Strengths, Struggles, and Strategies: How Adults with Serious Mental Illness Navigate Long-Term Romantic Relationships.

Married individuals and those in committed romantic relationships generally report having better mental health outcomes than their single or divorced counterparts. However, studies of romantic relationships for adults with mental illness have often ignored rewarding aspects of romantic relationships and have focused primarily on relationship difficulties. In this study, 23 adults with serious mental illness in long-term romantic relationships described their relationship strengths and struggles in small focus group discussions. Content analysis was used to characterize themes from participant accounts. Overall, participants described deep emotional bonds with their partners, a mutual willingness to work on their relationship, and good communication skills as relationship strengths. Mental health symptoms and internalized stigma were identified as major contributors to relationship struggles. Participants spontaneously identified intentional strategies that they used to navigate mental health challenges in their relationship that included self-directed, partner-directed, and couple-directed actions. Implications of findings for research and practice are discussed.

The Way I See It: Older Adults with Mental Illness Share Their Views of Community Life Using Photovoice.

The importance of community involvement for both older adults and individuals coping with mental illness is well documented. Yet, barriers to community integration for adults with mental illness such as social stigma, discrimination, and economic marginalization are often exacerbated by increased health and mobility challenges among older adults. Using photovoice, nine older adults with mental illness represented their views of community in photographs and group discussions over a six-week period. Participant themes of community life included physical spaces, valued social roles, and access to resources in the community. Themes were anchored by older adults' perceptions of historical and cultural time comparisons between 'how things used to be' and 'how things are now.' Barriers to community integration were often related to factors such as age, mobility, and resources rather than to mental health status. Program evaluation results suggest photovoice can promote self-reflection, learning, and collaboration among older adults with mental illness.

The Aftermath of Trauma and Abuse and the Impact on Family: A Narrative Literature Review.

The present narrative review examined quantitative and qualitative research on family members who support survivors of trauma or abuse. Studies included in the present review were found in peer-reviewed journal articles, available in English, published between 1980 and 2019, and focused specifically on the experiences of adult familial supporters of adult trauma and abuse survivors. A search of PsychInfo and Google Scholar identified 136 relevant articles, and analysis of their content generated the following categories: individual-level impacts (i.e., quality of psychological health, burden, secondary traumatic stress, quality of physical health, and positive impacts), interpersonal and environmental level impacts (i.e., quality of relationships with survivors, navigating environment, maltreatment and safety, and social impacts), and other experiences (i.e., social roles, needs, coping strategies, and sociocultural context). Findings indicate that the majority of existing studies examined the experiences of family members of adult survivors of military trauma. Results of the review suggest that family supporters of adult trauma and abuse survivors generally experience physical, emotional, cognitive, behavioral, social, safety, and relational impacts. Implications of review findings and directions for future research are discussed.

#MentalHealthArt: How Instagram artists promote mental health awareness online.

OBJECTIVES: Instagram artwork about mental illness was examined to learn how artists promote awareness about mental health and mental illness. STUDY DESIGN: Mixed methods predictive and descriptive analyses were conducted on a public dataset of artwork posts from Instagram. METHODS: One thousand art images were classified by media (painting, drawing, collage, photograph, digital art, printmaking, sculpture, jewelry, or other) and style (representational, nonrepresentational, and functional). Text captions were clustered using latent semantic analysis. Predictive modeling was used to determine whether the frequency of online community response to posts (likes and comments) varied by artwork features or tagged mental health condition. RESULTS: Results suggest that artists using mental health art hashtags most often posted two-dimensional, representational art with text descriptions about emotions and personal experience. However, the minority of images of functional art objects received the most frequent number of community responses. CONCLUSIONS: Findings suggest that artists may use informational and commercial strategies to engage online communities and promote mental health awareness.

Behind the Hashtag: Online Disclosure of Mental Illness and Community Response on Tumblr.

