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.

Recovery at 30: Perspectives from Psychiatry Clinicians and Senior Faculty.

According to William Anthony's "Recovery from mental illness: the guiding vision of the mental health service system in the 1990s," mental health recovery means "changing one's attitudes, values, feelings, goals, and skills in order to live a satisfying life within the limitations caused by illness." This seminal work served as an overarching goal, a call to action, and a roadmap for the enhancement of psychiatric recovery. Unfortunately, from many viewpoints, the goals encouraged by Anthony have not been achieved. Through semi-structured interviews with psychiatry clinicians and senior faculty members, this article aims to elucidate the current status of psychiatric recovery, how the movement progressed to this point, and where we could go from here. The development of the recovery movement will be discussed, along with its assumptions and explicit goals. The interviews focus on the extent to which these goals have been achieved, barriers to progress, whether goals should be revised, and how to achieve these goals.

Experiences of verbal violence among people with intellectual disabilities in Israel.

BACKGROUND: This study examines the extent of exposure to verbal violence experienced by people with intellectual disabilities and whether it differs based on their housing situation: living in the community, with family, or in a residential facility. METHOD: One hundred and eighty-nine people with intellectual disabilities were interviewed about their experience with verbal violence. RESULTS: Eighty-six percent reported experiencing verbal violence in their lifetime and approximately 77% experienced it the past week. Participants were most likely to be yelled at, and friends were the most common perpetrators. While there were few differences by setting, people living with their families were more likely to be laughed at and marginally more likely to experience rude comments. CONCLUSIONS: Verbal violence is prevalent in the lives of people with intellectual disabilities in Israel. Interventions are necessary to assist people with intellectual disabilities to deal with such incidents, with possible additional supports needed for those living with family.

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.

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).

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).

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.

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.

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.

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).

Housing and loneliness among individuals with serious mental illnesses.

BACKGROUND: People with serious mental illnesses (SMI) have higher levels of loneliness than the general population. Furthermore, people with SMI tend to be less satisfied with their housing and tend to move more frequently. AIM: This study aims to examine relationships between housing variables (whom they live with, duration of residence, and satisfaction) and loneliness among individuals with SMI. METHODS: Data were collected from 188 adults with SMI in greater Philadelphia area. Classification and Regression Trees (CART) were used to examine whether whom they live with, duration of residence, and housing satisfaction were associated with loneliness. RESULTS: Housing satisfaction was found to be the most prominent predictor of loneliness. Those who were unsatisfied with their overall housing conditions always had the highest level of loneliness, regardless of other factors. Even if they were satisfied with their housing conditions, their loneliness was higher if they had just moved to the new residence. Participants had lower loneliness the longer they lived in a residence and had the lowest loneliness levels after about three years. CONCLUSION: Housing is associated with loneliness among people with SMI. Psychiatric service providers should increase support to factors contributing to housing satisfaction and duration of residence, including active engagement in the community.

Peer-Facilitated Decision Making in Mental Health: Promises, Pitfalls, and Recommendations for Research and Practice.

Recognition has grown that peer support workers serve an important role in facilitating decision making about treatment and recovery among people with mental health conditions. This article provides examples of peer-facilitated decision support interventions in the literature, discusses promises and potential pitfalls associated with peers serving in decision support roles, and offers recommendations for research and practice. Examples were selected from the literature on decision support interventions for people with serious mental illnesses, such as schizophrenia, bipolar disorder, and major depression. Promises, pitfalls, and recommendations were informed by this research and by the literature on lived experience perspectives, the helper-therapy principle, and reported barriers to and facilitators of peers assisting with decision making. According to the included studies, peers may facilitate decision making in several ways (e.g., by asking service users about their goals or preferences, assisting them with using decision support tools, sharing stories, and facilitating access to information and resources). Peer-facilitated decision support may be associated with positive decision making and health outcomes for service users and peer support workers. However, providers need to carefully consider barriers to implementation of this support, such as inadequate resourcing, poor integration, and compromising of peer support values.

Autistic-Delivered Peer Support: A Feasibility Study.

