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While some international qualitative research has interviewed people with serious mental illnesses (SMI) about their experiences in the initial months of the COVID-19 pandemic, few US studies have explored their experiences and perspectives as the pandemic has continued. Drawing from disability studies perspectives, this qualitative study conducted in 2022 explored the experiences of people with SMI seeking services at community mental health centers during the COVID-19 pandemic. Fifteen clients who identified as living with an SMI and were clients during March 2020 were interviewed. Using narrative analysis, we identified an overarching tenor of client experiences: feeling left behind by institutions and society. This feeling of being left behind was conceptualized as three themes. As the literature around the COVID-19 pandemic grows and we attempt to integrate it into community mental health policy and practice, it is essential to include the experiences and perspectives of clients with lived experience of SMI., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

There is a high prevalence of loneliness among adults with serious mental illness (SMI) with most research focusing on stable contributing factors. This study sought to identify the role of dispositional loneliness and internalized stigma, as well as the momentary feelings of acceptance on experiential loneliness among adults with SMI. Data were collected using ecological momentary assessment via smart phones, and 89 adults with a SMI were included. Hierarchical linear modeling was used to identify the role of dispositional and experience factors in experiential loneliness. Findings indicated that (a) dispositional internalized stigma, (b) being at home, (c) being alone and, (d) a cross-level interaction between dispositional loneliness and feelings of acceptance best fit the data. The relationship of acceptance to experiential loneliness was strongest among the most lonely. Supporting people with SMI to develop social connections contributing to their relational value may enhance feelings of acceptance and reduce loneliness., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: Severe loneliness infrequently occurs in the general population but has very significant impacts on health and quality of life. This study examined the extent to which severe loneliness is experienced by adults with serious mental illnesses (SMIs) relative to adults in the general population and its possible implications for psychiatric rehabilitation services., Method: Data were gathered from samples of individuals with SMI ( N = 231) and a general community sample of adults ( N = 300) using the University of California, Los Angeles Loneliness Scale., Results: The results indicate that loneliness was much greater among those with SMI than the general adult population sample (Cohen's d = 1.220) and approximately 41% of the participants with SMI were "severely lonely" versus 7.3% of the non-SMI adult sample., Conclusions and Implications for Practice: Severe loneliness is extremely common among individuals with SMI. Psychiatric rehabilitation services that focus on socialization and mattering are needed to address this significant public health issue. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This review examines the reproductive health experiences of unhoused women and youth. Guided by the reproductive justice framework, this review examines barriers to accessing contraception, medical abortion, and prenatal care while homeless. Twenty-one articles were identified through keyword searches in Google Scholar, Ebscohost Academic Search Premier, and PsycINFO. In included articles, barriers were identified at the individual, relational, and contextual levels. Findings from this scoping review illustrate the need to examine multiple levels of analysis when seeking to improve access to family planning services for individuals experiencing homelessness. Included literature suggests an overabundance of research documenting barriers to contraceptive care relative to the literature examining abortion and prenatal care experiences and a scarcity of research examining barriers to reproductive justice among unhoused individuals who do not identify as women., (© 2022 Wiley Periodicals LLC.)

Background: People with serious mental illnesses (SMI) have higher levels of loneliness than the general population. Furthermore, people with SMI tend to be less satisfied with their housing and tend to move more frequently., Aim: This study aims to examine relationships between housing variables (whom they live with, duration of residence, and satisfaction) and loneliness among individuals with SMI., Methods: Data were collected from 188 adults with SMI in greater Philadelphia area. Classification and Regression Trees (CART) were used to examine whether whom they live with, duration of residence, and housing satisfaction were associated with loneliness., Results: Housing satisfaction was found to be the most prominent predictor of loneliness. Those who were unsatisfied with their overall housing conditions always had the highest level of loneliness, regardless of other factors. Even if they were satisfied with their housing conditions, their loneliness was higher if they had just moved to the new residence. Participants had lower loneliness the longer they lived in a residence and had the lowest loneliness levels after about three years., Conclusion: Housing is associated with loneliness among people with SMI. Psychiatric service providers should increase support to factors contributing to housing satisfaction and duration of residence, including active engagement in the community.

