Investigating the relationship between neighborhood experiences and psychiatric distress for individuals with serious mental illness

Public space as a potential resource during reentry for formerly incarcerated people with serious mental illnesses

BACKGROUND

Formerly incarcerated people with serious mental illnesses (SMI) are overrepresented in the criminal legal system. Professional-brokered "connecting" interventions are the predominant means for supporting community reentry, but they are vulnerable to the paucity of formalized services in areas of concentrated disadvantage. Public spaces offer unique opportunities for developing naturally occurring relationships and connecting to diverse forms of capital and resources.

METHODS

This qualitative study explored how 36 formerly incarcerated people with SMI navigated risks in public spaces, as they met the practical challenges of reentry while also examining the supportive resources and relationships they derive from spaces often perceived as risky.

RESULTS

Our findings indicated participants had dynamic and complex relationships to public spaces, including parks, coffee shops, and libraries and they used these spaces to create opportunities for solitude, socialization and resource acquisition. Spaces identified often featured: 1) activities and routines; 2) strong social infrastructure; and 3) opportunities for solitude and reflection.

IMPLICATIONS

These findings can inform future interventions that use dynamic public space features as resources during reentry from criminal legal settings for people with MI.

The relationship between social and environmental factors and symptom severity in the seriously mentally ill population

BACKGROUND

The goal of this article is to investigate the relationship of psychiatric symptom severity with internalised stigma, neighbourhood environment, and social support among individuals with serious mental illness.

METHOD

Using a longitudinal study design we examined the relationship between psychiatric symptom severity with internalised stigma, neighbourhood environment, and social support among 271 adults with serious mental illness recruited from new admissions to two urban mental health clinics.

RESULTS

After controlling for demographics increased stigma levels predicted greater symptom severity, as measured by the Positive and Negative Syndrome Scale (PANSS) Positive, Negative, and General Psychopathology scales over a 4-year period (p < .05). In adjusted models, individuals who reported living in more disadvantaged neighbourhoods also reported higher PANSS Negative and General scores over time (p < .05). Social support from friends and relatives was not significantly related to PANSS Positive, Negative, or General Psychopathology scores among individuals with serious mental illness.

CONCLUSIONS

Individuals with serious mental illness who experience internalised stigma and neighbourhood disadvantage experience greater symptom severity over time. Targeting stigma and housing during treatment could potentially impact symptom severity in this population.

Exploring factors related to supportive housing tenure and stability for people with serious mental illness

Overall, the retention of people with serious mental illness (SMI) in supportive housing is high. However, some supportive housing settings report average stays of only 15 months, and others report declines in housing retention over time. Many studies report variables associated with supportive housing stability and tenure, but there are few extensive, focused investigations on the subject. Hence, a literature review was conducted to investigate factors associated with supportive housing stability and tenure among people with SMI. The review of the included 28 papers reveals that the factors associated with supportive housing stability and tenure fell into two general categories of individual factors (including psychiatric factors and prior homelessness), and contextual factors (including program characteristics and sense of community and social support). In conclusion, further focus on contextual factors, as well as a potential reframing of individual factors as contextual, may be helpful in addressing issues related to supportive housing stability and tenure for people with SMI.

Les visions du rétablissement dans des services résidentiels en santé mentale d’une région québécoise

Objectif À la suite d’une réorganisation dans le secteur de l’hébergement en santé mentale dans une région québécoise, cette étude descriptive a évalué l’intégration des principes de rétablissement selon des utilisateurs de services (n = 25), des responsables de milieux d’hébergement (n=19) et des professionnels de la santé et de services sociaux (n = 30).

Méthode La version française du Recovery Self-Assessment a été remplie par tous. Les utilisateurs de services ont également rempli l’Échelle de satisfaction envers les domaines de la vie. Des questions qualitatives supplémentaires écrites ont été posées.

Résultats La plupart des utilisateurs de services étaient globalement satisfaits de leur résidence actuelle, mais ont noté que les options d’intervention et aborder les besoins sexuels pourraient être améliorés. Les intervenants considèrent qu’il y a une intégration significativement plus faible des différentes dimensions du rétablissement que les deux autres groupes (p < 0,001). Les trois groupes ont indiqué que les utilisateurs de services devraient être davantage impliqués dans la planification des services en résidence.

Conclusion L’intégration des points de vue a mis en lumière le besoin de travailler de façon collaborative pour soutenir le processus de rétablissement dans les milieux d’hébergement et impliquer davantage les personnes utilisatrices de services.

Getting Old Well in Sub Saharan Africa: Exploring the Social and Structural Drivers of Subjective Wellbeing among Elderly Men and Women in Uganda

While literature attempts to explain why self-reported subjective wellbeing (SWB) generally increases with age in most high-income countries based on a social determinants of a health framework, little work attempts to explain the low levels of self-report SWB among older persons in sub-Saharan Africa. Using the 2013 Uganda Study on Global Aging and Health with 470 individuals, this research examines (i) direct and indirect effects of age on SWB through social and structural determinants, and (ii) how direct and indirect effects vary by gender. Results show a significant direct and negative effect of age on SWB (β = 0.42, p = 0.01). Six indirect paths were statistically significant and their indirect effects on wellbeing varied by gender. Providing support, education, working status, asset level, financial status and financial improvement were significantly positively associated with men’s SWB, whereas younger age, providing community support, participating in group activities, number of close friends/relatives, government assistance and all socio-economic variables were significantly positively associated with women’s SWB. Strategies to address gendered economic, social and political inequalities among and between elderly populations are urgently needed.

