Social Inclusion and Stipend Enhance Recovery, Study Suggests

A recent study in the International Journal of Social Psychiatry examines the experiences of participants with “enduring mental illness” (EMI) in a financially subsidized socialization program.

A team of researchers led by Dr. Ann Sheridan at UCD School College Dublin found that participants gained the following benefits:

1. An increased sense of confidence, social mastery, and belonging,
2. Exposure to novel activities such as cultural events and exercise,
3. Access to social activities that would have been inaccessible without the program’s monthly stipend.

The authors assert that interventions aimed at strengthening social support should be embedded within participants’ broader communities and be adapted to meet participants’ needs (e.g. by providing a stipend if necessary).

For the purposes of the study, the authors define those with “enduring mental illness” (EMI) as individuals who have received diagnoses of schizophrenia, schizophrenia spectrum and delusional disorders, mood disorders, and psychoactive substance-induced disorders, according to International Classification of Disease 10 criteria. The authors note that a number of people with EMI diagnoses have social networks that are limited to immediate family and service setting contacts. They write that EMI-diagnosed individuals’ opportunities for robust and varied social contact may be narrowed by stigma, factors in their living environment, and obstacles to employment. This is important to consider given friendship and social contact’s protective health benefits.

The authors argue that mental health recovery requires that individuals have social support within their own communities, not in mental health service environments alone. Befriending programs – also called supported socialization programs – aim to build such support by facilitating the development of “intentional friendships” within participants’ communities. Supported socialization programs have been found to help alleviate emotional distress and depressive symptoms and enhance social functioning and connectedness in those with “enduring mental illness.”

The current study represents the qualitative portion of a randomized controlled trial of supported socialization for individuals with EMI diagnoses. Participants (n = 70) were service users with EMI diagnoses recruited from Irish mental health organizations who were “determined to have moderate to severe impairment in social and occupational functioning.” Participants were randomly assigned to two groups – a Volunteer Partnered Group (VPG) and a Stipend Only Group (SOG). Those in the Volunteer Partnered Group were paired with a community volunteer partner, with whom they engaged in social activities for 2 hours a week for 9 months.

Participants received a €20 stipend each month in order to help offset the costs of social activities. SOG members were given the same monthly stipend to promote “self-driven socialization,” and were not matched with a partner. Participants in both groups documented their program experiences in journals, which the researchers subsequently analyzed using Thematic Analysis. Because of notable similarities in the experiences documented by both groups, the researchers chose to analyze the groups’ narratives together.

The researchers identified the following themes in participants’ reflections:

Experiencing ‘normal life’

• All participants wrote about the significance of taking part in “normal,” “everyday” social activities such as getting coffee, chatting, and going for a walk, activities which enabled them to “get some respite from focusing on their perceived ‘difference’ from others,” and thus brought a sense of “‘normalcy’ to their lives.” SOP participants also shared that the stipend had allowed them to connect with others in ways that were previously out of reach due to poverty.

“‘Normalising’ one’s experiences in life is a central component of service user defined recovery meaning in EMI,” the researchers write.

“Achieving belonging”

• VPG participants discussed how having a volunteer partner fostered a greater sense of belonging and helped shield against experiences of social exclusion. For example, one participant expressed delight at having her partner’s companionship at a party that she would have normally attended alone.

Strengthening capacity to socialize and see self as social being

• VPG participants wrote about sharing activities from the program with family and friends – for example, taking them to the places they had visited with their volunteer partner – which may indicate that participants gained social skills and experiences that they will use after the program ends.

“Engaging with culture”

• Many participants were exposed to cultural events such as live music, theater, and museums through the program. Engagement in cultural activities was inspiring and mood-boosting for participants. It also allowed them to learn about cultural resources and activities available to them in their greater community.

“Culture has been conceptualised as an agent of social inclusion; it has the capacity to narrow social inequalities and enhance social cohesion.”

Support in enhancing physical health

• A number of participants became newly involved in physical activities such as walking, swimming, and boxing.These experiences were reported by members of both groups – for example, some SOG participants used their stipend to join a gym, and some VPG participants engaged in physical activities with their volunteer partner and found the relationship to be motivating. This was particularly notable given that several participants reported that they “had lived a largely sedentary life prior to the programme.”

These findings underscore the vital role of social contact – particularly everyday social activities – in recovery. The authors note that although research and practice increasingly acknowledge service users’ socio-emotional needs, these needs must be attended to not only in the context of service settings but also in the greater community (social prescribing represents one such effort).

Furthermore, in order to support true social inclusion, the authors write that socialization programs should be tailored to accommodate participants’ varying needs. The researchers found that participants faced different hurdles to socializing – for some, the primary barrier was financial, and for others, it was relational, which was aided by having a partner volunteer present to facilitate connection to the community at large.

“Rather than immersion in the worlds created and managed by mental health services, community integration needs to be directed towards co-designing activities with people with experience of mental illness.”

 

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Sheridan, A., O’Keeffe, D., Coughlan, B., Frazer, K., Drennan, J., & Kemple, M. (2018). Friendship and money: A qualitative study of service users’ experiences of participating in a supported socialisation programme. International Journal of Social Psychiatry, 0020764018763692. (Link)