Police are often called to address concerns about people experiencing homelessness, with arrests often resulting from low-level, nonviolent crimes, and violations of minor nuisance ordinances. In Portland, Oregon, advocates lobbied for a new model of emergency response for 911 calls involving unhoused community members and people experiencing behavioral health crises. To ensure the program reflected the needs and perspectives of people experiencing homelessness, teams of researchers, community volunteers, and people with lived experience interviewed 184 people in camps, shelters, and parks. Teams asked unhoused people how the program should be designed, including who the first responders should be, how they should approach individuals in crisis, what resources they should provide, and how they should be trained. This article describes the methods, findings, and recommendations from our collaborative survey process aimed at ensuring that the voices of people experiencing homelessness informed the development of the Portland Street Response pilot program., (© 2021 Wiley Periodicals LLC.)

Little research has examined the full-range of participation among adults on the autism spectrum. The current study addresses this knowledge gap by comparing the frequency, importance, breadth, and sufficiency of participation between autistic adults and adults in the general population. Autistic adults participated less, had fewer areas that were important to them, participated in fewer areas that were important to them, and were less satisfied with their participation even after controlling for demographic characteristics. Moreover, this study raises questions about what influences their perceptions about the breadth of activities that are important to them and the degree to which they desire to participate in those areas. Suggestions for future interventions and research are offered., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Mental health services and interventions have increasingly focused on the importance of community participation and mobility for people with serious mental illnesses (SMI). This study examined the role that visits to community mental health centers (CMHCs) may play in increasing community mobility of people with SMI. Eighty-nine adults with SMI receiving services at three CMHCS were tracked with GPS-enabled phones over a 13-day period. Findings revealed that participants visited more destinations on days they went to a CMHC compared to days they did not. They also spent more time out of the home and traveled greater distances. Results suggest that the benefits of visiting a mental health center appear to go beyond treatment outcomes, but also point to the possibility that obligations, whether to a clinic appointment or possibly vocational, educational, leisure, faith, or social commitments, may be an important stepping stone to more mobility and intentional, sustained community participation., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

[Correction Notice: An Erratum for this article was reported online in Psychiatric Rehabilitation Journal on May 20 2021 (see record 2021-48272-001). In the original article, the following acknowledgments were missing from the author note: : "The contents of this article were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; Grant 901F0065-02-00; Mark S. Salzer, principal investigator). However, the contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and endorsement by the federal government should not be assumed. The authors are grateful to Kevin Frech, Stephany Wilson, Alison Weigl, Jared Pryor, David Glogoza and Katie Pizziketti for their assistance with data collection and analysis and to Alex Fechner for providing his implementation of the ST-DBSCAN algorithm in RapidMiner." All versions of the original article have been corrected.] Objective: The purpose of this study was to determine if environmental novelty was associated with neurocognitive function among adults with serious mental illness. Method: Participants were recruited from community mental health centers ( n = 117), and received a Global Positioning System (GPS) enabled cellular phone for 13 days. Data were also collected on cognitive function and recent participation in community-based activities. Independent samples t-tests were conducted to identify differences in neurocognitive function between participants who predominantly stayed in their homes ("homebodies") versus those who ventured more often from their homes ("venturers"). Analyses were also undertaken to identify if the nature of community participation activities mediated the relationship of neurocognitive function to group membership. Results: Overall, 74% of GPS signals were from participants' home residence. Homebodies demonstrated significantly poorer cognitive function than venturers, and this relationship was not mediated by a number of unique destinations or breadth of community participation activities. Conclusions and Implications for Practice: This study identified a subset of adults with serious mental illnesses who left their homes infrequently and who demonstrate significantly poorer cognitive function than those who left their homes more frequently. Spending extensive amounts of time in an unchanging environment may be a contributing factor to poor cognitive function, and a potential area for intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Overall, the retention of people with serious mental illness (SMI) in supportive housing is high. However, some supportive housing settings report average stays of only 15 months, and others report declines in housing retention over time. Many studies report variables associated with supportive housing stability and tenure, but there are few extensive, focused investigations on the subject. Hence, a literature review was conducted to investigate factors associated with supportive housing stability and tenure among people with SMI. The review of the included 28 papers reveals that the factors associated with supportive housing stability and tenure fell into two general categories of individual factors (including psychiatric factors and prior homelessness), and contextual factors (including program characteristics and sense of community and social support). In conclusion, further focus on contextual factors, as well as a potential reframing of individual factors as contextual, may be helpful in addressing issues related to supportive housing stability and tenure for people with SMI., (© 2021 Wiley Periodicals LLC.)

