Building on Recovery: Embracing Community Inclusion in Mental Health Policies and Services.

Recovery is real and has had a transformative impact on mental health policies and services, including shifting the focus from chronicity and symptom management to the realization that individuals with mental health issues can lead meaningful lives. However, recovery has been defined, described, understood, and measured in a wide variety of ways that may account for misuses and abuses in its application and possible stagnation in its impact. It is argued that the mental health field must now build upon the strong foundations of recovery by integrating a well-established rights-oriented framework. While recovery emphasizes personal growth and hope, a rights-based perspective underscores inherent dignity, autonomy, and opportunities for acceptance and embrace in engaging in valued social roles. The addition of a rights-based framework - community inclusion, to conversations involving recovery, is aligned with the origins of recovery and how it is commonly understood, and also connects the mental health field to the dramatic positive impacts that have emerged from the longstanding centrality of this concept in the broader disability community.

The Role of Acceptance in Everyday Loneliness Among Adults with Serious Mental Illness.

There is a high prevalence of loneliness among adults with serious mental illness (SMI) with most research focusing on stable contributing factors. This study sought to identify the role of dispositional loneliness and internalized stigma, as well as the momentary feelings of acceptance on experiential loneliness among adults with SMI. Data were collected using ecological momentary assessment via smart phones, and 89 adults with a SMI were included. Hierarchical linear modeling was used to identify the role of dispositional and experience factors in experiential loneliness. Findings indicated that (a) dispositional internalized stigma, (b) being at home, (c) being alone and, (d) a cross-level interaction between dispositional loneliness and feelings of acceptance best fit the data. The relationship of acceptance to experiential loneliness was strongest among the most lonely. Supporting people with SMI to develop social connections contributing to their relational value may enhance feelings of acceptance and reduce loneliness.

Community Participation of Individuals with Mental Illnesses in Rural Areas: Stakeholder Perspectives on Barriers and Facilitators.

Community inclusion and participation are social determinants of physical and mental health. This study examines activity preferences, barriers to engagement, and potential strategies for facilitating community participation for individuals with serious mental illness living in rural communities. Data for this qualitative study were collected in a series of focus groups with a stakeholders in rural Pennsylvania. Written responses to questions on activities, barriers, facilitators, and solutions were analyzed by members of the research team. The activities that are important to our participants included both those readily accessible in rural areas and those only accessible in more urban areas. Many of the barriers identified aligned with prior research (e.g., poverty, community mobility issues). A number of novel and feasible solutions to overcome barriers were provided at the policy, program, and practice levels, some of which that can be implemented immediately, to increase participation, and improve overall health of people with mental illnesses.

Short Report on Effectiveness of an Autistic-Delivered Peer Support Program: Preliminary Results.

There is little research on the effectiveness of autistic peer-delivered services. This study examines early outcomes associated with the Community Autism Peer Specialist program (CAPS), which was created in partnership with autistic individuals and is delivered by autistic adults who have received training in the delivery of peer support services to enhance the community functioning of autistic youth and adults. A single group pre-test/post-test design was used to examine early outcomes in the areas of independent living needs, social functioning, service engagement, and quality of life. A total of 23 individuals with autism aged 14-41 years were included in the study. Reductions were found in social functioning impairments and unmet needs after three months in the program. Participants also reported greater engagement in mental health services and activities that promote wellness compared with before the program. This study suggests that peer support services delivered by autistic peers may be an effective intervention approach for autistic youth and adults. Future studies with a more rigorous study design (e.g., randomized controlled trials), a larger sample size, and longer-term outcome measurements are needed to further investigate the effectiveness of CAPS and similar autistic-delivered services.

Using GPS and Self-Report Data to Examine the Relationship Between Community Mobility and Community Participation Among Autistic Young Adults.

