Social interaction among people with psychiatric disabilities - Does attending a day centre matter?

Background:Engaging in social interaction has, for people with psychiatric disabilities, been shown to enhance well-being and the experience of meaning and to generally prevent the worsening of mental illness.Aim:The aim of the study was to investigate how day centre attendees differed from non-attendees regarding different aspects of social interaction and to investigate how occupational factors, including day centre attendance, and previously known predictors were related to social interaction in the study sample as a whole.Methods:A total of 93 day centre attendees and 82 non-attendees with psychiatric disabilities were examined regarding social interaction, subjective perception of occupation, activity level, sense of self-mastery and socio-demographic and clinical variables. Data were analysed with non-parametric statistics, mainly logistic regression.Results:Social support was mainly provided by informal caregivers such as family members. The day centre attendees had more social relations but did not experience better quality or closeness in their relationships than non-attendees. Important factors for social interaction were subjective perceptions of daily occupation, being married/cohabiting, self-mastery and severity of psychiatric symptoms.Conclusion:Alternative ways of enhancing social interactions in the community is needed, targeting the group’s feeling of satisfaction and value in daily life together with self-mastery

Perceived social status among people with psychiatric disabilities attending work-oriented and meeting place-oriented day centers

BACKGROUND: Day centers have been criticized for giving attendees a lower social status because they only offer activities that are often work-like although not financially of benefit to attendees. OBJECTIVES: To explore day center attendees' perceived social status and to identify associations among the attendees with the center's orientation with activity, well-being, and psychiatric symptoms. METHOD: Day center attendees in meeting place-oriented (n = 39) and work-oriented (n = 54) day centers in Sweden were interviewed addressing the targeted factors using both self-rated and interview-based instruments. RESULT: Attendees rated themselves close to the middle on the social status measure. No difference between groups based on day center orientation was found. Their self-perceived positioning on social status was positively related to the worker role, occupational engagement, self-rated health, self-esteem, self-mastery, and depressive symptoms. Logistic regression models showed better self-rated health was the only predictor of belonging to the group with a higher level of social status when dichotomized according to the median. Self-rated health was the strongest indicator for scoring above the 75th percentile on perceived status, followed by self-esteem, which was also a significant indicator. CONCLUSION: These findings yielded new knowledge concerning perceived social status in the target group and the importance of health and self-esteem

Measuring perceived meaningfulness in day centres for persons with mental illness

Rationale: As support in leading a meaningful and active life, a person with mental illness is often given the opportunity to attend a day centre. However, few studies have investigated the meaningfulness perceived by the person visiting a day centre. For such a purpose, a self-report instrument was developed. Aims: To explore whether perceived meaningfulness, as expressed in the recently developed instrument Evaluation of Perceived Meaning in Day Centers (EPM-DC), could be viewed as one dimension and also to investigate the psychometric properties of this instrument. Methods: Persons with mental illness attending five day centres in Sweden participated and completed the questionnaire. The data were analysed by Rasch analysis. Major findings: The study showed that the concept captured in the instrument could be viewed as unidimensional and the result gave preliminary evidence for sound psychometric properties. Principal conclusion: The results indicate promising signs of validity and reliability, but the suitability of self-reporting may be questioned

Improving community health networks for people with severe mental illness : a case study investigation