Community participation is important to the well-being of people with serious mental illnesses. While theories suggest that depressive symptoms can negatively impact community participation, evidence from previous studies was inconclusive. This study analyzed the relationship between severity of depressive symptoms and various participation constructs including number of days of participation in various community activities, breadth of interests in participating in community activities, and satisfaction with the amount to which one participates. A national sample of individuals with serious mental illnesses (n = 296) was employed. Overall, those who were severely depressed had fewer total days of participation, reported fewer participation areas as important, were less likely to participate in those areas that were important to them, and were less likely to participate as much as they wanted to in areas that were important to them. This relationship generally remained even after controlling for demographics. Overall, the findings from this study suggest that greater attention should be paid to the relationship between depressive symptoms and community participation in this population, including explorations that examine how the promotion of participation may have an impact on depressive symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Following deinstitutionalization, services and housing for people with serious mental illnesses (SMI) became concentrated in economically disadvantaged urban centers. As these areas gentrify, affordable housing for people with SMI is increasingly found in nonurban areas. Although nonurban environments provide benefits for the general population, people with SMI living in nonurban areas perceive higher levels of mental illness stigma. Thus, the relationship between perceived stigma and negative outcomes such as high psychological distress and low sense of community may be stronger in nonurban areas. Data collected from 300 adults with SMI living in urban and nonurban areas were analyzed using a moderated regression design. Urbanicity did not moderate the relationships between perceived stigma and negative outcomes. However, associations were found between urbanicity, perceived stigma, sense of community, and psychological distress, supporting the need to address mental illness stigma in all settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Individuals with serious mental illnesses generally spend extensive amounts of time at home and alone. The aim of the current study was to examine differences in emotional states between being at home and being in the community, and between being alone and being with others. Ecological momentary assessment was utilized 3 times per day over 14 days with 91 individuals with serious mental illnesses to assess where they were, who they were with, and momentary feeling of depressed mood, loneliness, and happiness. A total of 2,257 data points were analyzed with hierarchical linear modeling. Participants were at home 70.6% of the time and alone 58.6% of the time. After controlling for diagnosis and symptoms, being in the community was associated with lower depressed mood, lower loneliness, and greater happiness, and being with others was associated with lower loneliness and greater happiness. There was no significant interaction effect between being at home and being alone on any emotional states. Being in the community and being with others contributed to more favorable emotional states among individuals with serious mental illnesses. These findings support the need to promote opportunities for community participation and interactions with others outside of one's home. Policies, programs, and clinical practices should align with the goal of supporting people with serious mental illnesses to actively engage in community living to facilitate their emotional well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: This study aimed to clarify the extent of community participation by individuals with serious mental illnesses in comparison with the general population., Methods: Participants with serious mental illnesses (N=300) were recruited from 21 outpatient mental health organizations throughout the United States, and the participants without serious mental illnesses (N=300) were recruited from a stratified sample from across the United States. All participants completed the Temple University Community Participation Measure., Results: The groups differed in community participation amount, number of important areas, breadth, and sufficiency of community participation. Differences between groups in amount of participation were not evident after analyses controlled for income and car ownership. However, differences in number of important areas, breadth of participation, and sufficiency remained after analyses controlled for demographic and economic factors., Conclusions: Car ownership and income are important factors in amount of community participation, but differences in other areas remain, plausibly affecting the health and wellness of persons with serious mental illnesses.

