Left Behind: Experiences of Community Mental Health Center Clients with Serious Mental Illness During the COVID-19 Pandemic.

While some international qualitative research has interviewed people with serious mental illnesses (SMI) about their experiences in the initial months of the COVID-19 pandemic, few US studies have explored their experiences and perspectives as the pandemic has continued. Drawing from disability studies perspectives, this qualitative study conducted in 2022 explored the experiences of people with SMI seeking services at community mental health centers during the COVID-19 pandemic. Fifteen clients who identified as living with an SMI and were clients during March 2020 were interviewed. Using narrative analysis, we identified an overarching tenor of client experiences: feeling left behind by institutions and society. This feeling of being left behind was conceptualized as three themes. As the literature around the COVID-19 pandemic grows and we attempt to integrate it into community mental health policy and practice, it is essential to include the experiences and perspectives of clients with lived experience of SMI.

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.

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).

Reproductive justice for unhoused women: An integrative review of the literature.

This review examines the reproductive health experiences of unhoused women and youth. Guided by the reproductive justice framework, this review examines barriers to accessing contraception, medical abortion, and prenatal care while homeless. Twenty-one articles were identified through keyword searches in Google Scholar, Ebscohost Academic Search Premier, and PsycINFO. In included articles, barriers were identified at the individual, relational, and contextual levels. Findings from this scoping review illustrate the need to examine multiple levels of analysis when seeking to improve access to family planning services for individuals experiencing homelessness. Included literature suggests an overabundance of research documenting barriers to contraceptive care relative to the literature examining abortion and prenatal care experiences and a scarcity of research examining barriers to reproductive justice among unhoused individuals who do not identify as women.

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.

Community Participation Comparison Between Adults on the Autism Spectrum and Adults in the General Population.

Little research has examined the full-range of participation among adults on the autism spectrum. The current study addresses this knowledge gap by comparing the frequency, importance, breadth, and sufficiency of participation between autistic adults and adults in the general population. Autistic adults participated less, had fewer areas that were important to them, participated in fewer areas that were important to them, and were less satisfied with their participation even after controlling for demographic characteristics. Moreover, this study raises questions about what influences their perceptions about the breadth of activities that are important to them and the degree to which they desire to participate in those areas. Suggestions for future interventions and research are offered.

Engaging unhoused community members in the design of an alternative first responder program aimed at reducing the criminalization of homelessness.

Police are often called to address concerns about people experiencing homelessness, with arrests often resulting from low-level, nonviolent crimes, and violations of minor nuisance ordinances. In Portland, Oregon, advocates lobbied for a new model of emergency response for 911 calls involving unhoused community members and people experiencing behavioral health crises. To ensure the program reflected the needs and perspectives of people experiencing homelessness, teams of researchers, community volunteers, and people with lived experience interviewed 184 people in camps, shelters, and parks. Teams asked unhoused people how the program should be designed, including who the first responders should be, how they should approach individuals in crisis, what resources they should provide, and how they should be trained. This article describes the methods, findings, and recommendations from our collaborative survey process aimed at ensuring that the voices of people experiencing homelessness informed the development of the Portland Street Response pilot program.

Getting out of the house: The relationship of venturing into the community and neurocognition among adults with serious mental illness.

