Connectedness and Citizenship: Redefining Social Integration

Columbia University, New York, New York, United States
Psychiatric Services (Impact Factor: 2.41). 05/2007; 58(4):469-74. DOI: 10.1176/
Source: PubMed

ABSTRACT Despite decades of deinstitutionalization, individuals with psychiatric disabilities living outside the hospital may be described as in the community, but not of it. To effectively address the persisting problem of social exclusion of persons with psychiatric disabilities, new conceptual tools are needed. To address this need, a new definition of social integration is offered.
The definition is based on data from a qualitative study. Data collection consisted of individual, unstructured interviews with 56 adults who have been psychiatrically disabled (N=78 interviews) as well as ethnographic visits to five service sites working to promote social integration for their users (N=8 visits). An interpretive approach was used to analyze the data.
Social integration is defined as a process, unfolding over time, through which individuals who have been psychiatrically disabled increasingly develop and exercise their capacities for connectedness and citizenship. Connectedness denotes the construction and successful maintenance of reciprocal interpersonal relationships. Social, moral, and emotional competencies are required to sustain connectedness. Citizenship refers to the rights and privileges enjoyed by members of a democratic society and to the responsibilities these rights engender. The definition calls for full rights and responsibilities of citizenship.
The new definition sets an ideal, but not unrealistic, standard for social integration in the context of psychiatric disability. High standards encourage mental health professionals and policy makers to rethink what is possible for mental health services and to raise expectations for connectedness and citizenship among persons once disabled by mental illness.

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Available from: Kim Hopper, Apr 07, 2014
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    • "The capabilities framework is a powerful construct in disability discourse related to the social and economic isolation experienced by people with mental illness (Ware et al. 2007; Baumgartner & Burns, 2014). Shifting the focus from a position where disability is located in personal functioning to a position where disability is located in the opportunities provided by society for social reintegration and participation, Sen's work provides a basis for conceptualising social integration as 'a process, unfolding over time, through which individuals who have been psychiatrically disabled increasingly develop and exercise their capacities for connectedness and citizenship' (Ware et al. 2007). Similarly, in relation to poverty and (mental) health, the capabilities framework can help shift the focus away from considering economic exclusion a consequence of individual dysfunction; towards an understanding of the structural social, economic and political forces that so often render people vulnerable to both poverty and mental illness. "
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    ABSTRACT: The relationship between poverty and mental health is indisputable. However, to have an influence on the next set of sustainable global development goals, we need to understand the causal relationships between social determinants such as poverty, inequality, lack of education and unemployment; thereby clarifying which aspects of poverty are the key drivers of mental illness. Some of the major challenges identified by Lund (2014) in understanding the poverty-mental health relationship are discussed including: the need for appropriate poverty indicators; extending this research agenda to a broader range of mental health outcomes; the need to engage with theoretical concepts such as Amartya Sen's capability framework; and the need to integrate the concept of income/economic inequality into studies of poverty and mental health. Although income inequality is a powerful driver of poor physical and mental health outcomes, it features rarely in research and discourse on social determinants of mental health. This paper interrogates in detail the relationships between poverty, income inequality and mental health, specifically: the role of income inequality as a mediator of the poverty-mental health relationship; the relative utility of commonly used income inequality metrics; and the likely mechanisms underlying the impact of inequality on mental health, including direct stress due to the setting up of social comparisons as well as the erosion of social capital leading to social fragmentation. Finally, we need to interrogate the upstream political, social and economic causes of inequality itself, since these should also become potential targets in efforts to promote sustainable development goals and improve population (mental) health. In particular, neoliberal (market-oriented) political doctrines lead to both increased income inequality and reduced social cohesion. In conclusion, understanding the relationships between politics, poverty, inequality and mental health outcomes requires us to develop a robust, evidence-based 'political economy of mental health.'
    Epidemiology and Psychiatric Sciences 03/2015; 24(02):1-7. DOI:10.1017/S2045796015000086 · 3.91 Impact Factor
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    • "Researchers from various disciplines have tried to define and measure community integration (CI) as well as related concepts such as social inclusion and citizenship (Dorvil et al. 2005; Ware et al. 2007; Wong and Solomon 2002). CI was originally conceptualized as physical presence in a neighborhood and was operationalized as the cumulative frequency of self-initiated participation and use of community resources (Segal et al. 1980). "
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    ABSTRACT: This study examines community integration among homeless adults with mental illness 6 and 12 months after random assignment to Housing First (independent apartments or congregate residence) with support services or to treatment as usual (TAU). Residence in independent apartments was associated with increased 'psychological integration' for participants with less severe needs; however, no significant improvement in 'physical integration' was observed among any of the intervention groups. Analysis of individual items on the Psychological Integration subscale revealed that, compared to TAU, participants assigned to independent apartments were more likely to endorse statements related to the emotional components of community but not statements related to neighboring. Participants assigned to the congregate residence were more likely to endorse knowing their neighbors, but not interacting with neighbors or the emotional components of community. Findings are discussed in terms of housing program as well as broader contextual factors.
    Community Mental Health Journal 12/2013; 50(5). DOI:10.1007/s10597-013-9672-9 · 1.03 Impact Factor
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    • "Uncovering ways to encourage community inclusion and participation has emerged as a high priority among mental health advocates, policy makers, and researchers (Davidson 2005; Nelson et al. 2001; Townley and Kloos 2011; Ware et al. 2007; Yanos 2007). Although community integration encompasses numerous factors, including participation in community activities, social relationships with peers of one's own choosing, and perceptions of belonging to the community, we focus here on the role that casual, routine interactions with community members, termed distal supports (Wieland et al. 2007), can play in promoting community integration and recovery from mental illness. "
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    ABSTRACT: Although an extensive body of literature highlights the important role of social support for individuals with psychiatric disabilities, definitions of support tend to be restricted-focusing on intimate relationships such as friend and family networks and ignoring the role of casual relationships existing naturally in the community. This mixed-methods study of 300 consumers of mental health services in the Southeastern US aims to better understand the impact of community supports, termed distal supports, on community integration and recovery from mental illness. Qualitative content analysis, tests of group mean differences, and hierarchical linear regression analyses revealed the following: (1) participants primarily reported receiving tangible support (e.g., free medication/discounted goods) from distal supports rather than emotional support (e.g., displays of warmth/affection) or informational support (e.g., provision of advice); (2) women and older participants reported more distal supports than men or younger participants; and (3) distal supports played a unique role in predicting community integration and recovery even after accounting for the influence of traditional support networks. Results highlight the importance of considering diverse types of social support in naturally occurring settings when designing treatment plans and interventions aimed at encouraging community participation and adaptive functioning for individuals with psychiatric disabilities.
    American Journal of Community Psychology 05/2013; 52(1). DOI:10.1007/s10464-013-9578-2 · 1.74 Impact Factor
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