Sexual and gender minority individuals with severe mental illness (SMI) are amongst the most marginalized individuals in North American society. They face multiple and intersecting forms of discrimination that compound the effects of having a major mental illness, hampering recovery and frustrating efforts to meaningfully participate in our communities. Previous work has made it clear that the development of evidence-based interventions needs to be informed by a better understanding of points of access to community, the barriers, and the strategies by which access is negotiated. Complementing a study of community participation amongst an ethnoracially diverse group of individuals with schizophrenia in Toronto, Ontario, this project will involve the development of a new arm of the study that would focus specifically on lesbian, gay, and transgender individuals with schizophrenia. Specifically, this study will identify the experiences, beliefs, behaviors, and places that constitute community participation for lesbian, gay, and transgender (LGT) people with schizophrenia and those with whom they interact. It will provide an intensive and nuanced description of community participation for these groups that will offer policy makers and clinicians in-depth information which may help them in improving services. In the course of the study, the community participation experiences of 16 lesbian, gay, bisexual, and transgender individuals with schizophrenia would be assessed 3 times over a 1 year period. Using interviews, ethnographic observation, and the creation of maps to geographically locate places of risk and resource, we will examine the physical, social, psychological, political, economic, and cultural dimensions of community participation. Inquiry will extend from individuals with schizophrenia to include family members and service providers of participants as well as community members with whom they are in frequent contact (e.g., convenience store clerk). In a context of an increasing emphasis upon community participation as a treatment goal and civil right, and evidence indicating the negative impacts on mental health of discrimination and social exclusion, the proposed study represents an important and much called for line of investigation. With an in-depth understanding of community participation for this population we will be in a far better position to begin to explore how we might better facilitate inclusion and, in turn, evaluate those efforts. 1

Public Health Relevance

Severe mental illnesses such as schizophrenia which affect hundreds of thousands of Americans and their families present a tremendous challenge to care providers and high burdens to our healthcare system. This challenge is both amplified and protracted for sexual and gender minority individuals who face multiple forms of discrimination and barriers to recovery and community participation. Our work will lay the groundwork for our developing a better understanding about how we can reduce that discrimination in community contexts and develop interventions to facilitate community participation among sexual and gender minority individuals with severe mental illness.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Small Research Grants (R03)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Morris, Sarah E
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Centre for Addiction and Mental Health
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Pilling, Merrick; Howison, Meg; Frederick, Tyler et al. (2017) Fragmented inclusion: Community participation and lesbian, gay, bisexual, trans, and queer people with diagnoses of schizophrenia and bipolar disorder. Am J Orthopsychiatry 87:606-613
Kidd, Sean A; Howison, Meg; Pilling, Merrick et al. (2016) Severe Mental Illness in LGBT Populations: A Scoping Review. Psychiatr Serv 67:779-83