Peer support has been an undeveloped pathway for filling the service gap and to generate employment opportunities for autistic individuals. Peer supports have been deployed widely in mental health and among veterans and understanding the utility of this service modality among autistic individuals illuminates opportunities for research, policy, and practice. This study examined characteristics of participants in an autistic-delivered peer support program and reports on use of and satisfaction with the program. Half of autistic participants had a co-occurring mental health diagnosis. Participants reported multiple areas of unmet needs and participant satisfaction with the program was high (90%). The findings of this study point toward autistic-delivered peer support as a promising avenue for future development.

Community participation differences between Black and White adults with serious mental illness.

Promoting community participation is a core goal of behavioral health services for persons with serious mental illness (SMI) regardless of their racial/ethnic background. While practitioners are trained to respect diversity and culture, little is known about how racial/ethnic minorities participate in their communities during the recovery process. This is especially true for Black adults, who are disproportionately represented in current services. This study sought to compare differences in community participation experiences and interests between Black and White adults with SMI. Secondary data (n = 799) were analyzed from studies involving Black and White adults with SMI using the Temple University Community Participation Measure. Regression analyses were conducted to identify potential differences in four areas: amount of participation in a variety of community activities; number of activities participants deemed important; number of important activities actually performed; and the percentage of important activities performed as much as desired (i.e., sufficiency). Compared to White adults, Black adults had greater amounts of community participation overall and in a number of specific community activities (e.g., worship, visiting park/recreation center). Black adults also reported more community activities as important and were more likely to engage in their important activities. Relative to White adults, results suggest that Black adults with SMI were interested in and engaged more in social activities-potentially enhancing their sense of group solidarity and personal mental health recovery. Accordingly, practitioners should be aware of, and attend to, possible racial/ethnic differences in community participation, and its possible role in promoting or hindering recovery across diverse populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Predictors of worklife burnout among mental health certified peer specialists.

Certified peer specialists (CPSs) are a growing workforce that uses their lived experience of a behavioral health disorders plus skills learned in formal training to deliver support services. Despite their important role in the mental health care system and research on their working conditions, experiences of burnout have not been widely studied among CPSs. This study uses survey data from CPSs who were currently employed in any type of job, providing peer support services or not. Using the Maslach Burnout Inventory (MBI) and Areas of Worklife Survey (AWS), along with other measures of personal and job characteristics, relationships of predictors variables to burnout measures were described in unadjusted and adjusted linear regression models. Scores on each of the averaged burnout measures differed significantly between those employed in peer services jobs and those in other job types, with those in peer services jobs reporting lower exhaustion, cynicism, and higher professional efficacy. Better workload and fairness were associated with significantly lower exhaustion, and better reward and community were both associated with significantly lower cynicism. Those employed in peer services jobs had fewer signs of burnout than those in other occupations, in keeping with prior research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Employment Outcomes After Certification as a Behavioral Health Peer Specialist in Four U.S. States.

OBJECTIVE: A 3-year study explores employment outcomes of certified peer specialists (CPSs). Analyses reported here identified relationships between demographic, clinical, work history, and geographic characteristics and employment status and current employment in peer services jobs versus other jobs. METHODS: The study recruited adults who recently became a CPS, regardless of current employment status, in four states. Online survey data were collected from March to October 2020 and included demographic information, health status and diagnoses, mental health service use, motivations for becoming certified, employment history, and job characteristics, including job satisfaction. Descriptive statistics and logistic regression models were used to compare groups. RESULTS: Of 681 respondents, 591 provided data on current employment and were included. Participants who received Social Security Disability Insurance or Supplemental Security Income, veterans, those who used outpatient counseling or therapy, and those who did not disclose their mental health status in the workplace were less likely to report current employment. Lack of disclosure and higher local unemployment rates contributed to a lower likelihood of working in peer services jobs, whereas individuals reporting depressive disorders were more likely to hold such jobs. Compared with those in other jobs, those in peer services jobs reported longer job tenure, and a larger proportion received employee benefits. Job satisfaction was significantly higher among those with peer services jobs. CONCLUSIONS: Workers with a CPS credential had higher employment rates, compared with adults with psychiatric disabilities, and the quality of peer specialist jobs was equal to or higher than the quality of other jobs held by study participants.