recipients who used services. A drop-in center evaluation found: a slight majority of the participants were male; their ages ranged from 32 to 55; all were psychiatrically labeled; all were living in the community, and a slight majority lived alone; the vast majority were currently receiving mental health services; and all had been previously hospitalized.

The grant was awarded to the Maine Department of Mental Health, Office of Community Support Systems. The State then provided the funding to the Portland Coalition for the Psychiatrically Labeled (PCPL).

The PCPL administrative structure was composed of a Board of Directors, staff, and members. The PCPL Board existed prior to the grant and was composed entirely of consumers/survivors. The Board was elected annually and was provided with training. Paid staff included an Executive Director, an Assistant Executive Director, a Consultant/Planner, an Office/Work Skills Manager, a Peer Support Program Coordinator, a House Advocate, a Clerical Supervisor, and Stipend Workers. The State also provided three inkind positions, serving in the roles of Community Support Program Director, Mental Health Program Coordinator, and Management Analyst II. PCPL staff characteristics were not provided in detail, but it was noted that all were consumers/survivors.

It was reported that staff attended training sessions in management skills and desktop publishing. In addition, stipend workers received group and individual training, and advocacy training was provided to members and staff. "Flextime" was available to staff by prior agreement with the Executive Director. Leaves of absence due to illness could be granted for up to six months.

A number of materials were developed over the course of the project, including newsletters, a poetry book, a Board training notebook, a monthly update, bylaws, personnel policies, and job descriptions. It was noted that the use of documentation (e.g., memos, bimonthly update reports) helped to alleviate personnel issues and stabilized the organization.

PCPL collaborated with a wide array of other organizations in achieving its goals and objectives, including: other disability groups, the State protection and advocacy agency, mental health providers, nonprofit management consultants, advocacy groups, and family groups, and universities.

During the grant period, a total of $540,500 was expended for this effort. Of this amount, approximately $469,500 was Federal funding, $66,000 was State funding and $5,000 was local funding.

Listed below are the issues which developed during the project's implementation. A retreat at the start of Year 3 developed a strategic plan for improving internal communication in order to solicit input from all members, staff, and Board regarding these issues and other internal and external affairs of PCPL.

It was reported that this was due to the Executive Director resigning and the time needed to hire a replacement. A reorganization occurred after the change in Executive Director, including other personnel changes and a revision of the bylaws, personnel policies, and job descriptions. The hiring process for several staffers took longer than anticipated, and there was ongoing staff turnover.

A decision was made not to attempt to expand within Maine (as originally planned) and instead to focus programming locally on the Portland area.

A lack of typewriters, word processors, and other equipment hampered the job training stipend program.

The reports indicated that interpersonal conflicts developed between staff and members. This was a major problem encountered during the project. It affected the entire staff and membership. This resulted because some members obtained employment, while others did not.

This resulted in problems of resource allocation and staff burnout, and was due to a lack of organizational planning.

A descriptive, summary evaluation of PCPL's drop-in center was completed and was based on interviews with members who used the drop-in center and observation of drop-in center activities. This evaluation found that a majority of participants reported that the center has helped them stay out of the hospital; a majority felt more confident since coming to the center; almost all would recommend the center to others; and a majority said that coming to the center has helped them cope better with their problems.

The overall evaluation focused on the need for continued development of PCPL organizational features, and the following recommendations were offered by the evaluators:

• PCPL should do planning with an expert facilitator to clarify priorities, specify objectives, create an action plan, and build cohesiveness.
• Training on conflict resolution should be provided to Board, staff, and membership to defuse the tensions that developed during organizational change and growth and employment of certain members.
• Experts in group process and team building should be used to provide training to staff and Board and serve as facilitators during Board meetings.
• Board training should be provided annually, along with a packet of written materials.
• Board terms should be overlapping, and provisions should be made for alternates.
• Leadership training should be provided to members.
• Training and technical assistance should be provided to the Board and Executive Director on hiring practices to address staff turnover as well as on strengthening interpersonal relations.
• PCPL should clarify and enforce policies and procedures, including preparing up-to-date policy manuals and offering training to groups and individuals on policy implementation.

A final comment within the evaluation indicated the overall success of this effort: ". . . the project has demonstrated, without a doubt, that consumers can plan and run their own organization . . ."

PCPL was successful in obtaining funding for continued operations.

MISSOURId

The Self-help Center
Kirkwood, MO

This project developed The Self-help Center, a drop-in center in Kirkwood, MO, for self-help and advocacy services. Specifically, the Center was set up to offer self-help group meetings, peer case management, a drop-in center (offering recreational activities, socialization, respite care for families, a game room, and a reading room), and a self-help and advocacy clearinghouse (providing hotline services, information on advocacy, legislature visits, position paper development, and publication of a rights information pamphlet).

Grant funding enabled The Self-help Center to offer the following services:

• Advocacy. The center assisted in filing a lawsuit on patients' rights, obtained representation on various boards and commit-tees, collected information on consumer/survivor grievances, and advocated that all publicly contracted agencies be required to have consumers/survivors on their Boards of Directors.
• Dissemination and Public Education. The center presented at various conferences, published newsletters, distributed 1,000 pamphlets, and developed a clearinghouse library.
• Drop-In Center. The center operated 30 hours per week, with 20 people served per day. Weekly membership meetings, exercise classes, and biweekly volunteer training meetings were held.
• Support Groups. The center sponsored support group meetings of national model self-help programs such as Recovery, Inc., Project SHARE, Overeaters Anonymous, and the Missouri Mental Health Consumer Network, among others.

Initially, the grant was provided to the Missouri Department of Mental Health, which then provided the funding to the Mental Health Association (MHA) of St. Louis. The MHA served as the fiduciary agent for The Self-help Center. The Center’s members elected representatives to a Board of Directors, as well as officers who functioned in a member/staff role in running the center. The day-to-day decisions were made by a majority vote of the participants at weekly membership meetings. The project eventually received its incorporation and no longer worked through the MHA, as it was able to provide its own accounting services.

The Board consisted of six consumers/survivors, a family member, and one additional interested individual. Factionalism within the Board presented some obstacles, as did ongoing struggles between the Board and the Director.

