A systematic review of consumer-providers' effects on client outcomes in statutory mental health services: The evidence and the path beyond

Consumer-provider involvement in the delivery of mental health services has steadily increased in the past several decades; however, the effects on client and service outcomes have remained unclear. The objectives of this paper are to (a) summarize a Cochrane review of consumer-providers’ effects on client outcomes in statutory mental health services and (b) discuss several key issues that, if addressed, might strengthen evidence in this area. We searched The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, and Current Contents until March 2012 to identify relevant studies. Studies were eligible for inclusion if they randomized adult clients to statutory mental health services delivered with and without consumer-provider involvement. Eleven studies met the eligibility criteria and were divided into 2 separate comparison groups: studies comparing consumer-providers with professionals employed in the same role within a mental health service (5 studies) and studies comparing mental health services with and without consumer-providers as an adjunct to the service (6 studies). The limited outcome data available from the studies indicated no difference in quality of life, function, social relations, mental health symptoms, client satisfaction, or attrition in those receiving services from consumer-providers compared with those who did not. None of the studies reported any adverse outcomes for clients. Addressing several key issues could strengthen the evidence such as: core outcome measures, appropriate study designs for evaluating complex interventions, minimal cross-contamination of treatment groups for community-based interventions, improved trial reporting, and the use of systematic reviews to inform future research.