Social Networks of Persons with Serious Mental Illness: Structure, Transactions, and Satisfaction

Background and Purpose: Social integration refers to the development and exercise of capacities for social connectedness, a process through which individuals living with serious mental illness (SMI) establish and maintain reciprocal relationships with their family, friends, peers and community members (Ware et al., 2007). Social network analysis allows for assessment of network structure and transactions that may contribute to social connectedness and satisfaction with one's social relations. Despite their relevance to social work practice, few studies to date have examined the social network characteristics of individuals with SMI and the extent that network structure and transactions are associated with consumers' subjective quality of life in social relations.

Methods: The study sample of 252 participants was randomly selected from supportive independent housing (SIH) programs targeted for low-income psychiatric consumers. Structured consumer interviews provided data on socio-demographic and clinical characteristics, social network structure characteristics (i.e., size, composition, intensity of contact, and density), social network transaction characteristics (i.e., types of support rendered, perceived support, and reciprocity of support), and subjective satisfaction with social relations (Quality of Life scale, Lehman, 1988). Mixed model ANOVAs were conducted to examine the extent to which social network transactions differ among types of relationships. Ordinary least squares regression was employed to estimate the relationships between network characteristics and satisfaction with social relations.

Results: Average social network size of the sample was 14 members (SD=6.77) with network membership comprising friends or acquaintances (41.9%), family members (38.6%), and professionals (19.5%). Only one-fifth of participants' network members had a psychiatric history. Participants provided to and received from family members at a higher rate than other network segments (i.e., friends/acquaintances and professionals) across all types of support with the exception of problem solving support, which was received from professionals at the highest rate. Reciprocity was most common with family members across all types of support, followed by reciprocity with friends and professionals. Controlling for the effects of socio-demographic and clinical characteristics, network size, network density, intensity of contact, and reciprocity in tangible support were positively related to level of satisfaction with social relations.

Conclusions and Implications: This study counters the commonly-held assumption regarding the lack of social ties and normalized social relationships among individuals living with SMI. By highlighting the importance of family members in affecting both the network structure and network transactions, the findings lend support to efforts by social workers and case managers at connecting psychiatric consumers with their family members in order to promote social integration and increase consumers' satisfaction with social relations. The significant association between reciprocity of tangible support and satisfaction with social relations found in this study suggests the critical role that material resources play in the lives of psychiatric consumers with limited income. Services aimed at resource development with this population could allow for more frequent exchange of tangible resources between consumers and their network members. This, in turn, may enhance consumers' satisfaction with social interactions, thereby promoting the goal of social integration.