title: Self-stigma and empowerment in combined-CMHA and consumer-run services: two controlled trials.
abstract: OBJECTIVE
  Self-help agencies (SHAs) are consumer-operated service organizations managed as participatory democracies involving members in all management tasks. Hierarchically organized board- and staff-run consumer-operated service programs (BSR-COSPs) are consumer managed, but they afford members less decision-making power. This study considered the relative effectiveness of SHAs and BSR-COSPs working jointly with community mental health agencies (CMHAs) and the role of organizational empowerment in reducing self-stigma.
  
  
  METHODS
  Clients seeking CMHA services were assigned in separate randomized controlled trials to a trial of combined SHA and CMHA services versus regular CMHA services (N=505) or to a trial of combined BSR-COSP and CMHA services versus regular CMHA services (N=139). Self-stigma, organizational empowerment, and self-efficacy were assessed at baseline and eight months with the Attitudes Toward Persons With Mental Illness Scale, the Organizationally Mediated Empowerment Scale, and the Self-Efficacy Scale. Outcomes were evaluated with fully recursive path analysis models.
  
  
  RESULTS
  SHA-CMHA participants experienced greater positive change in self-stigma than CMHA-only participants, a result attributable to participation in the combined condition (b=1.20, p=.016) and increased organizational empowerment (b=.27, p=.003). BSR-COSP-CMHA participants experienced greater negative change in self-stigma than CMHA-only participants, a result attributable to participation in the combined service (b=-4.73, p=.031). In the SHA-CMHA trial, participants showed positive change in self-efficacy, whereas the change among BSR-COSP-CMHA participants was negative.
  
  
  CONCLUSIONS
  Differential organizational empowerment efforts in the SHA and BSR-COSP appeared to account for the differing outcomes. Members experienced reduced self-stigma and increases in self-efficacy when they were engaged in responsible roles.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Segal
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Silverman
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Temkin
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003156:Community Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D011209:Power, Psychological; D012649:Self Concept; D020377:Self Efficacy; D012657:Self-Help Groups / Q000458:organization & administration / Q000706:statistics & numerical data*; D013240:Stereotyping