"Opening and Closing Doors": How Families Influence Community Experiences Among Individuals with SMIs

Background and Purpose: Research suggests that families can be both a facilitator of and a barrier to community integration, an important indicator of recovery for individuals with serious mental illnesses (SMIs). Whereas families have been linked with the presence of tangible and intangible social support and social resources, they have also been identified as a source of stigma and social isolation. However, little is known about how families influence community experiences that could facilitate or impede the process of community integration, particularly among individuals participating in Assertive Community Treatment (ACT), who may experience significant social isolation outside of their mental health services. The present study aims to explore the mechanisms through which families influence community experiences among individuals with SMIs participating in ACT services.

Methods: The study analyzed data from 30 individuals with SMIs participating in ACT services in a large northeastern state as a part of a larger study that aimed to understand how individuals with SMIs defined and experienced their communities. Semi-structured interviews about participants’ community experiences were analyzed using ResearchTalks' "Think and Shift, Sort and Sift" approach including quote identification, diagramming, memoing, creating individual participant episode profiles and topic monitoring. Findings were interpreted within the context of the Structural, Functional, and Experiential (SFE) model of community.

Results: The data revealed two overarching themes on how families influenced community experiences of individuals with SMIs participating in ACT services. Positive family relationships (e.g., frequent communication, spending quality time, and providing positive appraisals) served to open doors (i.e., facilitating and/or reinforcing community experiences) vis-a-vis existing and/or new communities. This might have been due to families providing tangible resources (e.g., housing, financial support), creating a sense of psychological safety, and passing down family values and norms. Negative family relationships (e.g., relationships that expose participants to stigma, violence or abuse), served to close doors by hindering development of new social relationships and/or contributing to participants cutting existing social ties. This might have been due to negative family relationships causing psychological distress and trust issues due to unresolved trauma.

Conclusions and Implications: Our findings illustrated a nuanced and complex ways in which family influenced community experiences among individuals with SMIs. In accordance with the SFE model of community, the study expands previous knowledge on how family as a structural community facilitates various positive and negative community experiences and influences other community structures, functions and experiences. The current study suggests specific and targeted ways in which policies and practices could develop and improve to enhance community experiences within the context of participants’ existing family relationships.