Social networks and psychological disability among housed and homeless users of self-help agencies

Social networks and subjective wellbeing of adults in a Housing First program

This study explored the social network properties and the correlates between social networks and subjective wellbeing of adults (N = 80) in a Housing First (HF) program. Using structured interviews, participants' social network properties were assessed. Bivariate correlations and backward multiple regression analyses were conducted to determine the association between social networks and subjective wellbeing. Findings indicate a combination of years of homelessness, years in housing, frequency of contact, intimate relationship, and perceived social support significantly predicted subjective wellbeing (F (5, 74) = 2.74, p = 0.025). While perceived social support was positively associated with subjective wellbeing, frequency of contact was negatively associated with subjective wellbeing. It is recommended that service providers develop strengths-focused perspectives of the social networks of HF residents as potential contributors to subjective wellbeing. Service providers may need to pay more attention to HF residents with frequent contacts with network members, as they may have more distress.

Mental health consumer concept mapping of supportive community

This research engaged consumers with severe and persistent mental illness receiving services in the public mental health sector in creating a comprehensive list of 110 needed community services and supports, then individually sorting and rating these items. Within the resulting concept map generated by Concept System software and as interpreted by the study participants, successfully living in the community is actualized when there is an outer layer of support regarding basic needs; financial means; individualized, comprehensive and available services; competent and caring staff; community education; legal rights enforcement; and social change directed at dismantling the discrimination and stigma associated with mental illness. Peer support and services is critical component, providing a transformational space from basic survival into recovery, supporting personal development and skills building and further social development. This study demonstrates that adult public mental health consumers actively receiving services can engage in collaborative research in meaningfully determining what their needs are, conceptualizing what the services should be and how developed, and articulating service prioritization.

A little goes a long way: the impact of distal social support on community integration and recovery of individuals with psychiatric disabilities

Although an extensive body of literature highlights the important role of social support for individuals with psychiatric disabilities, definitions of support tend to be restricted-focusing on intimate relationships such as friend and family networks and ignoring the role of casual relationships existing naturally in the community. This mixed-methods study of 300 consumers of mental health services in the Southeastern US aims to better understand the impact of community supports, termed distal supports, on community integration and recovery from mental illness. Qualitative content analysis, tests of group mean differences, and hierarchical linear regression analyses revealed the following: (1) participants primarily reported receiving tangible support (e.g., free medication/discounted goods) from distal supports rather than emotional support (e.g., displays of warmth/affection) or informational support (e.g., provision of advice); (2) women and older participants reported more distal supports than men or younger participants; and (3) distal supports played a unique role in predicting community integration and recovery even after accounting for the influence of traditional support networks. Results highlight the importance of considering diverse types of social support in naturally occurring settings when designing treatment plans and interventions aimed at encouraging community participation and adaptive functioning for individuals with psychiatric disabilities.

Individual characteristics of the literally homeless, marginally housed, and impoverished in a US substance abuse treatment-seeking sample

BACKGROUND

Many researchers and clinicians believe that understanding substance use problems is key to understanding homelessness. This study's purpose was to test, in a national sample of urban substance abuse treatment seekers, whether (1) income was related to amount of money spent on substances and (2) homeless chronic substance users had more severe psychosocial problems or histories than housed chronic substance users.

METHOD

Questions assessing homelessness were inserted into the Drug Evaluation Network System-a computer-assisted intake interview (including the Addiction Severity Index) implemented in addiction treatment programs across the U.S. Based on these data, clients were divided into four residential groups: literally homeless (n = 654), marginally housed (n = 1138), housed poor (n = 3119), and housed not poor (n = 718). Income, human capital (education level and acquisition of a trade/skill), substance use, mental health, and social support were examined.