IMPORTANCE: Community participation of autistic adults is important for health and well-being. Many clinical efforts and interventions aim to enhance community participation in this population. OBJECTIVE: To empirically examine the relationship between community participation and community mobility. DESIGN: A randomized controlled trial using data from baseline and 4- to 6-wk follow-up. SETTING: Community organizations serving autistic adults in Philadelphia. PARTICIPANTS: Sixty-three autistic young adults with data on community mobility and participation from a prior study on public transportation use. OUTCOMES AND MEASURES: Participants were tracked with GPS-enabled cell phones over a 2-wk period. A spatiotemporal data mining algorithm was used to compute the total number of destinations, nonhome destinations, unique destinations, percentage of time spent outside the home, and median daily activity space area from the GPS data. The Temple University Community Participation measure was used to collect self-report data in 21 different areas, and total amount, breadth, and sufficiency of participation were calculated. RESULTS: Moderate and statistically significant associations were found between community mobility and participation variables at baseline and follow-up. However, changes in community mobility were not related to changes in community participation. CONCLUSION: Health policymakers and providers should consider community mobility as a factor that can affect community participation in autistic individuals. Plain-Language Summary: Lower levels of community participation among autistic young adults affect health outcomes and overall quality of life. Community mobility is often a barrier to community participation. An understanding of the relationship between community mobility and community participation can lead to occupational therapists tailoring specific interventions and policies that support autistic young adults to engage in important life activities within the community.

Employment of Certified Peer Specialists in Mental Health Professional Shortage Areas.

The current demand for mental health services is exacerbated by an ongoing shortage of behavioral health care providers in the United States. The Health Resources and Services Administration has identified 5,833 Mental Health Professional Shortage Areas (MHPSAs), many of which are rural, and could be served by Certified Peer Specialists (CPSs). This paper examines the relationship between CPS employment and MHPSA residency. Data are from a 2020 survey of 572 CPS certified in one of four states. Random effects logistic regression models were used to test the relationship between MHPSA residence and employment outcomes. Of 166 unique counties identified by participant zip codes, 47 were characterized as being MHPSAs with 14% of participants residing in one of these counties. A higher proportion of those living in MHPSAs were employed in peer support jobs (rather than other job types or unemployed) compared to those living in non-MHPSAs (68% vs. 54%, p = .020). MHPSA residential status was not a significant predictor of employment status (OR = 1.14, p = .728) but was significantly associated with greater likelihood of employment in peer support compared to other jobs, both for the entire sample (OR = 2.13, p = .026), and among those currently employed (OR = 2.90, p = .032). The greater likelihood of working in peer support among those residing in MHPSAs suggests that CPSs may leverage their credential to address shortages. As a result, peer support may become a more necessary part of the traditional service array. Policies that enable CPS to practice in MHPSAs should be encouraged.

Community Mental Health Center Visits and Community Mobility of People with Serious Mental Illnesses: A Facilitator or Constraint?

Mental health services and interventions have increasingly focused on the importance of community participation and mobility for people with serious mental illnesses (SMI). This study examined the role that visits to community mental health centers (CMHCs) may play in increasing community mobility of people with SMI. Eighty-nine adults with SMI receiving services at three CMHCS were tracked with GPS-enabled phones over a 13-day period. Findings revealed that participants visited more destinations on days they went to a CMHC compared to days they did not. They also spent more time out of the home and traveled greater distances. Results suggest that the benefits of visiting a mental health center appear to go beyond treatment outcomes, but also point to the possibility that obligations, whether to a clinic appointment or possibly vocational, educational, leisure, faith, or social commitments, may be an important stepping stone to more mobility and intentional, sustained community participation.

Lifespan service receipt and unmet needs among individuals on the autism spectrum.

