Constructing Individuals' Lived Experiences in Shaping Social Inclusion: Voices of Persons in Recovery From Mental Illness

Background and Purpose: Social inclusion is a key principle, value, and goal for mental health policy and services for persons with severe mental illness in the United States.  Recent work using a capability framework has conceptualized social inclusion as quality of life, which includes not only functioning and satisfaction, but also the manifestation of self-directed capability for building and maintaining social relationships (Hopper, 2007; Ware et al. 2008).  Prior research has not adequately examined the relational dimension of social inclusion by exploring the ways in which persons in recovery understand and define their own relationships with various communities.  Informed by the capability framework, we aimed to address the following questions: Which sets of people within and outside the mental health system do persons in recovery construct as their communities? How do they construct their interactions with others in these communities?

Methods: We used a constructivist/interpretive perspective and a modified grounded theory research approach (Charmaz, 2006).  We recruited a purposive sample of 20 persons in recovery who were heterogeneous with respect to race/ethnicity, gender, sexual orientation and gender identity, mental health diagnosis and current housing arrangement.  We sought a diverse sample to elicit perspectives of participants who may experience challenges integrating into the community due to discrimination and to capture themes that cut across differences (Patton, 2002).  During in-depth semi-structured interviews, participants were asked about their definitions of community, the particular communities to which they belonged, and the nature of their relationships with individuals and groups in these communities.  The authors wrote summaries and analytic memos and successively coded, compared, recoded, and restructured codes of the transcribed interviews.  Triangulation by investigator and theory (Denzin, 1989) was used to enhance rigor.

Results: We found a range of participant perceptions and experiences of community unique to various life circumstances,  which we summarized graphically as a schema capturing two dimensions: 1) types of communities involved (mental health and wider communities); and 2) level of involvement (ranging from mere physical presence to reciprocity/responsibility).  From the interviews, we reconstructed narratives representing competencies in connection with community engagement.  We identified interpersonal skills acquired through previous educational and work experiences (social currency), volunteering as a way of giving back to the communities where participants received supports or services (moral competency) and learning to “respect” mental illness (empathy or emotional competency) to be critical for maintenance of reciprocal interpersonal relationships and taking up responsibility in both mental health and wider communities.

Conclusions and Implications:  Persons in recovery perceive and experience community in a myriad of ways that are influenced by personal life circumstances.  Despite the goal of social inclusion, some persons in recovery integrate primarily into mental health “enclaves” whereas others are engaged in the broader community.  Identifying competencies in the context of community engagement activities that enhance self-directed capability would enable social work practitioners to effectively support the recovery of mental health service users in achieving their individual aspirations for inclusion and moving toward a wider range of communities if they so wish.