Abstract
While recent work on community integration for individuals with serious mental illnesses (SMIs) has focused on the multi-dimensionality of community integration, it has not been fully rooted in how consumers define and experience communities for themselves. Guided by symbolic interactionism theory, the goal of the present study is to explore definitions of community as provided by individuals with SMIs, and to incorporate those definitions into a theoretical framework of community to inform community integration efforts in the context of mental health services and recovery. Semi-structured interviews were conducted between November 2017 and September 2018 with 90 racially/ethnically diverse participants who were 18 years and older with an SMI and receiving community mental health services. Interviews were audio-recorded, transcribed, and analyzed using ResearchTalk’s "Sort and Sift, Think and Shift" methodology. Themes derived from participants’ definitions of community included a structural aspect of people and places; a functional aspect of socializing, helping and receiving resources; and an experiential aspect of shared struggles and experiences, finding safety, and identifying with others. To this end, we propose a Structural, Functional and Experiential (SFE) model of community. The SFE model of community provides a conceptual framework and guidance for clinicians, researchers, policy makers and service stakeholders regarding the complexity and variability of community for their consumers, which is essential to their recovery. Application of the SFE framework for assessment and intervention is discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Armour, M. P., Bradshaw, W., & Roseborough, D. (2009). African Americans and recovery from severe mental illness. Social Work in Mental Health, 7(6), 602–622. https://doi.org/10.1080/15332980802297507.
Barry, C. L., Huskamp, H. A., & Goldman, H. H. (2010). A political history of federal mental health and addiction insurance parity. The Milbank Quarterly, 88(3), 404–433. https://doi.org/10.1111/j.1468-0009.2010.00605.x.
Bhattacharyya, J. (2004). Theorizing community development. Community Development, 34(2), 5–34. https://doi.org/10.1080/15575330409490110.
Blackshaw, T. (2009). Key concepts in community studies. Thousand Oaks: Sage Publications Limited.
Blumer, H. (1986). Symbolic interactionism: Perspective and method. Berkeley: University of California Press.
Bond, G. R., Salyers, M. P., Rollins, A. L., Rapp, C. A., & Zipple, A. M. (2004). How evidence-based practices contribute to community integration. Community Mental Health Journal, 40(6), 569–588. https://doi.org/10.1007/s10597-004-6130-8.
Bradshaw, T. K. (2008). The post-place community: Contributions to the debate about the definition of community. Community Development, 39(1), 5–16. https://doi.org/10.1080/15575330809489738.
Bredewold, F., Hermus, M., & Trappenburg, M. (2018). ‘Living in the community’the pros and cons: A systematic literature review of the impact of deinstitutionalisation on people with intellectual and psychiatric disabilities. Journal of Social Work. https://doi.org/10.1177/1468017318793620.
Brennan, M. A., & Brown, R. B. (2008). Community theory: Current perspectives and future directions. Community Development, 39(1), 1–4. https://doi.org/10.1080/15575330809489737.
Bromley, E., Gabrielian, S., Brekke, B., Pahwa, R., Daly, K. A., Brekke, J. S., et al. (2013). Experiencing community: Perspectives of individuals diagnosed as having serious mental illness. Psychiatric Services, 64(7), 672–679. https://doi.org/10.1176/appi.ps.201200235.
Carter, M. J., & Fuller, C. (2016). Symbols, meaning, and action: The past, present, and future of symbolic interactionism. Current Sociology, 64(6), 931–961. https://doi.org/10.1177/0011392116638396.
Charmaz, K. (2014). Constructing grounded theory. Thousand Oaks: Sage.
Cohen, A. P. (1985). The symbolic construction of community. Abingdon: Routledge.
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. Thousand Oaks: Sage publications.
Dear, M. J., & Wolch, J. R. (2014). Landscapes of despair: From deinstitutionalization to homelessness (Vol. 823). Princeton: Princeton University Press.
Dedoose Version 8.0.35 (2008) w. a. f. m., analyzing, and presenting qualitative and mixed method research data. Los Angeles, CA: SocioCultural Research Consultants, LLC. Retrieved from http://www.dedoose.com.
Finnerty, M. T., Manuel, J. I., Tochterman, A. Z., Stellato, C., Fraser, L. H., Reber, C. A., et al. (2015). Clinicians’ perceptions of challenges and strategies of transition from assertive community treatment to less intensive services. Community Mental Health Journal, 51(1), 85–95. https://doi.org/10.1007/s10597-014-9706-y.
Gronfein, W. (1985). Psychotropic drugs and the origins of deinstitutionalization. Social Problems, 32(5), 437–454. https://doi.org/10.2307/800774.
Hillery, G. A. (1955). Definitions of community: Areas of agreement. Rural Sociology, 20, 111–123.
Lauer, M., & Brownstein, R. (2008). Replacing the revolving door: A collaborative approach to treating individuals in crisis. Journal of Psychosocial Nursing and Mental Health Services, 46(6), 24–32. https://doi.org/10.3928/02793695-20080601-06.
Maietta, R. (2006). State of the art: Integrating software with qualitative analysis. In L. Curry, R. Shield, & T. Wetle (Eds.), Improving aging and public health research: Qualitative and mixed methods (pp. 117–139). Washington, DC: American Public Health Association and the Gerontological Society of America.
Mancini, A. D., Moser, L. L., Whitley, R., McHugo, G. J., Bond, G. R., Finnerty, M. T., et al. (2015). Assertive community treatment: Facilitators and barriers to implementation in routine mental health settings. Psychiatric Services, 60(2), 189–195. https://doi.org/10.1176/appi.ps.60.2.189.
