A Social Ecological Approach to Investigating Relationships Between Housing and Adaptive Functioning for Persons with Serious Mental Illness

This paper seeks to advance mental health—housing research regarding which factors of housing and neighborhood environments are critical for adaptive functioning, health, and recovery for persons with serious mental illness (SMI). Housing and neighborhood environments are particularly important for persons with SMI because of the prevalence of poor housing conditions among this population. Most mental health—housing research has been limited by a focus on problems in environments and functioning. The paper seeks to expand the mental health—housing research agenda to consider protective factors that promote community integration and adaptive functioning. We provide an account of how social ecology theory transformed a research program, from examining individual risk factors to investigating the functioning of persons in the contexts of their housing and neighborhood experiences. The resulting housing environment framework—physical aspects of housing and neighborhoods, social environment of neighborhoods, and interpersonal relationships tied to housing—allows for identification of opportunities for health promotion and facilitation of participation in community-based settings. This program of research draws upon several methods to understand the social experience of persons with SMI living in community settings—survey research, qualitative interviews, Geographic Information Systems, participatory research, and visual ethnography. In this paper, we present how social ecology theory was instrumental in the development of new housing environment measures, the selection of appropriate research methods, and framing research questions that are building a new empirical base of knowledge about promoting adaptive functioning, health, and recovery for persons with SMI living in community settings.     

Occupationally Embedded Exercise Versus Rote Exercise and Psychosocial Response in College-Aged Females

Community integration through occupational engagement is an integral tenet of occupational therapy. However, little is known about how pets may assist this process. This study explores community integration through pet ownership as a meaningful, lifelong, occupation for one person with bipolar illness receiving Assertive Community Treatment. Using a case study approach, eight qualitative interviews, as well as observation and analysis of pet photos, were conducted with the mental health consumer and also with members of her social network. Data were analyzed inductively according to the constant comparative approach. The findings reveal that pet ownership assisted the person to counterbalance and move beyond stigma through pets as enablers of: “continuity,” “belonging,” “action and self-construction,” “acceptance,” and “participation.” This process was influenced by the “severity of illness,” “view of community,” and “supports and resources.” The results contribute to our understanding of pet ownership as a means to community integration. The study indicates that to enable persons with a mental illness to engage in pet ownership, occupational scientists need to examine and understand this occupation in the broader context of recovery, health, and well-being. A perspective of pet ownership as meaningful occupation challenges occupational therapists to develop strategies to actively engage clients and their pets in their community.     

Poverty and Serious Mental Illness: Toward Action on a Seemingly Intractable Problem

This paper examines the issue of poverty among people with serious mental illness (SMI), positioning it as a key issue to be confronted by community mental health systems and practitioners. The paper reviews three perspectives on poverty, considering how each sheds light on poverty among people with SMI, and their implications for action: (a) monetary resources, (b) basic needs, and (c) capabilities. The paper argues that community mental health programs and systems are currently unable to address poverty as they are overly focused on individual‐level interventions that, on their own, cannot raise people out of poverty. The paper calls for a social justice value, informed by the concept of citizenship, as a necessary complement to the recovery concept that has informed community mental health practice for almost 25 years. Finally, the paper argues that community psychologists, with their concepts, methods, and values, are well positioned to contribute to this important issue. However, it also contends that addressing poverty requires collaboration from community psychologists with researchers and practitioners from other fields and domains of expertise to begin to make progress.     

Rehabilitative Beit Midrash as a means for advancing the community integration of Ultra Orthodox Jewish persons with severe mental illness

ABSTRACT

Religious Jews with severe mental illness often encounter barriers to involvement in religious activities in their community affecting their ability to become integrated into their community. Therefore, a study was conducted in Israel examining the contribution to community integration through a programme providing religious persons with mental illness an opportunity to participate in religious studies. An A-B research design was implemented among 42 Ultra-Orthodox Jewish persons with severe mental illness utilising a culturally-oriented structured instrument. The study showed that the opportunity for involvement in religious studies could advance the participants’ sense of social interaction in their community as well as their sense of psychological integration with other religious people. It also strengthened their confidence in their ability to further get involved in religious studies in the community. Rehabilitation services providing persons with severe mental illness an opportunity for involvement in religious studies can act as a springboard for advancing their community integration.     

