Consumer Operated Services— ‘An Evidence Based Practice’

This article is the first in a series about the unique role that Peer and Family Run Agencies play in the Arizona Behavioral Health System.

The system of services in the behavioral health system has undergone many changes in the past fifty to eighty years.  One of the areas where change has (occurred, that has demonstrated observable and measurable positive results has) been in the development of the role of consumers as providers of and partners in the delivery of services.   What was originally an informal supportive relationship between persons who received services, there is now a network of organizations and a structure of services that are uniquely identified as consumer operated services.  In the past few years, the Federal Government through the Substance Abuse and Mental Health Services Administration (SAMHSA) of the Department of Health and Human Services recognized “Consumer Operated Services” as being an “Evidence Based Practice” –one that has been identified through formal research and data analysis as having a higher rate of effectiveness in (assisting) the persons they serve achieve recovery. The assistance is presented in demonstrated effective principals of sustainable models of recovery.

History of Consumer Operated Services

The word “Recovery” itself tells us a little about the history of this work.  The practice of persons helping others to achieve recovery began in the Substance Abuse field in the 1920’s where one alcoholic helped another get and stay sober.  This led to Alcoholics Anonymous.  Persons who faced challenges in other areas of their lives took the example of AA the principles and applied them in new areas. This was the case with behavioral health.

In the 1960’s we began to see big changes when consumers began to express that they had rights.  Consumers began to form groups that became very important as Psychiatric Hospitals began closing across the country and the former residents from those hospitals were set adrift in an increasingly impersonal and sometimes hostile society.

Starting in the early 1970’s consumers began to formally organize to offer services through drop-in centers.  These effective settings began to shape thinking about what role these services should play in the behavioral health system. 

In the 1980’s and 90’s, the Federal Government began funding model programs around the country that were to develop a “continuum of care( that consistently demonstrated and developed with a guiding principal to include) that any (sustainable )system of service (delivery will include) a range of service options from institutions to community based programs including Consumer Operated Services.

 In the 1990’s, consumers began organizing to express their desire to influence their own services and the broader system of care.  This movement operated under the motto, “Nothing about Us without Us.” This led to opportunities for persons from the behavioral health community as well as persons from other disability groups to gain access to national forums and policy groups where decisions were being made about how services and the society will look in the future.  During this time landmark victories were achieved in the 1990 passage of the Americans With Disabilities Act guaranteeing civil rights to people with disabilities and the Supreme Court’s Olmstead decision of 1999 guaranteeing people with disabilities the right to live and receive services in the community rather than being confined  in institutions. 

Consumer Operated Services Defined

Changes in the 1980’s and 90’s led to formation of more Consumer Operated Service Organizations (COSO’s) across the country including in Arizona.  Services were refined and the unique role for these organizations was developed.  Research shows that Consumer Operated Service Organizations are grounded in identified values and traditions.  These are:


Organizational Values

Š       Belief in peer based support

Š       ( Partnering with) professionals

Š       Voluntary membership

Š       Egalitarianism

Š       Non-bureaucratic

Š       Informal

Services are to be based on:

Š       Empowerment

Š       Independence

Š       Responsibility

Š       Choice

Š       Respect and Dignity

Š       Social Action



There is great variation among COSO’s in the services (that are) provided, the (composition) of the organization and this ( delivery platform can be responsive to community challenges and provide advantageous community developed solutions) .  Briefly, the research shows that persons involved in COSO’s showed greater gains overall in subjective outcomes than for persons involved in traditional behavioral health services.  (The Research demonstrates that an individual’s) participation in COSO’s leads to (observable and tangible) increases in (individual) well-being and in (an overall) sense of empowerment. (These results have been gleaned from outcome surveys) and have been compared to persons receiving traditional behavioral health services.  Researchers identify that the Consumer Operated Programs have worked to transform the content and character of community mental health services in a recovery based mental health system.