Consumer-providers of care for adult clients of statutory mental health services

In mental health services, the past several decades has seen a slow but steady trend towards employment of past or present consumers of the service to work alongside mental health professionals in providing services. However the effects of this employment on clients (service recipients) and services has remained unclear.We conducted a systematic review of randomised trials assessing the effects of employing consumers of mental health services as providers of statutory mental health services to clients. In this review this role is called consumer-provider and the term statutory mental health services refers to public services, those required by statute or law, or public services involving statutory duties. The consumer-provider s role can encompass peer support, coaching, advocacy, case management or outreach, health services (case management roles (4 trials), facilitating group quality of life (mean difference (MD) -0.30, 95 confidence interval (CI) -0.80 to 0.20); depression (data not pooled), general mental health symptoms (standardised mean difference (SMD) -0.24, 95 CI -0.52 to 0.05); client satisfaction with treatment (SMD -0.22, 95 CI -0.69 to 0.25), client or professional ratings of client-manager relationship; use of mental health services, hospital admissions and length of stay; or attrition (risk ratio 0.80, 95 CI 0.58 to 1.09) between mental health teams involving consumer-providers or professional staff in similar roles.There was a small reduction in crisis and emergency service use for clients receiving care involving consumer-providers (SMD -0.34 (95 CI -0.60 to -0.07). Past or present consumers who provided mental health services did so differently than professionals; they spent more time face-to-face with clients, and less time in the office, on the telephone, with clients friends and family, or at provider agencies.Six trials involving 2215 people compared mental health services with or without the addition of consumer-providers. There were no significant to 0.79), attendance rates (SMD 0.52 (95 CI -0.07 to 1.11), hospital admissions and length of stay, or attrition (risk ratio 1.29, 95 CI 0.72 to 2.31) between groups with consumer-providers as an adjunct to professional-led care and those receiving usual care from health professionals alone. One study found a small difference favouring the intervention group for both client and staff ratings of clients needs adverse outcomes for clients, the potential benefits and harms to the consumer-providers themselves (including need to return to treatment), of the consumer-provider role (eg specific tasks, responsibilities and expected deliverables of the role) and relevant training for the role so that it can be readily implemented. The weight of evidence being strongly based in the United States, future research should be located in diverse settings including in low- and middle-income countries.