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Studies of deaf individuals generally indicate higher levels of mental illness and negative mental health outcomes compared to the general population (Anglemyer and Crespi in JAMA 2018: 3285153, 2018; Dammeyer and Chapman in JAMA 52: 807-813, 2017; Fellinger et al. in JAMA 379: 17-23, 2012; Hall et al. in JAMA 52: 761-776, 2017; as reported by Leigh and Pollard (M. Marschark and P. Spencer (eds) Oxford handbook of deaf studies, language and education, Oxford University Press, UK 2003); Landsberger et al. in JAMA 45, 42-51, 2014; Pollard in JAMA 39, 147-160, 1994). The purpose of this study is to understand the demographic variables, psychiatric symptoms, functioning, resilience, and recovery in a sample of 11,703 deaf adults. The de-identified dataset was provided by Beacon Health Options and Maryland Behavioral Health Administration and includes information about deaf adult consumers of public behavioral health services. Findings revealed that compared to hearing consumers in the dataset, deaf consumers were less likely to live in independent housing. They were more likely to live in structured community housing, such as group homes, or be homelessness. They had higher rates of arrests and incarcerations, higher proportion of unemployment, and higher rates of cigarette smoking. Deaf participants had lower rates of substance use. Deaf women in this sample reported significantly more difficulty in managing their psychiatric symptoms than deaf men. Deaf people of color had lower levels of psychiatric dysfunction, lower resilience, and greater recovery compared to white participants, which was inconsistent with other studies of people of color. Younger participants had significantly more difficulty with psychiatric symptoms and functioning than those in the older groups. Those who were 31-55 years old had higher resilience than those who were older than 56 years old. The author offers several recommendations for further research of the mental health of deaf populations, especially round race, age, and gender.

Despite a steady decline in smoking rates in recent decades, individuals with mental illness continue to smoke at disproportionately higher rates than the general population. Adults with mental illness are motivated to quit and quit with rates similar to the general population when evidence-based cessation interventions are used. To build an evidence base for a wellness and cessation curriculum aimed at individuals with mental illness, the Breathe Easy Live Well (BELW) program was pilot tested in two group homes in North Carolina in the spring of 2014. Evaluators conducted pre- and post-implementation site visits and interviews with program instructors to assess outcomes as well as barriers and facilitators to implementation. Qualitative analysis of the data indicated that implementation was successful in both group homes, and the following themes emerged: (1) Training and technical assistance provided throughout implementation was sufficient; (2) Instructors used prior professional experiences and goal setting to facilitate program success and participant engagement; (3) Fostering positive coping strategies contributed to reports of reduced smoking; (4) Curriculum length may be a barrier to recruitment. Additional results included an increased interest among group home residents in more diligently managing mental illness symptoms and one group home moving the designated smoking area out of the direct path of the entrance/exit. Results of this pilot project suggest that BELW could be a potentially useful tool for group home staff to address health and wellness along with smoking cessation among individuals with mental illness.

Goal-oriented thinking, including hope and self-efficacy, might play a constructive and integral role in the substance abuse recovery process, although such an effect may differ by race. The current study investigated hope and self-efficacy, specifically abstinence self-efficacy, as predictors of negative affect (i.e. depression and anxiety) in a longitudinal sample of men and women in substance abuse recovery who lived in sober living homes. We found hope agency and self-efficacy were related but not identical constructs; hope agency and self-efficacy predicted depressive and anxiety symptoms for individuals in recovery, yet these relationships were moderated by race. Theoretical and clinical implications for promoting positive affect among individuals in substance abuse recovery are discussed.

Effects of living near people with mental illness in community settings have been researched as part of psychiatric reform evaluation. However, these studies have been carried out mostly in industrialized countries, where social contexts differ from those in which psychiatric reform is now being implemented. To analyze the effects of community life with people with mental illness in the neighborhoods in which they live, in Buenos Aires, Argentina. A questionnaire was administered to randomly-selected neighbors of group homes of a discharge program and an equivalent control area (n = 236). Data was analyzed both quantitatively and qualitatively. Significant differences were found between being a neighbor and having a high degree of acceptance toward people with mental illness. In addition, significant associations were found between neighbors having a high-perceived social cohesion and having a high level of acceptance toward the mentally ill. Living near people with mental illness is associated with better acceptance toward them; these results are congruent with those results found in other cultural contexts. Fil: Ardila Gómez, Sara Elena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Área de Salud Pública y Salud Mental; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina Fil: Guadalupe, Ares Lavalle. Universidad de Buenos Aires. Facultad de Psicología. Área de Salud Pública y Salud Mental; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina Fil: Fernández, Marina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina Fil: Hartfiel, María Isabel. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina Fil: Borelli, Mariana. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Programa de Rehabilitación y Externación Asistida; Argentina Fil: Canales, Valeria. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina Fil: Stolkiner, Alicia Ines. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina

