"It's the day-to-day living that matters": the meaning and process of community in the lives of a couple with significant psychiatric disabilities

Exploring the Role of Social Support in Promoting Community Integration: An Integrated Literature Review

Community integration has emerged as a priority area among mental health advocates, policy makers, and researchers (Townley, Miller, & Kloos, 2013; Ware, Hopper, Tugenberg, Dickey, & Fisher, 2007). Past research suggests that social support influences community integration for individuals with serious mental illnesses (Davidson, Haglund, Stayner, Rakfeldt, Chinman, & Tebes, 2001; Davidson, Stayner, Nickou, Styron, Rowe, & Chinman, 2001; Wong & Solomon, 2002), but there has not yet been a systematic review on this topic. Therefore, the purpose of this paper was to explore the influence of social support on community integration through a review of the existing literature. An extensive literature search was conducted, resulting in 32 articles that met the search criteria. These articles were organized into three categories: defining community integration, supportive relationships, and mental health services. The search results are analyzed according to the types of support being provided. Article strengths, limitations, implications, and future directions are also addressed. Overall, the findings of this review suggest that social support, which may be provided by a variety of individuals and services, plays an important role in promoting community integration for individuals with serious mental illnesses. Therefore, as community mental health research and practice continues to promote community integration for individuals with serious mental illnesses, the mental health field should emphasize the importance of social support as a key factor influencing community integration.

Understanding perceptions of community participation in persons with severe mental illness: A mixed-methods approach

OBJECTIVES

This study aims to measure community participation in persons with severe mental illness (SMI) in Toronto, Ontario and outlines a methodological approach for understanding the dimensions of community participation.

METHODS

A mixed methods approach was used to define activity spaces through participatory mapping and a qualitative survey interview for participants (N = 31), selected through a stratified purposeful sampling strategy. Five neighbourhoods in Toronto were sampled in an attempt to obtain an ethnically diverse sample. Participants were interviewed over the study period and asked to draw maps indicating places that constituted their community. A qualitative interview was also administered to understand participants' perceptions of their communities. Point locations from the mapping exercise were used to measure and construct activity spaces using a mean circle approach; outlying locations were simultaneously recorded. Observed spatial patterns were then analyzed alongside the findings of the qualitative interviews.

RESULTS

There were no observed relationships between the number of locations reported by participants and the resultant activity space or outlier count. There were no quantitative relationships between activity space size and perceptions of community by participants. However, qualitative data revealed that a number of underlying factors (mental health status and associated stigma; relationships with friends and family; cultural background; income; and neighbourhood safety) influenced participants' activity spaces.

CONCLUSIONS

These results highlight the ways that community participation is influenced by an interplay of determinants, all of which have implications for service delivery and population-level interventions. They also point to the importance of mixed methods approaches in spatial analysis.

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.

Experiencing community: perspectives of individuals diagnosed as having serious mental illness

OBJECTIVE

Community integration is recognized as a crucial component of recovery from serious mental illness. Although the construct of community integration can be measured with structured instruments, little is known about the subjective and experiential meaning of community and community involvement for persons with serious mental illness.

METHODS

In 2010, 30 individuals with serious mental illness treated in two public mental health clinics completed semistructured interviews that elicited the places and people that they associate with the experience of community and the larger meaning of community in their lives.

RESULTS

Participants described four experiences as integral to their concepts of community: receiving help, minimizing risk, avoiding stigma, and giving back. Participants looked for communities that provide reliable support, and they described the need to manage community contact in order to protect themselves and others from their symptoms and from discrimination. Most participants experienced communities centered on mental health treatment or mentally ill peers as providing opportunities for positive engagement.

CONCLUSIONS

The experience of having a serious mental illness shapes preferences for and perceptions of community in pervasive ways. Participants described community involvement not as a means to move away from illness experiences and identities but as a process that is substantially influenced by them. Mental health communities may help individuals with serious mental illness to both manage their illness and recognize and enjoy a sense of community. The findings indicate the need for further research on the relationship between community integration and outcome in serious mental illness.

Community contexts of human welfare

This chapter identifies "context minimization error" as the tendency to ignore the impact of enduring neighborhood and community contexts on human behavior. The error has adverse consequences for understanding psychological processes and efforts at social change. The chapter describes a series of theoretical models of how neighborhoods and community settings are associated with various aspects of human welfare and reviews evidence of associations of contexts with health, psychological distress, risky behaviors, psychological attitudes, and child development. It suggests that many psychological processes may play out differently in different contexts and that contextual factors interact with sociocultural characteristics of individuals in predicting outcomes. People, in turn, can shape community contexts. A more sophisticated understanding of the effects of contexts depends on more sophisticated approaches to assessing them.