Professional Perspectives Regarding the Merit of the Role of the Consumer Specialist and the Responsibility Group

By Randy Starr


Randy Starr is a staff training and development instructor at the Elgin Mental Health Centre in Illinois, USA. Randy has had a successful reintegration into the community after five years of hospitalization as a 'Not Guilty by Reason of Insanity' detainee. He has written a number of articles and a book that is his autobiographical account of his journey 'Not Guilty by Reason of Insanity: One Man's Recovery' (2000).

The following piece by Randy is the findings of a series of interviews he conducted with several professionals regarding their perspective on the consumer specialist/peer counselor/ patient advocate role he used to hold. In Australia, consumer consultants have become integral in mainstream services but the role has not been developed in all forensic services, nor has it been evaluated. Staff will find the following useful to support the creation of the role and to evaluate it.


Mr. M., a hospital administrator, states: While the concept of using a former patient is not new, it was certainly new to this program. I've only been here a few years. I had barely arrived when I heard about using (a consumer specialist) in our (forensic) program. I said yes. But not because I thought it was a good idea, but rather because I knew somebody else had already decided that and I figured we would just have to keep a close eye on him. I knew I was certainly working in an environment much different than corrections and I didn't know exactly what this consumer specialist was about to do. I thought that he would look at things like food, recreation and our physical plant. He would be telling us that the food was bad and that we needed to brighten the place up. Nothing, we didn't already know, and nothing that needed to be reported by a former patient. As I've told everybody since, I've learned a great deal about the abilities of our clinical staff and about being open-minded enough to use all the resources available to treat patients.


Mr. L., a master's level social worker states: I think it's important for the patient to hear someone whose life is so similar to theirs telling them his or her own experiences. And in a way, reinforcing the kinds of things we do and say in more, perhaps, in a clinical or academic kind of way. Reinforcing in their own words what we (already) try to tell the patients. So I think that's one way in which working with a consumer specialist is so good. But it works the other way around too. Differences in culture and education apply to us too. They apply to our ability to understand. Sure, we're all trained in the empathetic response and the non-judgmental and all of that. But the consumer specialist is someone who can feed back to us some of the ways maybe in which we are coming across. That we're not even aware. But even if it's not actively alienating (the patients) it isn't helpful as it could be or should be to the guys (or gals) we're trying to work with. So for the most part I really appreciate the opportunity to work with a consumer specialist.


Dr. M., a psychiatric medical physician states:

It's critical that the consumer specialist has their own act together so to speak. That what illness they've recovered from in the past has been successfully addressed. And I think it's also very important that the consumer specialist not have an axe to grind, nor have a secret agenda. That can potentially be very damaging, if the consumer specialist were strongly pro-patient, or, for example, pro-treatment plan. Certainly, in the two consumer specialists I've dealt with those have never been issues. Just prior to my work in the forensic system I spent well over fifteen years working in the private sector largely with alcoholics and with people suffering from addictions. From that background I learned something very important. I think we all know that twelve step programs, Alcoholics' Anonymous in particular, have a significantly better track record than psychiatry or formal medicine. As far as helping these (forensic cases), I'm not going to get into debating which is better. I did learn, however that it's people who have been there, in terms of active alcoholism but is now involved in meaningful recovery. I have learned more as a certified "addictions'-ologist" from those recovering people, for example, than I ever did from seminars, textbooks, or research papers. So with that in mind, getting back to the role of the consumer specialist, I think one of the enormous advantages of having somebody (who has been there and done that) is that they can share their stories in a way that our (forensic) patients can truly identify with them. You can't approximate or intellectually strive towards compassion. I've never heard voices, I've never been actively delusional so the best I can do is to try to understand. And I can be sympathetic to somebody who suffers from these symptoms but it's really difficult to be truly empathic. By having the consumer specialist available to us, particularly in the forensic setting, somebody who's been on the other side, not only psychiatrically but legally, that person can be extraordinarily valuable, both to staff as well as the patients (in the healing and recovery process).


