A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
Serious mental illness such as major depression, bipolar disorder, or schizophrenia can have an impact on a person’s ability or desire to participate in their community. This could lead to people with serious mental illness spending significantly more time at home than their peers without one, meaning less participation and activity in their community. Research suggests that increased community participation outside of the home is closely associated with improved physical and mental health for people with serious mental illness. Research also suggests that just getting out and about more often improves both frequency and the variety of participation in the community among those with serious mental illness. As a result, mental health services and interventions have increased emphasis on improving community participation for these individuals.
For individuals with severe mental illness, some types of community participation are obligatory, such as visits to Community Mental Health Centers. It may be conceivable that while one is out in the community on a given day for such obligatory activities, it may provide the person with opportunities to also engage in other types of community participation on that day. In a recent NIDILRR-funded study, researchers looked at whether obligation-based activities such as visits to CMHCs would increase community engagement for people with serious mental illness. Specifically, the researchers wanted to know whether community mobility was greater on days that people with serious mental illness had CMHC appointments compared to the days they did not. They also wanted to know if there are differences between those who live in urban versus suburban settings.
Researchers from the project on Identifying Enabling Environments Affecting Adults with Psychiatric Disabilities looked at community mobility data collected from 89 participants from 3 Philadelphia-area CMHCs. The participants were between 18 and 65 years old and had a diagnosis of major depression, manic episode, psychotic disorder, or mood disorder with psychotic features. All of the participants were receiving case management or outpatient services at a CMHC. They had all lived in a stable residence for at least six months with no plans to move and were able to freely leave and return home without restriction.
The study consisted of three phases. The first was an initial interview, at which time the participants were issued cell phones with GPS tracking software. Beginning the day after the initial interview, the participants were tracked for 13 full days using the GPS. The tracking software recorded location data in 1-minute increments, collecting up to 18,720 data points per participant. For each participant, the researchers tracked the total number of destinations they visited, number of unique destinations, minutes outside of the home, distance traveled, activity space area (range on a map where all of the visits occurred), number of non-CMHC destinations, and number of unique non-CMHC destinations. By tracking unique destinations, the researchers could see how many different places a participant might have visited in a day. These parameters were measured for CMHC appointment days and non-appointment days. Additionally, the researchers compared those parameters between the participants who lived in an urban and suburban setting. Finally, all participants completed a second face-to-face interview about 18-20 days after the first interview. At this stage, they also returned the cell phones.
When the researchers compared the data for CMHC appointment days and non-appointment days, they found the following:
- Participants visited more non-CMHC destinations on CMHC appointment days.
- Participants visited more unique destinations on CMHC appointment days.
- Participants traveled more total distance on CMHC appointment days.
When the researchers compared the data for suburban and urban participants, they found that:
- Suburban participants visited more non-CMHC destinations on CMHC appointment days than urban participants.
- Suburban participants visited more unique destinations on both appointment and non-appointment days than urban participants.
- Suburban participants traveled more total distance on both appointment and non-appointment days than urban participants.
In addition, the researchers found that suburban participants spent a greater amount of time outside of the home on non-appointment days than urban participants. They also accessed a greater number of activity space areas than urban participants on both appointment and non-appointment days.
The authors suggested that, for people with serious mental illness, leaving the house to attend CMHC appointments may be a catalyst to increasing their community participation. In this study, the participants had greater community mobility on days when they attended appointments at the CMHC than on non-appointment days, indicating that having an obligation like a health appointment may help to spur additional community participation. The authors also noted that visits to CMHCs may be especially helpful for people with serious mental illness living in urban settings to increase the time they spend outside of the home, given that they normally spend less time in the community compared to their suburban counterparts.
The authors also suggested that future studies could investigate what types of specific activities people with serious mental illness participate in before and after CMHC appointments and whether their activities are independently initiated or a part of a group. The authors also suggested that future research may benefit from examining access to transportation for people with serious mental illness and how that potentially affects their community mobility and participation. The authors acknowledged that, because this study only examined participants from urban and suburban areas, the results may not apply to people with serious mental illness living in rural areas. Despite that limitation, this study may be a positive step toward helping people with serious mental illness increase their integration into the communities in which they live.
To Learn More
The Rehabilitation Research and Training Center on Community Living and Participation of Individuals with Serious Mental Illness has a large collection of guides, graphics, calendars, and other tools to encourage greater community activity and participation of people with serious mental illness and their families.
Centers for Independent Living are organizations operated by and for people with disabilities that offer a range of services and supports for full community participation. These can include social and volunteer programs, transportation programs, employment services, and community activities.
To Learn More About this Study
Townley, G., Brusilovskiy, E., Klein, L., McCormick, B., Snethen, G., & Salzer, M.S. (2021) Community mental health center visits and community mobility of people with serious mental illnesses: A facilitator or a constraint? Community Mental Health Journal, 2021. This article is available from the NARIC collection under Accession Number J86196.