Schizophrenia,Community Integration,and Recovery

Abstract

Rooted in deinstitutionalization policy, the community inclusion required by the Olmstead case, and the grass roots recovery movement, community integration for those who have diagnoses of serious mental illnesses has become an increasingly important policy goal. The purpose of this project was to examine empirical evidence describing experiences with social or community integration for people with psychiatric disabilities, with a particular interest in the schizophrenias. Studies chosen for review all involved direct survey or interview data from people with psychiatric disabilities and examined subjective experiences with social relationships or linked social participation with clinical, functional, or quality of life outcomes. Experiences involving the dynamics of social stigma, the achievement of personal agency, and innovative pathways to satisfying social inclusion are core themes found that are highly relevant for practitioners. Social work, with its ecological perspective, is well suited to address the complexities of conflicting interests and objectives that have arisen in mental health care in the pursuit of community integration. Suggestions for fruitful responses are presented.     

Social enterprises as enabling workplaces for people with psychiatric disabilities

In recent years, western governments influenced by neoliberalism have emphasized paid work as a key route to social inclusion and community participation for people with psychiatric disabilities. Although paid work can offer many rewards, access to mainstream employment for people with psychiatric disabilities is difficult as they continue to encounter discrimination and a lack of workplace accommodation. One response to these challenges has been the creation of social enterprises as ‘alternative spaces’ of employment for people with psychiatric disabilities. On the basis of interviews with key informants from 21 different social enterprises across Ontario, Canada, this paper critically analyzes the strategies used by organizations to create jobs that are both accommodating for people, but also conducive to the ongoing success of the business.     

‘I couldn’t just entirely be her sister’: the relational and social policy implications of care between young adult siblings with and without disabilities

Research has commonly explored siblings of people with disabilities’ roles in care for their brothers or sisters with disabilities. Social policy has also commonly framed young adult siblings of people with disabilities as ‘young carers’. However, there has been less consideration of the implications of care for the relationship shared between young adult siblings with and without disabilities and of what this may mean for social policy. What do different types of care mean for sibling relationships? What are the relational and social policy implications of care between siblings? Drawing on a qualitative study of 25 siblings with disabilities and 21 siblings without disabilities aged 15–29, this article explores how young adult siblings perceive, talk and act with regard to the different types of care enacted between them. The article identifies how, during young adulthood, some types of care can endanger siblings’ capacity to feel like siblings and discusses ways that young adult siblings talk and act in order to – as best they can – keep their role within the bounds of a normative sibling relationship. The findings are discussed in light of implications for social policy, particularly with regard to seeing siblings of people with disabilities as ‘young carers’.     

Precarious lives and resistant possibilities: the labour of people with learning disabilities in times of austerity

This paper draws on feminist and queer philosophers? discussions of precarity and employment, too often absent from disability studies, to explore the working lives of people with learning disabilities in England in a time of austerity. Recent policy shifts from welfare to work welcome more disabled people into the job market. The reality is that disabled people remain under-represented in labour statistics and are conspicuously absent in cultures of work. We live in neoliberal-able times where we all find ourselves precarious. But, people with learning disabilities experience high levels of uncertainty in every aspect of their lives, including work, relationships and community living. Our research reveals an important analytical finding: that when people with learning disabilities are supported in imaginative and novel ways they are able to work effectively and cohesively participate in their local communities (even in a time of cuts to welfare). We conclude by acknowledging that we are witnessing a global politics of precarity and austerity. Our urgent task is to redress the unequal spread of precaritization across our society that risks leaving people with learning disabilities experiencing disproportionately perilous lives. One of our key recommendations is that it makes no economic sense (never mind moral sense) to pull funding from organisations that support people with intellectual disabilities to work.     

‘I shouldn’t be living there because I am a sponger’: negotiating everyday geographies by people with learning disabilities

Learning disability policy has for some time been framed by the goal of inclusion which purports to enable people with learning disabilities to lead a ‘life like any other’ person. This article examines the extent to which this is the case in England, by tracing the lived experiences of people with learning disabilities within their communities. The article draws on two interlinked qualitative studies involving interviews that examined their local place-based experiences of inclusion and exclusion. The findings reveal ‘moments of inclusion’ and opportunities for social encounter from peer support, but these were situated amidst wider experiences of exclusion and harassment.     