Mr. C., a college-degree level mental health counselor, states: The consumer specialist and I were co-leaders on the unit of the Responsibility Group for approximately two years. It was not only a very enjoyable experience, but it was professionally rewarding. Our group met weekly and lasted for about an hour. We used an educational format and we included women patients, in particular, who were either unfit to stand trial or not guilty by reason of insanity. Some of these women have murdered. The advantage of the group, for me, is the fact that the consumer specialist co-leader has been a patient of services. The women relate to that greatly because he's been through what they're going through. He made a commitment to the treatment which paid off. It's very inspiring for them to see someone who has gone through the status of patient and who is now a very respected and revered employee. On what it's going to be like, those first couple of weeks out of the hospital after discharge and the importance of complying with the guidelines of the court order, that things aren't always going to be rosy, that there are people there to help you make this adjustment. If you're committed to your recovery and treatment, that there's an obtainable goal. And I just want to underscore the value of being a co-leader with the consumer specialist. The fact that he has gone through the system, has made successful adjustment. Just the role modeling that he provides is invaluable.


Mr. D., a college-degree level mental health counselor, states: We've made great use of the narrative articles written by our consumer specialist. With his permission, I make duplications and we hand them around the table and take turns reading them out loud. The real wonder and effectiveness of reading them is that it gives the long term not guilty by reason of insanity recipient, in particular, a sense of hope. A sense that they're not by themselves. That someone else has walked the steps before them, really has made a recovery and return to the community in a very effective way. And not only that, has actually come back to the hospital setting to say thank you and work with recipients who are still in the middle of the whole process. So our consumer specialist has entered into a partnership with us. Where he walks side by side with our clients and actually helps them to see that this can work. The treatments are effective and that the programs can help them rebuild their shattered lives.


Dr. H., a forensic psychologist, states: I've been working with forensic patients for ten years. I often use our consumer specialist's articles in my substance abuse groups. I think that the idea of peer counseling and self-help originated with the substance abuse movement. So a lot of his articles apply very well to our people in the substance abuse groups, particularly in areas of responsibility and relapse prevention, in terms of both mental illness and substance abuse. So his articles work very well with forensic patients because they are on issues that are very important for our patients. And when it comes from someone who has been there, the patients tend to listen more closely, to really make changes. Because they're able to see that somebody else has been able to change and they think that then maybe they can change. The interesting thing was when we first heard that we were going to have someone like a consumer specialist around, or a peer counselor so to speak, or advocate, we thought that he would be criticizing what we were doing and critiquing it. That has not been the case at all. Our consumer specialist has been very supportive of what we're doing and it has worked out well in terms of holding us responsible for getting the benefits from their treatment and making changes. They're able to see that they have a positive example in front of them. Our consumer specialist does that for them.  We're grateful.


Mr. J., a master's degree social worker and unit director, states: Some of the things I feel very strongly about are what's good about the consumer specialist's position and about Randy's fulfillment of that position especially. The thing about a real partnership is a certain spirit that's involved. That people are people. Whether those people are staff, whether those people are patients, whether they're consumers in the past, whether they currently are, whether they're family members, whether they're law enforcement, or whomever, out there they're all people. They all bring their personal perspective to the process. I think signified in that learning is how to listen and how to bring those groups together is something our consumer specialist does exceptionally well. Our consumer specialist has recently been the center of some interfacing with mental health and mental health professionals. In terms of the forensic program, it's almost like you have to be halfway involved in the criminal justice system and half way involved in the mental health system. Our consumer specialist once again covers that gamut with his personal experience and also with his professional experience. Now I think that's something I find instructive of times. I think that our consumer specialist has a unique way of getting through to a law enforcement person as much as he would to a mental health professional. That's a pretty tough fence to straddle so I think that's something he's uniquely suited to. That we all need to wholeheartedly appreciate.


Mr. Z., a master's level social worker states: Our consumer specialist makes the whole experience of treatment in therapy more accessible to both the patient and the clinician. Our consumer specialist as a former patient can bring something to the therapeutic table that none of the rest of us can because he's actually been there. I've seen some of the most remarkable turn-arounds in patients who actually can, instead of at first getting into denial and rationalization can actually benefit from witnessing someone who has actually embraced their mental illness and the wrongness of their crime and moved on positively with their life. They find it very difficult to actually admit, or to cognitively become aware of their mental illness. Our consumer specialist can actually get up there and say "I've been there and I've done that." I refer all of my patients to the Responsibility Groups that our consumer specialist was instrumental in putting together and co-leads with our clinical staff. It's a key group. It's one of our most enthusiastically attended groups. Most of our patients here are going to at sometime in the future reintegrate into the community. While we have them here we want to help better instill in them the importance of taking responsibility for their lives. Our consumer specialist helps us hammer away at getting that point across to our patients. It's not easy.