Introduction Policy drivers in mental health to address personal recovery, stigma and poor physical health indicate that new service solutions are required. This study aimed to understand how connections to people, places and activities were utilised by individuals with severe mental illness (SMI) to benefit health and wellbeing. Methods A five-module mixed-methods design was undertaken in two study sites. Data were collected from 150 network-mapping interviews and 41 in-depth follow-up interviews with people with SMI; in-depth interviews with 30 organisation stakeholders and 12 organisation leaders; and 44 telephone interviews with practitioners. We undertook a three-stage synthesis process including independent lived experience feedback, and a patient and public involvement team participated in tool design, data collection, analysis and write-up. Results Three personal network types were found in our study using the community health network approach: diverse and active; family and stable; formal and sparse. Controlled for other factors we found only four variables significantly associated with which network type a participant had: living alone or not; housing status; formal education; long-term sickness or disability. Diagnosis was not a factor. These variables are challenging to address but they do point to potential for network change. The qualitative interviews with people with SMI provided further understanding of connection-building and resource utilisation. We explored individual agency across each network type, and identified recognition of the importance and value of social support and active connection management alongside the risks of isolation, even for those most affected by mental illness. We identified tensions in personal networks, be that relationships with practitioners or families, dealing with the impact of stigma, or frustrations of not being in employment, which all impact on network resources and well-being. The value of connectedness within personal networks of people, place and activity for supporting recovery was evident in shaping identity, providing meaning to life and sense of belonging, gaining access to new resources, structuring routines and helping individuals ‘move on’ in their recovery journey. Health-care practitioners recognised that social factors were important in recovery but reported system-level barriers (workload, administrative bureaucracy, limited contact time with clients) in addressing these issues fully. Even practitioners working in third-sector services whose remit involved increasing clients’ social connection faced restrictions due to being evaluated by outcome criteria that limited holistic recovery-focused practices. Service providers were keen to promote recovery-focused approaches. We found contrasts between recovery ideology within mental health policy and recovery practice on the ground. In particular, the social aspects of supporting people with SMI are often underprioritised in the health-care system. In a demanding and changing context, strategic multiagency working was seen as crucial but we found few examples of embedded multisector organisation partnerships. Conclusion While our exploratory study has limitations, findings suggest potential for people with SMI to be supported to become more active managers of their personal networks to support well-being regardless of current network type. The health and social care system does not currently deliver multiagency integrated solutions to support SMI and social recovery

Experience of meaning in everyday occupations among unemployed people with severe mental illness.

Abstract The aim of this qualitative study was to examine the different facets of meaning that people who are severely mentally ill and unemployed may find in their everyday occupations. Twelve unemployed people with severe mental illness, six who attended day centres and six who did not, were interviewed regarding their experience of meaning in everyday occupations. The data were analysed with content analysis. The results showed that meaning was experienced when feeling competent and having a balance between different meaningful occupations that helped the informants control their mental illness. Themes of meaning were: being socially engaged, feeling competent and accepted by society, creating routines and being productive, being creative and seeking knowledge, and taking care of body and mind. Substitutes for paid work were found in occupations such as taking care of the household or being productive at a day centre. The results suggest that people with severe mental illness should be encouraged to play an active role in their rehabilitation process, and receive support from the occupational therapist in addressing aspects such as forming a social network and daily routines, and finding a balance between work-like occupations and rest

Experiences of Everyday Occupation among People with Psychiatric Disabilities - Relationships to social interaction, the worker role and day centre attendance

The thesis aims to explore subjective experiences of everyday occupation, social interaction and the view of the worker role among people with psychiatric disabilities(PD), while also addressing the importance of day centre attendance. The thesis consists of one qualitative study, exploring which characteristics in everyday occupation provide meaning to people with PD, and three quantitative studies based on questionnaires to both day centre attendees and non-attendees. Study I showed that feeling competent and having a balance between different meaningful occupations helped having control over mental illness. Being social, creating routines and being productive and creative were important to the experience of meaning, as was taking care of body and mind. Study II showed that having less depression and a high activity level were strong predictors of having highly valued everyday occupations. Having a high level of self-mastery seemed to predict both better occupational value and satisfaction with daily occupation. Better satisfaction with daily occupation was further related with being older and having less general psychopathology. The result from Study III showed that the person who was the most supportive and closest to the participants was a family member, but many of them reported to be without such a close and supportive person. Cohabitating and having a high level of positive subjective experiences of occupation were predictors of the quantity of social interaction. Having a high level of self-mastery, a low level of depression and fewer positive symptoms as well as being more satisfied with daily occupation were important for qualitative aspects of social interaction. Study IV showed that having a high activity level, a high level of self-mastery, being younger and having less severe depressive symptoms were indicators of a more positive view of the worker role. The importance of day centre attendance was also explored. The day centre group experienced a higher level of occupational value, was more active and met more people than the non-attendees.When examining aspects of the worker role significant differences were found on the item level, indicating a stronger worker role among participants attending day centres with a work focus. The results of this thesis add new knowledge regarding the everyday life among the target group and may be used in developing community-based mental health care services