Timely data on service use and needs across the lifespan are essential to developing an effective and efficient service delivery system that is responsive to developmental issues. This study uses data from one of the largest statewide surveys conducted between 2017 and 2018 to compare service use and unmet needs among individuals on the autism spectrum across the lifespan. A statewide sample of 5792 caregivers of autistic children and adults were included in the study. Logistic regressions were conducted to compare service use and need among six age groups ranging from early childhood (0-5 years) to later adulthood (31+) while adjusting for sociodemographic characteristics. We found that the transition-age adult group (18-21 years) was less likely to receive services, including speech/language therapy, occupational therapy, one-on-one support, and social skill training, than adolescents. However, case management and mental health services increased with age. Young adults (22-30 years) were more likely to report unmet needs than both adolescents and transition-age adult groups. The use of services overall decrease and service needs increased compared to results from an earlier statewide survey that was conducting in 2009-2010. These results can be used to inform developmentally appropriate autism-related healthcare policies and service development and delivery. This study offers a more detailed look at differences between adult age subgroups that are novel. Further research is needed about the prevalence of ASD in adulthood, clinical trajectories, and outcomes in order to support autistic adults in getting the appropriate services and supports.

Exploring the Impact of Verbal Abuse on Recovery: A Mediation Study.

OBJECTIVE: People with serious mental illnesses are exposed to high rates of verbal abuse. This study examines the impact of such experiences on loneliness and social support, which is hypothesized to ultimately diminish recovery. METHOD: Fifty participants with serious mental illnesses reported on their experiences with verbal abuse, loneliness, social support, and recovery. RESULTS: Verbal abuse was found to be related to loneliness and social support, and both mediated the relationship between verbal abuse and recovery. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Verbal abuse is an all too common experience of people with serious mental illnesses that ultimately affects their recovery. Specifically, exposure to verbal abuse may impact recovery by increasing sense of loneliness and perceived social support. The implications are that a heightened awareness of verbal abuse and its impact on recovery should draw attention to interventions that decrease exposure and increase self-advocacy to combat negative outcomes.

The influence of sense of community on the relationship between community participation and mental health for individuals with serious mental illnesses.

The goal of the current study is to better understand the association between community participation and mental health by investigating sense of community as a potential mediating factor between community participation, psychological distress, and mental health functioning. A survey was administered to 300 adults with serious mental illnesses using community mental health services in the United States in a cross-sectional design. Hayes PROCESS macro (model 4, version 2.16; Hayes, 2013) was employed to test all of the hypotheses. Results indicate that sense of community partially mediated the association between community participation and psychological distress, as well as mental health functioning. Implications include contributing to the current knowledge base about the influence of community factors on mental health and informing future interventions aimed at promoting community participation of adults with serious mental illnesses.

Using Geospatial Research Methods to Examine Resource Accessibility and Availability as it Relates to Community Participation of Individuals with Serious Mental Illnesses.

Greater community participation among individuals with serious mental illnesses is associated with better psychosocial and health outcomes. Typically, studies examining community participation have utilized self-report measures and been conducted in limited settings. The introduction of methodological advances to examining community participation of individuals with serious mental illnesses has the potential to advance the science of community mental health research and invigorate the work of community psychologists in this area. This study employed an innovative geospatial approach to examine the relationship between community participation and resource accessibility (i.e., proximity) and availability (i.e., concentration) among 294 individuals utilizing community mental health services throughout the United States. Findings suggest small but significant associations between community participation and the accessibility and availability of resources needed for participation. Furthermore, findings demonstrate the importance of car access for individuals residing in both urban and non-urban settings. The methods and results presented in this study have implications for community mental health research and services and provide an illustration of ways that geospatial methodologies can be used to investigate environmental factors that impact community inclusion and participation of individuals with serious mental illnesses.

Associations between the peer support relationship, service satisfaction and recovery-oriented outcomes: a correlational study.