Higher levels of community mobility have been shown to be associated with better physical health, mental health, and quality of life. The ability to move about one's community is also expected to facilitate community participation, which is an aspect of health functioning. This study uses Global Positioning Systems (GPS) technology to track various dimensions of community mobility, such as destinations, time outside the home, and distance traveled, and examine the relationship between these variables and community participation in a sample of individuals with serious mental illnesses (SMI). This population was selected because they are known to have diminished health functioning in terms of their community participation, and the goal is to explore the extent to which mobility limitations may account for this. A total of 103 individuals with serious mental illnesses were recruited from mental health agencies and consented to having their mobility tracked using GPS for 13 days and answering questions about their community-based activities. Greater amount of participation was associated with having more destinations and spending more time out of the house, but not with traveling larger distances and having a greater activity space. None of the mobility variables were related to the number of important participation areas or sufficiency of participation. The findings support the hypothesis that greater mobility is related to more participation, although satisfaction with the degree to which one participates does not appear to be impacted, suggesting that other factors need to be accounted for. Health policymakers and providers should pay attention to community mobility as a factor that affects health outcomes such as participation, in individuals with serious mental illnesses, and other populations. In particular, attending to access to personal transport, public transportation, and other mobility options appears to be important, as well as interventions aimed at encouraging greater community mobility., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Sense of community and well-being are considered core tenets in the field of community psychology, acting as focal points for theory, research, and action. This integrative review synthesizes the empirical literature on sense of community and well-being with respect to four research questions focused on the relationships between these variables, the methodologies used to study those relationships, and how future research might expand upon the current literature. A search of the available literature produced 30 articles that met the search criteria, based primarily on conceptualizations and measurement of both sense of community and hedonic and eudaimonic well-being. This review suggests a general consensus across the literature of a positive relationship between sense of community and well-being among both youth and adults in a variety of settings, and discusses the strengths and limitations of this area of research, pointing to the need for more nuanced, ecologically valid research that incorporates more qualitative and critical methodologies. We hope that this review can promote a more thorough understanding of how sense of community and individual well-being relate to each other, and that ongoing research in this area can be a catalyst for action research and interventions that are applied to pressing contemporary issues as well as strengths-based approaches focused on how to foster and support the well-being of individuals within their community contexts., (© 2020 Society for Community Research and Action.)

Prior research with youth experiencing homelessness suggests that community experiences can play an important role in their resilience and well-being. This literature suggests that a sense of community (SOC) and social support may be two key interpersonal factors related to the well-being of this population. However, quantitative research exploring these relationships has resulted in inconsistent findings, which may be due to a lack of understanding regarding youth's definitions of and experiences with community. This study utilized semistructured qualitative interviews with 24 youth experiencing homelessness to explore their definitions of community, how it is important to them, what communities they are a part of, and how these communities contribute to their well-being. Overall, findings suggest that (a) youth generally define community in ways that align with current theory on SOC, (b) youth view community as important, and (c) their experiences within community settings promote their overall well-being in various ways. However, the findings also suggest that community is not always a positive experience for these youth. This study has implications for how to promote the well-being of youth experiencing homelessness, as well as how SOC and social support may relate to the well-being of this population., (© 2020 Wiley Periodicals, Inc.)

Social networks are regarded as an asset to community integration. While family and friends provide important sources of support, familiar strangers like neighbors can facilitate support through anonymous, but meaningful interactions. Among individuals with serious mental illnesses (SMI), these interactions can help to compensate for increased social isolation and smaller networks of peers. This study explores whether neighbors can play a unique role in decreasing loneliness and bolstering a sense of community for individuals with SMI. Participants in this study were drawn from 2 samples: (a) 232 individuals with SMI receiving services at outpatient community mental health centers throughout the United States; and (b) 300 adults recruited from the Truven Health Analytics' PULSE survey. Independent-samples t tests were performed to compare neighbor relationships between individuals with and without SMI. Multiple regression analyses were conducted to examine associations between neighbor relationships, sense of community, and loneliness. As hypothesized, individuals with SMI reported weaker relationships with their neighbors, as well as higher levels of loneliness and lower levels of community connectedness compared to individuals without SMI. For participants in both groups, the quality of neighbor relationships was significantly associated with their loneliness and sense of community regardless of how many neighbors they reported feeling close to. Participants with SMI indicated their sense of community and experiences of loneliness were associated with their relationships with their neighbors, no matter the quantity. Providers might capitalize on the utility of neighbors by expanding social and support networks of clients with SMI. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Objective: Explore the association between loneliness and psychiatric hospitalizations, functioning, and physical health conditions in people with serious mental illness., Methods: Data were included from 349 individuals with serious mental illnesses, aged 18+ years, who participated in two consecutive cross-sectional survey studies conducted between 2013 and 2018., Results: A higher number of psychiatric hospitalizations in the past six months was associated with greater loneliness. The Short-Form-12 mental component score was a highly significant correlate, accounting for a significant amount of variance in loneliness scores. The physical component score and the bodily pain subdomain of the Short-Form-12 were also significantly associated with loneliness, with individuals with lower physical functioning and greater bodily pain reporting more loneliness. Having a higher total number of health conditions, higher total number of conditions that cause pain, and the presence of at least one respiratory condition were found to be associated with greater loneliness., Discussion: Loneliness may be an important dimension of health as related to health conditions associated with pain, functioning, and psychiatric hospitalizations among people with serious mental illness. These finding reinforce the powerful role of socio-cultural and environmental factors in shaping whole health in people with serious mental illness.