[Correction Notice: An Erratum for this article was reported online in Psychiatric Rehabilitation Journal on May 20 2021 (see record 2021-48272-001). In the original article, the following acknowledgments were missing from the author note: : "The contents of this article were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; Grant 901F0065-02-00; Mark S. Salzer, principal investigator). However, the contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and endorsement by the federal government should not be assumed. The authors are grateful to Kevin Frech, Stephany Wilson, Alison Weigl, Jared Pryor, David Glogoza and Katie Pizziketti for their assistance with data collection and analysis and to Alex Fechner for providing his implementation of the ST-DBSCAN algorithm in RapidMiner." All versions of the original article have been corrected.] Objective: The purpose of this study was to determine if environmental novelty was associated with neurocognitive function among adults with serious mental illness. Method: Participants were recruited from community mental health centers (n = 117), and received a Global Positioning System (GPS) enabled cellular phone for 13 days. Data were also collected on cognitive function and recent participation in community-based activities. Independent samples t-tests were conducted to identify differences in neurocognitive function between participants who predominantly stayed in their homes ("homebodies") versus those who ventured more often from their homes ("venturers"). Analyses were also undertaken to identify if the nature of community participation activities mediated the relationship of neurocognitive function to group membership. Results: Overall, 74% of GPS signals were from participants' home residence. Homebodies demonstrated significantly poorer cognitive function than venturers, and this relationship was not mediated by a number of unique destinations or breadth of community participation activities. Conclusions and Implications for Practice: This study identified a subset of adults with serious mental illnesses who left their homes infrequently and who demonstrate significantly poorer cognitive function than those who left their homes more frequently. Spending extensive amounts of time in an unchanging environment may be a contributing factor to poor cognitive function, and a potential area for intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

"Getting out of the house: The relationship of venturing into the community and neurocognition among adults with serious mental illness": Correction.

Reports an error in "Getting out of the house: The relationship of venturing into the community and neurocognition among adults with serious mental illness" by Bryan P. McCormick, Eugene Brusilovskiy, Gretchen Snethen, Louis Klein, Greg Townley and Mark S. Salzer (Psychiatric Rehabilitation Journal, Advanced Online Publication, Apr 01, 2021, np). In the original article, the following acknowledgments were missing from the author note: : "The contents of this article were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; Grant 901F0065-02-00; Mark S. Salzer, principal investigator). However, the contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and endorsement by the federal government should not be assumed. The authors are grateful to Kevin Frech, Stephany Wilson, Alison Weigl, Jared Pryor, David Glogoza and Katie Pizziketti for their assistance with data collection and analysis and to Alex Fechner for providing his implementation of the ST-DBSCAN algorithm in RapidMiner." All versions of the original article have been corrected. (The following abstract of the original article appeared in record 2021-32212-001). Objective: The purpose of this study was to determine if environmental novelty was associated with neurocognitive function among adults with serious mental illness. Method: Participants were recruited from community mental health centers (n = 117), and received a Global Positioning System (GPS) enabled cellular phone for 13 days. Data were also collected on cognitive function and recent participation in community-based activities. Independent samples t-tests were conducted to identify differences in neurocognitive function between participants who predominantly stayed in their homes ("homebodies") versus those who ventured more often from their homes ("venturers"). Analyses were also undertaken to identify if the nature of community participation activities mediated the relationship of neurocognitive function to group membership. Results: Overall, 74% of GPS signals were from participants' home residence. Homebodies demonstrated significantly poorer cognitive function than venturers, and this relationship was not mediated by a number of unique destinations or breadth of community participation activities. Conclusions and Implications for Practice: This study identified a subset of adults with serious mental illnesses who left their homes infrequently and who demonstrate significantly poorer cognitive function than those who left their homes more frequently. Spending extensive amounts of time in an unchanging environment may be a contributing factor to poor cognitive function, and a potential area for intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Depressive symptoms and community participation among individuals with serious mental illnesses.

Community participation is important to the well-being of people with serious mental illnesses. While theories suggest that depressive symptoms can negatively impact community participation, evidence from previous studies was inconclusive. This study analyzed the relationship between severity of depressive symptoms and various participation constructs including number of days of participation in various community activities, breadth of interests in participating in community activities, and satisfaction with the amount to which one participates. A national sample of individuals with serious mental illnesses (n = 296) was employed. Overall, those who were severely depressed had fewer total days of participation, reported fewer participation areas as important, were less likely to participate in those areas that were important to them, and were less likely to participate as much as they wanted to in areas that were important to them. This relationship generally remained even after controlling for demographics. Overall, the findings from this study suggest that greater attention should be paid to the relationship between depressive symptoms and community participation in this population, including explorations that examine how the promotion of participation may have an impact on depressive symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Exploring urbanicity and its relationship with stigma and well-being outcomes for people with serious mental illnesses.