Paid staff included an Executive Director, an Assistant Director, a Drop-In Center Manager, two Clerical Workers, a Homeless Coordinator, a Benefits Acquisition Specialist, a Case Management Supervisor, a Clearinghouse Manager/Director of Advocacy, a Maintenance Worker, and a Technical Advisor (from the MHA). These positions were primarily part-time positions. All staff were current or former consumers/survivors, with the exception of the Technical Advisor. Attempts were made to use a Transitional Employment worker from a nearby psychosocial program to fill some of the clerical positions. Some members were also provided with stipends ($75 per month) to work approximately one day per week per-forming various tasks (outreach, recreation, food services). These workers were elected by the membership to fulfill these roles.

The staff were mostly Caucasian; there was an equal balance between men and women; and there was one physically disabled individ-ual and five former SSI/SSDI recipients. A number of volunteers assisted, including five parents. Training was provided to staff on counseling skills and orientation to case man-agement. Staff were initially permitted to attend self-help group meetings during paid time for their own mental health.

A variety of program and administrative materials were developed, including: drop-in center rules and regulations, weekly drop-in center attendance summary, monthly financial reports, and financial procedures. The project interacted with a number of organizations and entities, including advocacy groups, family groups, mental health providers, State and local mental health authorities, and other consumer/survivor self-help projects.

The project documents reported that a total of $490,239 was spent on this effort, of which $461,116 was Federal funding and $29,123 was from other sources.

The following issues were encountered during the implementation of this project:

• Staff Turnover and Other Personnel Matters. A major problem was staff instability, as four employees left. Another problem was the lack of afford-able health insurance coverage. Staff were provided with $100 per month for this purpose, but it did not cover this cost. Another problem identified was the difficulty that members had in setting boundaries in staff and member relation-ships. The two way nature of these rela-tionships (sharing problems as well as listening to service recipients and being “advice givers”) made this difficult. A great deal of time was spent in staff meetings on these issues.
• Heavy Paperwork Load. The Executive Director reported being overwhelmed with paperwork and accounting.
• Site Selection/Renovations. A site was selected, renovations were com-pleted four months later, and donated office equipment was received. How-ever, delays occurred when the Fire Marshal required extensive modifications, and during a long negotiation with the State regarding day program licensure requirements.
• Community Resistance. Implementation was difficult because of the "NIMBY" ("Not In My Back Yard") phenomenon during site selection and development.

Overall evaluation findings indicated that the project met most of its stated objectives. A large majority of participants reported that "People who come here are learning to depend on themselves more," and "People are encouraged to make their own decisions." A majority of participants felt more confident about making their own decisions, and many agreed with the statement "everyone pitches in." An impressive 90% said that people are proud of the drop-in center. All staff and Board said their work has made them more confident to help others.

Other findings included: a majority considered the center a good place to "be yourself" and a place to talk about hopes and dreams; a majority stated that "it's true that it's a place to share feelings without being put down". A large majority said that they felt accepted at the center and that they now have more friends.

Respondents' impressions regarding what contributes to the longevity and success of a self-help program such as this one were also reported, including:

• Operational effectiveness;
• Member satisfaction;
• The attractiveness of the self-help philosophy, with its emphasis on empowerment and experiential knowledge;
• Strong organizational leadership;
• Strong administrative backing from the Department of Mental Health and NIMH; and
• Interpersonal interaction and social support.

Despite repeated and varied attempts, the project was unsuccessful in obtaining continuation funding and ultimately had to cease operations.

NEW HAMPSHIRE

A Way to Better Living
Manchester, NH
Do Drop-In Center
Concord, NH

The overall project goal was to enhance consumer/survivor involvement in service planning, service provision, and evaluation in order to overcome obstacles presented by geographic isolation and to address the need for more opportunities for consumers/survivors to actively participate in providing peer self-help, social and educational opportunities, education and information dissemination activities, and community support services. Two projects were proposed and are described below. A special effort was made to increase minority participation and to emphasize services for individuals experiencing homelessness, substance abuse problems, and developmental disabilities.

A Way to Better Living, Inc. (AWBL) of Manchester, NH, sought to provide peer support for consumers/survivors released from NH State Hospital and others in reintegrating into mainstream society. The program would accomplish this by demonstrating how peers might reach their best potential and helping to lessen stigma.

The Merrimack County Drop-In Center in Concord, NH (later named the Do Drop-In Center), developed a drop-in center and a telephone support line to address socialization and support.

AWBL provided the following services:

• Outreach. Friendly Companions, an outreach program, used peer volunteers to help facilitate delivery of community-based services.
• Information Dissemination. A Speakers Bureau provided monthly talks to increase consumer/survivor knowledge and skills. A newsletter was created and distributed monthly, and a manual of information on community services, laws, regulations, rights and responsibilities was developed.
• Financial Assistance and Food Services. A revolving security deposit loan fund provided limited loans for peers to acquire independent, private housing and a food bank assisted in providing food supplies.

The Do Drop-In Center provided a drop-in center in the lower level of a clubhouse program which operated 5:00 p.m.-9:30 p.m. weekdays and 10:00 a.m.-9:30 p.m. on week-ends. The program offered an organized activity each night, support groups two nights per week, and a telephone support line staffed by volunteers.

A total of 230 individuals were served by the two programs, 140 at AWBL and 90 at the Do Drop-In Center. The largest proportion of service recipients lived in group homes, subsidized housing, and supervised apartments. A minority lived in individual homes or with family.

At AWBL, the majority of service recipients were female, Caucasian, and age 30-40. Unemployment and psychiatric history data were not reported.

At the Do Drop-In Center, the majority of service recipients were male, Caucasian, and age 36-45. Sixty-one percent were unemployed, and only seven percent had full-time employment.

Funds were provided to the NH Division of Mental Health, which then provided funds to the two programs. AWBL eventually obtained independent, nonprofit status. Each project had its own Board of Directors, Project Directors, and staff. The overall project had a Statewide Advisory Council of consumers/survivors and family members which met regularly with the Director of the NH Division of Mental Health. AWBL requested a local church to act as its Board of Directors and provided its services through the church, prior to gaining independent nonprofit status. The Do Drop-In Center elected its own Board of consumers/survivors.

Paid staff at AWBL included a Project Director, a Project Manager, a Secretary, and a Treasurer. Volunteers at AWBL, called "Friendly Companions" provided peer support services. Paid staff at the Do Drop-In Center included a Program Director, an Activities Coordinator, an Outreach Coordinator, a Program Manager, an Operation Supervisor, and Administrative Assistants. Most of the positions at the Do Drop-In Center were part-time, in order to allow flexibility in hiring (based on differing project needs and skills of individuals) and to allow for flexible accommodation of the needs of consumers/survivors. The State provided additional inkind staff support.

