Community Integration for Individuals with Severe Mental Illness: Effects of Service Intensity
With its roots in the de-institutionalization movement, re-integration into the non-mental health (NMH) community has been recognized as an important component of recovery for individuals with serious mental illness (SMI) (Abdallah, 2009). However, there is little research on the extent of community-integration for individuals with SMI. Many consumers are embedded into varying intensities of mental health (MH) treatment and we have little understanding of how this impacts community integration. Existing empirical evidence fails to give sufficient credence to individual differences and external factors that might impact the way community is conceptualized and utilized by the SMI (Townley et al., 2009). Current study defines community-integration as belonging and participation using measures of community-integration, social capital and social network. The present study: (i) examines the level of community-integration for a sample of SMI individuals living in the community; (ii) explores the relationship between service intensity and community-integration for individuals with SMI into MH and NMH communities.
Data from an ongoing NIMH-funded study were collected from 33 ethnically diverse individuals with SMI treated in two public mental health clinics: a high-intensity assertive community treatment team (ACT) and low-intensity usual-care (UC). Integration into mental health and non-mental health communities was measured by: (i) a community-integration scale (McColl et al., 2001); (ii) the Involvement in Community Activities scale (Wallace et al., 2000); (iii) social capital scale (Van Der Gaag and Webber, 2008), (iv) and social network maps (Rice, 2010). The UC and ACT groups were equivalent on gender, diagnosis, symptomatology, and functioning.
The whole sample felt more integrated into MH community versus NMH community (p<0.01). Their network consisted of an average of 40% MH connections and 34% family. In terms of social capital, the whole sample received their social capital from NMH sources versus MH sources (p<0.01). These findings were replicated in the ACT and UC groups separately (p<0.05). Upon comparison, ACT group received more social capital from MH sources as compared to UC group (p<0.05) and UC group received more social capital from NMH sources (p<0.1). ACT group’s average proportion of network consisting of MH connections was higher than UC group (p<0.001) and UC group’s average proportion of networks consisting of family was higher than ACT group (p<0.001).
Findings indicate a paradox in the perceived aim of psychosocial interventions and recovery and the actual experience and perception of community by individuals with SMI. Our data suggested that while the current service delivery system aims for recovery and re-integration of individuals with SMI in to the NMH community, individuals are more integrated into the MH than NMH communities. More intensive services lead to further encapsulating individuals in the MH community. While ties to the MH treatment settings are valued, individuals with SMI seek their social capital from NMH sources. Results offer preliminary suggestions that the idea of community-integration is not as clear-cut as previously presumed. Subjective experiences of having a mental illness and the intensity of services received play an important role in defining community experience and recovery.