Lauren Gonzales

Microaggressions experienced by persons with mental illnesses: an exploratory study

OBJECTIVE Microaggressions are subtle verbal or behavioral communications of disparaging messages to people based upon membership in a socially marginalized group. Their negative impact has been demonstrated for racial/ethnic groups, gender, sexual orientation, and physical disability, but currently no research exists on microaggressions as experienced by persons with mental illnesses. METHOD Qualitative data were gathered from 4 focus groups with 2 samples: adult mental health consumers in an assertive community treatment program and college students with mental illness diagnoses. Focus group transcripts were then analyzed using an open coding approach (Strauss & Corbin, 1990) to identify hierarchical themes and categories. RESULTS Five major themes were identified, including invalidation, assumption of inferiority, fear of mental illness, shaming of mental illness, and second class citizen. Perpetrators of microaggressions were most commonly identified as being close friends, family members, and authority figures. Importantly, participants reported experiencing more overt discrimination experiences than subtle microaggression experiences. Reported negative outcomes related to microaggression experiences included isolation, negative emotions, and treatment nonadherence. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Reported consequences of microaggressions have important implications for mental health treatment, especially as perpetrators were reported to include treatment providers and were usually unaware of such negative social exchanges. Loss of social support reported by participants and the frequent occurrence of microaggressions within close relationships implies these experiences could contribute to internalization of stigmatizing attitudes toward mental illness. Directions for future research include an investigation of motivation and reasoning behind perpetration of microaggressions against persons with mental illnesses.

Change in internalized stigma and social functioning among persons diagnosed with severe mental illness

This study examined the relationship between change in internalized stigma and social functioning over time. Thirty-five individuals with severe mental illness completed measures of self-stigma, social functioning and symptoms at baseline, 4 months, and 7 months. Change in self-stigma was significantly negatively related to change in social functioning, controlling for negative symptoms.

Participation in peer support services and outcomes related to recovery.

OBJECTIVE This article presents findings from a naturalistic study that explored the impact of peer support participation on recovery-related outcomes over a 6-month period. In particular, this study hoped to fill gaps in the literature regarding the process through which personal change occurs in peer support organizations. METHOD Fifty people newly involved in services provided by Baltic Street AEH (Advocacy, Employment, Housing), a consumer-operated organization, participated in the study. Participants were interviewed at entry and 3- and 6-month follow-up. Attendance records were reviewed to determine the number of days attended, and the sample was divided into 2 categories: minimal or nonattenders (n = 25) and moderate or high attenders (n = 21). The relationship between attendance and outcomes related to recovery over time was examined using a mixed effect regression analysis, allowing data to be included for participants with at least 1 follow-up interview (n = 38). RESULTS Relative to minimal or nonattenders, moderate or high attenders showed statistically significant improvements over time in internalized stigma, self-esteem-self-efficacy, and community activism-autonomy. No statistically significant differences were observed between groups in hopelessness, social functioning, symptom severity, coping with symptoms, or substance use. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This study demonstrates the potential impact of engagement in peer support services on some subjective aspects of mental health recovery. Namely, change mechanisms could be hypothesized to include identity transformation (from patient to peer). Future directions should continue to investigate potential mechanisms of change with larger samples in randomized studies. (PsycINFO Database Record

The mental illness microaggressions scale-perpetrator version (MIMS-P): Reliability and validity

The study objective was to develop a new measure for use in the empirical measurement of microaggression behaviors perpetrated towards persons with mental illness and examine its psychometric properties. Following development of an initial item pool, 505 participants (students at a large college in New York City and community members recruited through Amazons Mechanical Turk program) completed an online survey including a 20-item measure of microaggression behaviors. Exploratory factor analysis revealed three subscales: Assumption of Inferiority (α=0.81), Patronization (α=0.78), and Fear of Mental Illness (α=0.63). Additional analyses supported convergent validity of the measure with two widely used measures of mental illness stigma. The MIMS-P is the first instrument to measure microaggressions endorsed by perpetrators against a socially marginalized group and demonstrates strong psychometric properties. Inclusion of this scale in future research can help facilitate understanding of perpetrator perspectives and assist with intervention development.

Individual and neighborhood predictors of mental illness stigma in New York state.