AWBL reported that all paid staff were female consumers/survivors, and most were ages 50-60. The Do Drop-In Center reported that all staff were consumers/survivors from the local county.

The Friendly Companions at AWBL were given specialized training. At the Do Drop-In Center, training was provided to telephone support line volunteers in listening skills, dealing with threats of harm to self or others, and accessing available resources. Project Directors provided additional training to staff depending upon need, and State Division of Mental Health staff provided ongoing consultation.

Program materials developed by the two projects included newsletters, organizational bylaws, job descriptions, and an information sheet for Food Bank recipients at AWBL, and a telephone log sheet to record hotline information at the Do Drop-In Center.

The two projects coordinated their activities with several other groups, including: community service agencies, mental health providers, family groups, hospitals, churches, and mental health providers.

Prior to this project, at least three self-help projects were known to exist in New Hampshire. After the initiative, it was reported that at least 12 new self-help efforts had been developed, including: a satellite program out of the Do Drop-In Center, a social club established at AWBL, a Statewide consumer/survivor council, a Statewide network of regional councils, and consumer/survivor-operated services in six regions of the State. Two of the services which were developed were a consumer/survivor-operated discount retail store and the Wyman Way Co-op (a consumer/survivor-run consortium of businesses).

The total budget for the three years of the demonstration project was $254,666, of which $229,250 was Federal funding and $25,416 was State funding.

The following issues were encountered during the implementation of this project:

• Startup Delays. Delays in passing funds to the projects (which were caused, in part, by State funding regulations and grantee inexperience) caused some service delivery delays at AWBL and resulted in an initial lowering of consumer/survivor interest in the project at the Do Drop-In Center.
• Transportation. AWBL was unable to provide transportation services to service recipients due to insurance constraints.
• Lack of Organized Activities. A lack of organized activities in the first year at the Do Drop-In Center was later addressed, and the Center began to offer food, dances, bowling trips, field trips and a pool table.

A limited process evaluation was conducted on both programs, using questionnaires to collect data on participant demographics and ratings of services.

AWBL's "Friendly Visitor" outreach program served five to ten service recipients per month; the Speakers Bureau conducted approximately 10 engagements per month; and 400 copies of the newsletter were distributed each month. The food service was the most popular service, particularly at the end of the month, due to economic conditions in New Hampshire. The evaluator stated: "Many consumers told us that they depended on the food supplies to make it through the month, that without this service, they would go hungry."

The Evaluator also found that AWBL was "...blessed with an incredibly devoted staff, with a very low rate of turnover . . . [The] pro-gram offers a comprehensive, varied approach to consumer needs . . . which work together to provide consumers with economic, educational, and emotional support when they need it most."

The Evaluator found the Do Drop-In Center was most successful, as it had ". . . grown from a rather small, underutilized social club to a popular, well attended social center for area consumers . . . [it] provides a safe place...[and] fulfills an important role. ...Social bonds are created, maintained and strengthened. As consumers' social networks expand, demand on emergency services and mental health supports [drops]. . . . [Participants] had a place to call their own." For those employed by the Do Drop-In Center, it provided an ". . . important stepping stone to further employment opportunities [and] provided consumers with an opportunity to prove that they can handle the responsibilities of a job."

Recommendations, based upon the evaluation, included:

• All key persons and organizations should be involved from the beginning to build a constituency, generate support, clarify expectations, and enhance the capacity of the system to support these projects.
• Future projects should focus on assisting consumers/survivors in developing natural support systems. This will require a sufficient level of funding for adequate service and meaningful evaluation research.
• Future evaluations should focus on the most effective methods of increasing rates of employment for consumers/survivors and assisting them in obtaining high school diplomas or GED's. This will also require a sufficient level of funding.
• While the continuation status of these programs was not reported, the following quote was taken from the Final Report: "...[the] Division [is] exploring [the] financial viability of continuation with general fund dollars [at a] time of financial uncertainty in New Hampshire; nonetheless, the Division is committed to continuing the funding of these projects."

NEW YORK

Share Your Bounty/Friends of the Homeless
New York, NY

The overall goal of this effort, which was titled Friends of the Homeless and later renamed Share Your Bounty/Friends of the Homeless (SYB), was to expand the activities of a consumer/survivor-operated food bank and out-reach program which had been in operation since 1984, serving people who were experiencing homelessness, primarily in the Bronx and Manhattan. The project's activities included raising food donations from local suppliers and distributing them directly to homeless persons on the streets, in shelters, or through other community agencies.

Specific objectives for this initiative were: establishing an independent organizational base in order to assure consumer/survivor control (by obtaining office space and nonprofit status); expanding and diversifying the project's workforce; and increasing the project's efficiency, number of shelters reached, and number of clients served (by purchasing a van and driver to pick up and deliver food). The project also planned to offer job placement assistance through a vocational rehabilitation counselor; to disseminate results through presentations at conferences and at meetings of national consumer/survivor organizations; and to meet with consumer/survivor groups at all adult State hospitals to develop interest in replicating the project, including holding a Statewide conference and providing technical assistance to those interested. The project also hoped to develop additional funding resources by creating relationships with the New York State Office of Mental Health, municipal agencies serving homeless individuals, and corporate donors.

Funding enabled Share Your Bounty/Friends of the Homeless to provide the following services:

• Sandwich Delivery and Basic Food Supplies. Until new policies forced homeless individuals out of the building, SYB provided sandwich delivery to this population at Grand Central Station. SYB also provided basic food supply to shelters and other delivery points in the city.
• Technical Assistance and Training. SYB conducted workshops throughout the State, which contributed to the development of four other consumer/survivor-run projects, including a consumer/survivor-operated food bank called "Harlem Dollar Stretchers," an outreach effort to homebound elderly persons in the Bronx, an "adopt-a-family" donation effort at a hospital, an "adopt-a-shelter" program, and a consumer/survivor-run coffee stand at several mental health residences. Consumer/survivor staff input also directly stimulated the development of a consumer/survivor-run case management program.
• Committee Work and Housing Advocacy. Staff served on various task forces, committees, and workshops. Staff assisted the New York City Department of Mental Health in initiating an Integrated Neighborhood Housing Project (INHP). INHP was an effort to promote community acceptance of people with mental illness living in the community in various New York City neighborhoods.
• Information Dissemination. A video-tape of SYB was developed and distributed widely and shown on White Light Communications (a consumer/survivor-run video production project in Vermont, discussed elsewhere in this chapter), and several articles were accepted for publication in Hospital & Community Psychiatry and the monthly bulletin of the New York State Office of Mental Health.
• Other Services. SYB acted as fiduciary for a Consumer/Survivor Resource and Information Center at Bronx Psychiatric Center. In the last year of the project, as an increasingly larger number of people in need of help came to the project's offices, SYB began to offer crisis intervention, referral to social services, and peer support.

