Consumer/survivor participation in the operation of community mental health agencies and programs in metro Toronto: input or impact?

The main purpose of this study was to obtain an overview of consumer/survivor participation in the operation of community mental health agencies in Metro Toronto. This article describes, from the viewpoint of agency executive directors, the nature and extent of consumer/survivor involvement and the difficulties encountered in implementing it. It appears that while involvement is increasing in specific, measurable ways in many agencies, the actual impact of consumers/survivor input on agency philosophies, policies, and practices is, at best, unclear. Agency directors tend to account for this in terms of the failure of consumers/survivors to "fit in" and meet agency expectations. Drawing on the literature on consumer/survivor involvement, the author suggests that the more fundamental problem is the continued imbalance of power between consumers/survivors and agency staff and the failure of agencies to create an environment conducive to meaningful consumer/survivor participation. There is, however, a high degree of interest in receiving support to address the issues encountered in developing partnerships with consumers/survivors.