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Articles   |    
Experiencing Community: Perspectives of Individuals Diagnosed as Having Serious Mental Illness
Elizabeth Bromley, M.D., Ph.D.; Sonya Gabrielian, M.D., M.P.H.; Benjamin Brekke, B.S.; Rohini Pahwa, M.A., M.S.W.; Kathleen A. Daly, M.D., M.P.H.; John S. Brekke, Ph.D.; Joel T. Braslow, M.D., Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200235
View Author and Article Information

Dr. Bromley, Mr. Benjamin Brekke, Dr. Daly, and Dr. Braslow are affiliated with the Department of Psychiatry and Biobehavioral Sciences, Semel Institute Center for Health Services and Society, University of California, Los Angeles (UCLA), 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024 (e-mail: ebromley@ucla.edu). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles Veterans Affairs Healthcare Center, Los Angeles, where Dr. Gabrielian is affiliated. When this research was completed, Dr. Daly was with the Los Angeles County Department of Mental Health, Los Angeles. Dr. Braslow is also with the Department of History, UCLA. Ms. Pahwa and Dr. John S. Brekke are with the University of Southern California School of Social Work, Los Angeles.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  Community integration is recognized as a crucial component of recovery from serious mental illness. Although the construct of community integration can be measured with structured instruments, little is known about the subjective and experiential meaning of community and community involvement for persons with serious mental illness.

Methods  In 2010, 30 individuals with serious mental illness treated in two public mental health clinics completed semistructured interviews that elicited the places and people that they associate with the experience of community and the larger meaning of community in their lives.

Results  Participants described four experiences as integral to their concepts of community: receiving help, minimizing risk, avoiding stigma, and giving back. Participants looked for communities that provide reliable support, and they described the need to manage community contact in order to protect themselves and others from their symptoms and from discrimination. Most participants experienced communities centered on mental health treatment or mentally ill peers as providing opportunities for positive engagement.

Conclusions  The experience of having a serious mental illness shapes preferences for and perceptions of community in pervasive ways. Participants described community involvement not as a means to move away from illness experiences and identities but as a process that is substantially influenced by them. Mental health communities may help individuals with serious mental illness to both manage their illness and recognize and enjoy a sense of community. The findings indicate the need for further research on the relationship between community integration and outcome in serious mental illness.

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Table 1Communities named by clients in intensive treatment and usual care
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