Little specific information was reported on the consumers/survivors who were served by the project. It was estimated that approximately 100 homeless individuals per day were receiving food at Grand Central Station, during the period when the project provided street food distribution. Most of these individuals were African American and Latino males, ages 18 to 40.

Initially, the grant was provided to the New York State Office of Mental Health, which pro-vided the funds to the Bronx Psychiatric Center. Bronx Psychiatric Center acted as the fiscal agent for SYB until the project attained independent nonprofit status. It was proposed that if a conflict developed between the project workers and the hospital, the issue would be sent to an outside committee composed of two consumer/survivor consultants, a provider, and staff of the State Office of Mental Health.

During its first year of operation, SYB became a separate organization. SYB developed a management team composed of the Executive Director, Treasurer/Secretary, Resource Manager, Outreach Manager, and Operations Manager. A bookkeeper, business accountant, project evaluator, and a con-sumer/survivor evaluator were later added to the team. Three employees served as the Board of Directors. An Advisory Council of providers was also developed. This organizational model was described as a "supportive to separatist" self-help project (see description of Chamberlin's and Emerick's typologies in the literature review in Chapter 1). Professional involvement diminished as the program handled its own financial matters and retained its own lawyer.

Paid staff consisted of: an Executive Director, a Treasurer/Secretary, an Outreach Manager, a Resource Manager, an Operations Manager, Food Distributors, Drivers, an Office Manager, a Senior Research Assistant/Field Trainer, Consumer Consultants, a Consumer Evaluator, and a Business Accountant. In-kind staff, funded elsewhere, included: an Assistant Director, Project Workers, a Custodian, a Bookkeeper, a Secretary, a Research Supervisor, Bronx Psychiatric Center Consultants, a Principal Consultant, and a Senior Research Advisor.

The Project Workers were all consumers/survivors from the Bronx Psychiatric Center. One-half were formerly homeless, 72% were African American or Latino, 18% were Caucasian. Some were still hospitalized, and some had extensive work histories. Education levels ranged from ninth grade to law school graduate; the majority had a high school diploma. Two of the staff had previous self-help movement experience. A total of 46 people participated as paid staff during the life of the project.

Staff attended and presented at various conferences and trainings. Some staff received training on organizational management and fiscal accounting. The Office Manager and the Bookkeeper obtained training in computerized bookkeeping.

At the start of the project, it was determined that there would be no staff stratification based on level of disability. Staff could decide to reduce work activities or take temporary leave, if needed. By Year 2, the Office Manager had been providing peer counseling to staff, and there was interest in developing a drop-in center at the SYB offices. In the following year, all staff including the Executive and Assistant Directors rotated jobs so that all staffers would have familiarity with all positions and so that staff could trade jobs if they disliked what they were doing.

The project collaborated with a number of organizations, including: hospitals, research organizations, homeless service providers, advocacy organizations, food banks, universities, supermarkets, churches, soup kitchens, and State and local mental health authorities.

Total Federal funding for the project was $378,420.

The following issues were encountered during the implementation of this effort:

• Office Space. Originally, the project was established at a temporary space at the Bronx Psychiatric Center. The project later obtained its own space, which greatly facilitated a sense of independence.
• Delay in Receiving Project Funding. It was reported that this was due to delays in achieving nonprofit status.
• New Homeless Policy at Grand Central Station. SYB was forced to stop food distribution at Grand Central Station, due to a new policy against food distribution and against homeless people congregating at the station.
• Leadership Gaps. The resignation of the Executive Director and the unexpected death of a board member left a gap in leadership.
• Provider vs. Consumer/Survivor Issues. Differing perceptions by consumers/survivors and professionals regarding what direction the organization should be taking created friction and distrust. These problems were exacerbated at the end of the grant, when non-consumer/survivor outsiders' ideas regarding how SYB could be continued resulted in tense communications.
• Decisionmaking Hierarchy. The Final Report indicated that the board and the management team were often the sole individuals involved in decision making. This hierarchical structure prevented some participants from learning to take responsibility and learning how the organization functioned.
• Drug Abuse Among the Homeless. This contributed to the decision to stop street food distribution, as some SYB members felt at-risk as a result of their own substance abuse histories.

The evaluation consisted of a qualitative study, using participant-observation, individual interviews, focus groups, and documentation of activities.

Overall findings indicated that the project, by becoming consumer/survivor-run, had "self-deinstitutionalized" itself and its members. SYB members felt they had learned much about the work world from their positions, learned work skills transferable to other jobs, took great pride in helping others, and found their work to be flexible, enjoyable, and meaningful.

Statements from the staff included:

• "Now I've realized how we need people, others need me and I need others."
• "[At SYB],...no one judges you."
• ". . . [The] program has contributed to the emotional, spiritual and financial transition from the hospital."

Members stated that they learned to get along with one another, problem solve together, air out their feelings, and encourage one another. Members supported one another to be drug-free and to act responsibly. They developed a sense of independence, autonomy, and self-confidence that many said they had not felt before. One participant stated: "What's empowering for us is to do our own thing now."

It was noted that staff provided peer sup-port/self-help to one another and to otherpeers. SYB had become a ". . . family center where members socialized, played music, and discussed their problems with one another . . . birthdays were celebrated . . . [it] took on the aspect of a 'home' . . . members referred to each other as 'family'. Members provided crisis management for one another. At least five members were hospitalized briefly; members would visit and phone regularly, and sometimes people got day passes to come to work. All returned to work after their hospitalizations."

According to the evaluation, one of the principal benefits of the project was that it ". . . demonstrated that consumers can form an autonomous organization which aided them in transition from [a] long-term, institutionalized [setting] to successful community integration; [it] demonstrated that such an organization can provide its members with a number of essential functions (i.e., socialization) without professional service providers; [and it] demonstrated that SYB members remained committed to [the task] for the duration of the grant, despite occasional setbacks."

The impact was also felt on the community, where "former mental patients were seen as capable and motivated to provide much-needed outreach and goods to those who are even more destitute. SYB contributed to a destigmatization of formerly institutionalized people, [and] a considerable number of empowerment efforts across the State were begun in the wake of SYB."