Facilitating community connections among people with mental illnesses: Perspectives from grassroots community leaders

We conducted focus groups comprising 20 grassroots community leaders to identify social and structural elements that affect community engagement among people with serious mental illnesses. Community leaders not affiliated with mental health systems have been mostly left out of the discussions about inclusion and engagement, even though they possess unique information about the places where they live and can be essential partners in making community connections. The findings from the focus groups point to elements that both facilitate and inhibit connections, as well as roles community mental health practitioners may take on, to engage with community leaders and people with mental illness to minimize barriers and foster connections in community settings. Additionally, the focus groups elucidated the interplay between the right to be a member of one's community and a community's responsibility to create a welcoming environment. The current study garnered information regarding the broader needs and implications of community connections, as well as some specific suggestions to enhance community engagement among people with serious mental illness. Hesitation and stigma around engaging individuals with mental illnesses were identified as barriers to inclusion. Further study about how community leaders and groups may be involved in facilitating meaningful community connections is recommended.

Stranger support: How former prisoners with mental illnesses navigate the public landscape of reentry

BACKGROUND

Prisoners with mental illnesses (MI) are released from prison into environments where they are under-treated and under-supported by our criminal justice, social service, and health systems. Public space and interactions within those spaces have been shown to have positive effects in similar populations, including individuals with MI. This qualitative study explored the role different interactions play during the course of reentry. The study aimed to understand the more everyday relational dynamics that former prisoners with MI experience in public and private spaces.

METHODS

Semi-structured interviews on both experiences of public spaces and interactions within were conducted with 36 former prisoners with MI. Go-along interviews were conducted as a follow-up to these interviews with a subsample of 11 participants in order to identify and describe public spaces and interactions within those spaces. Phenomenological analysis was used to analyze data collected.

RESULTS

Participants described an array of supportive relationships with familiar strangers fostered in public spaces. Participants also described receiving stranger support from relationships typically associated with conventional and institutional supports. This form of "stranger support" was juxtaposed against the burdens and risks of reciprocal intimate relationships.

IMPLICATIONS

Public space and public space interactions can provide support streams to counterbalance the more complex support of intimate relationships. Providers might consider the utility of familiar strangers in helping clients to navigate these sometimes risky, but potentially fruitful spaces.

Housing and Support Narratives of People Experiencing Mental Health Issues: Making My Place, My Home

Background: Choice, control, privacy, and security are widely reported housing preferences of mental health consumers, are associated with improved well-being and greater housing satisfaction, and are important for recovery. This paper describes housing and neighborhood experiences from a larger qualitative study that sought to learn with people experiencing mental health issues about their everyday lives in an Australian urban community. Methods: A participatory approach to health research informed this study. A participatory reference group, including four people with consumer perspective knowledge and experience of mental health issues and four mental health practitioners with service provider and researcher perspectives, worked together to design and implement this study over a 4-year period. Thirty-nine participants were recruited, including 18 women and 21 men living in metropolitan Melbourne and receiving community mental health care for ongoing mental health issues related mainly to either psychotic or affective disorders. Participants each took part in one to three interviews or a focus group. The data were transcribed and analyzed using narrative and thematic analytic strategies, underpinned by reflective discussions with the participatory reference group. Findings: Participants' experiences of their housing and neighborhoods emphasized qualities that either contributed to or challenged their sense of being "at home." Identifying with a place as home was transformative, especially when supported by friendly neighborhood interactions, safety, and accessibility of local amenities. Unsatisfactory housing situations and limited income worked against participants' efforts to regain a sense of well-being and improve their situations. When being home was challenging, strategies used to counteract this included getting a pet and getting out as a means of resisting isolation at home. Differing views and ways of using the available support workers were described, suggesting tensions between seeking to be self-sufficient and valuing support. Conclusions: Social housing locations and housing-related support should explicitly attend to safety and security concerns. Collaborative care planning and outreach support should attend to supports for navigating issues with neighbors, housing, harnessing natural supports, and opportunities for being in others' company, as well as recognizing the importance of pets in people's lives. Understanding the strategies that mental health consumers find helpful in creating a sense of being at home, and the role of "place" in recovery merit further consideration in research and practice.

The influence of sense of community on the relationship between community participation and mental health for individuals with serious mental illnesses

The goal of the current study is to better understand the association between community participation and mental health by investigating sense of community as a potential mediating factor between community participation, psychological distress, and mental health functioning. A survey was administered to 300 adults with serious mental illnesses using community mental health services in the United States in a cross-sectional design. Hayes PROCESS macro (model 4, version 2.16; Hayes, 2013) was employed to test all of the hypotheses. Results indicate that sense of community partially mediated the association between community participation and psychological distress, as well as mental health functioning. Implications include contributing to the current knowledge base about the influence of community factors on mental health and informing future interventions aimed at promoting community participation of adults with serious mental illnesses.

