Say you are depressed. Or struggling with addiction. You call one of those 800 numbers for a referral to a good therapist. The voice on the other end of the line asks the name of your insurer.

No insurance means no doctor. No doctor means no treatment. No treatment means you may die. Welcome to the world of corporate medicine.

You have two choices. Call Jack Kevorkian or move to a world of cooperative medicine. The Center for a Healthy World (CHW), a training, therapy and service cooperative, is run by Dr. Dori Middleman out of her home in Merion, PA. Like the networks operated by hospitals such as Thomas Jefferson, CHW is a referral system. However, unlike others, CHW's network of professionals takes no money from its patients. CHW refers patients to volunteer professionals specializing in counseling, psychotherapy and body work. Clients, in turn, volunteer with a charitable organization of their own choice. Middleman says there is no financial limitation to participating in the network, though CHW is designed to provide health care to those who otherwise could not afford it.

Middleman, a psychiatrist, says the center's philosophy is inspired by what she calls "a concept of giving." Its mission is two-fold: To offer clients free, high-quality care, and the gratification of giving service to others through volunteer work. And to offer therapists free quality training and supervision, involvement in a network of like-minded professionals, and the gratification of giving service and watching that service grow through their clients' payment in volunteer work.

"I come from a family that is very service oriented, interested in their community, and in helping people. I do that in my work for money, but I wanted to facilitate helping people without dealing with the insurance companies," says Middleman.

Middleman initially created the center in 1994. The idea, she says, was simple. Treat people with a variety of mental health needs, and require payment not in dollars, but in service hours. For each hour of therapeutic care, patients volunteer two hours with a charitable organization of their choice. Thus, as CHW's brochure says: "CHW is a pyramid of people giving service, and each volunteer is a center for the generation of a healthy world."

Middleman prefers that CHW be sustained by those directly involved with the network, not foundations, public funding or insurers. With the center operating out of Middleman's home, overhead expenses are low and incidental costs like postage and office supplies are paid out-of-pocket. With no funding source, CHW operates without a budget, a staff or any exchange of money, depending on the service given by volunteer therapists and other health professionals. Cynthia Brooks of Endow-A-Home (EAH), a city nonprofit which places homeless female-headed families into permanent housing while providing counseling and life skills education, says that the CHW volunteers have provided an "excellent experience" for her clients. Almost all of EAH's clients are survivors of sexual assault or domestic violence, and 85 percent are in recovery from drug addiction.

Brooks says that her organization was in desperate need for services targeted for pre-school and elementary-aged children, but since 90 percent of her budget goes directly to the purchase of homes, hiring professional therapists was out of the question. CHW held an arts and crafts camp for homeless children run by its volunteer counselors. While children played games and socialized, child counseling specialists watched for signs of mental illness.

"In summary, it was a fantastic success. Kids we didn't know needed help got care," says Brooks, adding that her organization also needed therapeutic help for the children's mothers. "Matching a therapist with a mother and having them volunteer their services with others was an excellent experience," Brooks says.

Pattie Hillkirk also offers unqualified praise for CHW. Hillkirk, who runs Camp Dream Catcher for children who either have HIV/AIDS themselves or have a family member who does, says that the staffers for the one-week camp were unique in that they had medical expertise that other volunteers often lack, and provided quality service for free that couldn't be matched.

"The Center for a Healthy World offers people who don't have the resources for therapy a tremendous opportunity to get together with providers. The whole feeling behind the center is one of giving, and clients feel really good about giving service in return," she says.

Since, as Middleman puts it, "CHW does not exist as a clinic," clients come from all over the Philadelphia region and are linked with therapists and charities in their own communities.

Initially the center's client and volunteer base has stemmed from the suburbs, but in recent months more Philadelphians have become involved. Currently, CHW has 75 patients and a network of 75 therapists. Middleman says she does not know how many people and organizations have benefited from CHW over the three years it has been operating, but she has received inquiries from healthcare professionals in other states seeking to use CHW as a model locally. Expect to see similar models become more common as government funds for health care shrink.

Hillkirk, a therapist, says both her camp and Middleman's CHW came about from the women seeing that poor people's needs were not being met by traditional healthcare providers.

"Health insurance companies restrict people without money from getting the care they need. Both the camp and CHW come from the same thing—seeing a need in the community and doing something about it," says Hillkirk.