Negative consequences of community group participation for women's mental health and well‐being: Implications for gender aware social capital building

Participation in community groups is argued to be an important way to create health‐promoting social capital. However, relatively little attention has been paid to the ways in which gender affects the health promotion potential of participation. This paper reports on a qualitative study of women's experiences of participation in a diverse range of community groups, and considers how such involvement can potentially have a negative impact upon mental well‐being. In‐depth interviews were conducted with 30 women in Adelaide, South Australia. Women's accounts of their group involvement reflected that their identities as mothers were particularly important in shaping their participation. Some women reported difficulties in combining group involvement with their family responsibilities. Stress attached to negotiating social interaction within groups was also raised as an issue. It was found that participation can reinforce gender inequality and potentially have severe negative consequences for mental health, issues that need to be considered alongside the potential health benefits. The findings are considered in light of Bourdieu's critical conceptualization of social capital. Copyright © 2008 John Wiley & Sons, Ltd.     

Understanding community re-entry of former prisoners with mental illness: a conceptual model to guide new research

Criminal justice, mental health, and social service professionals face a myriad of role expectations in working with prisoners with mental illness to facilitate community re-entry. These expectations include those related to law enforcement, social welfare, and administrative efficiency. The challenge for front line workers and the multiple systems that employ them is to integrate all these expectations effectively on behalf of the individual as well as the community. Current models of re-entry for individuals leaving prison with mental illness focus on the management and interaction of service systems. This paper presents a model of prisoner re-entry that incorporates a larger social context, illustrating dynamics related to both individuals with mental illness leaving prison and their interaction with the community setting. This model was generated through an interdisciplinary team effort. It was refined through a focus group process that included advocates, community members and other informants from mental health and criminal justice systems in five states. The model is designed to generate new questions for research that address both individual and community level issues.     

社区矫正人员的心理需求理论——基于扎根理论

目的：探究社区矫正人员心理需求理论。方法：运用扎根理论,在文献查阅和田野调查的基础上编写访谈稿,抽取20人访谈,将访谈稿转录后筛出15份,运用Nvivo11软件分析。结果：社区矫正人员的心理需求包括三大类属：接纳现实,维护自我形象,恢复和重建;三大需求具有心理过程上的阶段性,并在回归社会和心理健康水平上有递进关系;针对社区矫正人员、其家人、社区矫正工作人员、社区矫正心理工作者,提出“明白事、接纳人、好发展”的建议。结论：初步得出有中国特色的社矫人员心理需求理论。     

Who talks? The social psychology of illness support groups

More Americans try to change their health behaviors through self-help than through all other forms of professionally designed programs. Mutual support groups, involving little or no cost to participants, have a powerful effect on mental and physical health, yet little is known about patterns of support group participation in health care. What kinds of illness experiences prompt patients to seek each other's company? In an effort to observe social comparison processes with real-world relevance, support group participation was measured for 20 disease categories in 4 metropolitan areas (New York, Chicago, Los Angeles, and Dallas) and on 2 on-line forums. Support seeking was highest for diseases viewed as stigmatizing (e.g., AIDS, alcoholism, breast and prostate cancer) and was lowest for less embarrassing but equally devastating disorders, such as heart disease. The authors discuss implications for social comparison theory and its applications in health care.     

Addressing the Challenge of Community Reentry Among Released Inmates with Serious Mental Illness

The purpose of the paper is to discuss the formidable challenges to community reentry and reintegration faced by U.S. prison inmates with serious mental illness and to describe various strategies for improving transitional services for these individuals. We review epidemiologic data supporting the high prevalence of severe mental illness in U.S. prisons as well as the historical factors underlying the criminalization of the mentally ill. The importance and challenges of providing adequate psychiatric care for mentally ill prisoners during their incarceration are discussed. We also review the numerous psychosocial and economic challenges confronting these individuals upon their release from prison, such as unemployment and vulnerability to homelessness, as well as specific barriers they may encounter in attempting to access community-based mental health services. We follow with a discussion of some of the more promising strategies for improving the transition of the mentally ill from prison to the community. In the final sections, we review the evidence for a relationship between serious mental illness and recidivism and briefly discuss emerging alternatives to incarceration of the mentally ill.     

