harm. there was anger and resentment toward a profession that had the authority to label them as mentally disabled and was perceived as infantilizing them and disregarding their wishes. 1980s and 1990s by the 1980s, individuals who considered themselves "consumers" of mental health services rather than passive "patients" had begun to organize self-help/advocacy groups and peer-run services. while sharing some of the goals of the earlier movement, consumer groups did not seek to abolish the traditional mental health system, which they believed was necessary. instead, they wanted to reform it and have more choice. consumer groups encouraged their members to learn as much as possible about the mental health system so that they could gain access to the best services and treatments available. in 1985, the national mental health consumers' association was formed in the united states. a 1986 report on developments in the united states noted that "there are now three national organizations ... the ‘conservatives’ have created the national mental health consumers' association ... the ‘moderates’ have formed the national alliance of mental patients ... the ‘radical’ group is called the network to abolish psychiatry". many, however, felt that they had survived the psychiatric system and its "treatments" and resented being called consumers. the national association of mental patients in the united states became the national association of psychiatric survivors. "phoenix rising: the voice of the psychiatrized" was published by ex-inmates (of psychiatric hospitals) in toronto from 1980 to 1990, known across canada for its antipsychiatry stance. in late 1988, leaders from several of the main national and grassroots psychiatric survivor groups decided an independent coalition was needed, and support coalition international (sci) was formed in 1988, later to become mindfreedom international. in addition, the world network of users and survivors of psychiatry (wnusp), was founded in 1991 as the world federation of psychiatric users (wfpu), an international organisation of recipients of mental health services. an emphasis on voluntary involvement in services is said to have presented problems to the movement since, especially in the wake of deinstitutionalization, community services were fragmented and many individuals in distressed states of mind were being put in prisons or re-institutionalized in community services, or became homeless, often distrusting and resisting any help. science journalist robert whitaker has concluded that patients rights groups have been speaking out against psychiatric abuses for decades - the torturous treatments, the loss of freedom and dignity, the misuse of seclusion and restraints, the neurological damage caused by drugs - but have been condemned and dismissed by the psychiatric establishment and others. recipients of mental health services demanded control over their own treatment and sought to influence the mental health system and society's views. the movement today in the united states, the number of mental health mutual support groups (msg), self-help organizations (sho) (run by and for mental health consumers and/or family members) and consumer-operated services (cos) was estimated in 2002 to be 7,467. in canada, csi's (consumer survivor initiatives) are the preferred term. "in 1991 ontario led the world in its formal recognition of csi's as part of the core services offered within the mental health sector when it began to formally fund csi's across the province. consumer survivor initiatives in ontario building an equitable future' (2009) pg 7. the movement may express a preference for the "survivor" label over the "consumer" label, with more than 60 percent of ex-patient groups reported to support anti-psychiatry beliefs and considering themselves to be "psychiatric survivors." there is some variation between the perspective on the consumer/survivor movement coming from psychiatry, anti-psychiatry or consumers/survivors themselves. the most common terms in germany are "psychiatrie-betroffene" (people afflicted by/confronted with psychiatry) and "psychiatrie-erfahrene" (people who have experienced psychiatry). sometimes the terms are considered as synonymous but sometimes the former emphasizes the violence and negative aspects of psychiatry. the german national association of (ex-)users and survivors of psychiatry is called the bundesverband psychiatrie-erfahrener (bpe). there are many grassroots self-help groups of consumers/survivors, local and national, all over the world, which are an important cornerstone of empowerment. a considerable obstacle to realizing more consumer/survivor alternatives is lack of funding. alternative consumer/survivor groups like the national empowerment center in the us which receive public funds but question orthodox psychiatric treatment, have often come under attack for receiving public funding and been subject to funding cuts. as well as advocacy and reform campaigns, the development of self-help and user/survivor controlled services is a central issue. the runaway-house in berlin, germany, is an example. run by the organisation for the protection from psychiatric violence, it is an antipsychiatric crisis centre for homeless survivors of psychiatry where the residents can live for a limited amount of time and where half the staff members are survivors of psychiatry themselves. in helsingborg, sweden, the hotel magnus stenbock is run by a user/survivor organization "rsmh" that gives users/survivors a possibility to live in their own apartments. it is financed by the swedish government and run entirely by users. voice of soul is a user/survivor organization in hungary. creative routes is a user/survivor organization in london, england, that among other support and advocacy activities puts on an annual "bonkersfest". wnusp is a consultant organization for the united nations. after a "long and difficult discussion", enusp and wnusp (european and world networks of users and survivors of psychiatry) decided to employ the term (ex-)users and survivors of psychiatry in order to include the identities of the different groups and positions represented in these international ngos. wnusp contributed to the development of the un's convention on the rights of persons with disabilities and produced a manual to help people use it entitled "implementation manual for the united nations convention on the rights of persons with disabilities", edited by myra kovary. enusp is consulted by the european union and world health organization. in 2007 at a conference held in dresden on "coercive treatment in psychiatry: a comprehensive review", the president and other leaders of the world psychiatric association met, following a formal request