Involving People with Disabilities in Volunteer Roles

Abstract

According to the 2002 National Health Interview Survey, 33.7 million non-institutionalized Americans have limitations in usual activities. A recent poll on community participation found that, overall, people with disabilities have lower rates of community participation compared to those without disabilities. An analysis of that same poll concluded that people with disabilities continue to be treated as second class citizens by being excluded from the mainstream of everyday life. Social role valorization theory proposes creating and supporting socially valued roles for people who are kept at a social distance. It is through these valued social roles that they gain equal access to other opportunities that society has to offer. One such socially valued role is that of a community volunteer. Volunteer activities can foster a social environment where people with disabilities are seen as credible coping individuals. This paper reports the results of a survey of twenty-six community agencies which regularly use volunteers. The purpose of the survey was to identify barriers to volunteer opportunities for people with disabilities and to explore openness to methods to remove the barriers through community collaborations.     

Impact of training on pre‐service teachers' attitudes and concerns about inclusive education and sentiments about persons with disabilities

Inclusion of students with disabilities into regular schools is now one of the most significant issues facing the education community both nationally and internationally. In order to address this issue there is widespread acceptance that teacher training institutions must ensure that new teachers are trained to teach effectively in classrooms where there are students with a variety of learning needs. Utilizing a data set of 603 pre‐service teachers from Australia, Canada, Hong Kong and Singapore this study reports the effects of training in inclusive education on pre‐service teacher attitudes towards inclusion, their sentiments about people with a disability and their concerns about inclusion. The results are discussed in relation to a range of factors that could have produced different gains in their attitudes, sentiments and concerns among cohorts from different countries.     

Social assistance in Austria: regulating the poor as in-between

Not only the concept of social inclusion is widely recognized as an important basis today for making social policy, but it also provides a platform for the policing of the poor. Thinking uncritically about social inclusion prevents us from seeing how it operates to re-inscribe subordination even as we help the poor overcome their marginalization. With an awareness of the paradox of inclusion, it is possible to examine how welfare policy today operates to discipline the poor as people who must accept their plight at the bottom of the socioeconomic order. While formal policy may not make this paradox apparent, the disciplinary effects of an inclusionary social assistance policy are starkly visible when we examine its implementation, where we can see how the excluded become included in ways that perpetuate their subordination. Social assistance recipients obtain a benefit, but the way they are treated does not correspond with full social rights, which is reminiscent of Georg Simmel's discussion of the poor. As exemplified by research at one local social assistance office in Austria, welfare recipients are ultimately neither included nor excluded. Welfare, as administered today, upholds the system of social stratification by perpetuating an ‘in-between’ status for the claimants of social assistance benefits at the frontline.     

Voices of youths on engagement in community life: a theoretical framework of belonging

Little is known from the perspectives of youths with intellectual and developmental disabilities themselves about their experiences related to inclusion, engagement in community life and friendship, and their quality of life. The Voices of Youths research project used an inclusive approach to learn from youths about these experiences. Twenty-four youths (age 13–24 years) with a range of intellectual and developmental disabilities diagnostic ‘labels’ participated in three video-recorded, community-based interviews. Constructivist grounded theory data analysis revealed a theoretical framework comprising the core concept of belonging and four associated concepts: engaging with similar people, having social relationships, negotiating meaningful roles, and navigating norms and expectations – finding a good fit. The findings contribute new knowledge about the ways in which these youths experience a sense of belonging from their own perspectives and can inform development/enrichment of policies, programmes, and services for these youths.     

Mobile skilled workers: Making the most of an untapped rural community resource

Many small rural communities have a flow of skilled people through the community, including employees from the government, non government and private sectors on fixed-term contracts, and a range of professionals, often attracted by amenity and seeking a sea change or tree change. The aim of the study reported in this paper was to investigate how rural communities can optimise benefits from professional and other highly skilled workers in the context of an increasingly mobile and transitory workforce. The paper examines the characteristics and attributes of mobile skilled workers from six different Australian rural communities and one Canadian rural community. It overviews the reasons why mobile skilled workers become involved in rural communities, the process of integration, and the reasons why they decide to stay or leave. If rural communities better understand the characteristics and motivations of mobile skilled workers, they will be able to better harness the potential of this group. Community settings and, to a lesser extent, policy, make a difference to mobile skilled worker integration and community participation. Community settings such as culture, interactional infrastructure and leadership influence the integration process for mobile skilled workers. Effectiveness of the integration process determines the nature and extent of mobile skilled worker contribution to the community and the likelihood that the worker will be retained in the community. Rural communities that make the most of the available pool of skills provided by mobile skilled workers can increase resilience, community capacity, identification and uptake of opportunities such as new enterprises, good practice in natural resource management, enhanced social and leisure opportunities, and the quality and range of local services.     