The mediating effect of neighbor relationship between community social support and elderly's subjective well-being in China

This study aimed to investigate the relationship between community social support, neighbor relationship, and the subjective well-being of the elderly in China. Structural equation modeling was used to test the hypothesized model based on a sample of 2732 senior adults from 2010 Chinese General Social Survey. Results showed that community social support could indirectly affect the subjective well-being of the elderly through the complete mediating effect of neighbor relationship, although there was no significant correlation between community social support and the elderly's subjective well-being. Implications for theory, social work, and social policy were discussed.

Fragmented inclusion: Community participation and lesbian, gay, bisexual, trans, and queer people with diagnoses of schizophrenia and bipolar disorder

Community participation is often cited as a crucial component of wellness for people with mental health diagnoses. Few studies explore community participation from the perspective of lesbian, gay, bisexual, trans, and queer (LGBTQ) people with diagnoses of schizophrenia and bipolar disorder. This article describes an in-depth qualitative study with 16 LGBTQ people; 18 social service workers; and 2 key informants in Toronto, Ontario that examined access to communities for LGBTQ people with mental health diagnoses. Results indicate that community participation is particularly relevant to this group given the functions of communities for marginalized people as a source of support and resistance. However, the participants faced barriers to accessing support and creating social networks due to the lack of intersectional inclusion in various contexts, including LGBTQ communities and mental health/mad communities. (PsycINFO Database Record

"What's Wrong with the Seed?" A Comparative Examination of an Empowering Community-Centered Approach to Recovery in Community Mental Health

This cross-sectional group comparison aimed to examine whether personal empowerment, recovery and community integration were associated with the individual's participation in an empowering community-centered model of intervention. Ninety-three participants from an empowering community-centered community mental health organization were compared with a matched group of individuals from standard interventions of four equivalent organizations. Results showed that participants taking advantage of the empowering community-centered approach were more involved in high recovery-oriented programs; and attained higher levels of personal goals and hope, empowerment, and of community integration. An involvement in high recovery-oriented programs (supported employment or independent housing) revealed improved outcomes for the individual. In conclusion, the findings suggested a transformative impact of the empowering community-centered model both at the individual and the program level by altering the resource accessibility and social conditions for people who experience mental illness. The implications of findings for transforming community mental health practice are discussed in detail.

Canadian community mental health workers' perceived priorities for supportive housing services in northern and rural contexts

A relationship between mental health and supportive housing has been established, yet there exist enduring challenges in meeting the supportive housing needs of people with severe mental health problems. Furthermore, not all stakeholder viewpoints of supportive housing services are well documented in the research literature, and research has tended to focus on supportive housing provision in large, urban centres. Potentially, distinct challenges and opportunities associated with the provision of supportive housing services in smaller urban and rural communities that define the greater geographical terrain of Canada and other jurisdictions are less developed. This study describes community mental health service workers' priorities for supportive housing services. Using Q methodology, 39 statements about supportive housing services, developed from a mixed-methods parent study, were sorted by 58 service providers working in four communities in northern Ontario, Canada. Data used in this study were collected in 2010. Q analysis was used to identify correlations between service workers who held similar and different viewpoints concerning service priorities. The results yielded four discrete viewpoints about priorities for delivery of supportive housing services including: a functional system, service efficiency, individualised services and promotion of social inclusion. Common across these viewpoints was the need for concrete deliverables inclusive of financial supports and timely access to adequate housing. These findings have the potential to inform the development of housing policy in regions of low population density which address both system and individual variables.

Resident and proprietor perspectives on a recovery orientation in community-based housing

OBJECTIVE

Stable housing is a fundamental human right, and an important element for both mental health recovery and social inclusion among people with serious mental illness. This article reports findings from a study on the recovery orientation of structured congregate community housing services using the Recovery Self-Assessment Questionnaire (RSA) adapted for housing (O'Connell, Tondora, Croog, Evans, & Davidson, 2005).

METHODS

The RSA questionnaires were administered to 118 residents and housing providers from 112 congregate housing units located in Montreal, Canada.

RESULTS

Residents rated their homes as significantly less recovery-oriented than did proprietors, which is contrary to previous studies of clinical services or Assertive Community Treatment where RSA scores for service users were significantly higher than service provider scores. Findings for both groups suggest the need for improvement on 5 of 6 RSA factors. While proprietors favored recovery training and education, and valued resident opinion and experience, vestiges of a traditional medical model governing this housing emerged in other findings, as in agreement between the 2 groups that residents have little choice in case management, or in the belief among proprietors that residents are unable to manage their symptoms.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

This study demonstrates that the RSA adapted for housing is a useful tool for creating recovery profiles of housing services. The findings provide practical guidance on how to promote a recovery orientation in structured community housing, as well as a novel approach for reaching a common understanding of what this entails among stakeholders. (PsycINFO Database Record