Structural, Functional and Experiential (SFE) Model of Community for Individuals with Serious Mental Illnesses: Implications for Community Integration and Recovery

Purpose: Community integration for individuals with serious mental illnesses (SMIs) is recognized as the “external, concrete manifestation” of recovery, an important outcome of mental health treatment and a challenge for mental health services. While recent work on community integration for individuals with SMIs has focused on the multi-dimensionality of community integration, it has not been fully rooted in how consumers define and experience communities for themselves. Guided by symbolic interactionism theory, the goal of the present study is to explore definitions of community as provided by individuals with SMIs, and to incorporate those definitions into a theoretical framework of community to inform community integration efforts in the context of mental health services and recovery.

Methods: Semi-structured interviews were conducted between November 2017 and September 2018 with 90 racially/ethnically diverse participants who were18 years and older with an SMI and receiving community mental health services in three different geographical locations in the United States. Interviews were audio-recorded, transcribed, and analyzed using ResearchTalk’s "Sort and Sift, Think and Shift" methodology. This methodology includes a flexible combination of diagramming, memoing, creating individual participant “episode profiles,” and monitoring salient topics using a parsimonious set of codes grounded in careful review of the data.

Results: Themes derived from participants’ definitions of community included a structural aspect of people and places; a functional aspect of socializing, helping and receiving resources; and an experiential aspect of shared struggles and experiences, finding safety, and identifying with others. To this end, we propose a Structural, Functional and Experiential (SFE) model of community that describes specific elements of community definitions nested within each other, whereby tangible elements of community (structural) are intersect with some intangible aspects of community (functional and/or experiential).

Conclusion and Implications: The results of the present study suggest the need for community integration interventions that are flexible, personalized, multifaceted and start from an individual’s own conceptualization of community, and build upon their existing communities, or at least their concepts of community. The SFE model of community, based on the voices and lived experience of consumers, provides an overarching organization of the factors comprising community. These factors account for the complexity of the community experience while also creating a flexible approach for clinicians and providers to conceptualize and design community integration services. The SFE framework provides an overarching structure that encapsulates the community experiences of individuals with SMIs and guidance for clinicians, researchers, policy makers and service stakeholders regarding the complexity and variability of community for their consumers, which is critical to their recovery.