Many professionals, administrators, and State officials, in informal conversation, expressed positive changes in attitudes towards consumers as a result of their contact with SYB. It should also be noted that SYB received Honorable Mention for the 1989 Hospital & Community Psychiatry Achievement Award, presented by the American Psychiatric Association.

Some concerns were raised that the grant's implementation imposed "structural and bureaucratic constraints" on SYB. The quick and large growth of the organization was a positive in terms of the organization's ability to disseminate information, but it also produced self-management growing pains, along with a lack of appropriate technical assistance and education. The "use of outside professionals [rather than consumers] made SYB members wary and uncomfortable with the 'outside' world of non-consumers." This highlighted some differences between participating members and professionals and contributed to tensions.

A series of recommendations were offered, based on the evaluation:

• The State Office of Mental Health should develop technical assistance programs to help consumer/survivor-run programs develop or expand in the areas of incorporation, bylaw development, organizational structure, legal consultation, budgeting, grants management, reporting requirements, and payroll. Wherever possible, this assistance should be provided by other consumers/survivors.
• The New York State Office of Mental Health and the New York City Department of Mental Health should develop a policy concerning the support and development of consumer/survivor initiatives, and this policy should be linked to longer-term planning for financing consumer/survivor initiatives. They shouldidentify staff points of contact and funding sources and mechanisms.
• Staff should include at least one bilingual individual.
• Consumer/survivor organizations may want to develop a "Friends of . . ." group, consisting of non-consumers/survivors or consumers/survivors who are not members, for the purpose of networking and fundraising.

Attempts were made to secure continued State funding, city homeless funding, and corporate support, but these efforts to continue the program's funding were ultimately unsuccessful.

OREGON

Mind Empowered, Inc./Spreading Empowerment, Enlightenment, and Dignity
Portland, OR

The purpose of this effort was to establish, via Mind Empowered, Incorporated (MEI), in Portland, Oregon, outreach services to help consumers/survivors achieve coping and community living skills and a better quality of life and to provide an array of services which assist, support, and empower psychiatrically disabled persons. Activities were organized around three main program elements: training, which focused on developing a cadre of peer outreach counselors, support services which utilized peer counselors and volunteers, and public education/advocacy, which worked to combat stigma through public education and policy advocacy efforts. Specific goals included: developing an existing nonprofit consumer/survivor-operated corporation into a well-organized entity based on sound operating principles; establishing a curriculum and training peer outreach counselors on a quarterly basis; providing stipend-supported and volunteer placements; establishing effective peer support and advocacy services; and pursuing public education and advocacy efforts to combat the stigma of mental illness.

The Final Report indicated that the project had been renamed SEEDS (Spreading Empowerment, Enlightenment, and Dignity).

Funding enabled MEI to provide the following services:

• Training. Core trainings were organized and held weekly on topics such as: mental illness, medication and side effects, accessing community resources, psychosocial rehabilitation, dual diagnosis assessment and referral, personality disorders, suicide intervention, and violence.
• Public Education, Advocacy, and Information Dissemination. A clearing-house was developed, numerous public information and interagency presentations were made by project staff, and members participated on a variety of committees.
• Drop-In Center and Support Groups. A drop-in center, open Monday-Saturday, 10 a.m.-7 p.m., was started. Holiday dinners were prepared and served on Thanksgiving and Christmas, and monthly dances and cookouts were held. Three time-limited peer support groups met weekly on a variety of issues.
• Outreach Services. Outreach was conducted at a homeless shelter and a State hospital.

Services were open to individuals, 18 years of age and older, who had a psychiatric disability. The program further targeted: people who were in hospitals preparing for discharge, who cannot access mental health services due to long waiting lists; those homeless or at-risk of becoming so; those labeled "hard-to-treat", who don't want to be identified with the formal system; and those who wished to supplement their involvement with professional mental health service providers. Recipients of services were primarily male, age 30-50, and Caucasian.

The grant was provided to the Oregon Mental Health Division (MHD), which provided the funding to MEI. Initially, MEI used the Mental Health Association of Oregon as its fiscal agent until it attained nonprofit status and became sufficiently established to do its own fiscal books and payroll.

The Board of Directors already existed at the time of the grant application. It required a majority of its membership to be consumers/survivors. Paid staff included an Executive Director, an Outreach Manager, a Socialization Team Leader/Coffee House Manager, a Skill Trainer, an Information and Referral Team Leader, a Volunteer Team Leader, a Secretarial Team Leader, and several Stipend Positions. The State provided several in kind positions, including: a Manager of Community Programs, a Coordinator of Community Programs, and several Consultants.

MEI policy required that a majority of staff have a history of serious mental illness as well as the capability to perform duties. Where qualified consumers/survivors could not be found for positions requiring an essential type of expertise, non consumers/survivors could be employed, but in such cases they were to be screened carefully to insure compatible values and a commitment and understanding of consumer/survivor empowerment. Efforts were also made to recruit minority individuals. The Final Report stated that all paid staff were consumers/survivors, and the total number employed throughout the project was 22.

The project's personnel policies specifically addressed the issue of providing reasonable accommodations. This included paid time off, at the discretion of the Executive Director, to permit stabilization of acute illness and reallocation of duties when necessary.

A number of materials were developed over the course of the project, including: a program flyer; job descriptions; a client intake form; a daily contact log; member's weekly contacts; a daily time record for staff; an expense summary form; an employment application; an evaluation intake form; progress notes; a goal setting form; an informed consent form; and policies regarding personnel, the drop-in center, outreach, and information and referral services.

The project coordinated its efforts with a number of other organizations, including: mental health providers, hospitals, the National Association for Rights, Protection, and Advocacy, universities, County Commissioners, Social Security offices, homeless service providers, Parks Department special programs, churches, and Oregon Public Radio.

A total of $480,353 was spent on this effort, of which $399,196 were Federal funds and $81,157 were State funds.

The following issues were encountered during the implementation of this project:

• Systems Change. Oregon's mental health system experienced broad operational and philosophical changes which impacted upon this project, including the implementation of Public Law 99-660. This legislation mandated consumer/survivor involvement in State mental health planning councils. As a result, consumers/survivors were more accepted and included as valued participants.
• Staff Turnover. There were reports that staff turnover created some delays in the implementation of certain project activities.
• Funding. A ten percent reduction in funding by NIMH across all projects resulted in the project needing to cancel publication of the MEI newsletter.

