Purpose: Both the NIMH's Community Support System and ensuing progressive recovery models posit that an array of services and supports is necessary to enable consumers with serious mental illness to live successfully in the community and to enhance their quality of life. A central tenet is that formal mental health services should be normalized and should incorporate natural supports. Yet, relatively little was known about the relationship between informal social networks and formal care in the arena of serious mental illness until recently.

In support of complementary and bridging theories, my research found that the size of certain network sectors was related both to the need for and to the receipt of more formal services. Efforts to integrate these and other recent findings and to develop network theory have led me to reconsider the concept of network orientation originally introduced by Tolsdorf in his work with psychiatric patients during the 1970's. Network orientation refers to an actor's beliefs, attitudes, and expectations regarding the potential usefulness of the social network in coping with life's challenges and problems. This paper proposes a conceptual model of the relationship between social networks and formal care that includes a role for network orientation.

Methods: Using a nonexperimental, cross-sectional design, this study recruited a nonprobability sample of 112 clients from 4 Community Support Programs. Subjects were 18 years or older and met the state criteria for enrollment in programs that serve adults with serious mental illness. Extensive data on networks, social support, stigma, clinical factors, and formal services were gathered through face-to-face interviews using the Network Interview Schedule, written structured questionnaires including the Network Orientation Scale, and records reviews.

Results: This analysis tested whether network orientation mediates the relationship between social networks and formal mental health services found in my initial study. Controlling for age, sex, race/ethnicity, education, diagnosis, symptoms, and global functioning, results of OLS regression models show that network orientation mediates the relationship between the following network factors and formal services: total network size, number of key supporters, number of non-kin, number of consumers, number of professionals, and number of multiplex ties.

Implications for Social Work: This research informs social work practice by demonstrating that consumers' network orientation or their beliefs, attitudes, and expectations about the potential utility of these networks as social and support resources for coping with the challenges and stress of everyday life mediates the extent to which network structure is related to the need for and use of formal services. The potential for networks to provide support rests not simply on size or other network characteristics but also on consumers' perceptions about these networks. Our practice can improve the lives of consumers by focusing on cognitive strategies that may help them better assess the support capacity of their networks and, thus, integrate systems of informal and formal care.