Structured shared decision making in mental health shows promise in supporting service user involvement in critical decision making and provides a process to open all treatment and service decisions to informed and respectful dialogue.

Objective: Small business is a favorably regarded institution in America. Given employment disparities among individuals with psychiatric disabilities compared to other workers, self-employment has potential to promote career development and community integration. However, little is known about what has helped or hindered current small business owners with psychiatric disabilities. This exploratory study identified characteristics of individuals' work and disability histories, as well as business characteristics, that can inform policy and practice development in support of disability-owned small businesses. Method: A nonprobability sample of 60 U.S. adults with a history of psychiatric disability who were self-employed in 2017 completed a web-based survey that asked about demographics, experiences of disability, motivations for self-employment, and business characteristics. Results: Most survey respondents were operating new, very small, unincorporated home-based service businesses on a part-time basis. Respondents were educated, typically with extensive work histories, but had experienced discrimination and unpleasant attitudes from coworkers and supervisors. Responses highlighted the importance of freedom and work-life balance. Conclusions and Implications for Practice: Self-employment is not necessarily a fit for everyone, but for individuals with psychiatric disabilities, it may be a pathway back to work. The size of the respondent businesses and the part-time nature of the work suggests that individuals with psychiatric disabilities are operating very small businesses that may serve as a wage employment alternative if they are able to grow in the future, or be sustained as a part-time adjunct to public benefits or other paid or unpaid work. Impact and ImplicationsSelf-employment is one strategy to improve employment and financial outcomes for individuals with psychiatric disabilities while also promoting community inclusion. This research is an important first step in exploring self-employment among people with psychiatric disabilities so that others can learn about how it works. It shows that some self-employed individuals with psychiatric disabilities are running very small businesses part time, supplementing their income. They have had negative experiences in the workplace and have chosen self-employment seeking freedom, flexibility, and work-life balance.

The extensive involvement of people with psychiatric histories in project design and implementation were important strategies that contributed to this study's success.

Objective: Intentional Peer Support (IPS) is a peer-developed, theoretically based, manualized approach that is used in multiple countries. This research aimed to develop and test a measure that can be administered to service users to provide quantitative data for assessing IPS core competencies (IPSCC) in outcomes research. Methods: Ten items based on IPSCC dimensions were developed and revised in an iterative process and administered in face-to-face interviews with 84 respondents. Internal consistency, test-retest reliability, and convergent validity were examined. Results: The IPSCC measure demonstrated good internal consistency (Cronbach's alpha of .85) and 2-week test-retest reliability (r = .98, p < .001), as well as satisfactory convergent validity. Conclusions and Implications for Practice: This study provides a foundation for future process-oriented research on IPS, and potentially other forms of peer support, to systematically document and appraise participant experiences. Impact and ImplicationsThis research study developed a measure to look at service users' experience of IPS. The IPSCC scale was found to address three underlying factors: Connection, Risk, and Communication. It had acceptable measurement properties commonly used in scale development, and the results fit with theories of peer support. It can also be used in research studies on other forms of peer support.

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