Dialectical behavior therapy group skills training in a community mental health setting: a pilot study

Effective and affordable therapies are needed for treating people with severe and persistent mental illness in a community mental health setting. In this pilot study, we evaluated the effectiveness of a modified dialectical behavior therapy (DBT) protocol for improving symptoms and functioning in a cohort of persons with severe and persistent mental illness. We provided six months of weekly DBT skills training in a group setting. Depression symptoms decreased significantly after treatment. There was a wide range of number of sessions attended, with a minority of the participants completing the full course of treatment. Increased attendance was correlated with improvements in depression symptoms, overall symptoms, quality of life, and community functioning. The study findings suggest that the group skills training component of DBT can be successfully implemented in a community mental health center and that further research to determine its efficacy in comparison to other treatments is warranted.     

Adapting to Context in Community-Based Participatory Research: “Participatory Starting Points” in a Chinese Immigrant Worker Community

Community-based participatory research (CBPR) is increasingly being used to better understand and improve the health of diverse communities. A key strength of this research orientation is its adaptability to community contexts and characteristics. To date, however, few studies explicitly discuss adaptations made to CBPR principles and processes in response to community context and partners’ needs. Using data from our CBPR study, the San Francisco Chinatown Restaurant Worker Health and Safety Project, and drawing from literature on immigrant political incorporation, we examine the links between the contexts of the Chinese immigrant worker community, adaptations made by our collaborative, and study outcomes. In particular, we explore the concepts of contexts of reception and participatory starting points, which may be especially relevant for partnerships with immigrant communities whose members have historically had lower rates of civic and political participation in the US. We discuss contextual findings such as worker partner accounts of language barriers, economic and social marginalization, and civic skills and participation, as well as subsequent adaptations made by the partnership. We also describe the relative effectiveness of these adaptations in yielding equitable participation and building partners’ capacity. We conclude by sharing lessons learned and their implications for CBPR and partnerships with immigrant communities more broadly.     

Dialectical Behavior Therapy Group Skills Training in a Community Mental Health Setting: A Pilot Study

Abstract

Effective and affordable therapies are needed for treating people with severe and persistent mental illness in a community mental health setting. In this pilot study, we evaluated the effectiveness of a modified dialectical behavior therapy (DBT) protocol for improving symptoms and functioning in a cohort of persons with severe and persistent mental illness. We provided six months of weekly DBT skills training in a group setting. Depression symptoms decreased significantly after treatment. There was a wide range of number of sessions attended, with a minority of the participants completing the full course of treatment. Increased attendance was correlated with improvements in depression symptoms, overall symptoms, quality of life, and community functioning. The study findings suggest that the group skills training component of DBT can be successfully implemented in a community mental health center and that further research to determine its efficacy in comparison to other treatments is warranted.     

Mental health needs of the chronically mentally ill elderly

The treatment histories and current social, financial, and clinical status of 111 chronically mentally ill (CMI) persons over the age of 60 were examined. Information was obtained from Ss, family, mental health records, and mental health professionals familiar with Ss. Psychiatric symptoms were observed in 74% of Ss. Many Ss experienced long periods without acute episodes of illness. Recurring episodes eventually appeared in most Ss, however, and ongoing deficits in daily functioning and social contacts were prototypical. Two thirds of the Ss were living in the community, relying heavily on family contacts; the rest lived primarily in nursing homes (23.4%) or psychiatric hospitals (7.2%). Social support was the best predictor of level of functioning. Findings suggest that failure of CMI elderly to use mental health services is not due to lack of need. Mental health services currently do not appear to be meeting the needs of this population.     

Community-based services and resources: The significance of choice and diversity

Conclusions We are reminded by the growth of consumer-run approaches of the value of diversity and individual choice in community support of persons with severe mental illness. These ideas are evident in the alternative approaches that have been developed to serve persons who have not been reached by more traditional services. The ACT program, described by Bond et al. (1990), is an example of a service approach designed to be responsive to individuals' day-to-day needs as they define them. Continued development of this type of alternative service should be encouraged.Persons coping with severe mental illness benefit from a variety of community supports and resources. Strategies that encourage consumer involvement, ownership, and control help to provide diversity of services and to empower the consumer. Our efforts, as professionals, to provide community services can be enhanced by (a) supporting diversity of service and resource options, both inside and outside of the professional mental health system; (b) developing services that are responsive to individuals needs as they define them; and (c) facilitating the process of consumer choice in selecting resources options.The author expresses thanks to Marc A. Zimmerman and Richard H. Price for comments on earlier drafts of this paper.     

