Using primary care-based mental health registers to reduce social exclusion in patients with severe mental illness

Are resilience and perceived stress related to social support and housing stability among homeless adults with mental illness?

Perceived stress has been associated with adverse health outcomes. Although people experiencing homelessness often report multiple acute and chronic stressors, research on resilience and perceived stress on the general homeless population is limited. This longitudinal study examined homeless adults with mental illness who were part of a 24-month trial of Housing First to explore: (a) changes in levels of resilience and perceived stress during the trial, and (b) the association between levels of resilience and perceived stress with measures of social support, social functioning and percentage of days stably housed over the study period. This longitudinal study (2009-2013) that used trial data included 575 participants in Toronto, Ontario. Of these individuals, 507 were included in this study. Connor-Davidson Resilience Scale and Perceived Stress Scales (PSS) measured the two outcomes, resilience and perceived stress. Time (baseline, 12 and 24 months), housing stability and three measures of social support and social functioning were the main predictors. A longitudinal analysis was done with repeated measures analysis of resilience and perceived stress using linear mixed models with random intercepts. Mean resilience scores increased (baseline: 5.1 [95% CI: 4.9, 5.2], 12 months: 5.5 [95% CI: 5.3, 5.7], 24 months: 5.6 [95% CI: 5.4, 5.8]), and PSS scores decreased (baseline: 22.3 [95% CI: 21.5, 23.0], 24 months: 18.6 [95% CI: 17.9, 19.4]). In the multivariable analyses, increased resilience was associated with higher scores on the three social support and social functioning measures, (estimates = 0.12, 0.04, 0.02) but not percentage days stably housed. Lower PSS scores were associated with higher scores on all three social support and social functioning measures (-0.20, -0.33, -0.21) and higher percentages of days stably housed (-0.015). Strong social support and social functioning may minimise the harmful effects of stressful life events on homeless individuals by increasing resilience and reducing stress. Interventions to help homeless people build appropriate support networks should be delivered in parallel to efforts that increase housing stability.

Concepts of social inclusion, exclusion and mental health: a review of the international literature

Social inclusion and exclusion are concepts which have been widely associated with politics and policy in the first decade of the 2000s. People with mental health problems have become the focus of a range of social inclusion initiatives. A literature review was conducted to explore the peer-reviewed evidence relating social inclusion/exclusion and mental health. In total 36 papers were included in the review from the UK, Canada, Australia and Scandinavia. The papers had used a range of different approaches to research and evaluation. The included papers associated being socially included to: social roles and responsibilities such as employment, participation in social activities, environmental work and voting. Although some papers engaged in a critical discussion of the concept, many offered only simplistic accounts or definitions. Social inclusion is such a widely used term within political and policy discourses that it is surprising so little research is available within the mental health realm. There was a lack of clarity related to the concept of social exclusion and the qualitative studies focused entirely on the experiences of being excluded within an institutional or semi-institutional setting. The relationship between exclusion, inequality and injustice is identified and the relevance of the concept to current and future mental health policy is questioned.

[The lived experience of stigma among mentally ill persons]

PURPOSE

The purpose of this study was to explore the subjective experiences of stigma among mentally ill persons.

METHODS

Phenomenological methodology was used for the study. Participants were twelve people with mental illness enrolled at the S community mental health center in GyeongGi-Do. Data were collected via in-depth interviews from August 30 to October 1, 2010 and analyzed using Colaizzi's framework.

RESULTS

Four themes and sixteen formulated meanings were identified for the stigma experiences of participants with mental illness. The four themes were 'Incapable of struggling against unfair treatment', 'Living as an outsider', 'Being constrained by oneself', 'Being in suspense over disclosure of oneself'.

CONCLUSION

The results from this study underscore the need for an educational and awareness programs to reduce public stigma among the general population and self-stigma among people with mental illness. In addition, efforts are also needed to prioritize mental illness stigma as a major public health issue at the government and community level.

For the Marginalized or for the Integrated? A Comparative Study of Addiction Treatment Systems in Sweden and the United States

This article compares the roles of two different addiction treatment systems, one in Stockholm county, surrounding the Swedish capital, and the other in a county in Northern California, in relation to marginalized and socially integrated misusers. It investigates: (a) whether the Swedish treatment system, as suspected, treats more marginalized clients than the American system, (b) where in the two systems those with stronger or weaker social ties show up, and (c) what kind of formal and informal pressures the socially marginalized and more integrated groups experience. The analyses are based on structured interviews with two representative samples of clients/patients entering different parts of the treatment systems (926 persons in the Californian county in 1995, 1,865 persons in Stockholm county 2000–2001). The Stockholm county treatment system has a much higher share of marginalized persons than the Californian, and a large proportion in California, almost one third, has both a job and a stable housing (15% in Stockholm). The Stockholm clients were considerably older. Drug use was connected with a marginalized position in both countries, and particularly so in Stockholm. The socially integrated in Stockholm stood out as the group with the highest share of alcohol-dependent persons, the highest Addiction Severity Index (ASI) alcohol scores, and the highest amount of heavy drinking. In both sites, the marginalized had more treatment experience and were more often found in inpatient treatment. There was a somewhat clearer social division in the U.S. system than in the Swedish. Some reasons for this are discussed, including the relation of the treatment system to other handling systems.

Social exclusion and mental health: conceptual and methodological review

BACKGROUND

The concept of social exclusion is now widely used in discussions about the nature of disadvantage, and there are ongoing initiatives to promote social inclusion among those with mental health problems.

AIMS

To conduct a conceptual and methodological review of social exclusion, focusing initially on the origins and definitions of the concept and then on approaches to its measurement, both in general and in relation to mental health.

METHOD

We used two main strategies. First, we utilised expertise within the study team to identify major texts and reviews on social exclusion and related topics. Second, we searched major bibliographic databases for literature on social exclusion and mental health. We adopted a non-quantitative approach to synthesising the findings.

RESULTS

There is no single accepted definition of social exclusion. However, most emphasise lack of participation in social activities as the core characteristic. There are a number of approaches to measuring social exclusion, including use of indicator lists and dimensions. In the mental health literature, social exclusion is poorly defined and measured.

CONCLUSIONS

If social exclusion is a useful concept for understanding the social experiences of those with mental health problems, there is an urgent need for more conceptual and methodological work.

Preliminary development and validation of an Australian community participation questionnaire: types of participation and associations with distress in a coastal community

Participating in the social and civic life of communities is protectively associated with the onset and course of physical and mental disorders, and is considered important in achieving health promotion goals. Despite its importance in health research, there is no systematically developed measure of community participation. Our aim was to undertake the preliminary development of a community participation questionnaire, including validating it against an external reference, general psychological distress. Participants were 963 randomly selected community members, aged 19-97, from coastal New South Wales, Australia, who completed an anonymous postal survey. There were 14 types of community participation, most of which were characterised by personal involvement, initiative and effort. Frequency of participation varied across types and between women and men. Based on multiple linear regression analyses, controlling for socio-demographic factors, nine types of participation were independently and significantly associated with general psychological distress. Unexpectedly, for two of these, "expressing opinions publicly" and "political protest", higher levels of participation were associated with higher levels of distress. The other seven were: contact with immediate household, extended family, friends, and neighbours; participating in organised community activities; taking an active interest in current affairs; and religious observance. We called these the "Big 7". Higher levels of participation in the Big 7 were associated with lower levels of distress. Participating in an increasing number of the Big 7 types of participation was strongly associated in linear fashion with decreasing distress.