Is It Safe?: Community Integration for Individuals with Serious Mental Illness

Background and Purpose

Community integration is a common goal of recovery-oriented public mental health services for individuals with serious mental illnesses (SMI). However, for individuals with SMI who often have extensive experiences with trauma and victimization, live in high poverty neighborhoods, and have histories of homelessness and substance use; it is less clear how concepts of safety shape their experience of community and processes of community reintegration. The goal of the current study is to understand how safety concerns by individuals with SMI relate to their community integration.  

Methods

Semi-structured interviews and social network mapping were completed with 20 participants with SMI receiving services from community mental health centers in Los Angeles County (70% male; Mean Age = 42.79, SD = 12.09). Respondents were asked about their definition of community, the communities that they have and currently belong to, and if they have any related safety concerns. Guided by constructivist grounded theory, data were analyzed through constant engagement with the data using the following phases of Sort and Sift, Think and Shift approach: data inventory, reflections, diagramming, categorization, memoing and episode profiling. These processes assisted in identifying researcher positionality and perspectives, and capturing emergent themes. Next, incidents related to community safety were identified and compared across interviews to further refine emergent themes around community safety.

Results

Community safety and violence emerged as a central theme in our analysis in a variety of ways and these experiences informed the ways they navigated their daily lives in community contexts. First, participants’ identities related to their mental illness made them feel particularly vulnerable to stigma in community contexts. This resulted in isolation from family members and friends (small networks), as well as adverse experiences with law enforcement in public spaces. Second, safety concerns were intimately interconnected with past experiences related to homelessness and substance use. In particular, women reported histories of street harassment, and sexual and intimate partner-based violence. Lastly, participants discussed community gang violence in their neighborhoods. Even without direct experiences with gang violence, participants reported awareness of gang activity in their neighborhood and consequent desires to relocate to safer areas. In contrast, treatment settings were often seen as safe environments, as participants discussed a sense of community among others within mental health settings (peers and providers), even in cases where interpersonal connections were absent.

Conclusions and Implications

These findings highlight the dynamic role that violence in community contexts plays in the lives of people with SMI. Aspects of our findings are specific to time and place, such as gang activity in Los Angeles, but also inform how people relate their experiences to their need for a sense of safety. In being keenly aware of their past and present vulnerabilities to violence, they often strategized ways to reduce exposure to further violence. These concerns often influenced their daily lived experiences, such as by limiting their time outdoors in certain neighborhoods or reducing interactions with family and peers. These findings suggest that an effective community reintegration practice should address client safety concerns.