from the world health organization, with four representatives from leading consumer/survivor groups. the national coalition for mental health recovery (formerly known as national coalition for mental health consumer/survivor organizations) campaigns in the united states to ensure that consumer/survivors have a major voice in the development and implementation of health care, mental health, and social policies at the state and national levels, empowering people to recover and lead a full life in the community. the united states massachusetts-based freedom center provides and promotes alternative and holistic approaches and takes a stand for greater choice and options in treatments and care. the center and the new york-based icarus project (which does not self-identify as a consumer/survivor organization but has participants that identify as such) have published a harm reduction guide to coming off psychiatric drugs and were recently a featured charity in forbes business magazine. mad pride events, organized by loosely connected groups in at least seven countries including australia, south africa, the united states, canada, the united kingdom and ghana, draw thousands of participants. for some, the objective is to continue the destigmatization of mental illness. another wing rejects the need to treat mental afflictions with psychotropic drugs and seeks alternatives to the "care" of the medical establishment. many members of the movement say they are publicly discussing their own struggles to help those with similar conditions and to inform the general public. survivor david oaks, director of mindfreedom, hosted a monthly radio show and the freedom center initiated a weekly fm radio show now syndicated on the pacifica network, madness radio, hosted by freedom center co-founder will hall. a new international coalition of national consumer/user organizations was launched in canada in 2007, called interrelate. impact research into consumer/survivor initiatives (csis) suggests they can help with social support, empowerment, mental wellbeing, self-management and reduced service use, identity transformation and enhanced quality of life. however, studies have focused on the support and self-help aspects of csis, neglecting that many organizations locate the causes of members’ problems in political and social institutions and are involved in activities to address issues of social justice. a 2006 series of studies in canada compared individuals who participated in csis with those who did not. the two groups were comparable at baseline on a wide range of demographic variables, self-reported psychiatric diagnosis, service use, and outcome measures. after a year and a half, those who had participated in csis showed significant improvement in social support and quality of life (daily activities), less days of psychiatric hospitalization, and more were likely to have stayed in employment (paid or volunteer) and/or education. there was no significant difference on measures of community integration and personal empowerment, however. there were some limitations to the findings; although the active and nonactive groups did not differ significantly at baseline on measures of distress or hospitalization, the active group did have a higher mean score and there may have been a natural pattern of recovery over time for that group (regression to the mean). the authors noted that the apparent positive impacts of consumer-run organizations were achieved at a fraction of the cost of professional community programs. further qualitative studies indicated that csis can provide safe environments that are a positive, welcoming place to go; social arenas that provide opportunities to meet and talk with peers; an alternative worldview that provides opportunities for members to participate and contribute; and effective facilitators of community integration that provide opportunities to connect members to the community at large. system-level activism was perceived to result in changes in perceptions by the public and mental health professionals (about mental health or mental illness, the lived experience of consumer/survivors, the legitimacy of their opinions, and the perceived value of csis) and in concrete changes in service delivery practice, service planning, public policy, or funding allocations. the authors noted that the evidence indicated that the work benefits other consumers/survivors (present and future), other service providers, the general public, and communities. they also noted that there were various barriers to this, most notably lack of funding, and also that the range of views represented by the csis appeared less narrow and more nuanced and complex than previously, and that perhaps the consumer/survivor social movement is at a different place than it was 25 years ago. a significant theme that has emerged from consumer/survivor work, as well as from some psychiatrists and other mental health professionals, has been a recovery model which seeks to overturn therapeutic pessimism and to support sufferers to forge their own personal journey towards the life they want to live; some argue, however, that it has been used as a cover to blame people for not recovering or to cut public services. there has also been criticism of the movement. organized psychiatry often views radical consumerist groups as extremist, as having little scientific foundation and no defined leadership, as "continually trying to restrict the work of psychiatrists and care for the seriously mentally ill", and as promoting disinformation on the use of involuntary commitment, electroconvulsive therapy, stimulants and antidepressants among children, and neuroleptics among adults. however, opponents consistently argue that psychiatry is territorial and profit-driven and stigmatizes and undermines the self-determination of patients and ex-patients. the movement has also argued against social stigma or mentalism by wider society. people within in the us, led by figures such as psychiatrists e. fuller torrey and sally satel, and some leaders of the national alliance on mental illness, have lobbied against the funding of consumer/survivor groups that promote antipsychiatry views or promote social and experiential recovery rather than a biomedical model, or who protest against outpatient commitment. torrey has said the term "psychiatric survivor" used by ex-patients to describe themselves is just political correctness and has blamed them, along with civil rights lawyers, for the deaths of half a million people due to suicides and deaths on the street. his accusations have been described as inflammatory and completely unsubstantiated, however, and issues of self-determination and self-identity has been said to be more complex than that.