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In September 1998 the University of Massachusetts Medical School, in partnership with a private vendor of correctional health care, began providing mental health services and other services to the Massachusetts Department of Correction. The experience with this partnership demonstrates that the involvement of a medical school with a correctional system has advantages for both. The correctional program benefits from enhanced quality of services, assistance with the recruitment and retention of skilled professionals, and expansion of training and continuing education programs. The medical school benefits by building its revenue base while providing a needed public service and through opportunities to extend its research and training activities. Successful collaboration requires that the medical school have an appreciation of security needs, a sensitivity to fiscal issues, and a readiness to work with inmates who have severe mental disorders and disruptive behavior. Correctional administrators, for their part, must support adequate treatment resources and must collaborate in the resolution of tensions between security and health care needs.

Objective: A national survey was conducted to determine the extent of consumer empowerment in the public mental health system., Methods: A questionnaire was sent to mental health authorities in all U.S. states and territories asking whether consumer empowerment or responsibility was defined in statutes, regulations, or policies and whether consumers or family members were employed in central or field offices of the authority. A rating scale measured the extent of consumer empowerment, and correlations were examined between this rating and other variables., Results: The survey achieved a 100 percent response rate. Twenty-two states (39 percent) addressed consumer empowerment and 16 (28 percent) consumer responsibility in a statute, regulation, or policy. Twenty-seven states (48 percent) had paid positions for consumers in central offices, and three (5 percent) had such positions for family members. Half the states had paid positions for consumers in field offices, and 12 states (24 percent) had such positions for family members. The extent of a state's consumer empowerment had no relationship to region of the country or the state's mental health budget. A significant positive relationship was found between extent of empowerment and the size of the state's population and the quality of its mental health services., Conclusions: State mental health authorities vary widely in their direct involvement with consumer empowerment. Results indicate that mental health authorities need to make a greater commitment to the achievement of such empowerment if it is to become a meaningful part of government involvement with mental health services.