Although studies indicate that stigmatizing attitudes persist in the general public, individual- and neighborhood-level factors that are associated with increased likelihood of holding stigmatizing attitudes have been seldom studied. This study examined the demographic and neighborhood correlates of stigmatizing attitudes among community members in New York State. Data were drawn from the Pulse of New York State Survey, a random-digit-dial survey of 806 New York State residents. Variables studied included demographic information, the Attitudes Toward Mental Illness Scale, and neighborhood disadvantage at the zip code level (using data on community characteristics from the 2000 and 2010 Census). Higher levels of completed education predicted less stigmatizing attitudes. Higher levels of neighborhood disadvantage predicted more stigmatizing attitudes with the 2000 Census, and obtained marginal significance within the 2010 Census. Political affiliation demonstrated the strongest relationship, with more conservative ideology predicting more stigmatizing attitudes. Results highlight the need to consider political affiliation and neighborhood disadvantage as target areas when planning interventions for reducing mental illness stigma.

An Examination of Eligibility Decisions in New York State's Assisted Outpatient Treatment.

OBJECTIVE The objective of this study was to compare assisted outpatient treatment (AOT) eligibility characteristics among participants receiving community treatment through AOT and non-AOT referrals. METHODS A total of 131 AOT and non-AOT charts were reviewed from three sites within one treatment agency in New York City. Intake information was coded for AOT eligibility information, suicide history, and risk of future violence according to the Historical Clinical Risk Management-20, version 3 (HCR-20V3), instrument. RESULTS No significant differences were found between groups for measurable AOT eligibility criteria. Compared with non-AOT participants, the participants referred through AOT scored significantly higher on HCR-20V3 for risk of future violence; however, most charts, including almost half of AOT participants, received low risk ratings. CONCLUSIONS Study findings raise questions about why some individuals, and not others, are referred to AOT in New York City.

Can reduced homelessness help explain public safety benefits of mental health court

Mental health courts (MHCs) represent an increasingly widespread approach to reducing criminal justice involvement of persons with mental illness through judicially supervised linkage to treatment and services. Whereas early MHCs were limited to individuals charged with nonviolent misdemeanors, more recent MHCs often include persons for which violence is a concern, such as those with histories of violence and felony arrests. Previous research has found that MHC participation can reduce the risk of community violence, yet research on what accounts for public safety benefits of MHCs is limited. This study evaluated the association between reduction in homelessness and violence risk in an MHC. Homelessness is common among justice-involved persons with mental illness, is a risk factor for recidivism, and may be reduced by MHC participation. This study compared rates of homelessness and violence over time for 88 participants who entered an MHC and 81 individuals who received treatment as usual (TAU), and evaluated homelessness as a mediator underlying public safety outcomes of MHC. Although the two groups had similar rates of homelessness at baseline, MHC participants were significantly less likely to be homeless at follow-up compared with the TAU group. For both groups, homelessness was positively related to violence during follow-up. Homelessness emerged as a significant mediator of the relationship between MHC participation and risk for violence during follow-up. The results suggest that reduction in homelessness can help explain favorable public safety outcomes of an MHC.

Association between housing, personal capacity factors and community participation among persons with psychiatric disabilities

There is a need to understand which housing and personal capacity factors facilitate and hinder maximum community participation among people with psychiatric disabilities. The present study examined housing and personal capacity factors associated with community participation in a large sample of persons with psychiatric disabilities living in the same neighborhoods (defined by specified zip codes). Three hundred and forty-three persons with psychiatric disabilities were recruited from congregate and independent scatter-site housing programs in 3 New York City-area neighborhoods with high concentrations of housing for persons with psychiatric disabilities. Participants completed measures of community participation, psychiatric symptoms, substance use, independent living-skill, self-efficacy, and coping style. Community participation measures grouped into 3 factors: social community participation, physical community participation, and vocational involvement. Social community participation was associated with negative symptoms and active coping, but not by housing. Independent living-skill moderated the relationship between independent scatter-site housing and social community participation. Physical community participation was associated with negative symptoms, active coping, independent living-skill, and residence in independent scatter-site housing. Vocational involvement was only associated with negative symptoms. Findings suggest that a complex array of personal capacity and housing factors are associated with community participation among persons with psychiatric disabilities.