Becoming a consumer-provider of mental health services: Dialogical identity development in prosumers in the United States of America and Japan

ABSTRACT The aim of this study was to examine the process in which peer-delivered service providers, or prosumers, developed an identity as a prosumer in the United States and Japan. Participants were 25 prosumers from the United States and 23 from Japan, who provided peer-delivered services for wages. The authors analyzed data from qualitative, in-depth interviews and created a conceptual model of prosumer identity development. In addition, the authors identified common themes that characterized their experiences as developing prosumers and contextual factors that affected their identity development from a social constructionist perspective. Results indicate the following: (1) prosumers experience sense of worth and/or distress affected by societal, cultural, and historical factors of their environment associated with prosumer work; and (2) prosumers develop a prosumer identity as they pursue a sense of worth and actively address distress, by integrating the preexisting consumer and provider positions at a higher level. Participants who had established prosumer identity described how they created unique relationships with consumers and colleagues rather than seeking to fit into predesigned molds. In conclusion, the authors discuss the vital connection of prosumer identity development with relationships with consumers and colleagues, and roles and needs of supervision and training for prosumers to promote their identity development through open discussion as well as active exploration of sense of worth and distress, and possible impact of prosumer identity development for inducing organizational and systemic changes in mental health service system.