challenges. Peer leadership has been found to be a key component of successful self-management programs (Lorig et al., 2001). Peer support programs also are identified in the Chronic Care Model of illness management (described in Chapter 5) as a useful mechanism for supporting patients in their illness self-management (Bodenheimer et al., 2002b). Studies of illness self-management programs have shown that when peers are well trained and given a detailed protocol, they teach as well as and possibly better than health professionals (Lorig and Holman, 2003).

Peer support programs are a strong component of mental health care, as described above. Peer-based support services in recovery from substance-use problems and illnesses have an even longer history, extending from the eighteenth century to the present and encompassing Native American “recovery circles”; fraternal temperance societies; and social support provided within inebriate homes and asylums, half-way houses, and self-managed recovery homes (White, 2002, 2004). Twelve-step mutual support groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA) are used as a routine adjunct to treatment and are relied on as a form of long-term aftercare for many alcohol and drug treatment programs today (McElrath, 1997; Troyer et al., 1995). The efficacy or effectiveness of the largest addiction-oriented mutual aid/self-help group, AA, has been the focus of increased research and several reviews in recent years (e.g., Emrick et al., 1993; Kaskutas et al., 2003; Kelly et al., 2002; Tonigan and Toscova, 1996). This work has documented correlational evidence of a relationship between AA attendance and, more strongly, AA “involvement” (e.g., having a sponsor, being a sponsor, working the steps) and positive drinking-related outcomes. In addition, participation in self-help groups has been associated with lower subsequent health care costs (Humphreys and Moos, 1996, 2001).

Advance directives26,27 Psychiatric advance directives, like advance directives used in general health care, are intended to preserve consumers’ ability to engage in self-direction during times when their decision-making capacity or ability to communicate their preferences might be impaired. Psychiatric instructional directives typically address such issues as preferred medications, treatments, service providers and locations, and who is to be notified about hospitalizations and allowed to visit. Psychiatric proxy di-


Advance directives for mental health care are legally executed documents stating an individual’s preferences regarding various aspects of psychiatric treatment in times of crisis, inpatient care, or otherwise impaired decision making.


Information in this section incorporates content from the commissioned paper “‘Patient-Centered’ and ‘Consumer-Directed’ Mental Health Services” by Judith A. Cook, PhD, Professor and Director, Center on Mental Health Services Research and Policy, University of Illinois at Chicago.

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