Since deinstitutionalization, achieving community integration for individuals with serious mental illnesses (SMIs) has been a key aim for mental health services. However, considering the multitude of definitions and conceptualizations of community, there is a lack of clarity in how mental health providers perceive and implement community integration services. The primary focus of the present study was to identify, from the perspective of service providers, ways in which community integration services are conceptualized and to provide a framework that reflects the full spectrum of strategies and services that should be included in public mental health services facilitating community integration. We discuss implications for mental health services.
Using constructivist grounded theory, 18 semi-structured interviews with community mental health service providers and administrative staff were conducted and analyzed. Respondents were asked about their definitions of communities and community integration for their consumers. Interviews were transcribed verbatim and analyzed using principles of ground theory and ResearchTalks' "Think and Shift, Sort and Sift" approach, including quote identification, diagramming, memoing, creating individual participant episode profiles and monitoring of the data. These processes guided us to identify emergent categories and develop a framework to analyze the concept of community integration from the perspective of service providers and administrators.
Broadly, providers interpreted community integration to mean establishing independent living for clients in their local communities. We identified a relationship between the components of services providers emphasized and providers’ role in services. Executive leadership emphasized the importance of self-efficacy, occupational and educational activities, and graduation from services whereas direct care providers were more focused on the minutiae of safety, housing stability, stigma, and connections to community groups outside of mental health services. Direct service staff, particularly field-based, emphasized emotional safety and social connections. While the responses by providers shared similarities in regard to the interpreted goal of community integration, the different components of integration were often discussed as discrete activities.
In analyzing these activities, and their relation to integration, we created a five-component framework of community integration services: physical and emotional safety, social connections, functional skills, occupational role, and advocacy. Physical and emotional safety emphasized addressing trauma related to feeling unsafe in communities, which was reported to impede independent living. Social connections emphasized assisting clients in developing healthy social relationships in community contexts. The components of functional skills and occupational role, which were central across providers, focused on linkages to community-based resources and developing independent living skills. Lastly, some providers discussed fulfilling an advocacy role in their clients’ communities in order to reduce social stigma.
Conclusions and Implications:
Providers' definitions and activities reflected highly siloed approaches to community integration and often conflated community integration with self-sufficiency and functional independence from mental health services, which despite their overlap, are not synonymous. Our findings suggest the need to develop a more collaborative, team-based approach to community integration that emphasizes emotional security and participation in the community. The implications of these findings are particularly salient given the disproportionate impact of COVID-19 to marginalized communities.