BACKGROUND: The working alliance between non-peer providers and mental health consumers is associated with positive outcomes. It is hypothesized that this factor, in addition to other active support elements, is also positively related to peer support service outcomes. AIMS: This study evaluates correlates of the peer-to-peer relationship and its unique association with service satisfaction and recovery-oriented outcomes. METHOD: Participants were 46 adults with serious mental illnesses taking part in a peer-brokered self-directed care intervention. Pearson correlation analyses examined associations among peer relationship factors, services-related variables and recovery-oriented outcomes (i.e. empowerment, recovery and quality of life). Hierarchical multiple regression analyses evaluated associations between relationship factors and outcomes over time, controlling for other possible intervention effects. RESULTS: The peer relationship was not related to number of contacts. There were robust associations between the peer relationship and service satisfaction and some recovery-oriented outcomes at 24-months, but not at 12-months. These associations were not explained by other possible intervention effects. CONCLUSION: This study contributes to a better understanding of the positive, unique association between the peer-to-peer relationship and outcomes, similar to what is found in non-peer-delivered interventions. Implications for program administrators and policymakers seeking to integrate peer specialists into mental health service systems are discussed.

[Community inclusion as a human right and medical necessity for individuals with serious mental illnesses]. / La inclusión comunitaria en personas con trastornos mentales severos como un derecho humano y como una necesidad médica.

Community inclusion refers to equal opportunities for people to participate in the community and willingness to welcome and active community attitude. The opportunity to participate in the community is both a medical necessity and a rights issue. This concept provides a novel theoretical framework for the advancement of mental health policies, programs, and global practices that enable the development of the well-being and health of people with mental disorders. Eleven fundamentals for promoting community inclusion of individuals with serious mental illnesses that are supported by key conceptual, theoretical, and research evidence. These fundamentals reflect beliefs and schemas that need to be present to truly prioritize and facilitate inclusion, intervention strategies and achieve the most impactful objectives that were expected. The greater inclusion, greater community participation, which includes work, education, religion and spiritual participation, and other domains associated with having a life that makes sense, all of which generates physical, cognitive and mental benefts for anyone, disregarding the presence or absence of a mental disorder. The concept of community inclusion offers a transformative next step in the delivery of mental health services that clearly articulates community participation in meaningful areas as the target for promoting full health and wellness.

Intermethod reliability and factors affecting recall with the Temple University Community Participation measure.

BACKGROUND: Increased interest in promoting community inclusion of adults with serious mental illnesses will necessitate advances in measuring community participation as an outcome of such efforts. AIMS: The primary aim of this study is to examine the intermethod reliability of the Temple University Community Participation (TUCP) measure with a daily checklist approach. Secondary aims are to explore the influence of frequency and importance of participation on recall consistency. METHOD: One hundred and seven individuals diagnosed with a schizophrenia-spectrum disorder, bipolar disorder, or major depression completed a daily checklist of community participation in 25 areas. Approximately 30 days later they completed the TUCP measure involving recall of participation in these same areas. RESULTS: TUCP responses were highly correlated with totals from the daily checklists. Participation areas with more participation days have higher TUCP-diary checklist correlations. Importance of the participation area did not appear to affect correlations. CONCLUSIONS: The TUCP is a usable and relatively unobtrusive measure of community participation. Modest evidence found that more frequent events were recalled more consistently.

Self-determination and self-efficacy as predictors of campus engagement among college students with serious mental illnesses.

OBJECTIVE: Campus engagement, including participation in student organizations and groups, is important for both academic and health outcomes. Yet, college students with serious mental illnesses demonstrate lower levels of campus engagement compared to peers without mental illnesses. To inform psychiatric rehabilitation approaches that might enhance this outcome, the purpose of this study was to test an integrated model of self-determination and self-efficacy theories to predict campus engagement within this student population. METHODS: Sixty-seven college students with serious mental illnesses completed measures assessing self-determination constructs (autonomy, competence, and relatedness), college self-efficacy, and campus engagement. Correlational and path analytic models examined relationships among these variables. RESULTS: Bivariate and multivariate analyses supported the interrelationships among the variables. Specifically, the theory-driven path model demonstrated that autonomy (but not competence or relatedness) was a significant predictor of college self-efficacy, which in turn was associated with campus engagement. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings particularly highlight the importance of autonomy and self-efficacy for promoting campus engagement among college students with serious mental illnesses. As such, they may be relevant targets for psychiatric rehabilitation interventions, such as supported education, that are designed to enhance student success. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Independence through community access and navigation: A supported leisure intervention for individuals with negative symptoms.