Dr. X., a forensic psychologist, states: There are a lot of things that you need to come to an understanding about our patients. The patient needs to take responsibility for their illness and I as a facilitator can tell that particular patient to take that responsibility or help give that patient the tools that are necessary to make that recovery as best as possible. One of these ways is through the Responsibility Group. As a psychologist, I work with behavioral programming to better allow the patient to demonstrate more appropriate ways of interacting with others. The group is a very important part of treatment because it allows the patient an opportunity to focus on, and to better realize that they're not alone. That other patients have similar problems and that there are also other people in this world suffering with mental illness. The group that I'm working with, and find most beneficial, is with our consumer specialist and it's the Responsibility Group. It's especially helpful on several different fronts. The first is that our consumer specialist himself was once a forensic patient, was accused of a crime, did commit a violent crime and went through the complicated process of recovery and was successful with that journey. He exercised responsibility during the course of his treatment and, in doing so, he's become now a productive member of society and is giving back to the community. He's walked their emotionally painful footsteps. All I can do is offer the theoretical or the educational material but working with somebody who's experienced it brings an entirely different flavor to the group. It brings a reality and it gives the patient, for the most part, hope. Hope that they too can get through it and because this is all about treatment, hope is perhaps the most important ingredient of all.


Ms. C., a master's level registered nurse and forensic unit nursing manager states: I utilize his expertise on many different levels. In an administrative way, I discuss issues with him. I've called upon him as a member of the clinical team when I have concerns about some of our patients whom may need real unabashed honesty from Randy. About why they're here, how he was once a patient himself, how he was able to move on with life to the level of success he has now in his own life. Just recently I asked him to stop by and to discuss with me and some of my nursing team his perception of his treatment of so many years ago. It was an invaluable experience for my nurses. His honesty, his candor and his humility. About one particular situation in particular as a grown man, an inpatient, he told of having to stop and ask for a roll of toilet paper from a staff member who was simply to busy using the telephone, and for apparent personal usage. Who was simply too busy on the phone to even meet and speak with Randy, to take just a few minutes to pause from the phone call, to get him some needed toilet paper. After Randy left from that conversation with us, the discussion generated from those in attendance, regarding some of the things shared with us during that half an hour session was more valuable than four hours in an academic classroom. I think that our staff, while they all understand that our patients are very human people and have very human problems and needs, and often very special needs at that, sometimes the pressure and demands on our time during the course of a day are great. And the expectations of our superiors, our peers, and the system, unfortunately override the true and real needs of the patients. Sometimes we forget that the patients are real people, just like the rest of us. We ideally like to think that our staff are able to leave their family and personal issues at the door when reporting for work, when they enter the unit, but we know from often painful experience that just doesn't always happen. In utilizing Randy's insights, experiences and ability and willingness to address delicate issues associated with staff, and patient interactions, sensitivity to such issues is enhanced. It helps in the development, the training of my staff. His directness, his honesty, his courage are appreciated by many staff and many patients. He shares of himself with all of us at whatever level we approach him. Often I've watched the consumer specialist Randy Starr work with our patients and staff on the units. It's hard to measure in words the value he brings to those individuals. He gives a sense of hope to both the patients and to the staff.  He was there, where they're at now but he's moved on. That is so important, giving a sense of hope to these people. It's a big learning experience to me personally, to meet somebody who has been on the other side of the therapeutic fence. As a caregiver and as a registered nurse, I've always thought that we, as staff, should be advocates for our patients. Sometimes we forget that and someone in Randy's role, like Randy, brings us back to that.


A closing statement from Randy:  I'd like to make a pitch for the forensic patients. A lot of us are people who have done bad things but we're not bad people. Remember that if you can, and as far as the demands of being a staff member working with this population. Regarding hope, if you had hope when you came into this field forensic mental health, keep it. If you've already lost it, try to get it back. And if you can't say yes to either option maybe you simply need a break from time to time. If nothing else, take a periodic vacation. Always make sure to take care of yourself along the way because if you don't take proper care of yourself, you won't be able to take care of the rest of us in need either.


Randy Starr