Community integration has emerged as a priority area among mental health advocates, policy makers, and researchers (Townley, Miller, & Kloos, 2013; Ware, Hopper, Tugenberg, Dickey, & Fisher, 2007). Past research suggests that social support influences community integration for individuals with serious mental illnesses (Davidson, Haglund, Stayner, Rakfeldt, Chinman, & Tebes, 2001; Davidson, Stayner, Nickou, Styron, Rowe, & Chinman, 2001; Wong & Solomon, 2002), but there has not yet been a systematic review on this topic. Therefore, the purpose of this paper was to explore the influence of social support on community integration through a review of the existing literature. An extensive literature search was conducted, resulting in 32 articles that met the search criteria. These articles were organized into three categories: defining community integration, supportive relationships, and mental health services. The search results are analyzed according to the types of support being provided. Article strengths, limitations, implications, and future directions are also addressed. Overall, the findings of this review suggest that social support, which may be provided by a variety of individuals and services, plays an important role in promoting community integration for individuals with serious mental illnesses. Therefore, as community mental health research and practice continues to promote community integration for individuals with serious mental illnesses, the mental health field should emphasize the importance of social support as a key factor influencing community integration., (© 2019 Society for Community Research and Action.)

Objective: Research has suggested that individuals with serious mental illnesses are not as physically healthy as the general population and are more likely to experience physical illnesses such as diabetes, obesity, and cardiovascular and respiratory diseases. Less is known about how physical health may be related to community participation among individuals with serious mental illnesses, although research with adults in the general population has suggested strong negative associations between health impairments and engagement in a variety of activity domains., Methods: In this study, the authors drew from two national data sets to examine the relationship between physical health impairments and community participation among 300 participants with serious mental illnesses and 300 participants without serious mental illnesses., Results: For participants in both groups, physical health concerns and use of mobility aids were associated with lower reported rates of community participation., Conclusions: Findings shed light on the complex association between physical health impairments and community participation while also suggesting the need to focus on other potential barriers to participation among individuals with serious mental illnesses.

Homeless youth are adolescents and young adults who do not have stable dwellings but instead live on the streets, in shelters, or in other unstable situations. Although researchers have begun examining well-being among this population, little is known about components of well-being that are relevant to homeless youth or which factors predict differences in well-being. This study examined psychological well-being and its associations with demographic characteristics, intrapersonal factors (mental health, optimism, and self-esteem), and social-contextual factors (social support, sense of community, and empowerment) among 100 youth experiencing homelessness. All of the intrapersonal and social-contextual variables were associated with well-being at the bivariate level. In the full regression model, only self-esteem and psychological distress remained significant. Findings inform future research and program development at homeless service centers., (© 2019 Wiley Periodicals, Inc.)

The goal of the current study is to better understand the association between community participation and mental health by investigating sense of community as a potential mediating factor between community participation, psychological distress, and mental health functioning. A survey was administered to 300 adults with serious mental illnesses using community mental health services in the United States in a cross-sectional design. Hayes PROCESS macro (model 4, version 2.16; Hayes, 2013) was employed to test all of the hypotheses. Results indicate that sense of community partially mediated the association between community participation and psychological distress, as well as mental health functioning. Implications include contributing to the current knowledge base about the influence of community factors on mental health and informing future interventions aimed at promoting community participation of adults with serious mental illnesses., (© 2018 Wiley Periodicals, Inc.)