RESULTS

The literally homeless was not the poorest group, although these clients did spend the most money on substances. All four groups' incomes were positively related to amount of money spent on drugs, but only the marginally housed's income was related to money spent on alcohol. The literally homeless had the most severe alcohol, mental health, and social support problems. The literally homeless and marginally housed had similar incomes and human capital and the most severe cocaine problems. In general the housed poor and housed not poor fared better than the literally homeless and marginally housed groups.

DISCUSSION

Practitioners should continue to intervene with the homeless and consider working with the marginally housed's social support systems. Future research should examine the marginally housed as an at-risk group for homelessness.

Community Membership and Social Networks in Mental Health Self-Help Agencies

This article explores community membership among self-help agency (SHA) participants. It is suggested that SHAs foster the enhancement of peer-oriented social networks, leading to the experience of shared community. Social network analysis was used to examine the structure of support mechanisms, and to assess levels of community membership through peer inclusion. Results indicate that both individual and organizational characteristics play roles in predicting peer presence in social networks. Organizational empowerment is a key factor, with the SHA emerging as a promising locus for peer support development through enhanced social networks. Implications for the organization of consumer-based services are discussed.

Substance use and mental disorder diagnostic profiles in a sample of long-term self-help agency users

This study examined the prevalence of substance use and mental disorder profiles in a sample of mental health self-help attendees. Findings demonstrate that the rates of these disorders are equivalent to or exceed those found in clinical and community samples. Implications for the role that self-help agencies play in the lives of vulnerable individuals, as well as the justification for increased funding from drug and alcohol treatment sources, are discussed.

Determinants of client outcomes in self-help agencies

OBJECTIVE

This study assessed the relationship between the outcomes of clients of client-run self-help agencies and attendance at the agency, satisfaction with the agency, psychological disability, and organizationally mediated empowerment, that is, the provision of opportunities for clients to meaningfully participate in decisions about their care and the care of others in the agency. The outcomes assessed were independent social functioning, assisted social functioning, and personal empowerment.

METHODS

A total of 255 long-term users of four self-help agencies were interviewed at baseline and six months later. Univariate descriptive analyses as well as t tests describing changes in outcomes were conducted. The relationship of each of the four determinants to the three outcomes, after controlling for baseline status on the given outcome and other covariates, was assessed with structural modeling using Amos software.

RESULTS

On average, personal empowerment among the clients of the self-help agencies increased, independent social functioning remained the same, and assisted social functioning decreased during the six-month follow-up period. Multivariate analyses showed a positive association between organizationally mediated empowerment and all three outcomes.

CONCLUSIONS

The significant ingredient promoting positive outcomes for clients of self-help agencies appears to be the provision of opportunities for clients to meaningfully participate in decisions about their care and the care of others in the organization.

Measuring clients' satisfaction with self-help agencies

OBJECTIVE

Clients' satisfaction with their involvement in treatment decisions has been largely overlooked in the formulation of satisfaction measures. The authors describe the development of a scale that assesses clients' satisfaction with services and with their involvement in treatment decisions.

METHODS

Long-term users of four client-operated mental health self-help agencies were interviewed at baseline (N=310) and six months (N=248) using the 11-item Self-Help Agency Satisfaction Scale (SHASS). The scale was developed on the basis of consumers' input about their satisfaction with services and their involvement in treatment decisions. To explore the relationship between satisfaction as measured by the SHASS and outcomes, the six-month interview included four outcome measures-independent and assisted social functioning, symptom severity, and a sense of personal empowerment. Internal consistency, stability, and discriminant validity were evaluated.

RESULTS

Factor analyses confirmed that the SHASS has two subscales, one assessing service satisfaction and the other assessing satisfaction with involvement in treatment decisions. The scale and its subscales showed high internal consistency, moderate stability, and discriminant validity. The SHASS subscales showed modest associations with two of four outcome measures-assisted and independent social functioning.

CONCLUSIONS

The SHASS is a brief instrument that can be used to measure clients' satisfaction with their involvement in treatment in mental health self-help agencies.