Following deinstitutionalization, services and housing for people with serious mental illnesses (SMI) became concentrated in economically disadvantaged urban centers. As these areas gentrify, affordable housing for people with SMI is increasingly found in nonurban areas. Although nonurban environments provide benefits for the general population, people with SMI living in nonurban areas perceive higher levels of mental illness stigma. Thus, the relationship between perceived stigma and negative outcomes such as high psychological distress and low sense of community may be stronger in nonurban areas. Data collected from 300 adults with SMI living in urban and nonurban areas were analyzed using a moderated regression design. Urbanicity did not moderate the relationships between perceived stigma and negative outcomes. However, associations were found between urbanicity, perceived stigma, sense of community, and psychological distress, supporting the need to address mental illness stigma in all settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Exploring factors related to supportive housing tenure and stability for people with serious mental illness.

Overall, the retention of people with serious mental illness (SMI) in supportive housing is high. However, some supportive housing settings report average stays of only 15 months, and others report declines in housing retention over time. Many studies report variables associated with supportive housing stability and tenure, but there are few extensive, focused investigations on the subject. Hence, a literature review was conducted to investigate factors associated with supportive housing stability and tenure among people with SMI. The review of the included 28 papers reveals that the factors associated with supportive housing stability and tenure fell into two general categories of individual factors (including psychiatric factors and prior homelessness), and contextual factors (including program characteristics and sense of community and social support). In conclusion, further focus on contextual factors, as well as a potential reframing of individual factors as contextual, may be helpful in addressing issues related to supportive housing stability and tenure for people with SMI.

Emotional states associated with being in the community and being with others among individuals with serious mental illnesses.

Individuals with serious mental illnesses generally spend extensive amounts of time at home and alone. The aim of the current study was to examine differences in emotional states between being at home and being in the community, and between being alone and being with others. Ecological momentary assessment was utilized 3 times per day over 14 days with 91 individuals with serious mental illnesses to assess where they were, who they were with, and momentary feeling of depressed mood, loneliness, and happiness. A total of 2,257 data points were analyzed with hierarchical linear modeling. Participants were at home 70.6% of the time and alone 58.6% of the time. After controlling for diagnosis and symptoms, being in the community was associated with lower depressed mood, lower loneliness, and greater happiness, and being with others was associated with lower loneliness and greater happiness. There was no significant interaction effect between being at home and being alone on any emotional states. Being in the community and being with others contributed to more favorable emotional states among individuals with serious mental illnesses. These findings support the need to promote opportunities for community participation and interactions with others outside of one's home. Policies, programs, and clinical practices should align with the goal of supporting people with serious mental illnesses to actively engage in community living to facilitate their emotional well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining the relationship between community mobility and participation using GPS and self-report data.

Higher levels of community mobility have been shown to be associated with better physical health, mental health, and quality of life. The ability to move about one's community is also expected to facilitate community participation, which is an aspect of health functioning. This study uses Global Positioning Systems (GPS) technology to track various dimensions of community mobility, such as destinations, time outside the home, and distance traveled, and examine the relationship between these variables and community participation in a sample of individuals with serious mental illnesses (SMI). This population was selected because they are known to have diminished health functioning in terms of their community participation, and the goal is to explore the extent to which mobility limitations may account for this. A total of 103 individuals with serious mental illnesses were recruited from mental health agencies and consented to having their mobility tracked using GPS for 13 days and answering questions about their community-based activities. Greater amount of participation was associated with having more destinations and spending more time out of the house, but not with traveling larger distances and having a greater activity space. None of the mobility variables were related to the number of important participation areas or sufficiency of participation. The findings support the hypothesis that greater mobility is related to more participation, although satisfaction with the degree to which one participates does not appear to be impacted, suggesting that other factors need to be accounted for. Health policymakers and providers should pay attention to community mobility as a factor that affects health outcomes such as participation, in individuals with serious mental illnesses, and other populations. In particular, attending to access to personal transport, public transportation, and other mobility options appears to be important, as well as interventions aimed at encouraging greater community mobility.