A member satisfaction survey revealed that a majority felt that the center was a major factor in providing them with socialization opportunities and money management skills. Participants valued it as a place to learn about mental illness, low-cost housing, and employment opportunities and many stated the project played a central role in their social lives. Other findings included: a majority felt they had found help for their problems at the center (primarily housing, Social Security, or other practical information); and that the center was a place where hopes and dreams could be discussed. Most said they were encouraged to make their own decisions and that a lot of day-to-day problems were solved through involvement with the center. Overall conclusions found that: members value MEI in the community; many would feel an extreme loss if the center were to close; and MEI assists individuals in linking with community services which enable them to live independently.

An analysis of staff contact logs revealed that housing was the most requested service, followed by money management assistance and interagency referrals.

A process evaluation noted that the greatest strengths and successes of the effort were that consumers/survivors can develop an organization, overcome difficulties, make contact with other consumers/survivors, and deliver needed services. MEI maintained a continuity of vision and philosophy and developed extraordinarily helpful and beneficial relations with other grassroots and consumer/survivor empowerment interests. MEI demonstrated that consumers/survivors can move through the stages of interest, opportunity, learning, and service to others.

Some unanticipated benefits were reported, as well. The project provided a training and proving ground for consumers/survivors' efforts in mental health work, as a number are now working with other agencies. The relation-ship between the State and the project was especially important during the application and preparation process.

Several recommendations resulted from this evaluation:

• Training sessions should offer a mix of exploration and problem solving.
• The evaluation would have been more successful if a State/project cooperative system of record keeping that reported more useful program information had been created. With appropriate opportunities for incorporating feedback, such information would have contributed greatly to decision making, clarifying focus, and documenting changes.
• The theory and practice of self-help and its impact on staff learning, development, and self-esteem should be examined. There is a need for further examination of the model of "becoming interested, volunteering, learning, and moving into staff positions."

It was noted that in 1991, MEI received the Small Employer (of handicapped individuals) of the Year Award by the Oregon Disabilities Commission and the Excellence Award by the Oregon Division of Mental Health and Developmental Disability Services.

The State Division of Mental Health and Developmental Disability Services remained committed to ongoing funding of this project. Continued State funding for SEEDS and for a new program entitled CSP, the Community Survival Program, was awarded.

TENNESSEE

Friends Helping Friends
Nashville, TN

The overall objective of this project was to develop and operate a drop-in center and related services, called Friends Helping Friends, to meet the socialization and support needs of consumers/survivors in Nashville, Tennessee. The goals of the project were: to empower consumers/survivors by helping them to gain control over their lives and the services they receive (by developing self-confidence and self-esteem and by rotating leadership positions and responsibilities); to provide emotional support to consumers/survivors (through a support group, friendship networks, and drop-in activities); to combat stigma (through a speakers bureau); and to promote consumer/survivor independence through consumer/survivor-run services (a housing loan program, a crisis intervention/respite care program, job placement services, and roommate matching services).

Grant funding enabled the project to provide the following services and supports:

• Drop-In Center. The center offered crisis intervention, peer counseling, hospital visits, an information bureau, referral services, recreation and socialization activities, meals, and holiday gatherings. The center was open seven days per week, including holidays and evening hours.
• Speakers Bureau. Ten consumers/survivors were trained and then sent out to speak to groups on a variety of topics, ranging from housing to advocacy to blood pressure to first aid. Consumers/survivors gave an average of four presentations per month.
• Job Placement Service. Staff located employers who had temporary jobs and matched consumers/survivors with avail-able jobs. Park Center (a psychosocial program which served as this project's fiscal agent) provided an onsite Job Coach daily.
• Roommate Matching Service. The project provided assistance with locating apartments, moving, and follow up visits.
• Crisis Intervention/Housing Respite. This service was created to offer an alternative to hospitalization, when appropriate. The service was coordi-nated by Park Center, which placed an onsite Housing Specialist at Friends Helping Friends.
• Newsletter. The project published a bimonthly newsletter, which included a schedule of events, creative submissions, information on pending legislation, drop-in center statistics, and consumer/survivor concerns. The newsletter was distributed to over 400 people.
• Self-help Group. The project sponsored a weekly group which focused on sup-port, education, and advocacy regarding physical abuse, overmedication, and boarding home abuses.
• Loan Fund. A fund which made small, interest-free loans for housing and employment needs was set up. The maximum loan was $25, and a committee reviewed all requests, which included security deposits, furniture, eyeglasses, and car repairs.

Criteria for membership stated that individuals served must have a major "mental illness", be able to travel independently, and abuse no substances at the drop-in center. The definition was later broadened to include former consumers/survivors and homeless consumers/survivors. The definition was broadened in order to respond to concerns that people in need would be denied services.

A total of 300 individuals were served by the project. Fifty individuals, mostly homeless, were referred to other programs. A majority of service recipients were Caucasian males; the average age was 52. Thirty-six percent were African American, 60% had a high school education, 93% had been previously hospitalized, and 98% had previously used community mental health services.

The grant was awarded to the Tennessee Department of Mental Health/Mental Retardation, which provided the funds to a psychosocial program, House of Friendship/Park Center Association. Park Center acted as the project's fiscal agent. Initially, a Planning Group composed of consumers/survivors and providers was formed to help direct the pro-gram. This Planning Group later became more formalized, and members held elections for a President, Vice President, and Secretary. By Year Two, this Board had hired a Director, who, in turn, hired staff. Paid staff included the Director, two Peer Counselors, a Secretary, and an additional On-Call Peer Counselor.

A total of $237,000 was spent on this effort, of which $234,000 were Federal funds and $3,000 were individual donations.

The following issues were encountered during the implementation of this effort:

• Project Development. Initially, it was planned that two support groups would form the Nashville Consumer Consortium, which would then become incorporated and develop a board. This would enable them to contract directly for services. This apparently never happened, although the reasons are unclear from project materials.
• Project Location. The drop-in center was ultimately located within Park Center, as three other independent sites which were explored were deemed unsuitable due to high rent or crime.
• Project Autonomy. There were indications that the project did not have a sense of being consumer-run, due to its close affiliation with the Park Center. Sharing space and staff with this pro-gram contributed to this concern. In addition, with Park Center being the fiscal agent, this furthered the impression of excessive professional involvement with this project.

The project evaluation was conducted by the State Department of Mental Health and |Mental Retardation. Program aspects to be examined included the number served in various project activities vs. projections and member satisfaction.