People generally participate in research for three primary reasons: financial, altruistic/social, and personal/psychological. While we would expect individuals with serious mental illness (SMI) to share these reasons, this assumption has not been investigated. Ninety-two adults with SMI living in supportive housing were interviewed about their reasons for participating in a study examining their housing, well-being, and community experiences. Associations between participant characteristics and reasons for research participation were explored. Primary reasons for participation included "contributing to science/research" (37%, n = 34), "money" (33%, n = 30), "improving housing" (22%, n = 20), "having someone to talk to (2%, n = 2) and other (6%, n = 6). Secondary reasons were "money" (38%, n = 31), "contributing to science/research" (24%, n = 20), "improving housing" (24%, n = 20), "having someone to talk to" (2%, n = 2) and other (11%, n = 9). Additionally, 29% (n = 27) reported making housing or well-being changes since participating. Individual characteristics were not significantly associated with reasons for research participation. Participants' reasons for research participation mirrored the general population, with "improving housing" being a unique motivating factor. Participation in survey research could benefit people with SMI by prompting community engagement and consideration of housing issues., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: A broad range of estimates of recovery among previously institutionalized persons has been reported, but no current, community-based national estimate of recovery from serious mental illness exists. This study reports recovery rate results, based on a remission definition, and explores related demographic factors., Methods: A national, geographically stratified, and random cross-sectional survey conducted from September 2014 to December 2015 resulted in responses from more than 41,000 individuals. Lifetime prevalence of serious mental illness was assessed by asking about receipt of a diagnosis (major depression, bipolar disorder, manic depression, and schizophrenia or schizoaffective disorder) and hospitalization and impairment associated with the diagnosis. Recovery was determined by asking about impairments over the past 12 months., Results: Almost 17% reported receiving one of the diagnoses in their lifetime, 6% had a lifetime rate of a serious mental illness, and nearly 4% continued to experience interference associated with serious mental illness. One-third of those with a lifetime serious mental illness reported having been in remission for at least the past 12 months. Recovery rates were low until age 32 and then progressively increased., Conclusions: Lifetime estimates of diagnosed illness and current prevalence of serious mental illness are consistent with previous research. Results indicate that recovery is possible and is associated with age. Further research is needed to understand factors that promote recovery, and sustained evaluation efforts using similar parsimonious approaches may be useful in conducting timely assessments of national and local mental health policies.

Greater community participation among individuals with serious mental illnesses is associated with better psychosocial and health outcomes. Typically, studies examining community participation have utilized self-report measures and been conducted in limited settings. The introduction of methodological advances to examining community participation of individuals with serious mental illnesses has the potential to advance the science of community mental health research and invigorate the work of community psychologists in this area. This study employed an innovative geospatial approach to examine the relationship between community participation and resource accessibility (i.e., proximity) and availability (i.e., concentration) among 294 individuals utilizing community mental health services throughout the United States. Findings suggest small but significant associations between community participation and the accessibility and availability of resources needed for participation. Furthermore, findings demonstrate the importance of car access for individuals residing in both urban and non-urban settings. The methods and results presented in this study have implications for community mental health research and services and provide an illustration of ways that geospatial methodologies can be used to investigate environmental factors that impact community inclusion and participation of individuals with serious mental illnesses., (© Society for Community Research and Action 2017.)

Community psychology is rooted in community mental health research and practice and has made important contributions to this field. Yet, in the decades since its inception, community psychology has reduced its focus on promoting mental health, well-being, and liberation of individuals with serious mental illnesses. This special issue endeavors to highlight current efforts in community mental health from our field and related disciplines and point to future directions for reengagement in this area. The issue includes 12 articles authored by diverse stakeholder groups. Following a review of the state of community mental health scholarship in the field's two primary journals since 1973, the remaining articles center on four thematic areas: (a) the community experience of individuals with serious mental illness; (b) the utility of a participatory and cross-cultural lens in our engagement with community mental health; (c) Housing First implementation, evaluation, and dissemination; and (d) emerging or under-examined topics. In reflection, we conclude with a series of challenges for community psychologists involved in future, transformative, movements in community mental health., (© Society for Community Research and Action 2018.)

Articles published in the two most prominent journals of community psychology in North America, the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP), provide a clear indicator of trends in community research and practice. An examination of community psychology's history and scholarship suggests that the field has reduced its emphasis on promoting mental health, well-being, and liberation of individuals with serious mental illnesses over the past several decades. To further investigate this claim, the current review presents an analysis of articles relevant to community mental health (N = 307) published in the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP) from 1973 to 2015. The review focuses on article characteristics (e.g., type of article and methods employed), author characteristics, topic areas, and theoretical frameworks. Results document a downward trend in published articles from the mid-1980s to mid-2000s, with a substantial increase in published work between 2006 and 2015. A majority of articles were empirical and employed quantitative methods. The most frequent topic area was community mental health centers and services (n = 49), but the past three decades demonstrate a clear shift away from mental health service provision to address pressing social issues that impact community mental health, particularly homelessness (n = 42) and community integration of adults with serious mental illnesses (n = 40). Findings reflect both the past and present state of community psychology and suggest promising directions for re-engaging with community mental health and fostering well-being, inclusion, and liberation of adults experiencing serious mental health challenges., (© Society for Community Research and Action 2017.)