Loneliness and its association with physical health conditions and psychiatric hospitalizations in people with serious mental illness.

OBJECTIVE: Explore the association between loneliness and psychiatric hospitalizations, functioning, and physical health conditions in people with serious mental illness. METHODS: Data were included from 349 individuals with serious mental illnesses, aged 18+ years, who participated in two consecutive cross-sectional survey studies conducted between 2013 and 2018. RESULTS: A higher number of psychiatric hospitalizations in the past six months was associated with greater loneliness. The Short-Form-12 mental component score was a highly significant correlate, accounting for a significant amount of variance in loneliness scores. The physical component score and the bodily pain subdomain of the Short-Form-12 were also significantly associated with loneliness, with individuals with lower physical functioning and greater bodily pain reporting more loneliness. Having a higher total number of health conditions, higher total number of conditions that cause pain, and the presence of at least one respiratory condition were found to be associated with greater loneliness. DISCUSSION: Loneliness may be an important dimension of health as related to health conditions associated with pain, functioning, and psychiatric hospitalizations among people with serious mental illness. These finding reinforce the powerful role of socio-cultural and environmental factors in shaping whole health in people with serious mental illness.

Community Participation Differences Between Adults With or Without Serious Mental Illness.

OBJECTIVE: This study aimed to clarify the extent of community participation by individuals with serious mental illnesses in comparison with the general population. METHODS: Participants with serious mental illnesses (N=300) were recruited from 21 outpatient mental health organizations throughout the United States, and the participants without serious mental illnesses (N=300) were recruited from a stratified sample from across the United States. All participants completed the Temple University Community Participation Measure. RESULTS: The groups differed in community participation amount, number of important areas, breadth, and sufficiency of community participation. Differences between groups in amount of participation were not evident after analyses controlled for income and car ownership. However, differences in number of important areas, breadth of participation, and sufficiency remained after analyses controlled for demographic and economic factors. CONCLUSIONS: Car ownership and income are important factors in amount of community participation, but differences in other areas remain, plausibly affecting the health and wellness of persons with serious mental illnesses.

How Far Have we Come? An Integrative Review of the Current Literature on Sense of Community and Well-being.

Sense of community and well-being are considered core tenets in the field of community psychology, acting as focal points for theory, research, and action. This integrative review synthesizes the empirical literature on sense of community and well-being with respect to four research questions focused on the relationships between these variables, the methodologies used to study those relationships, and how future research might expand upon the current literature. A search of the available literature produced 30 articles that met the search criteria, based primarily on conceptualizations and measurement of both sense of community and hedonic and eudaimonic well-being. This review suggests a general consensus across the literature of a positive relationship between sense of community and well-being among both youth and adults in a variety of settings, and discusses the strengths and limitations of this area of research, pointing to the need for more nuanced, ecologically valid research that incorporates more qualitative and critical methodologies. We hope that this review can promote a more thorough understanding of how sense of community and individual well-being relate to each other, and that ongoing research in this area can be a catalyst for action research and interventions that are applied to pressing contemporary issues as well as strengths-based approaches focused on how to foster and support the well-being of individuals within their community contexts.

Community and well-being: A qualitative study of how youth experiencing homelessness define community and its relations to their well-being.

Prior research with youth experiencing homelessness suggests that community experiences can play an important role in their resilience and well-being. This literature suggests that a sense of community (SOC) and social support may be two key interpersonal factors related to the well-being of this population. However, quantitative research exploring these relationships has resulted in inconsistent findings, which may be due to a lack of understanding regarding youth's definitions of and experiences with community. This study utilized semistructured qualitative interviews with 24 youth experiencing homelessness to explore their definitions of community, how it is important to them, what communities they are a part of, and how these communities contribute to their well-being. Overall, findings suggest that (a) youth generally define community in ways that align with current theory on SOC, (b) youth view community as important, and (c) their experiences within community settings promote their overall well-being in various ways. However, the findings also suggest that community is not always a positive experience for these youth. This study has implications for how to promote the well-being of youth experiencing homelessness, as well as how SOC and social support may relate to the well-being of this population.