Meaningful Community Participation Key to SMI Recovery

Meaningful community participation such as employment, education, personal relationships, religious and spiritual activities, and engagement in civil life is a critical part of recovering from serious mental illness (SMI). In a session at APA’s 2023 Annual Meeting, speakers provided an overview on how to promote community inclusion for people with SMI from a variety of perspectives.

“We know from first-person accounts of recovery that self-directed activities that provide a sense of meaning and purpose to the individual with serious mental illness [SMI] are critical turning points that serve as significant personal markers of progress in recovery,” session chair Alexia Wolf, M.P.H., told Psychiatric News before the session. She is executive director of the Behavioral Health Consortium in Delaware and the social determinants of health expert for SMI Adviser, which sponsored the session. SMI Adviser is a free resource for all mental health professionals who treat patients with SMI; it is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and administered by APA.

“It has been well documented for years that the top three things that people with serious mental illness want are a place to live, a job, and intimate relationships,” she said. “Yet we continue to see high levels of unemployment for people with serious mental illness, with research indicating as many as 80% of people with mental illness are unemployed.”

Wolf added that psychiatrists and mental health professionals can play an integral role in helping people with SMI participate in their communities in meaningful ways. “It starts with taking a person-centered approach to caring for patients, one that focuses on what the person’s strengths, interests, and passions are and letting them drive the process from there,” she said.

Mark Salzer, Ph.D., a professor of social and behavioral sciences at Temple University, discussed the fundamental concepts, theoretical frameworks, and evidence for community inclusion. Examples of participation-oriented support initiatives found to be effective include supported housing, employment, education, and socialization.“Salzer cited research wherein people with SMI expressed the desire and ability to participate in their communities—70% wanted to work, 80% reported being extremely or very religious/spiritual, and 50% voted in the 2004 election. Also, 50% have access to computers and the internet, and their attitudes toward such technology are comparable to those of the general population.

Salzer emphasized the importance of working with patients as they journey through various transitions in their lives, such as the transition from a state hospital to the community. One key transition is reentering the community after leaving jail. “People with mental illnesses leaving jails report essential needs around housing and employment, but also needs around reconnecting with family, friends, faith, and other areas,” Salzer said.

He added that assisting patients through transitions involving housing is critical. “People with significant impairments can be housed, but research suggests that some people experience high levels of isolation and loneliness in their housing situation,” he said.

Jessica Klaver, Ph.D., the chief program officer at the Center for Alternative Sentencing and Employment Services, discussed forensic Assertive Community Treatment in New York City. Such treatment involves a criminal justice specialist who provides several services such as legal education for the care team and clients, prison and jail visits and discharge coordination, risk assessments for criminal behavior and violence, and evidence-based cognitive-behavioral interventions. A specialist with lived experience in the areas of mental illness, substance use, and/or criminal justice involvement provides peer support and grounds the team in recovery-oriented, trauma-informed care.

Helen “Skip” Skipper, B.S., a recovery coach and the founding executive director of the NYC Justice Peer Initiative, rounded out the session with a discussion of the initiative’s model for activating justice-involved peers. She described a justice-involved peer as “a person who uses lived experience with the criminal legal system to support others who are ensnared within the system.”

Skipper said that justice-involved peers use shared understanding, respect, and mutual empowerment as well as the power of storytelling to instill hope and determination in people with SMI as they seek meaningful participation in their communities.

“This is critical for successfully navigating complex systems that often exclude individuals with conviction histories or behavioral health diagnoses,” she said. ■