Supportive behaviors in natural support networks of people with serious mental illness.

Abstract

An issue of primary significance in the public mental health field is the extent to which interventions are effective in enhancing the community adjustment of people with serious mental illnesses. A fundamental goal of community support services is to integrate clients into the larger community by providing them with a range of resources that will result in greater levels of independent functioning. Thus, a key function of direct practitioners in all programs should be the of natural social support resources for clients to supplement their formal psychosocial rehabilitation activities. The use of natural supports by clients with serious mental illness is important to their stability because of limits in the scope and availability of formal services and the vulnerability of these services to shifts in political support and funding patterns. More important, social supports promote normalcy in clients' lifestyles. Although community-based programs have become preferred modalities for working with clients with serious mental illness, their potential for developing natural support resources has not been adequately examined. The National Institute of Mental Health (1991) asserted that studies of the origin, nature, constitution, and evaluation of informal social networks should be pursued to determine what factors promote their development (p. 27). Yet it is difficult to study informal support networks with this or any population, because although supports are of acknowledged importance, data that adequately describe their characteristics have not been compiled. This article describes the range of specific social support resources that clients with severe mental illness identify as important and describes a method for assessing social support patterns. Very little research has been done on clients' reports of their own experiences with support networks. Although the findings discussed in this article represent one step in a process of instrument for use by researchers, the authors believe that direct service providers will also benefit from an understanding of the behavior of supportive people and groups present in the lives of clients with serious mental illness. Practitioners can target their interventions to enhance supports that seem beneficial and may also use the authors' methods to perform social support assessments. CONCEPT OF SOCIAL SUPPORT Social support is important for all people in the promotion of physical health, mental health, stress-coping capability, and community living satisfaction (Bloom, 1990). The behaviors and relationships involved in social support have been conceptualized in various ways. Four examples may suffice to indicate conceptual differences among theorists: 1. Vaux (1988) defined social support as social networks, supportive behaviors, and support appraisals. 2. Sarason, Sarason, and Pierce (1990) considered social support to be primarily a cognitive or psychological characteristic of individuals. 3. Veil and Baumann (1992) broke social support down into four components: subjective beliefs, everyday support, potential support, and actual crisis support. 4. Richman, Rosenfeld, and Hardy (1993) specified eight types of support: (1) listening, (2) task appreciation, (3) task challenge, (4) emotional support, (5) emotional challenge, (6) reality confirmation, (7) tangible assistance, and (8) personal assistance. One problem in clarifying the concept of social support is that most research has been done with general populations. There has not been a clear appreciation of the fact that social supports are probably structured, perceived, and received differently in different populations. The characteristics of social support for seriously mentally ill people are different from those for the general population. Network structure is an essential support component, given that seriously mentally ill people tend to benefit from structure and predictability in their lives (Beels, 1981). …