Consumer Family Support

• Consumer Support (TMHCA) Service Description
• Why do we fund it?
• Whom does it serve?
• What are the outcomes?
• What evidence is available to support the service?

Service Description
TDMHDD provides funding to the Tennessee Mental Health Consumers' Organization (TMHCA), TN NAMI, and Frontier to support their consumer/family support activities. TMHCA receives funding to support their infrastructure and advocacy activities. TN NAMI receives funding to support their infrastructure, funding to their affiliate groups, and the Journey of Hope education efforts. Frontier receives a small grant to support consumer support groups.

TMHCA’s statewide office, located in Nashville, includes an executive director and office support. TMHCA has hired consumer advocates on a regional basis to provide education and advocacy in each of the seven regions. TN NAMI’s statewide office, located in Nashville, includes an executive director and office support. Consumers who attend one of three peer support centers where the consumer self-help groups are located staff the Frontier program.

Why do we fund it?
One of the primary missions of these organizations is to develop grassroots support for mental health consumers. These organizations accomplish this by offering emotional support, education, and information to their primary constituents through peer support. This effort helps to reduce stigma and also promotes mental health advocacy, wellness, and recovery. The end result is an educated and informed family and consumer movement.

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Whom does it serve?
The TMHCA program serves adults who are diagnosed with mental illness and co-occurring disorders. The TN NAMI program serves family members of persons who are diagnosed with mental illness and co-occurring disorders. The Frontier program serves adults who are diagnosed with mental illness and co-occurring disorders and who attend the Frontier peer support centers.

What are the outcomes?
A better-educated and informed family and consumer movement has helped to empower families and consumers statewide. This has had an impact both on a personal and system level. On a personal level, educated families and consumers are better able to make sound treatment and personal choices. Peer-support-related activities improve the participants’ daily functioning and increase the participants’ illness management. On a system level, empowered families and consumers have significantly contributed to positive change in the mental health system over the past 20 years. TN NAMI’s Journey of Hope educational course empowers family members through psychoeducation and peer support. It assists family members 1) in understanding symptoms of mental illness 2) in understanding better how to help their family member with recovery 3) and by reducing overall stress on the family.

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Is there research, evidence-based practice, best practice, or literature to support the service?
Peer support programming has been identified by SAMHSA as a promising practice that is currently being researched as a possible addition to the six SAMHSA-approved evidence-based practices (Illness Management and Recovery, Implementation Resource Kit User’s Guide, page 6). Research has shown that self-help can be just as effective as other therapeutic modalities (Gould & Clum, 1993). Reviews of peer-support/peer-provided-services research has come to positive conclusions (Davidson 1999; Solomon & Draine, 2001). Self-help seemed to improve symptoms, increase participants’ social networks and quality of life (Davidson, 1999) and participants had improved coping skills, greater acceptance of illness, improved medication adherence, and higher satisfaction of health (Raiff, 1984). Research has also demonstrated that peer support providers have fewer hospitalizations (Sherman & Porter, 1991) and offered personal growth in terms of increased confidence in their capabilities, ability to cope with the illness, self esteem and sense of empowerment (Salzer 1997). Given the consistency of the findings of decreased hospitalization or shortened length of hospital stay for peer provided services and peer providers themselves, there is a translation of financial savings to the system as hospitalization is one of the most expensive of services (Clarke, 2000; Sherman & Porter, 1991).

TN NAMI’s Journey of Hope is an example of family psychoeducation, which SAMHSA has identified as one of the six SAMHSA-approved, evidence-based practices (Family Psychoeducation, Implementation Resource Kit User’s Guide). SAMHSA’s approval of psychoeducation as an evidence-based practice was in part based on the following research:

Anderson, C.M., Griffin, S., Rossi, A., Pagonis, I., Holder, D.P., Treiber, R.: A comparative study of the impact of education vs. process groups for families of patients with affective disorders. Family Process 1986; 25:185-205.

Hogarty, G.E., Anderson, C.M., Reiss, D.J., Kornblith, S.J., Greenwald, D.P., Ulrich, R.F., Carter, M. Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia, II: Two-year effects of a controlled study on relapse and adjustment. Archives of General Psychiatry 1991; 4(4):340-347.

McFarlane, W.R., Link, B., Dushay, R., Marchal, J. Crilly, J.: Psychoeducational multiple family groups: Four-year relapse outcome in schizophrenia, Family Process 1995; 23(2):127-44.

McFarlane, W.R., Lukens, E., Link, B., Dushay, R., Deakins, S.A., Newmark, M., Dunne, E.J., Horen, B., Toran, J.: Multiple-family groups and psychoeducation in the treatment of schizophrenia. Archives of General Psychiatry 1995; 52(8):679-87.

The American Psychiatric Association cites family psychoeducation, used in conjunction with medication, as one of the most effective aids to recovery for schizophrenia. Research has shown that a significant reduction in relapse rates and unemployment occurs when family intervention, multi-family groups, and medication are used concurrently. The NAMI Family Education Program (Journey of Hope is Tennessee’s version) has earned a best practice status. Two studies conducted on NAMI’s Family Education Program showed that participants had an increased sense of empowerment regarding the system, the community, and family. They felt significantly more able to cope with the mental health system and felt an increased ability to cope with their family member who is diagnosed with mental illness or co-occurring disorder. Dr. Sue Pickett Schenk, UIC Center on Mental Health Services Research and Policy Research, has conducted research on the Journey of Hope. Two studies have shown that participants increased their knowledge and understanding of the treatment of mental illness, increased the family member’s problem management and communication skills, and created a more positive perspective on the future.

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