"a Safe Place to Live":the Importance of Neighborhood Safety in Community Experiences for Adults with Serious Mental Illness

Background and Purpose: For individuals with serious mental illness (SMI), community integration has the potential to improve quality of life and reduce social isolation by providing opportunities to live and interact with people in their neighborhood and community at large and create a sense of belonging. However, characteristics of neighborhoods (i.e. safety) in which adults with SMI choose to live or are placed may influence individuals' ability to fully integrate.  General population research suggests that neighborhood safety plays a significant role in sense of community and belonging. Similar results have been found for individuals with SMI however the experience may differ due to challenges of coping with a SMI. The purpose of this paper is to explore the role neighborhood safety plays in the experiences of community living and sense of belonging for adults with serious mental illness. 

Methods: Thirty in-depth semi-structured interviews were conducted with adults with serious mental illness receiving community-based mental health services in Baltimore, MD. Participants are predominantly Black/African American (80%), half female (50%) with a mean age of 48 (sd=16.0). Participants were recruited via agency-based consumer meetings, posted fliers and agency providers. Interviews elicited participants’ experiences of belonging to past and present self-defined communities. Interviews were transcribed verbatim and analyzed using principles of ground theory.  Using ResearchTalks' "Think and Shift, Sort and Sift" approach, tools including quote identification, diagramming, memoing, creating individual participant episode profiles and monitoring of community safety topics were used to identify salient themes that emerged within and across participant interviews. 

Findings: Data analysis revealed that safety, or lack thereof, in past and present neighborhoods in which they lived or live played a key role in the experiences of community for adults with serious mental illness.  Participants described traumatic events related to community violence, crime and drugs that happened mostly in neighborhoods where they previously resided. Participants also described feeling safe in agency housing, often juxtaposing the change from growing up or living in unsafe neighborhoods to feeling safe where they are now. Findings indicate that agency housing provides a sense of safety and comfort in terms of neighborhood placement and monitoring. Participants noted that in neighborhoods that they currently lived, neighbors were friendly, nice and looked out for each other. 

Conclusions and Implications: Findings bring to the forefront implications for understanding the impact of neighborhood safety on community integration for adults with SMI. At the micro level, interventions geared toward increasing community integration should include neighborhood level assessments of factors such as safety, crime, violence, and cohesiveness when assisting consumers in transitioning to independent living and integrating into the general community. At the macro level, mental health policies and practices that support full integration of individuals into the community need to consider and address the quality of communities into which we expect adults with SMI to integrate.