The present study examined personal disclosures about mental illness and the responses of online community members on the social media platform, Tumblr. We sampled public blog posts of 14,626 Tumblr users disclosing ten different mental health diagnoses using hashtags (e.g., #depression, #anxiety, and #anorexia). We examined the content of users' disclosures, predictors of disclosure frequency, and predictors of online community response. The content of most disclosures was related to users' emotions and cognitions about their mental health and their feelings of interpersonal loss and change over time. Content varied with users' disclosure frequency and with self-identified mental health diagnoses. Predictors of disclosure frequency included the "self effects" of writing about oneself or one's opinions, such as self-concept formation, and "reception effects" of receiving responses to one's writing. User disclosures generally increased with frequency of community response (reception effects), and the degree of this effect differed depending on the disclosed diagnosis (self effects). The responses of online community members also varied significantly across disclosed diagnoses. The implications of our findings for community research and action are discussed.

Self and sibling care attitudes, personal loss, and stress-related growth among siblings of adults with mental illness.

Although sibling ties are typically among the longest lasting family relationships, relatively little is known about how adult siblings navigate family caregiving when a brother or sister has a serious mental illness. The present study examined the role of primary caregiver status, perceived sibling illness severity, sibling relationship quality, and self and sibling caregiving attitudes in understanding reports of personal loss and stress-related personal growth among siblings of adults with serious mental illness. Online surveys were completed by 226 adult siblings (141 women; 85 men; mean age = 34 years; SD = 9.05). Results suggest that well siblings' reports of self and sibling caregiving attitudes significantly differed as a function of primary caregiver status (i.e., sibling, parents, or others as primary caregiver or no caregiver). Sibling caregiving attitudes differentially predicted well siblings' experience of personal loss and stress-related growth, regardless of demographics and primary caregiver status, perceived sibling illness severity, and sibling relationship quality. Greater ambivalence about providing care to their sibling with mental illness was associated with adults' reports of greater personal loss while higher levels of sibling balanced care priorities were significantly related to higher levels of personal growth. Greater self-care attitudes were significantly related to lower levels of both personal loss and personal growth for well siblings. Understanding sibling caregiving attitudes has important implications for research and interventions with families coping with mental illness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Stage and process models of consumer-oriented recovery among adults with serious mental illness: The role of personal loss and internalized stigma.

Consumer-oriented models have conceptualized recovery in two main ways: as a multicomponent process across various life domains, and as a series of identifiable stages occurring over time. The main goal of the present study was to determine whether psychosocial factors, namely internalized stigma and personal loss, predicted a greater amount of variance in reports of consumer-oriented recovery than demographic, treatment, and illness severity characteristics. Recovery was measured as both a stage and process. Using a sample of 160 adults with serious mental illness from community settings, hierarchical regression analyses were used to examine the relative contribution of demographic characteristics (age, gender), level of enrollment in mental health services, illness severity (psychiatric symptom frequency, insight), and psychosocial factors (personal loss and internalized stigma) on stage- and process-based recovery. Results showed that, beyond demographic, treatment, and illness severity factors, internalized stigma significantly predicted the lowest stage of recovery (moratorium), while personal loss significantly predicted the highest stage of recovery (growth). Neither psychosocial factor alone significantly contributed to the prediction of process-based recovery. Findings suggest that personal loss and internalized stigma are impediments to consumer-oriented recovery, and should be considered alongside clinical measures when evaluating models of mental health recovery. Implications for future research and social policy reform are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Recovery-oriented services in an inpatient setting: The role of consumers' views of therapeutic alliance and practitioner directiveness on recovery and well-being.

Using a sample of 60 adults with serious mental illness in an inpatient psychiatric hospital, the present study examined the role of therapeutic relationship characteristics between consumers and mental health providers and consumers' views of recovery-oriented service delivery and individual well-being. Specifically, the present study examined how consumers' reports of working alliance and provider directiveness were associated with consumers' views of recovery-oriented service delivery and individual well-being. After controlling for demographic characteristics, self-reported psychiatric symptoms and number of hospitalizations, findings suggested that consumers' reports of stronger working alliance and higher levels of provider directiveness were significantly related to higher perceptions of recovery-orientation in the inpatient hospital setting. Findings indicated that consumers' views of stronger working alliance were associated with higher levels of individual well-being. Implications of findings are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Beyond these walls: Can psychosocial clubhouses promote the social integration of adults with serious mental illness in the community?