This commentary reflects on the Community-Diversity Dialectic, summarizing its development and reviewing its impact on community psychology research and practice. Two contemporary examples are presented to illustrate both the possibilities of and challenges to bridging the gap between sense of community and diversity: the rise of the so-called "alt-right" on the one hand, and the popularity of Pokémon Go on the other. The article concludes with a brief discussion of Kurt Lewin's contributions to group dynamics theory, recommending that an emphasis on our interdependent fates and goals is paramount to reconciling the tensions between sense of community and diversity that persist in an increasingly complex multicultural world., (© Society for Community Research and Action 2017.)

Despite a wealth of studies examining the relationship between urbanicity (i.e., living in an urban area) and psychological distress, there is a paucity of research examining the relationship between urbanicity, community living, and community participation of adults with serious mental illnesses. This study addresses this knowledge gap by assessing urban and non-urban differences in community participation, sense of community, mental health stigma, and perceptions of the neighborhood environment among individuals with serious mental illnesses living independently throughout the United States. A total of 300 individuals with serious mental illnesses recruited from 21 outpatient mental health service organizations in 15 states completed a phone survey about their community living and participation experiences. Urbanicity was examined at two spatial scales (block group and county), and independent-samples t-tests were employed to assess urban and non-urban differences in community living and participation variables. Levels of community participation and perceptions of neighborhood quality and crime were higher in urban block groups; sense of community was higher in urban counties; and perceptions of mental health stigma were higher in non-urban counties. Results inform the methodological literature on best practices for assessing urbanicity, as well as interventions aimed at increasing community participation and improving aspects of the built and social environment that affect individuals who experience mental health distress., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: Although youth homelessness presents a significant public health problem, the needs of homeless youths with mental illness, as distinct from adults, are not well understood. This study examined the unique demographic, clinical, and service use characteristics of homeless youths., Methods: At Home/Chez Soi was a large randomized controlled trial of the Housing First model in five cities in Canada. Of 2,255 participants, 7% (N=164) were youths ages 18 to 24. Youths were compared with older participants on baseline demographic, clinical, and service use characteristics., Results: More youths than adults had not finished high school (76% versus 54%), had a drug use disorder (66% versus 52%), and had been assaulted in the past six months (44% versus 36%) (all p<.05). Fewer than half the youths (49%) had a regular medical doctor, 50% reported unmet need for health care, and 61% visited an emergency department in the past six months., Conclusions: This sample of homeless youths with mental illness had low education, high rates of substance use disorders and victimization, and problems accessing services. These findings suggest that youths have trajectories to homelessness and service needs that are distinct from adults and may guide future planning for this vulnerable population.

Although previous studies have informed our understanding of certain aspects of youth homelessness, few studies have critically examined the spatial and social environments utilized by youth as they navigate life on the streets. This study employed participatory mapping and Geographic Information Systems (GIS) to examine the activity spaces of homeless youth as they relate to sense of community and psychological well-being. Participants were 28 youth experiencing homelessness in Portland, Oregon, USA. Results suggest that youth engage most frequently in service-related activities, and their activity participation is significantly associated with sense of community and psychological well-being. The utility of innovative participatory methods for better understanding the diverse experiences of homeless youth is discussed alongside examination of their practical implications., (© Society for Community Research and Action 2016.)

This paper argues that the experience of homelessness is inherently traumatic and thus has the potential to affect the manifestation of mental illness. The experiences related to being homeless might act as specific and unique sources of vulnerability. This study included 424 people diagnosed with serious mental illnesses living in supported housing programs in South Carolina. Three hierarchical regression analyses measuring the impact of homelessness on three types of outcomes revealed the following: (1) ever experiencing homelessness as well as the amount of time spent homeless were related to higher levels of psychiatric distress, (2) ever experiencing homelessness was related to higher levels of reported alcohol use, and (3) total amount of time spent homeless was related to lower perceived recovery from mental illness. These findings suggest that experiencing homelessness might contribute to psychosocial vulnerability to negative mental health outcomes. Future investigations examining this concept of risk and vulnerability as a result of homelessness are in order.

This article examines later fidelity and implementation of a five-site pan-Canadian Housing First research demonstration project. The average fidelity score across five Housing First domains and 10 programs was high in the first year of operation (3.47/4) and higher in the third year of operation (3.62/4). Qualitative interviews (36 key informant interviews and 17 focus groups) revealed that staff expertise, partnerships with other services, and leadership facilitated implementation, while staff turnover, rehousing participants, participant isolation, and limited vocational/educational supports impeded implementation. The findings shed light on important implementation "drivers" at the staff, program, and community levels.

