COMMUNITY INTEGRATION

1. COMMUNITY INTEGRATION Mayview Steering Committee June 18, 2010

2. Community Integration • Definition: “The opportunity to live in the community, and be valued for one’s uniqueness and ability, like everyone else.” (Salzer, 2006) • Legal and Policy Grounding • Americans with Disabilities Act (1990) • Supreme Court Olmstead decision (1999) • President’s New Freedom Initiative (2001) • President’s New Freedom Commission Report (2003)

3. More people in the community. . . Number of individuals in State and County hospitals at the end of the year (From Annual Report – Admissions and Resident Patients, State and County Mental Hospitals, United States. Rockville, MD: Center for Mental Health Services).

4. But NOT OF the Community • Housing • Education • Employment • Health • Social roles • Leisure • Spirituality • Citizenship • Self-Determination • Peer Support • Transportation

5. Housing • Who owns? • Independent vs. Institutional setting • Room vs. Home • Yard vs. Grounds • Temporary vs. Permanent

6. Education • Cost • Opportunity • Self-efficacy • Transportation • Technology

7. Employment • Supported vs. “natural environment” • Living wage? • Effect on other benefits • Transportation • New skill requirements

8. Health • Preventive care vs. crisis care • Access to care • Coordination of care between PCP and others • Access to nutritious foods • Obesity • Access to recreational activities • Medication issues

9. Social Roles • Patient vs. citizen • Patient vs. family member and/or friend • Passive vs. active • Role of intimacy • Parenting opportunities

10. Leisure • Neighborhood of choice or by default? • Safety • Access to opportunities including art, libraries, parks, gym, etc. • Transportation issues

11. Spirituality/Religion • Choices • Membership vs. active participation • Openness of congregation/leadership

12. Citizenship • Voter registration • Access to information – newspapers, etc. • Literacy • Technology • Transportation

13. Self-Determination • Choice vs. initiative • Staff directed vs. person directed • Small daily decisions • Structure vs. free choice • Hygiene, meals, etc.

14. Peer Support • Recipient vs. provider • Hope • Role model • Self-efficacy • Relationships • Consistency

15. Rights Blocked • Review of state laws in 1999 pertaining to individuals with a mental illness and/or ruled as incompetent (increased in past ten years) • 37 states restrict the right to vote • 44 states restrict right to serve on a jury • 24 states restrict right to hold public office • 33 states allow as grounds for divorce • 27 states allow as grounds for limiting parental rights • Hemmons et al (2002)

16. SMI Associated with Custody Loss *Mothers with SMI 2.8 times more likely to experience out of home placement than those without a MI

17. Would Participate • Good place to live, meaningful work, and intimacy are top three things people want • 80% report being extremely or very religious/spiritual (Corrigan et al., 2003; Salzer, 2005) • 50% voted in 2004 election • 50% have access to computers and the Internet and have attitudes comparable to the general population (Salzer et al., 2003)

18. Could Participate • Participation-oriented supports initiatives can be effective • Supported housing • Supported employment • Supported education • Consumer/peer-delivered supports

19. Should Participate

20. Should Participate

21. Should Participate

22. Should Participate

23. Should Participate

24. Community Integration • 1) It is a RIGHT • 2) It offers opportunities for participation in various ROLES • 3) It promotes a sense of RESPONSIBILITY

25. Slides by Shirlee Hopper-Scherch and Mark Salzer, June, 2010