OBJECTIVE: The study examined factors associated with community integration experiences of adults with serious mental illness who were members of psychosocial rehabilitation clubhouses in New York City. METHOD: Ninety-two clubhouse members completed an online survey. The study examined relative contribution of adults' reports of individual factors (self-reported psychiatric symptoms, self-esteem), community supports (self-reported employment status and perceived family support), and the clubhouse environment (self-reported time spent in the clubhouse, clubhouse supportiveness, and practical orientation) in accounting for variation in members' reports of social integration within the clubhouse and within the larger community. RESULTS: Hierarchical linear regression results suggest a differential pattern of variables associated with participants' experience of social integration within the clubhouse versus outside the clubhouse with the larger non-mental-health consumers. Adults' reports of more time spent in the clubhouse and perceptions of clubhouse environment as having a more practical orientation were associated with adults' reports of greater social integration within the clubhouse. In contrast, greater self-esteem and being independently employed were associated with greater social integration outside the clubhouse. Perceived family support was associated with higher levels of social integration both within and outside the clubhouse setting. Conclusion and Implication for Practice: Greater social integration of clubhouse members both in and outside the clubhouse environment is essential in understanding community integration. Recommendations for the clubhouse model to improve community integration experiences of its members are discussed. (PsycINFO Database Record

Community Mental Health Care Providers' Understanding of Recovery Principles and Accounts of Directiveness with Consumers.

The present qualitative study examined community mental health providers' accounts of their therapeutic interactions with adults with serious mental illness in a recovery-oriented model of care. Ten long-time mental health care providers discussed their understanding of recovery principles, their use of directive practices, and factors that shape their work with consumers. Content analysis of mental health providers' accounts suggest that providers had no difficulty articulating basic principles of recovery-oriented care. Providers reported engaging in directive practices with consumers and described using traditional clinical factors such as level of functioning, degree of psychiatric symptoms, safety concerns, and legal status to assess consumers' ability for autonomous decision making. Providers generally did not express tension between their views of mental health recovery and their beliefs about utilizing directive approaches with consumers. Implications of present findings for research and practice are discussed.

Mental Health Care Providers' Views of Their Work with Consumers and Their Reports of Recovery-Orientation, Job Satisfaction, and Personal Growth.

The research examined the role of mental health care providers' perceptions of their professional relationships with consumers in understanding their reports of agency recovery-oriented services and their own sense of job satisfaction and personal growth. Multidisciplinary community mental health care providers (N = 105) responded to an online self-report questionnaire. Providers' reports of higher levels of working alliance and greater provider directiveness in working with consumers was significantly related to providers' reports of higher levels of agency recovery-orientation and higher levels of personal growth. Providers' reports of working alliance accounted for the largest proportion of variance in providers' reports of job satisfaction. Mental health providers' perceptions of relationships with consumers are central to understanding providers' views of agency recovery-orientation and sense of professional and personal well-being.

Stress-related personal growth among emerging adults whose mothers have been diagnosed with mental illness.

OBJECTIVE: This study explored whether emerging adults' reports of their relationships with their mothers who have been diagnosed with mental illness and their attempts to make meaning of the experience of having a mother with mental illness were associated with stress-related personal growth. METHODS: Fifty-two emerging adult children with mothers who have been diagnosed with mental illness responded to a self-report questionnaire containing measures of adult parent-child relationships, meaning making, and stress-related personal growth. RESULTS: Hierarchical multiple linear regression analysis of the cross-sectional data indicated that meaning making contributed to stress-related personal growth after accounting for emerging adult-mother relationship factors. Aspects of the emerging adult-mother relationship did not contribute to growth. CONCLUSIONS: Efforts to make meaning of having a mother with mental illness may facilitate growth among emerging adult children. Longitudinal investigations in larger samples are needed to better understand the relationship among interpersonal relationships, meaning making, and growth in this population. IMPLICATIONS FOR PRACTICE: Interventions with adult children of people with mental illness should address their capacity for personal growth.