Padgett, D. K. (2016). Qualitative methods in social work research (Vol. 36). Thousand Oaks: Sage Publications.
Padgett, D. K., Gulcur, L., & Tsemberis, S. (2006). Housing first services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice, 16(1), 74–83. https://doi.org/10.1177/1049731505282593.
Padgett, D. K., Henwood, B., Abrams, C., & Drake, R. E. (2008). Social relationships among persons who have experienced serious mental illness, substance abuse, and homelessness: Implications for recovery. American Journal of Orthopsychiatry, 78(3), 333–339. https://doi.org/10.1037/a0014155.
Pahwa, R., Bromley, E., Brekke, B., Gabrielian, S., Braslow, J. T., & Brekke, J. S. (2014). Relationship of community integration of persons with severe mental illness and mental health service intensity. Psychiatric Services, 65(6), 822–825. https://doi.org/10.1176/appi.ps.201300233.
Pahwa, R., & Kriegel, L. (2018). Psychological community integration of individuals with serious mental illness. Journal of Nervous & Mental Disease, 206(6), 410–416. https://doi.org/10.1097/NMD.0000000000000829.
Pahwa, R., Smith, M. E., Yuan, Y., & Padgett, D. K. (2019). The ties that bind and unbound ties: Experiences of formerly homeless individuals in recovery from serious mental illness and substance use. Qualitative Health Research. https://doi.org/10.1177/1049732318814250.
Pahwa, R., Patankar, K., Smith, M. E., & Ghosh, S. (2020). Social networks, community integration and recovery for individuals with SMI in India. Community Mental Health Journal. https://doi.org/10.1007/s10597-019-00546-x.
Pahwa, R., Dougherty, R., Kelly, E, Davis, L., Smith, M. E., & Brekke, J. S. (in press). Is it safe?: Community integration for individuals with serious mental illnesses. Research on Social Work Practice.
Saldaña, J. (2015). The coding manual for qualitative researchers. Thousand Oaks: Sage.
Salzer, M., & Baron, R. C. (2006). Community integration and measuring participation. Pennsylvania: University of Pennsylvania School of Medicine Philadelphia.
Townley, G. (2015). “It helps you not feel so bad—feel like you again”: The importance of community for individuals with psychiatric disabilities. Journal of Psychosocial Rehabilitation and Mental Health, 2(2), 113–124. https://doi.org/10.1007/s40737-015-0036-3.
Townley, G., Kloos, B., & Wright, P. A. (2009). Understanding the experience of place: Expanding methods to conceptualize and measure community integration of persons with serious mental illness. Health & Place, 15(2), 520–531. https://doi.org/10.1016/j.healthplace.2008.08.011.
Townley, G., Miller, H., & Kloos, B. (2013). A little goes a long way: The impact of distal social support on community integration and recovery of individuals with psychiatric disabilities. American Journal of Community Psychology, 52(1–2), 84–96. https://doi.org/10.1007/s10464-013-9578-2.
Tyler, R. (2006). Comprehending community. In S. Herbrechter & M. Higgins (Eds.), Critical studies, returning (to) communities theory, culture and political practice of the communal (Vol. 28, pp. 21–28). Amsterdam: NLD Editions Rodopi.
Wong, I., & Solomon, P. (2002). Community integration of persons with psychiatric disabilities in supportive independent housing: A conceptual model and methodological considerations. Mental Health Services Research, 4(1), 13–28. https://doi.org/10.1023/A:1014093008857.
Wong, I., Poulin, S. R., Lee, S., Davis, M. R., & Hadley, T. R. (2008). Tracking residential outcomes of supported independent living programs for persons with serious mental illness. Evaluation and Program Planning, 31(4), 416–426. https://doi.org/10.1016/j.evalprogplan.2008.07.001.
Wong, I., Sands, R. G., & Solomon, P. (2010). Conceptualizing community: The experience of mental health consumers. Qualitative Health Research, 20(5), 654–667. https://doi.org/10.1177/1049732310361610.
Wong, I., Stanton, M. C., & Sands, R. G. (2014). Rethinking social inclusion: Experiences of persons in recovery from mental illness. American Journal of Orthopsychiatry, 84(6), 685. https://doi.org/10.1037/ort0000034.
Acknowledgements
We would like to thank the member agencies, staff and consumer participants of the Los Angeles Practice-Based Research Network (PBRN), Recovery-Oriented Care Collaborative (ROCC) for all their support. We would also like to acknowledge the contributions of the New York State Assertive Community Treatment (ACT) institute, ACT service providers and ACT participants as well as the administrators, providers and consumers of People Encouraging People, Inc., Maryland for their participation. We could not have completed this project without their donation of time and resources.
Funding
This work was supported by New York University, Research Challenge Grant, “Community Integration of Individuals with severe mental illness—the social networks qualitative study” (6/17-11/18), University of Maryland School of Social Work intramural research grant, “Exploring Community Integration for Diverse Individuals with Severe Mental Illness” (7/17-6/18) and funds from Suzanne Dworak-Peck School of Social Work at University of Southern California.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Pahwa, R., Smith, M.E., Kelly, E.L. et al. Definitions of Community for Individuals with Serious Mental Illnesses: Implications for Community Integration and Recovery. Adm Policy Ment Health 48, 143–154 (2021). https://doi.org/10.1007/s10488-020-01055-w
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-020-01055-w