OBJECTIVE: Promoting leisure participation requires a collaborative approach that emphasizes personal interests, strengths, and motivations. The purpose of this article was to test the effectiveness of the Independence through Community Access and Navigation (ICAN) intervention on community participation, recreation participation, and positive emotions among individuals with schizophrenia spectrum disorders. Using motivational interviewing and an individualized placements and support framework, the ICAN intervention focuses on working with participants to identify and participate in personally meaningful leisure activities by connecting with personal motivations and mainstream community opportunities. METHOD: This randomized controlled trial was conducted with 74 participants diagnosed with schizophrenia with assessments conducted at baseline and posttreatment. Intervention effects were examined with repeated-measures analysis of variance (ANOVA). Multiple regression analysis was also performed using a change score as an outcome variable and baseline negative symptoms score, condition, and interaction as predictors. RESULTS: There was no significant main effect of ICAN on positive emotions, recreation participation, or community participation; however, among those in the experimental group, those with impairments in motivation and pleasure experienced improvements in community participation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: For individuals experiencing greater negative symptoms, a supported leisure intervention may be an effective strategy to explore personal motivations and increase leisure participation. Future research should test the intervention effectiveness specifically targeting a larger sample of individuals with more severe negative symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Disparities in severe loneliness between adults with and without a serious mental illness.

OBJECTIVE: Severe loneliness infrequently occurs in the general population but has very significant impacts on health and quality of life. This study examined the extent to which severe loneliness is experienced by adults with serious mental illnesses (SMIs) relative to adults in the general population and its possible implications for psychiatric rehabilitation services. METHOD: Data were gathered from samples of individuals with SMI (N = 231) and a general community sample of adults (N = 300) using the University of California, Los Angeles Loneliness Scale. RESULTS: The results indicate that loneliness was much greater among those with SMI than the general adult population sample (Cohen's d = 1.220) and approximately 41% of the participants with SMI were "severely lonely" versus 7.3% of the non-SMI adult sample. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Severe loneliness is extremely common among individuals with SMI. Psychiatric rehabilitation services that focus on socialization and mattering are needed to address this significant public health issue. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Participation in arts and culture among individuals with serious mental illnesses and its relationship to quality of life and recovery.

OBJECTIVE: Engagement in arts and cultural activities is valued and yields positive outcomes but may be understudied in populations with serious mental illness (SMI). Our aims are to evaluate the extent to which individuals with SMI deem participation areas related to arts and culture (e.g., going to a theater) to be important, and if important, how often they are being done and if it is enough in comparison to a nonSMI sample. METHODS: We conducted analyses using a sample of 1,120 individuals with SMI from nine research studies between 2008 and 2016 and a sample of 300 individuals without SMI that were part of the Truven Health Analytics PULSE survey. All participants completed a survey containing questions related community participation. Analyses were conducted using independent samples t tests, followed by analysis of variances, and chi-square tests. RESULTS: The results indicate that adults with SMI are as, or more interested in arts and cultural activities as adults in the general population, but do not participate in those areas as much as they would like in comparison. We also found that, as with the general population, participation in these areas is positively associated with quality of life and to a lesser degree, recovery. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Engagement in arts and culture activities may be an overlooked compared to other areas of participation, such as employment. Psychiatric rehabilitation practitioners may need to pay greater attention to areas related to art appreciation, rather than just art production. (PsycInfo Database Record (c) 2023 APA, all rights reserved).