Objective: This study compared the life changes of homeless people with mental illness participating in Housing First or treatment as usual and examined factors related to various changes., Methods: Semistructured narrative interviews were conducted with 219 participants in five Canadian cities at baseline; 197 were interviewed again at 18 months after random assignment to Housing First (N=119) or treatment as usual (N=78). Interviews were coded across 13 life domains, and each participant was categorized as reporting positive, mixed-neutral, or negative changes. Housing First and treatment as usual participants were compared with respect to change patterns. Thematic analysis was used to examine factors related to various changes., Results: The percentage of participants in Housing First reporting positive changes was more than double that for participants in treatment as usual, and treatment as usual participants were four times more likely than Housing First participants to report negative changes. Factors related to positive changes included having stable good-quality housing, increased control over substance use, positive relationships and social support, and valued social roles. Factors related to negative changes included precarious housing, negative social contacts, isolation, heavy substance use, and hopelessness. Factors related to mixed-neutral changes were similar to those for participants reporting negative changes but were less intense., Conclusions: Housing First with intensive support was related to more positive changes among homeless adults with mental illness across five Canadian cities. Those with poor housing or support, more common in treatment as usual, continued to struggle. These findings are relevant for services and social change to benefit this population.

Objective: Mental health consumer-run organizations (CROs) are a low-cost, evidence-based strategy for promoting recovery. To increase CRO utilization, characteristics that promote engagement need to be identified and encouraged. The study examined individual and organizational characteristics that predict three types of engagement in CROs-attendance, leadership involvement, and socially supportive involvement., Methods: Surveys were administered to 250 CRO members attending 20 CROs. Leaders of each CRO reported organizational characteristics through a separate questionnaire. Multilevel regression models examined relationships between predictors and indicators of CRO engagement., Results: Perceived sense of community was the only characteristic that predicted attendance, leadership involvement, and socially supportive involvement (p<.001). Perceived organizational empowerment, shared leadership, peer counseling, and several demographic characteristics also predicted some measures of engagement., Conclusions: CROs that can effectively promote sense of community, organizational empowerment, shared leadership, and peer counseling may be better able to engage participants. The discussion considers several strategies to enhance these characteristics, such as collectively establishing values and practicing shared decision making.

There is a disagreement in place-based research regarding whether objective indicators or individual perceptions of environments are better predictors of well-being. This study assessed environmental influences on well-being for 373 individuals with psychiatric disabilities living independently in 66 neighborhoods in the southeastern United States. Three questions were examined utilizing random effects models: (1) How much variance in personal and neighborhood well-being can be explained by neighborhood membership? (2) What is the relationship between participant perceptions of neighborhood quality and researcher ratings of neighborhood quality? and (3) What is the relative influence of individual perceptions, perceptions aggregated by neighborhood, and researcher ratings of neighborhood quality in predicting personal and neighborhood well-being? Results indicate that individual perceptions of neighborhood quality were more closely related to well-being than either aggregated perceptions or researcher ratings. Thus, participants' perceptions of their neighborhoods were more important indicators of their well-being than objective ratings made by researchers. Findings have implications for measurement approaches and intervention design in placed-based research.

This research sought to determine whether the implementation of Housing First in a large-scale, multi-site Canadian project for homeless participants with mental illness shows high fidelity to the Pathways Housing First model, and what factors help or hinder implementation. Fidelity ratings for 10 Housing First programs in five cities were made by an external quality assurance team along five key dimensions of Housing First based on 84 key informant interviews, 10 consumer focus groups, and 100 chart reviews. An additional 72 key informant interviews and 35 focus groups yielded qualitative data on factors that helped or hindered implementation. Overall, the findings show a high degree of fidelity to the model with more than 71% of the fidelity items being scored higher than 3 on a 4-point scale. The qualitative research found that both delivery system factors, including community and organizational capacity, and support system factors, training and technical assistance, facilitated implementation. Fidelity challenges include the availability of housing, consumer representation in program operations, and limitations to the array of services offered. Factors that accounted for these challenges include low vacancy rates, challenges of involving recently homeless people in program operations, and a lack of services in some of the communities. The study demonstrates how the combined use of fidelity assessment and qualitative methods can be used in implementation evaluation to develop and improve a program., (Copyright © 2013 Elsevier Ltd. All rights reserved.)