A consumer-operated case management project.

The idea that patients and former patients might themselves be involved in service delivery has become increasingly popular in recent years. Once viewed as an expression of patient protest without clinical merit, self-help services are now, at least in some places, accepted and endorsed by mental health planning authorities. This month's guest columnists describe the philosophical underpinnings of a state-funded consumer-operated case management program in Oregon and discuss both the hope and some of the potential difficulties that such an experimental effort may generate.