The role of the consumer in the leadership and management of mental health services.

OBJECTIVE: To reflect on consumer involvement in the leadership and management of mental health services through consideration of relevant policy directives, pertinent literature and current practice, and to consider the role of psychiatrists in promoting consumer involvement.
CONCLUSIONS: Both Australia and New Zealand have significant policy directives in relation to consumer involvement in mental health services. The actual realization of consumer involvement within the mental health sector is extremely variable and the extent of genuine participation highly questionable, particularly in regard to leadership and management roles. It is important that the rationale for consumer involvement is continually highlighted and understood by all mental health professionals, including psychiatrists, so as to discourage the practice of including consumers solely for the sake of adhering to political policies. The attitudes of health professionals have been identified as having the most significant impact on consumer involvement. It is questionable whether the critical contribution of consumer involvement in mental health services should remain dependent on the attitudes of non-consumers within the sector. In New Zealand, a paradigm shift is occurring with consumer involvement moving from a construct of 'participation' to one of 'leadership'. Psychiatrists can, and should, play a significant role in advocating for the development of mental health services in directions which support and promote consumer involvement at all levels.