Rohini Pahwa

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.

Relationship of community integration of persons with severe mental illness and mental health service intensity.

OBJECTIVE Community integration is integral to recovery for individuals with severe mental illness. This study explored the integration of individuals with severe mental illness into mental health and non-mental health communities and associations with mental health service intensity. METHODS Thirty-three ethnically diverse participants with severe mental illness were categorized in high-intensity (N=18) or low-intensity (N=15) mental health service groups. Community integration was assessed with measures of involvement in community activities, social capital resources, social support, social network maps, and subjective integration. RESULTS Although participants rated themselves as being more integrated into the mental health community, their social networks and social capital were primarily derived from the non-mental health community. The high-intensity group had a higher proportion of members from the mental health community in their networks and had less overall social capital resources than the low-intensity group. CONCLUSIONS The findings suggest opportunities and possible incongruities in the experience of community integration.

A dual change model of life satisfaction and functioning for individuals with schizophrenia

Despite the notion that increases in functioning should be associated with increases in life satisfaction in schizophrenia, research has often found no association between the two. Dual change models of global and domain-specific life satisfaction and functioning were examined in 145 individuals with schizophrenia receiving community-based services over 12 months. Functioning and satisfaction were measured using the Role Functioning Scale and Satisfaction with Life Scale. Data were analyzed using latent growth curve modeling. Improvement in global life satisfaction was associated with improvement in overall functioning over time. Satisfaction with living situation also improved as independent functioning improved. Work satisfaction did not improve as work functioning improved. Although social functioning improved, satisfaction with social relationships did not. The link between overall functioning and global life satisfaction provides support for a recovery-based orientation to community based psychosocial rehabilitation services. When examining sub-domains, the link between outcomes and subjective experience suggests a more complex picture than previously found. These findings are crucial to interventions and programs aimed at improving functioning and the subjective experiences of consumers recovering from mental illness. Interventions that show improvements in functional outcomes can assume that they will show concurrent improvements in global life satisfaction as well and in satisfaction with independent living. Interventions geared toward improving social functioning will need to consider the complexity of social relationships and how they affect satisfaction associated with personal relationships. Interventions geared towards improving work functioning will need to consider how the quality and level of work affect satisfaction with employment.

Mental illness disclosure decision making.

Disclosure related to mental illness has been linked to various positive outcomes, including better mental health. However, many individuals with serious mental illness (SMI) continue to practice non-disclosure. Even though disclosure inherently occurs within the context of one’s social relationships, research has generally conceptualized mental illness disclosure as an individual level phenomenon and neglected to consider preferences concerning to whom an individual discloses and the factors that influence this decision. The current study uses the disclosure decision-making model (DD-MM) by Greene (2009) to better understand the processes of mental illness disclosure preference and selective disclosure for individuals with SMI (n = 60) using multivariate random intercept logistic regression with an emphasis on the constituent factors of disclosure preference at both individual and relational levels. The majority of participants were found to practice selective disclosure, with 68% of the participants identifying at least 1 network member to whom they could disclose. Family members and friends were central to the selective disclosure process, comprising the greatest proportion of network members who, both were and were not identified as preferred confidants. Women were found to show higher odds of preference for mental illness disclosure than men. Having lower perceived social support was associated with lower odds of disclosure preference. Among relational factors, greater relationship availability and lower dyadic tangible social support were associated with lower odds of disclosure preference. Practice and research implications of using social network analysis to get a deeper understanding of disclosure and disclosure preference are discussed, including implications for future interventions targeting stigma reduction.

Social Support-Centered Versus Symptom-Centered Models in Predicting Functional Outcomes for Individuals with Schizophrenia

Objective: This study tests 2 competing models to explore the influence of symptomatology and social support on functioning for individuals with schizophrenia. The social support-centered model hypothesizes that symptoms have an indirect association with functioning through social support. The symptom-centered model hypothesizes that social support has an indirect association with functioning through symptoms. Method: These models were examined using 166 individuals with schizophrenia receiving community-based services. Results: For social functioning, the social support-centered model is an adequate fit to the data (χ2 = 0.316, df = 2, p = .854; CFI = 1.000, NFI = .990, AIC = 24.316, RMSEA = .000); however, the symptom-centered model is a poor fit to the data (χ2 = 15.597, df = 3, p = .001; CFI = .772, NFI = .718, AIC = 37.597, RMSEA = .160). For instrumental functioning, the symptom-centered model is an adequate fit to the data (χ2 = 2.265, df = 3, p = .519; CFI = .1.000, NFI = .959, AIC = 22.265, RMSEA = .000), but the social support-centered model is a poor fit to the data (χ2 = 21.585, df = 2, p = .000; CFI = .147, NFI = .345, AIC = 45.585, RMSEA = .244). Conclusions: Overall, the findings suggest that models for understanding functioning and interventions in schizophrenia need to be differentially focused, depending on the targeted outcome. Implications for social work practice and policy are discussed.