The purpose of this study was to explore potential racial differences in the experience of support offered by consumer-centered services for adults with serious mental illness. The study used hierarchical linear modeling to examine the level of support consumers report receiving from programs and the extent to which program-level characteristics reflecting racial diversity differentially influence white and African American consumers. The study used data from interviews with 1,072 white and African American consumers throughout Michigan and from selected program-level data. African Americans reported that a smaller proportion of their network comes from their program, although this is not related to program-level characteristics. Interaction effects suggest that the proportion of consumers in a program who are African American differentially influences the sense of community reported by white and African Americans. Implications for understanding racial dynamics within consumer-centered services are provided.
KEY WORDS: consumer-centered services; race; serious mental illness; social support
Since deinstitutionalization and the former-patient movement, mental health consumers have become increasingly involved in mental health services provision. Consumers have worked as advocates for systemic change, developed peer-led self-help groups, been hired to provide services in mental health service agencies, and established services run by and for consumers (Mowbray, Moxley, Jasper, & Howell, 1997; U.S. Department of Health and Human Services [DHHS], 1999). Consumer-centered services have become an important component of publicly funded mental health services.
Consumer-centered services share a philosophy of mutual support, community building, and self-help based on the foundation of a similar experience of mental illness. Given the marginalization of those suffering from mental illness, this shared experience can be a powerful means of developing supportive peer relationships. In addition, research on organizational participation has found that individuals feel more connected to an organization when they believe they are similar to its other members (Tsui & O'Reilly, 1989).
Mental illness is, however, only one aspect of a consumer's identity. The membership of consumer-centered services includes men and women of different age groups and from a variety of racial and ethnic backgrounds. Each of these characteristics contributes to an individual's experiences, including, but not bruited to, his or her experience of mental illness. This study considers the influence of race on the support that individuals receive from consumer-centered services.
Race has been found to be associated with how individuals present symptoms, how and where they seek help for a mental disorder, and the type of treatment they receive (DHHS, 1999). In addition, race is associated with the ways in which individuals structure and use their informal support networks (for example, Ajrouch, Antonucci, & Janevic, 2001; Taylor, Chatters, Tucker, & Lewis, 1990) and the extent to which they feel connected to an organization (Tsui & O'Reilly, 1989). The reasons for these findings are tied to both societal (for example, racial discrimination and fewer outpatient services located in largely African American communities) and cultural factors (for example, beliefs about the causes of mental illness and the role of family or stigma associated with seeking treatment) (LaVeist, 1994).
Although the presence of racial differences among consumers does not negate the influence of a similar experience of mental illness, it raises the question of whether this experience is enough to develop supportive peer relationships within a complex social context. However, the influence of race on the experiences of consumers in consumer-centered services in this regard has been largely ignored in the literature to date.
This study begins to examine this issue by comparing the experiences of white andAfrican Americans in relation to social support and community building in consumer-run drop-ins (CRDIs) and clubhouses throughout Michigan.
The importance of informal support networks in the lives of African Americans has been well documented (for example, Stack, 1974; Taylor et al., 1990). However, whereas African Americans seem to include more extended family in their network and have more frequent contact with network members (Ajrouch et al., 2001), white Americans do not necessarily receive less support. Rather, they rely more on friends and coworkers or receive more formal care (Holschuh, 2003; Kim & McKendry, 1998).
In addition, all individuals tend to include people who are like them in their support network. Sometimes referred to as homophily, this is the notion that "birds of a feather flock together" (McPherson, Smith-Lovin, & Cook, 2001). Homophily by race has been found to occur more broadly than for other social groupings (for example, gender or income) and to cut across all types of relationships (McPherson et al.). In part, this is a factor of demographics. For example, white people tend to have the most racially homogenous networks because there are more white people in the population. However, homophily occurs beyond what demographics alone would predict. Social factors, such as racial differences in education, income, and occupation, as well as personal factors, such as attitudes and bias, contribute as well (McPherson et al.). For these reasons, ethnic minority groups tend to have more homogenous networks than would be expected on the basis of racial composition of the population alone.
The principle of homophily applies to organizational participation and satisfaction. Substantial research has shown that individuals in an ethnic minority group, particularly a more stigmatized group, feel highly visible in an organization and consequently report less satisfaction (Kanter, 1977; Niemann & Dovidio, 1998). Other studies have found that the greater the difference between an individual and others in an organization, the lower his or her level of commitment to that organization (Tsui & O'Reilly, 1989).
Racial differences in how individuals structure and use social networks and the principle of homophily suggest that African American and white consumers may experience the supportive aspect of consumer-centered services differently. For example, if, as the literature suggests, African Americans rely more heavily on family and church...