For people with chronic mental illness, their support system (including direct support staff at group homes) play a key role in ameliorating exacerbations leading to crisis care. However, little information exists on curriculum or training programs focused on reducing exacerbations while promoting compassionate care. We developed, implemented and evaluated such a program that featured role-playing and animated videos supplemented with limited didactics. During development phase, direct support staff reviewed videos and rated them as depicting realistic situations with high acceptability. During implementation, the 6-week course (at least one staff from six different group homes not involved in the development phase) using a 3-month pre-post design found reductions in total number of incident reports and pre-specified outcomes of recipient right complaints, emergency calls, and psychiatric hospitalizations. The program demonstrated acceptability, improved care and better outcomes on some but not all outcomes. Improved training of direct support staff is possible and has positive outcomes.

Housing stability is a key component of rehabilitation for individuals with severe mental illnesses but remains a challenge for mental health service providers, particularly with young adults experiencing early mental health difficulties. The aim of this study is to explore perceptions of housing and home-leaving processes among young adults with emerging psychotic disorders and to compare it to the perceptions of young adults without psychotic disorders. A qualitative, grounded theory based, multiple case study was conducted among 52 adults aged 18-30 years old. Two core categories emerged in relation with perception of housing: choice/control over the residential environment, and housing opportunities over time. Difference between the groups include more coerced home-leaving for young adults with first-episode psychosis and low levels of choice, control and opportunities for a sub-group of participants living in group homes. The housing situation of young adults is analyzed and discussed from a systemic perspective.

Florida Medicaid claims data were used to assess antipsychotic medication use among children after therapeutic out-of-home mental health treatment. Fifty percent of youth received antipsychotics after the treatment episode, but differences exist across age, gender, and racial groups. Utilization was higher among males and youth ages 6-12, while blacks were less likely to be prescribed antipsychotics than whites. Youth receiving antipsychotics were less likely to return to out-of-home treatment within 6 months. However, among youth receiving antipsychotic medications, a higher medication possession ratio was not associated with the likelihood of returning to treatment. Such patterns require further investigation to determine whether they indicate inadequate treatment for some youth.

This study compared levels of loneliness, quality of life (QOL) and social support among people with serious mental illness (SMI) living in two different types of housing: group homes and supportive community housing. Forty persons with SMI living in supportive community housing and 57 living in a group home completed measures of QOL, symptoms, perceived social support and loneliness. Analysis of variance tests were conducted to examine whether there were differences in degree of loneliness, QOL and social support between the groups living in the two residential types. No significant differences between the two housing models were found. Correlational analysis, however, indicated a strong relationship between loneliness and QOL. Subsequent regression analysis revealed that residence in group homes moderates the relationship between social loneliness and QOL, such that social loneliness impacted QOL only among group home residence. Implications of the findings for understanding the impact of housing on QOL are discussed.

This paper is concerned with the care of the most difficult and severely disabled new patients presenting to mental health services in the U.K. Questions of definition will be examined and the clinical and social characteristics of the population discussed. Since the defining characteristics (and prevalence) of this group are strongly affected by the overall service context, the range of community provisions within one health district (Cambridge) will be described. Examples of a new kind of institutional solution-the 'ward-in-a-house'-will then be presented, together with the underlying principles of management and care. The benefits and limitations of the model will be discussed.

This qualitative study explores the experiences of emerging adults with serious mental health conditions (e.g., bipolar disorder, posttraumatic stress disorder) before and after they emancipate from the child welfare system and exit a transitional living program. Sixteen participants were interviewed before and 13 were interviewed after aging out. Findings suggest that transitional living programs services were appreciated for the relationships and safety net they fostered. Future plans were positive, but vague, and worries about the future were prevalent. Struggles with independence post-emancipation were common despite adult service use. Additional research is needed to understand how to best support these at-risk emerging adults.

