The 2003 New Freedom Commission on Mental Health report stated that mental health care must be transformed to promote recovery, both in the sense of the outcome of reduced or eradicated signs and symptoms of mental illness and in the sense of the process of living a full life in the community life even if individuals continue to experience signs and symptoms of serious mental illness. Some research involving persons with enduring mental illnesses, however, suggests that many people with serious mental illnesses, while residing in their communities, have not achieved a sense of belonging or acceptance as members of it. In our research, we have described such limited community participation as """"""""program citizenship,"""""""" involving high dependence on mental health staff and systems for social contact and support. Full citizenship, we have argued, involves a strong connection to the rights, responsibilities, roles, and resources that society makes available to its members, and to supportive interpersonal relationships in one's community. Yet does supporting the rights, responsibilities, valued roles, material resources, and social relationships of people with serious mental illnesses involve anything different than what is involved in supporting those same five R's among adults in general, or among adults who have experienced other significant life disruptions? Using a combination of qualitative and quantitative research methods, we propose to address this question through two specific research aims. First, we will study the perspectives and processes involved in claiming, or reclaiming, one's citizenship for persons whose life trajectories have been disrupted by a serious mental illness, a serious physical illness, military service, or incarceration, and for those who have not experienced these disruptions. Second, we will develop and pilot a measure assessing those elements of citizenship identified as being especially relevant to persons with mental illness. Following successful completion of this research we plan to validate our citizenship measure, determine its convergent and divergent validity in relation to measures of related constructs, and design, implement, and evaluate an experimental intervention to support and enhance the citizenship of people with serious mental illnesses.

Public Health Relevance

Development of a measure of citizenship may lead to development of interventions aimed at facilitating the achievement of citizenship and increased community inclusion of people with serious mental illnesses. Thus the proposed exploratory study is a relevant public mental health goal, one that is related to the New Freedom Commission's vision of a full life in the community for people with psychiatric disabilities. This goal, in fact, has been, along with development of effective community-based treatments, integral to the National Institute of Mental Health's key role in the community mental health movement that began more than forty years ago.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Study Section
Community Influences on Health Behavior (CIHB)
Program Officer
Rupp, Agnes
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Yale University
Schools of Medicine
New Haven
United States
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Rowe, Michael; Clayton, Ashley; Benedict, Patricia et al. (2012) Going to the source: creating a citizenship outcome measure by community-based participatory research methods. Psychiatr Serv 63:445-50