Lesley A. Tarasoff, MA PhD Candidate, Social & Behavioural Health Sciences

1. Lesley A. Tarasoff, MA PhD Candidate, Social & Behavioural Health Sciences Dalla Lana School of Public Health, University of Toronto Doctoral Student Research Trainee Schizophrenia Program, Centre for Addiction & Mental Health Canadian Public Health Association Conference – May 29, 2014 Interrogating “food insecurity” and “community integration”: The example of low-income people withschizophrenia in an urban setting

2. Acknowledgements • Research Team: Sean Kidd (PI), Tyler Frederick, Gursharan Virdee • Steering Committee: Kwame McKenzie, Steve Lurie, Larry Davidson, David Morris, Janet Mawhinney,Susan Pigott, Tatum Wilson • Lucy Costa and the Empowerment Council Advisory Committee • Summer students and volunteers • Participants • Funded by the Ontario Mental Health Foundation

3. Objectives • To consider the role of food in the lives of low-income people with schizophrenia in an urban setting, and in turn, what meanings of food and food access suggest about how we understand “food insecurity” and “community integration”

4. Methods • Purposeful, stratified sampling • Neighbourhood, ethnicity, gender • Longitudinal • 3 meetings over 8-10 months • Interviews, participatory mapping, walking tours, survey

5. Sample • 31 participants residing primarily in the neighbourhoods of Moss Park, Regent Park, and Parkdale • Age: Mean = 45; Min. = 28; Max. = 62; SD = 10.9 • Gender: 16 female (51.6%); 15 male (48.4%) • Ethnicity: 1 Latin American (3.2%); 9 African/African-Caribbean (29%); 7 South Asian/Middle Eastern (22.6%); 6 East Asian/Southeast Asian (19.4%); 8 White European/White Canadian (25.8%) • Sexual Orientation: All identified as heterosexual (100%) • Marital Status: 5 in dating relationship or married (16%)

6. Sample • Immigration Status: 19 first generation immigrants (61%) • Employment Status: 17 not in the labour force (not working, not looking) (54.8%) • Housing Type: 16 live alone in supported/subsidized housing (51.6%); 9 live in supported/subsidized housing with others (29%) • Age of diagnosis ranged from youth/teen to late 50s • Number of hospitalizations ranged from 0 to 30 • A few participants were hospitalized during the study (between sessions)

7. Results I • Community participation is a dynamic process, shaped by illness and non-illness associated social relationships and spaces, self-concept, and the resources available to a person

8. Results II • Food as it relates to social relationships and spaces • Limits the types of relationships you can have (e.g., dating) • The types of spaces one (can) frequent (e.g., meal programs (to eat and/or volunteer at), restaurants) is limited • “…I would go to parties, I would go to restaurants, I would do fun things man, I would shop, I would buy my girl stuff…”

9. Results III • Food as it relates to self-concept • “I’ll be glad when I get home. That way I can open the fridge and they [workers] close the fridge, [with a] lock, you know, they close the fridge, the cupboards, everything and so you can’t get any food. You only get served dinner 4:30. Seven o’clock is tea and one cookie. And she [worker] watches how many cookies you have, only one cookie each person. It’s hard.” • “I used to do the cooking and now I don’t do any cooking because the house they do the cooking.” • “…That’s why I didn’t want to get food bank. If you get the food bank it means you have no way to get food. The bottom of the society, you get the food bank.”

10. Results IV • Food as it relates to available resources • “I try not to go there because I don’t want to like I don’t want to go there to eat because I’m still hungry when I leave and I want seconds.” • “No, I don’t get three meals there. I just get… If I’m lucky I get breakfast and then I get maybe a hotdog or two for lunch. And supper, maybe a can of stew or something. But it’s not really a meal, the way it’s supposed to be.”

11. Conclusion • The role of food in the lives of low-income people with schizophrenia reveals a lot about various systems, how we think about “food insecurity” and the weakness/limits of “community integration” as a recovery goal • Implications beyond this population • Poverty as a social determinant of (mental) health; “poverty is the main issue that must be addressed to improve the health of Canadians and eliminate health inequities” (http://www.cma.ca/to-improve-health-tackle-poverty)

12. Thank you! • Questions? • Contact Information: lesley.tarasoff@camh.ca