The authors report on a group treatment approach developed for adults with schizophrenia who live in a Community Mental Health Center supported group home. The goals of the group intervention included cognitive rehabilitation and the development of effective communication and social skills. A variety of outcome measures used to evaluate the effectiveness of treatment revealed that the group modality promoted improved functioning in cognitive processing, social skills, and verbal communication. Although the results of the study can only be viewed as suggestive due to a small sample size and lack of a control group, the authors present a detailed group treatment format that can be utilized and further developed by people working with a severe and persistent mentally ill population.

Persons with SMI residing in community mental health center group homes received an educational intervention program on HIV/AIDS. As with virtually all such approaches provided for this population, the intervention was generalized from programs used with other populations, for example, users of intravenous drugs, gay men, and adolescents. Assessment of pre- and postintervention knowledge indicated no increase in accurate information. Further, consumers were initially uncertain regarding their risk for HIV infection; this attitude, too, remained unchanged. The research design employed did not compare persons with SMI with a normative sample receiving the same information, and assessed with the same instruments, limiting hypotheses about the generalizability of existing interventions. However, the data seems to suggest its potential inefficacy. Several findings are germane to effective educational intervention techniques.

The purpose of this study was to examine the social environments of adult homes in the community to determine if different types of adult homes existed and which environmental variables best described each home type. Three hundred and two adult home staff rated 10 social environment variables of 49 adult homes using Moos' Community Oriented Programs Environment Scale. Using cluster analysis, 4 distinct environmental home types were identified. Discriminant analysis suggested that homes in each cluster differed primarily in their degree of staff involvement, staff support and expression of anger.

This paper reports the results of a study of community acceptance of housing for the mentally ill in Maryland. The findings indicate that community opposition is less likely to occur (1) when establishing apartmental living arrangements rather than group homes, (2) in less organized neighborhoods, (3) where other housing for specialized populations has not been previously developed, and (4) by using a "low profile" strategy which avoids informing community members in advance of start-up.

The utilization of quality of life (QOL) in psychiatric community rehabilitation could be enhanced by developing an appropriate conceptual model of QOL. The focus of this study was to construct and test, using path analytic techniques, a pertinent conceptual model of QOL among people with schizophrenia living in the community. A total of 201 participants with schizophrenia living in the community were assessed with regard to their clinical characteristics and QOL. Findings largely supported the proposed model in which community/social functioning was the strongest predictor of QOL, followed by symptom levels. Important implications for the design and implementation of appropriate services in functioning augmentation that resulted in QOL enhancement were highlighted. Further recommendations on both clinical and environmental interventions to promote QOL were suggested.

In the last forty years deinstitutionalization has transferred the care of people with a serious mental illness from the psychiatric hospitals to community based facilities. More recently it has been questioned whether these new facilities offer the anticipated benefits of quality of life. This study examines the Quality of Life (QOL) of people diagnosed with schizophrenia living in two different accommodation facilities, hostels and boarding houses. QOL is examined from the resident's perspective. Lehman's (1988b) QOL Interview was used to measure objective, subjective, and global QOL of 60 participants in three hostels and two boarding house clusters. Hostel and boarding house data were compared and results showed that residents preferred boarding house accommodation. Overall, residents of both accommodation facilities reported satisfaction with QOL, and indicated that they regard them as asylum or sanctuary from the outside world.

Mutual- and self-help groups for persons with severe mental illness have typically been most accessible to individuals who live independently. In an effort to make their organization more accessible to those who live in residential treatment facilities, Schizophrenics Anonymous (SA) ran introductory mutual-help meetings in four group homes. The results of a quantitative/qualitative case study of this effort are reported. The SA meetings were characterized as more and less successful based on the criteria of residents' attendance, participation, evaluation of the meetings, and interest in continued participation. The following characteristics distinguished between more and less successful meetings: staff support, referent power (i.e., identification with group leaders), and resident characteristics (e.g., gender, education, marital status, level of symptomatology). In spite of behavioral and self-reported evidence of interest and involvement in the meetings and the potential for continued involvement in the organization, no group home residents continued their participation in SA following the introductory meetings. This finding is interpreted from an institutional theory perspective that focuses on incompatibility between the ideologies underlying mutual help and the residential treatment system.