Community-based arts initiatives: exploring the science of the arts.

In this introduction to the special issue, we describe some of the rewards and challenges of community-based arts initiatives for our discipline. We explore the inherent tensions between art and science that are reflected in community-based arts activities. We pose larger questions about researching community-based arts activities and defining the arts as a means of promoting social change. The diversity of populations, settings, and issues represented by the papers in the special issue are described and a common set of values, methods of inquiry and action are discussed.

Mental health system historians: adults with schizophrenia describe changes in community mental health care over time.

This qualitative study examined changes in community mental health care as described by adults diagnosed with schizophrenia with long-term involvement in the mental health system to situate their experiences within the context of mental health reform movements in the United States. A sample of 14 adults with schizophrenia who had been consumers of mental health services from 12 to 40 years completed interviews about their hospital and outpatient experiences over time and factors that contributed most to their mental health. Overall, adults noted gradual changes in mental health care over time that included higher quality of care, more humane treatment, increased partnership with providers, shorter hospital stays, and better conditions in inpatient settings. Regardless of the mental health reform era in which they were hospitalized, participants described negative hospitalization experiences resulting in considerable personal distress, powerlessness, and trauma. Adults with less than 27 years involvement in the system reported relationships with friends and family as most important to their mental health, while adults with more than 27 years involvement reported mental health services and relationships with professionals as the most important factors in their mental health. The sample did not differ in self-reported use of services during their initial and most recent hospitalization experiences, but differences were found in participants' reported use of outpatient services over time. Findings underscore the importance of the lived experience of adults with schizophrenia in grounding current discourse on mental health care reform.

Community-based theater and adults with psychiatric disabilities: social activism, performance and community engagement.

The present study is an in-depth qualitative inquiry with an established theater troupe composed of adults living with psychiatric disabilities known as The Stars of Light. A grounded theory methodology is used to describe dimensions of social activism and characteristics of theater as a medium of engagement at the individual, setting/troupe, and community levels of analysis. Analysis of a broad scope of interview data, performance content, community contacts, and historical data from the troupe's 19-year history led to the identification of eight emergent theoretical concepts formulated from 17 supporting associated themes. The theoretical concepts characterize the impacts of community-based theater in the lives of participants, and theater troupe processes that contribute to community education and positive social change for adults living with psychiatric disabilities. Advantages, limitations, and future directions for research and action in community-based theater settings are discussed within the context of present research findings.

Consumer perspectives and mental health reform movements in the United States: 30 years of first-person accounts.

OBJECTIVE: The present qualitative study examined 69 published first-person accounts written by adults diagnosed with schizophrenia from 1979-2010 within the historical context of the four major mental health movements in the United States. METHODS: Content analysis techniques were used to identify major topics and overarching content categories in the first-person accounts written over the 30-year period. The frequency of topics in each content category was examined as a function of the decade and corresponding mental health movement in which accounts were published. RESULTS: Five overarching content categories emerged reflecting authors' conceptualizations of schizophrenia, their experiences with psychiatric hospitalization, medications, coping with social stigma, and achieving and maintaining valued social roles. Two summary categories emerged reflecting authors explicit views about what helped and what did not help in their experience of living with schizophrenia. With the exception of social stigma, frequency of topics within content categories did not change as a function of decade and corresponding mental health movement. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Despite changes in mental health policies, treatment, and systems of care, the overall lack of significant differences in the content of first-person accounts across the 30-year period suggests an enduring nature to the experiences of individuals coping with schizophrenia. Implications of present findings for research and practice are discussed.

