Social Networks, Community Integration and Recovery for Individuals with SMI in India

Background

Cultural factors have known to have tremendous impact on the conception, course and the outcomes associated with the illness along with the experience of symptoms, types and acceptability of treatments and social tolerance of mental illnesses. Ethnic culture theory also assumes that concepts related to mental health, mental illnesses and mental health services varies based on tradition, cultural norms, and practices could impact mental health diagnosis, prognosis and protective factors differently. Concepts of recovery and community integration, that have been central to the conversation around the experience and outcomes related to mental illness have been largely unexplored in the developing contexts like India. Using pilot data, the present study makes an initial exploration into recovery and community integration experiences of individuals with SMI in India within the contexts of their social networks.

Methods

Egocentric network and survey data were collected from 56 individuals with SMI receiving community-based mental health treatment in two urban settings in India. Information was obtained for individuals’ demographic, social networks, and several clinical (i.e. psychiatric symptoms, functioning) and psychosocial (i.e. social support, stigma, social capital) variables. Participants were predominantly male (65%) with a mean age of 35.75 years (SD=11.24).  

Results

Univariate and descriptive analyses show that participants had an average network size of around 14 individuals (SD=7), and family made up for 57% of their networks (SD=22%), followed by mental health service providers (mean=16%,SD=11%) and friends (mean=11%,SD=14%). Men had significantly more friends in their networks as compared to women (t=2.31,df=54,p<0.05). On an average, participants indicated being stigmatized by around half of their social network members, of which, majority was identified as family members. At the same time, family members were also identified as their primary source of social support and social capital. Service providers comprised of only 16% on average of their social networks (SD=11%). Bivariate analyses of individual-level factors indicate that individuals’ perception of community integration in to the main stream community was positively related to their total network size (r=.301,p<0.05), their satisfaction with life (r=.489,p<.001) and psychosocial functioning (r=.431,p<0.01) and negatively related to their symptomatology levels (r=-.289,p<0.05) and levels of internalized stigma (r=-.326,p<0.05).

Conclusions

The findings throw light at the largely unexplored concepts of recovery and community integration within an Indian context. The initial findings show a very interesting dynamic whereby individuals with SMI were dependent on their family members for their emotional and instrumental needs. At the same time, these relationships were also a source of stigma and other negative experiences that could adversely affect their experience of a mental illness as well as their recovery and community integration. Service providers on the other hand, played a limited role in their day to day lives and were less central as compared to their family or other non-mental health based relationships. The study highlights the importance of understanding overarching concepts related to mental illness within the cultural context of an individual in order to provide more relevant care.