Respondents reported that they were proud of the center, and reported that they felt that the center: encouraged people to make their own decisions, helped people learn about resources, and encouraged people to share feelings without being put down. During the grant period, a Statewide consumer/survivor group, the Tennessee Mental Health Consumers' Association, was formed.

The evaluation found that a sizeable number of people thought that the center was owned by Park Center, and as a result, an interim recommendation was made that the drop-in center try to obtain its own space. The evaluators also recommended more social activities, more outreach to mental health centers, staff training and recognition within the mental health community, a new location for the drop-in center, and efforts to increase minority participation and enhance the cohesion of consumers/survivors, family members, and professionals.

The Final Report indicated that the project received $90,000 per year in continuation funding from the Tennessee Department of Mental Health/Mental Retardation.

VERMONT

White Light Communications
Burlington, VT

The original objective of this effort, called White Light Communications, was to use a portable satellite uplink vehicle for transmission of live public education productions to remote regions of Vermont. The project was originally set up to be financially self-sufficient by making its portable uplink available for rental fees to commercial users. Productions were distributed live, via satellite, on a weekly basis to 60,000 cable television subscribers in VT, and included public affairs items, public-interest stories, and entertainment produced by, and featuring, consumers/survivors. This effort provided opportunities for consumers/survivors to communicate directly to the public about their experience of being a psychiatric patient.

Project goals consisted of: public education to change attitudes and misinformation about mental illness; outreach to organize consumers/survivors by conducting State, regional, and national networking; and development of professional employment opportunities for consumers/survivors, including technical and managerial roles not usually available to such individuals.

The project focus was later changed from satellite uplink to direct video production, due to the price of purchasing equipment. The project developed several broadcast-quality productions for distribution on national cable systems; duplicated and sold videos of its productions; and worked on co-producing, directing, and staffing two interactive, live, national satellite broadcasts of consumer/survivor panels discussing major issues.

The following services were provided: o Weekly Productions. Half-hour weekly productions were distributed via cable networks in VT's three largest cities and in Syracuse, NY. Throughout the project, nearly 80 half-hour productions on a variety of consumer/survivor issues were made for a monthly cable show.

• Broadcast-Quality Productions. Three documentaries on consumer/survivor activities and perspectives were produced for national distribution during the project.
• Consumer/Survivor Involvement. Representation was obtained on several mental health boards and committees at the State and local levels.
• Networking. A relationship was established with a major video production and distribution company, and contacts were begun with national cable channels for broadcasting a production on Alternatives the fifth annual national mental health consumer/survivor conference, sponsored by NIMH and held in Pittsburgh.
• Interactive Satellite Conferencing. A concept for a national, interactive, live satellite television network production was developed and implemented, and the first broadcast of "Self-help Live" took place in 1991. This broadcast focused on highlighting a number of consumer/survivor leaders.
• Videotape Marketing. A list of 35 avail-able educational videotapes, all produced by the project, was compiled. The project distributed copies of these tapes. The videotapes were used to promote consumer/survivor education and provide professionals with education and training regarding consumers/survivors and their issues. The best productions were duplicated and a marketing brochure was developed and mailed to 15,000 potential customers. Sales of videos accounted for a percentage of the project's 1992 budget.

It was estimated that the project reached an estimated 1.6 million homes in the Boston, Seattle, New York City, upstate New York, and Vermont areas via public access cable television stations. A total of 38 states participated in the broadcast of "Self-help Live", with nearly 200 viewing sites.

The grant was awarded to the Vermont Department of Mental Health, which provided the funds to the Vermont Liberation Organization to operate the project.

Initially, the Vermont Liberation Organization (VLO) had an existing board which included eight consumers/survivors, one family member and two mental health professionals. The Board expanded to include business and communications experts, and periodically other constituent group representatives (i.e., other consumer/survivor groups, family groups, etc.) were asked to attend meetings to provide suggestions and feedback.

The staff of the project consisted of an Executive Director, an Office Manager, a Production Coordinator, and 30 part-time production assistants over the life of the project. Several communications professionals and business consultants assisted the project in creating a business plan, bookkeeping, project evaluation, and technical aspects of television production. All staff received two months of training at Adelphia Cable in Burlington.

All staff were consumers/survivors. The staff was all Caucasian, mostly New Englanders, 2/3 were female, and their ages ranged from 30-43. All staff were college graduates, and the mean income was $21,250.

Materials that were developed during the project included job descriptions, a brochure, videotapes and television productions, and a listing of videotapes available. The project interacted with several other entities, including local, state, and national cable and video production organizations, mental health technical assistance agencies, state mental health authorities, and universities.

A total of $529,475 was spent on this effort, of which $517,475 came from Federal funding.

The following issues were encountered during the implementation of this project:

• Purchase of Equipment Not Feasible. The original plan to purchase a portable satellite uplink and to lease it in order to generate revenues was not feasible due to cost. The project instead decided to establish a television production business and to distribute productions through existing networks.
• Struggles Regarding Commercial vs. Nonprofit Status. Originally, the project was set up to evolve into a viable commercial enterprise. The advisory commit-tee urged it to maintain its nonprofit status and to maintain its focus on promoting the consumer/survivor movement.

A staff survey was conducted, which found that all staff had high job satisfaction through-out the three years of the project. This survey also found that a wide array of employment activities were offered for participants, therewas a high level of acquisition of job skills, staff communication/relationship satisfaction was good, and employees felt high levels of social competence.

Four focus groups were organized, and a process evaluation of two television productions was completed. Findings indicated that the issues and problems portrayed in the productions were important and relevant, but they found that the informational content of the program could be enhanced by through the use of greater visual stimulation and narrative explanation of the content and background of people presented in the show.

Other evaluation activities included a survey of the cable audience, a telephone survey to study the impact and effectiveness of marketing the videotapes, an evaluation of the satellite teleconference broadcast, and a content analysis of the videotapes.

The telephone survey of the cable production audience revealed that, of those who watched the program, they liked it and found it easy to understand and informative about mental health issues. It also revealed that public attitudes towards individuals who are men-tally disabled were not very positive; however, those who viewed the show had more positive attitudes about the mentally disabled on each dimension as compared to non-viewers.

The telephone survey studying the impact of the marketing of video productions revealed that videotape customers represented a broad range of audience groups, with the largest percentage consisting of mental health professionals in private practice and individuals associated with self-help agencies.