Social networks and personal loss among young adults with mental illness and their parents: a family perspective.

OBJECTIVE: Study examined perceptions of personal loss due to mental illness and social network characteristics among young adults with a psychiatric disability and their parents. Research directly compared young adults' and parents' reports of personal loss, social network structure and support, and interpersonal loneliness. Relationships between perceived networks, personal loss, and loneliness for adults and parents were examined. METHOD: Sixty young adults diagnosed with schizophrenia or bipolar disorder and their parents from 30 families completed individual, semistructured interviews that assessed social networks, loneliness, and personal loss due to mental illness. RESULTS: Differences between young adults and parents were found in types of personal loss due to mental illness and the structure of their perceived networks. Parents reported larger networks with more family members than did adults, but no significant differences were found in perceptions of social support. Adults and their parents reported similar feelings of loneliness, but a differential pattern of relationships was found between perceived personal loss, network characteristics, and loneliness among adults and their parents. CONCLUSIONS: Study highlights importance of including both adults with psychiatric disability and their parents in family research. Comparing experiences of adults and parents can help to describe disruptions due to mental illness and perceived availability of social resources in the context of family life.

When mom has a mental illness: role reversal and psychosocial adjustment among emerging adults.

OBJECTIVE: Guided by a life course perspective, the present study examined whether aspects of the emerging adult-mother relationship, specifically affection, felt obligation, role reversal, and reciprocity, mediated the association between having a mother with mental illness and poorer psychological adjustment. METHOD: Emerging adults with mothers with mental illness (n = 52) and emerging adults without mothers with mental illness (n = 64) were recruited from institutes of higher education and responded to an online self-report questionnaire. Most participants (81%) were female. RESULTS: Results from multiple mediation analyses indicated a history of parent-child role reversal mediated the association between having a mother with mental illness and emerging adults' psychological symptoms. None of the assessed aspects of the emerging adult-mother relationship mediated the association between maternal mental illness and emerging adults' psychological well-being, but having divorced parents and being older was associated with lower levels of psychological well-being. CONCLUSIONS: Findings indicate role reversal contributes to emerging adults' psychological symptoms. Assessment of a history of role reversal may be relevant to clinical practice with emerging adults, particularly those with mothers with mental illness. Life course perspectives can inform future studies of emerging adults with mothers with mental illness.

Recovery-oriented services for individuals with mental illness and case managers' experience of professional burnout.

Present cross-sectional study examined perceptions of recovery-oriented services and reports of professional burnout and job satisfaction in a sample of 114 case managers working in community mental health centers across Ohio. The research examined the relative contribution of demographic characteristics, the structure of case management services, and case managers' beliefs about recovery-oriented services in describing their reports of professional burnout and job satisfaction. Regardless of individual characteristics of case managers and reports of the structure of their jobs, case managers who perceived their agency to offer higher levels of recovery-oriented services also reported lower levels of depersonalization and emotional exhaustion at work, and higher levels of professional accomplishment and job satisfaction. Directions for future research in the area are discussed.

Emerging adults' perspectives on their relationships with mothers with mental illness: implications for caregiving.

Guided by a life course perspective, the current study examined whether emerging adults with and without mothers with affective disorders viewed their relationships with their mothers differently, and whether aspects of the emerging adult-mother relationship were associated with reports of caregiving for mothers. Reports from emerging adults with mothers with affective disorders (n = 46) were compared to reports from emerging adults with mothers without mental illness (n = 64). Results indicated that emerging adults with mothers with affective disorders reported significantly lower levels of affection, felt obligation, reciprocity, and future caregiving intentions, and significantly higher levels of role reversal in their relationships with their mothers. Reported current caregiving levels did not differ between emerging adults with and without mothers with affective disorders. Hierarchical multiple regression analyses generally indicated higher levels of felt obligation were associated with higher levels of caregiving, regardless of maternal mental health status. Results and future research directions are discussed from a life course perspective.