'We are the evidence'--consumers seek shift in research focus. (Special Report: Evidence-Based Practices).

For people who have been diagnosed with a serious mental illness, especially those within the consumer-survivor recovery movement, the term "evidence-based treatment" can inspire both hope and fear.

The hope is that the push toward practices with a scientific base will include the qualitative experiences of people who have moved beyond the limitations of their diagnosis. But the term also brings the fear that an emphasis on double-blind randomized clinical trials, the gold standard for scientific research, will dismiss individual experience as mere anecdote and will entrench mental health in a medical model.

Dan Fisher, M.D., Ph.D., a member of the President's New Freedom Commission on Mental Health, has urged his fellow commissioners to be sure that their recommendations on evidence-based treatment be supportive of consumer-based, self-help initiatives.

"It could go either way," he said. "It really depends on how evidence is defined."

Fisher is co-director of the National Empowerment Center, a consumer-survivor advocacy organization based in Lawrence, Mass., and a staff psychiatrist at Riverside Community Mental Health Center in Wakefield, Mass. He and his associates reject the notion that mental illness is a biological disorder, believing instead that it results from severe emotional distress and loss of social role.

Consumers and advocates need to be involved in defining what constitutes evidence in order to promote the services they find most relevant, Fisher said. For people who experience mental illness, restoring hope is far more critical to recovery than are dopamine and serotonin levels, he believes.

The question for those involved in peer-based initiatives is how to encourage innovation if what you're thinking of doing has to be proven first, said Steve Coe, executive director of the New York City-based Community Access Inc.