Community Integration of Individuals With SMI: A Networks Perspective From India and United States
Community integration is central to definitions of recovery for individuals with severe mental illness (SMI). But, the idea of what is a “good” outcome in integration into the community is subjective (Bond, 2004). Exploration of the concepts of community integration across different societies will help us in answering questions about the community life of persons with SMI and understanding and facilitating the process of recovery (Townley, 2009). The present study uses the networks perspective and theoretical model by Wong and Solomon (2002) and (i) examines levels of integration into mental health (MH) and non-mental health (non-MH) communities for individuals with SMI living in the community in India and United States and (ii) examined the networks characteristics and levels of stigma of individuals with SMI in India and United States.
Methods:
Egocentric network and quantitative data were collected from individuals with SMI in United States (N=60) and India (N=26). US sample came from two treatment modalities: high-intensity assertive community treatment team (ACT) and low-intensity usual-care (UC), while India sample came from UC group. Integration into MH and non-MH communities was measured by community-integration scale (McColl et al., 2001); Involvement in Community Activities scale (Wallace et al., 2000); social support scale (Sherbourne, 1991); and social network maps (Rice, 2010). Stigma was measured by ‘Internalized Stigma of Mental Illness’ scale (Ritsher & Phelan, 2004). India and US samples were equivalent on gender, diagnosis, symptomatology and functioning.
Results:Indian sample was more integrated into non-MH community (p<0.001) and US sample was more integrated into MH community (p<0.001). Indian sample had more social support than US sample (p<0.05), but were also more stigmatized (p<0.05). From network perspective, Indian sample had their networks populated primarily from non-MH networks (88%), and had twice more family-members in their network as compared to the US sample. Upon comparing the groups within US, UC group had more social support and stigma as compared to ACT group, and was still more integrated into the MH community. ACT group had more MH connections than UC group (p<0.001) and UC group had more non-MH connections than ACT group (p<0.05).
Conclusions and Implications:
The findings indicate a paradox in the aim of psychosocial interventions and actual experience of community integration by individuals with SMI. Within US, while the current service delivery system aims for recovery and re-integration of individuals with SMI into the NMH community, individuals seem more integrated into the MH than NMH communities.
Additionally, our findings support the literature on cultural influences in the course and subjective experiences of having a mental illness. Indian sample seemed more aligned with the goals of recovery but also faced significantly more stigma than both US groups.
The results suggest that we need to be cautious in generalizing concepts of mental illness and community life of persons with SMI individuals with SMI in different countries. Results offer preliminary suggestions that cultural contexts as well as service intensity play an important role in defining community experience and recovery.