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Tanya (not her real name) was so pleased with the way she had been treated in a mental health crisis house, a project run by a service user-led voluntary organisation, that she wanted to give something back. She started volunteering informally as an advocate. But later, when she was readmitted as a resident, in her confused state she kept insisting that she was actually there as an advocate, which proved difficult for everyone.

"The problem was that people were becoming volunteers too quickly and too easily after being residents," says Jim Read, who supported the project on behalf of the Mental Health Foundation. "It would have been better if the person had left the house, had a gap and then been to an advocacy training group and had some support in the volunteer role."

Read continues: "The good, positive attributes about user-led services are their friendliness and informality and the fact that there are not too many strict boundaries. But you come to realise that you actually do need to have some boundaries. The project has now brought in rules which introduce a bit of space and distance."

The situation outlined above was just one of the sometimes painful lessons learned by seven groups creating such projects as part of the MHF's crisis programme.

The MHF's Crisis Project Workbook picks up the experience of the seven groups and turns it into positive and practical advice for others who might want to set up similar services.

Another project was a Derbyshire-based out-of-hours crisis helpline for the 180 users of a day centre. It was open 18 hours a week for 17 months and received just 25 calls in that time. Attempts were made to offer the helpline to a wider group of potential callers but frustrated volunteers were already drifting away and the helpline was closed down.

Of the seven user-led projects there were three telephone support lines, two "safe houses" open in the evenings and two residential services. They all aimed to provide a user-friendly, non-medical alternative to acute wards.

Read facilitated regular "learning sets" over a three-year period, in which people could learn together and generate ideas and solutions as they set about creating their organisations and services.

"You can't always see in advance what the issues are going to be. The aim of the workbook is to let you know what we wish we had known before we started," says Read, who wrote the Workbook.

The guide provides checklists, group exercises and handouts to stimulate thinking and help decision-making. There is valuable practical advice. For example:

• Being hampered by "nimbyism", and how to liaise effectively with local people.
• Facing hostility from mainstream mental health staff, and how to persuade them of the value of your project.
• Involving service users and survivors as management committee members and how to build their confidence and train them for their new responsibilities, such as employing people and budget management.
• Forming effective working partnerships with professionals and statutory services - how to maintain the user-led focus and ensure the professionals don't take over.
• Working out boundaries between often complicated relationships between management committee members, staff, volunteers and service users.

In-patient units are not seen as particularly therapeutic and service users have long expressed their wish to have choices in the services offered to them, according to Toby Williamson, head of strategies for living at the MHF.

"Having these alternative services can avert more serious crises. This programme has shown that it is feasible to set up alternatives, they can work well and we would like to see more of them," he says.

- The Crisis Project Workbook can be downloaded free at www.mentalhealth.org.uk 

Background

Scheme: Crisis project workbook, produced by Mental Health Foundation.

Inspiration: To help mental health users and survivors set up community based mental health crisis services as an alternative to acute in-patient care.

Cost: Depends on the scale of the project, opening hours, number of staff and how many are professionally qualified. The cost of running the residential crisis house projects ranged between more than £100,000 to more than £600,000.