From ex-patient alternatives to consumer options: consequences of consumerism for psychiatric consumers and the ex-patient movement.

The psychiatric consumer movement in the United States evolved out of the political activism of a small group of antipsychiatry "ex-patients" (former patients) early in the 1970s. The shift in the movement from radical opposition to the medical model to viewing the latter as a possible choice in treatment occurred gradually under a series of social and political changes (e.g., deinstitutionalization), responses to those changes (e.g., the Community Support Program of the National Institute of Mental Health), and the involvement of new actors on the scene (e.g., the National Alliance for the Mentally Ill, a family consumer movement). This article traces the evolution of the psychiatric consumer movement up to the early 1990s in the light of these larger social, political, and economic developments. The author then considers the consequences of that evolution for both consumers and the ex-patient movement in the context of the unique nature of consumerism in the United States and the more recent restructuring of mental health services under managed care.