Psychological Integration of Individuals into Mental Health and Non-Mental Health Communities - the Role of Service Providers

Background: Psychological community integration is an important dimension of recovery for individuals with serious mental illness (SMI). It refers to a person’s perception of their community integration. Social integration on the other hand, refers both to a person’s affiliation with social networks as well as social interaction with community members. Unlike psychological integration, which is more reflective, social integration is contingent on the activity and support of others. Nonetheless, there is an inextricable link between the both. The primary aim of the study was to explore psychological integration for individuals with SMI both through the applied concept of normalization as well as the subcultural mechanisms used by many individuals with SMI as well as its association with social integration and other psycho-social factors.

Methods: The study used self-report and ego-centric social network data from 60 individuals with SMI, receiving community-based mental health services. Information on psychological integration was derived from the Community Integration Measure (McColl et al., 2001). Social network interview was used to derive social integration indicator and measures for symptomatology, psychosocial functional and internalized stigma were used to get information on various psychosocial variables. Multivariate regression models were conducted to assess association between social integration and psychological integration in the mental health (MH) and non-mental health (NMH) communities for individuals with SMI.

Results: The regression model accounted for 40.4% and 32.7% of the variance for MH and NMH communities respectively. MH providers’ support was found to be associated with both psychological integration into the MH community and the NMH community. Every unit increase in access to social support from MH service providers was associated with .38 units higher psychological community integration in the MH community and .29 units higher psychological community integration in the NMH community. Also, social integration support from families and friend was not significantly associated with psychological integration in either community.  

Conclusions and Implications: The primary findings indicated that social integration indicator associated with service providers was associated with psychological integration in both MH and NMH communities, indicating social integration to be an important associate of psychological integration. Service providers were found to be as important, if not more important, in supporting the process of psychological integration into NMH communities. The relationship between social support from service providers and psychological integration in both the MH and NMH communities is supported by literature on engagement that suggests that consumers who are actively engaged in treatment also find it easier to engage with their social networks and NMH communities outside of their services. Our data suggest that in addition to providing services, providers are doing something meaningful to carry their impact on the lives of their clients well beyond MH services. They may assist with integration into that community and they may even influence their sense of belonging and identity in the NMH community. The study suggests support for a bifurcated conceptualization of psychological integration into MH and NMH communities and provides a more complex understanding of the concept of community integration.