Developing Roles and Skills in Community-Living Adults With Severe and Persistent Mental Illness

People with severe and persistent mental illness often experience a disruption in the development of social roles, and the skills within these roles. Role Development, a set of guidelines for practice, is an intervention to develop roles and skills. The purpose of this study was to continue to examine the efficacy of this intervention. Ten people attending two community mental health programs participated in evaluation and treatment based on Role Development. Quantitative pretest and posttest measures were used. Qualitative components were incorporated to get a sense of the experience involved in developing roles and skills. Quantitative results indicated statistical significance (p < .05) in the development of roles and skills. Qualitative data revealed multiple trends experienced by the participants. This study contributes to the evidenced-based knowledge regarding development of roles and skills for persons living with severe and persistent mental illness.     

Counseling Transgendered,Transsexual, and Gender‐Variant Clients

The emergent consciousness and political activism within the transgender community has important implications for the field of counseling. In the current paradigm, the focus has shifted from using surgical and hormonal interventions and thereby enabling transgendered persons to “pass” within the traditional gender binary of society to affirming the unique identities of transgendered persons. To prepare counselors, counselor educators, and counseling supervisors for this important challenge, the authors describe the evolving nature of the transgender community, discuss mental health issues and counseling interventions for use with transgendered clients, and present a case study detailing the progression of counseling with 1 transgendered client.     

Participatory Action Research

Abstract

Traditionally, mental health research has been conducted exclusively by professionals with little input and participation from individuals with mental illness themselves. Participatory action research (PAR) provides a more dynamic method of research, giving individuals the opportunity to become activists and advocates by influencing the direction of mental health research. This paper outlines important differences between PAR methodology and traditional research, with an emphasis on the differing roles of persons with mental illness in the two models. PAR is consistent with the recovery movement in several ways: both approaches value self-definition, empowerment, and experiential knowledge. As an example, this paper describes one project that incorporates principles of the participatory action research paradigm.     

New challenges in mental health of children for church and community

Conclusion The church has a ministry to implant a sense of fatherhood and motherhood to persons who are able to minister to children. If there is a total effort on the part of the church and community mental health resources toward youth, we shall be able to meet the crisis in the mental health of children. Of course, to hope that we can eradicate mental illness for successive generations is out of the question. At best, we shall have sounded the note for the mental health of the family. To impart a meaningful way of life for a child means that he must encounter responsible and loving persons who are able to relate and share various learning experiences. Adults need to have fun with children and affirm them as delightful and precious. Revitalizing a sense of being a therapeutic agent to children and families is another expression of renewal for the local church.     

Mental health matters: a multi-family framework for mental health intervention

This paper reports a collaborative project, developed jointly by a group of community mental health workers in association with a specialist team commissioned to initiate family work throughout a central London mental health provider. The result of this project – The 'Mental Health Matters Workshops'– was a series of day workshops for patients who had experienced a major mental illness, and their families, carers and mental health workers. The positive impact of the workshops on attenders is reported, as well as the development of a 'multi-family' and social network culture.     

Community Psychology and Community Mental Health: A Call for Reengagement

Community psychology is rooted in community mental health research and practice and has made important contributions to this field. Yet, in the decades since its inception, community psychology has reduced its focus on promoting mental health, well‐being, and liberation of individuals with serious mental illnesses. This special issue endeavors to highlight current efforts in community mental health from our field and related disciplines and point to future directions for reengagement in this area. The issue includes 12 articles authored by diverse stakeholder groups. Following a review of the state of community mental health scholarship in the field's two primary journals since 1973, the remaining articles center on four thematic areas: (a) the community experience of individuals with serious mental illness; (b) the utility of a participatory and cross‐cultural lens in our engagement with community mental health; (c) Housing First implementation, evaluation, and dissemination; and (d) emerging or under‐examined topics. In reflection, we conclude with a series of challenges for community psychologists involved in future, transformative, movements in community mental health.