A survey of "Self-help Live", the satellite teleconference broadcast, collected data from a total of 977 respondents. Findings included: 85% of respondents were satisfied with the production; 89% learned something new; participants were 72% Caucasian, 13% Native American, 12% African American, 2% Asian, and 1% Latino. Topics suggested for future broadcasts were: employment (42%), housing/homelessness (35%), and abuse of consumers/survivors (27%).

The content analysis of the productions revealed that 86% of the interviewees on the tapes were consumers/survivors, and 63% of the tapes examined involuntary treatment and hospitalization as a major informational focus. The evaluation report stated: "Clearly, the results indicate that involuntary treatment and hospitalization appear to be important issuesfrom the perspective of ex-patients, consumers and mental health consumer advocates." A total of 83% of the tapes had information on public education, and 7% had information on women's issues in the mental health system. The report went on to indicate that, with respect to the latter finding, women's issues were not explored in a significant way.

Overall conclusions, based on the above results, were as follows:

• Broadcast of the weekly program should be continued. The evaluation report stated: "It is evident that the availability of free public access cable channels provides an excellent medium that consumer groups . . . can utilize to promote consumer education and support networks."
• There is a strong market for materials produced by consumer/survivor-operated video production organizations. If the production quality and visual content are able to be improved, then the market is likely to grow.
• Employees were able to attain a wide range of job experiences and skills. However, turnover and other satisfaction ratings suggest the need to provide training, orientation, and job enrichment experiences for all employees, in order to foster personal and professional growth.

The final report also stated that the project's greatest strengths were its "ability to stay focused and maintain its clear vision as a communication source for the movement. Using many of the principles of the consumer and ex-patient movement, in the workplace, the staff was able to work [out] its difficulties, support one another, and work toward a common goal...The opportunity of having a non-stigmatized image in the business world played a major role in providing true community integration for mental health consumers and former patients...It affords a bridge across which people from both sides can work together as equals."

Overall recommendations based on this project included:

• Support for consumer/survivor public education efforts should be continued at the State and Federal levels. It is important for funding support to be provided for consumer-run business demonstration projects in order to promote community integration.
• Participation of State agencies and consumer/survivor service organizations in using the potential of satellite-interactive telecasts should be encouraged and increased.
• Preventive measures should be taken to foster personal and professional growth in the workplace (i.e., building a human environment in the workplace that is supportive and enhances communication, trust, self-esteem, and empowerment among the employees).
• Live video teleconference broadcasts should be continued by asking for State subscriptions. Participation in live teleconferences should be studied, including differences (if any) between levels of participation by consumers/survivors and non-consumers/survivors and the reasons people choose to participate or not participate.
• Research is needed to investigate the impact of teleconference broadcast programs such as "Self-help Live" on the consumer/survivor movement, net-working, and State consumer/survivor services in subscribing vs. non-subscribing States.
• There is a critical need to conduct process and outcome research on the use and application of communication technology in promoting public education, consumer/survivor networking, and prevention.

Though it had initially been hoped that the project could continue via the rental of uplink equipment, purchase costs prevented this from being a viable option. The project found that it was able to generate significant revenues through sales of tapes, and with a successful marketing campaign, it planned to generate a significant part of its future funding through tape sales and national commercial broadcasts. There were plans to continue the project after Federal funds expired; a number of contracts for production of public education materials were bid upon, and grant support was applied for from the van Ameringen Foundation and |the John D. and Catherine T. MacArthur Foundation. The project also reported that it had obtained subscriptions from 18 states for "Self-help Live". Ultimately, however, White Light was unable to generate confirmed funding and was forced to cease operations.

WASHINGTON

Capital Clubhouse
Olympia, WA

The overall goal of this effort was to develop a consumer/survivor designed, managed, and operated clubhouse program with a majority of consumers/survivors on the Board of Directors. The Clubhouse, named Capital Clubhouse, was situated in Olympia, Washington, and served a two-county area, with transportation provided to members.

Objectives included: starting three pre-vocational day programs; publishing a news-letter; providing social and recreational activities for participants; and starting a transitional employment program (TEP).

The following services were provided by the project: two slots in the Transitional Employment Program; a clerical unit, including production of a newsletter; a kitchen unit, called Cap-ital Cafe; and an outreach unit. Other activities included transportation, advocacy, drop-in center functions, and social/recreational activities. The Final Report indicated that other indirect services were offered, including information/referral, conference coordination, meal catering, provision of meeting space, anti-stigma programs, and dissemination of information about the project via speaking engagements and news and video releases.

The original eligibility requirements for service recipients were restricted to those deemed as having a serious mental illness. This was relaxed somewhat in later years, with an emphasis on those not receiving other services.

The project designated three categories of membership: "Regular Participation" (periodic attendance); "Daily Attendance"; and "Applications for Membership on File" (participant initiated contact and completed member-ship form, but participated very infrequently or not at all). The process for becoming a member included attending an initial meeting, participating in orientation, engaging in an interview with advocacy staff, and submitting a completed application form.

The Final Report indicated that the project served 101 participants. Characteristics included: 64% were female; almost all were Caucasian; and the average age was 40. Fifty-seven percent were single, 11% were married, and 32% were divorced; 57% lived alone, and 40% lived with a roommate or family. Eighty-two percent were unemployed and 14% had part-time work; 22% had less than a high school education, 21% had a high school diploma, 21% were college graduates, and 11% had completed postgraduate work. Ninety-three percent had prior hospitalizations and had a wide variety of diagnoses.

The grant was awarded to the Washington Division of Mental Health, which provided the funds to the Thurston-Mason County Regional Support Network. The Network then provided the funds to the Capital Clubhouse, which obtained its nonprofit status and began receiving funding directly from the State during the course of the project.

A Mental Health Consumers' Coalition (MHCC), composed of different area consumers/survivors, helped to develop a Board. The MHCC Board hired the Clubhouse staff and developed job descriptions for Board member duties and expectations. During Year Two, the Clubhouse developed its own ten-member Board. Eighty percent of the members were consumers/survivors. The Board met monthly, and had five committees: finance, fundraising/public relations, program, personnel, and nominations. Over time, an ad hoc Advisory Group was formed to assist theClubhouse Director. This group was composed of the State Community Support Programs Director, the MHCC Board Chair, a local mental health center manager, and the County Mental Health Coordinator.

Paid staff included an Executive Director, a Clubhouse Manager, two Consumer Clubhouse Staff Workers, and a Social/Recreational Program Staffer.