Neighbors often presume that group homes (GHs) have negative effects on their neighborhoods, but it is rather unclear how often GHs actually have adverse effects. Neighbors of GHs and a matched set of people who did not live near GH were interviewed. Neighbors of GHs were asked about their experiences with the specific GH near them, while "non-neighbors" were asked similar questions about their expectations of what it would be like to live near a GH. For both negative (e.g., noise, traffic) and positive effects (e.g., leaning about disabilities) of GHs, non-neighbors expected GHs would have a much greater impact on them than what was actually reported by neighbors. This research supports prior findings that expectations of negative effects are much greater than what is actually experienced by neighbors. It also suggests that GH operators might wish to capitalize on the positive expectations that may be over-shadowed by the more commonly voiced negative expectations.

The ethics and efficacy of notifying neighbors in advance of the establishment of group housing for the chronically mentally ill has generated much controversy, and recent federal anti-discrimination legislation has supported its discontinuation. In this study, representatives from 72 Massachusetts mental health agencies were interviewed regarding the siting strategies used in their most recent group housing development, and the community responses to that site. A majority of agencies were found to have used advance notification, and there was a significant association between notifying neighbors and community opposition. Agencies using advance notification were also significantly more likely to initiate post-siting community outreach activities.

Service needs of rural severely mentally ill and strengths of rural communities are addressed. Health care reform policy development at present appears to neglect the seriously mentally ill in general and rural services specifically. Examples of strategies to meet the needs for health care, psychiatric treatment, psychosocial rehabilitation and appropriate housing are described. The advantages and drawbacks of such efforts are considered.

Although placement in community housing is a frequent intervention with populations of seriously mentally ill homeless individuals, there has been little formal investigation of the criteria used by clinicians in screening individuals for such placement. In this paper, we describe screening a population of 303 homeless people with severe mental illness for placement in independent apartments. We assess subjects' level of risk along multiple dimensions and determine the contribution of each risk dimension to the final safety decision. In addition, we evaluate the validity of the risk measures with other measures of clinical condition. Two-thirds of the sample were judged as safe for independent living. Assaultiveness was the most frequent risk identified, followed by self-destructiveness, substance abuse, and medication non-compliance. The final safety decision was associated most strongly with assaultiveness, self-destructiveness, and medication non-compliance. We conclude that it is possible to assess risk with measures that are available from shelter and medical records, and call for more research on the role of medication non-compliance in safety decisions and for longitudinal research to validate risk assessments.

Ideologies of care, or systems of beliefs about the importance of particular goals and activities, help guide how care is provided. One currently pervasive ideology of care is that of normalization. In this paper, the ideologies of care of both house managers and direct care staff in group homes are contrasted. Results indicate that the ideology of direct care staff is less differentiated than that of the house managers. In addition, house managers are more likely to subscribe to a normalization ideology and less likely to subscribe to a family orientation ideology than are direct care staff. Ideological differences between house managers and direct care staff are only partially explained by differences in the demographic composition of the two groups.

The phenomenon of resistance to the establishment of group homes for mentally ill adults is well-documented. The extent to which such homes, once established, do or do not create problems for communities is less clear. The current study examined the impressions of residents of a group home neighborhood one year or more after the establishment of the home. Forty-one residents of group home neighborhoods and thirty-nine residents of control (non-home) neighborhoods responded to a survey about their impressions of how a group home had affected or (for controls) would affect their neighborhoods. More than one fourth of the group home neighbors did not even know that they were living near a home. Those who did know tended to report a negligible impact of the group homes on things such as property values, neighborhood crime, resident safety, and distressing incidents in the community. Most of these residents also indicated that they were satisfied with the group home in their neighborhoods. The actual experience of group home neighbors was far more favorable than what residents of the control neighborhood anticipated, despite lack of differences in demographic characteristics or overall attitudes toward community care of mentally ill persons. Results support the view that the feared consequences of group home establishment in residential neighborhoods do not occur and that such homes may gain reasonable acceptance after they are established.