'The more things change…': Barriers to community services utilisation in Queensland

Community services are central to the lives of many elderly Australians or Australians with disabilities if they are to remain in the community. Over the past two decades, significant advances have been made in policy and associated programs, significantly improving the standards of service delivery. This research reports on the perceptions of service providers in community services for people with disabilities in six communities in Queensland. It illustrates that significant barriers to service utilisation remain, despite reform. It suggests that continuous efforts to promote service access need to be built in at the program level.     

Representing the Views of Disabled People in Community Care Planning

The 1990 NHS and Community Care Act requires social services departments in Britain to involve representatives of service users in the preparation of their annual community care plans. This paper gives a critical account of the different ways in which the views of disabled people are sought and represented in community care planning; and of the organisational and practical barriers which disabled people and their organisations are likely to encounter in representing their views to service planners. People with learning disabilities, older disabled people, people with sensory impairments and disabled people from Black and ethnic minority communities are particularly likely to be excluded from current consultation procedures. The paper concludes that present methods of representation place considerable burdens on both individual disabled people and on their organisations. Consequently, disabled people may increasingly question the effectiveness and usefulness of their involvement in community care planning, in the light of the many other issues which are important to them.     

The question of community attachment revisited

In this paper we compare the relative effects of satisfaction with specific community (neighborhood) attributes and social integration into the community on community attachment. Previous research on community attachment has not assessed the importance of satisfaction with specific attributes as a determinant of attachment. Instead, this research has focussed on integration into the social life of a community as the primary source of community attachment. We find that although social integration has the more important effect on attachment, satisfaction with specific community attributes also has a statistically significant effect. People who are satisfied with the general physical appearance, the noise level, and the quality of neighbors in their communities tend to be more attached to them than those who are less satisfied. We address the theoretical and policy implications of this finding. In short, this finding implies, contrary to previous thought, that it is possible for there to be higher levels of attachment to communities that appear to be lacking a well‐developed social life. It also implies that levels of attachment to communities could be enhanced by programs that improve certain features of the physical environment which are seen as indicative of the quality of communities as good places to live.     

'A Little Inconvenience': perspectives of Bengali families of children with disabilities on labelling and inclusion

Based on the findings of a qualitative study, this article describes how Bengali mothers of children with disabilities in Calcutta, India use the colloquial term 'inconvenience' to talk about their child's disabilities. Data were collected through extensive interviews and participant observations. Findings indicate that the mothers use of the colloquial term 'inconvenience' forms a significant aspect of their efforts to educate their community and create inclusion for their children. Findings of this study have implications for the role of local language in enhancing the inclusion of people with disabilities in developing countries such as India.     

Social entrepreneurship as an employment pathway for people with disabilities: exploring political–economic and socio-cultural factors

The current economic climate demands more innovative approaches to increasing labor market participation for people with disabilities. Social entrepreneurship (SE) offers one alternative employment pathway. However, little is known about the broader factors influencing SE for people with disabilities. Using empirical data from focus groups comprised of social entrepreneurs with disabilities and interviews with key stakeholders working in the fields of policy, disability, and business, this research frames its analysis in the intersection of disability studies and entrepreneurship to explore which factors influence the potential for SE to provide equal participation opportunities for people with disabilities in the labor market. Findings suggest that further consideration of political–economic and socio-cultural factors is needed if we are to better understand the potential of SE for people with disabilities.     

