Healing Despite Stigma: An Ethnographic Assessment of a Recovery Center for People with Mental Illness

Introduction: Stigma and discrimination against individuals living with serious mental illness (SMI) result in decreased life opportunities, loss of independent functioning, and can have negative consequences for personal relationships, education, employment, and stable housing.  Recovery centers are physical entities offering services and resources for people living with SMI in which trained, paid, and high-functioning consumers deliver services, often with the assistance of non-consumer staff.  Recovery centers have emerged as a promising practice for promoting empowerment and community integration of consumers by providing both clinical services and skill building opportunities. However the evidence base vis-a-vis recovery centers is low. As such, the purpose of this presentation is to explore consumer perspectives on a) discrimination and exclusion resulting from societal stigma of mental illness and b) how participation in recovery center activities promotes self-efficacy, self- worth, and empowerment towards achieving recovery goals. 

Methods:  Five focus groups were conducted at the Pathways to Housing Resource Center during regular intervals between July 2008 and October 2009 interspersed with regular participant observations.  This involved a researcher attending the center to observe activities, participate in classes, or attend social events. In addition, we selected consumers to take for lunch or accompany on walks around the neighborhood to further elicit their perspectives on the center. Qualitative thematic analysis was used to analyze data. Members of the research team conducted analysis independently at first and then discussed emerging themes and came to consensus regarding our conclusions. This form of multiple coding in qualitative research is recommended for improving validity and is known as a strong check and balance of observer bias.

Results: Consumers described the omnipresence of negative public attitudes towards people living with SMI, and reported a variety of personal challenges resulting from anticipated and lived episodes of discrimination.  Experiences of discrimination included exclusion from employment and from decisions regarding their medical and psychiatric care.  Because consumers had experienced such discrimination, they were also fearful of the potential for discrimination by anyone who is aware of their mental illness.  Consumers described many ways in which the Recovery Center promoted self-determination and empowerment by providing education about mental illness and legal rights. Consumers also described feeling empowered to choose when to disclose their illness, and to challenge stereotypes of individuals with SMI.  Participating in a Recovery Center appeared to protect against self-devaluation while fostering a sense of optimism in changing others’ negative views or actions. 

Conclusion: Recovery Centers are places where consumers share and support one another from experiences of discrimination, and increase self-esteem and self- efficacy through building a variety skills and strategies needed for successful community life.  Participating in a recovery center can empower consumers to defy beliefs that are commonly held about people living with mental illness. This Recovery Center appears to have a positive influence on empowerment, self-esteem, and the potential for community integration, but future research is necessary to formally test its impact on these domains.