Community reintegration for people with psychiatric disabilities: challenging systemic barriers to service provision and public policy through participatory action research

People with psychiatric disabilities represent a growing group within the population of nursing home residents in the USA. Despite a preference for living in community‐based settings, the availability of supportive services for community living is hindered by barriers at both the service provision and public policy levels. Therefore, understanding and responding to the community living and participation needs of people with psychiatric disabilities is a highly relevant area for action research. This paper discusses a participatory action research endeavor carried out in collaboration with key personnel at Centers for Independent Living who work to provide community reintegration services for individuals with psychiatric disabilities. The events of this 15 month partnership are extensively described, analyzed and discussed. Findings reflect the critical need for communication, dialogue and action to support people with psychiatric disabilities in the community.     

Curriculum Access for Pupils with Disabilities: an Irish experience

For young people with physical disabilities in Ireland, gaining access to a school represents only the first tentative step on the way to full participation in the curriculum alongside their peers. While government policy explicitly favours the inclusion of young people with disabilities within mainstream education there is little evidence of planning at a systemic level to facilitate this process. This small scale, qualitative study attempts to ascertain the reality of inclusion within mainstream settings for young people with physical disabilities. The results indicate that the young people often experienced exclusion from full curricular access. The implications of these findings are discussed in relation to developing inclusive structures that facilitate curricular access for young people with disabilities within Irish post-primary schools.     

Rural communities and well‐being: a good place to grow up?

This study looks at young people's accounts of life in communities in rural northern Scotland, and considers in what ways affective and social aspects of community are bound up with well‐being, over and above young people's concerns for the future, rural youth transitions, and out‐migration. Interviews were held with 15–18 year‐olds in four study areas (16 groups, N=60+) and a parallel survey of 11–16 year‐olds was conducted in eight study areas (N=2400+). Themes to emerge from the interviews included: opportunities locally, the future and staying on, as well as local amenities and services; but older teenagers also spoke at length about their social lives, family and social networks, and their community, both as close‐knit and caring and as intrusive and controlling. Rural communities were seen as good places in childhood, but not necessarily for young people. In parallel with that, the survey data paints a picture where feelings of support, control, autonomy, and attachment were all associated with emotional well‐being. Importantly, links between emotional well‐being and practical, material concerns were outweighed by positive identifications of community as close‐knit and caring; and equally, by negative identifications as intrusive and constraining, where the latter was felt more strongly by young women. Certainly, beliefs about future employment and educational opportunities were also linked to well‐being, but that was over and above, and independently of, affective and social aspects of community life. Additionally, migration intentions were also bound up with sense of self and well‐being, and with feelings about community life; and links between thoughts about leaving and community life as controlling and constraining were, yet again, felt more strongly by young women. Thus, gender was a key dimension affecting young people's feelings about their communities with significant implications for well‐being, and out‐migration. The study illustrates the importance of understanding the experiences young people have of growing up in rural areas, and how they evaluate those experiences: particularly, how life in rural communities matters for young people's well‐being; and especially, for young women.     

Community Care in Taiwan

SUMMARY

This article explores the policy definitions and the funder roles of central and local governments in community care in Taiwan. The notion of community care has been adopted in Taiwan following the model of Hong Kong but the main question of the article is whether this has resulted in actual service provisions at the community level, forming an alternative to institutional care. The data has been collected from several sources: policy documents, official statistics, surveys, general reports, funding provision reports, and empirical studies. The results show that neither central nor local authorities are seriously involved in caring for elderly people or persons with disabilities in Taiwan's communities. In Taiwan, community care for these groups of people still means, in practice, informal care provided by female family members without any support from public policies.     

The critical space between: Access, inclusion and standards in information technologies

By examining the Canadian standards system, and especially the work of the Canadian Standards Association (CSA) related to accessibility, this article explores the question: can legislation and/or standards ensure access and inclusion for people with disabilities in the area of information technologies? And if so, what type is required? It argues that the standards system in Canada privileges the voices of industry while creating a discourse of public accountability and corporate social responsibility. This paradox leads to an undervaluing of the need for addressing issues of accessibility and inclusion in information technologies. By proactively seeking out innovators in the disability community and bringing them to the table, the CSA could open up the standards development discussions and find creative solutions to accessibility barriers. The principles of balanced representation and consensus decision-making open the possibility for discussions around standards that can effectively address access and inclusion of people with disabilities in the development and use of information technologies, but only if the systemic barriers to both individual and organizational participation are recognized and addressed.