Community Mental Health Organizations Research Articles

Impact of the COVID-19 Pandemic on Turnover Rates Among Staff in Community Mental Health and Substance Use Organizations.

This article explores the historic impact of the COVID-19 pandemic on turnover rates among staff in community mental health and substance use organizations in the United States. While existing literature extensively covers turnover in physical healthcare settings, the mental health and substance use sector's unique challenges have received less attention. The study utilizes a six-year dataset from a large multi-service organization in the northeast to analyze turnover patterns before, during, and after the pandemic. Key findings include a spike in turnover during the pandemic, particularly in Hospital Diversion Programs, and significant variations by age and gender. Despite the pandemic not significantly affecting overall turnover rates, the results offer insights into specific groups at risk for turnover, such as staff under 29 years old. The study concludes by discussing the implications for targeted retention strategies, especially as mental health organizations nationwide adopt the Certified Community Behavioral Health Center model.

Building a culture of workforce wellness using implementation science-informed strategies: A qualitative content analysis.

Successfully addressing burnout in health and human services settings is a topic of growing interest and impact in the field. Implementation science gives us strategies to build organizational readiness to create a culture of workforce wellness. This study used strategies for identifying and preparing wellness champions and building feedback loops to begin to build a culture of workforce wellness. The primary aim of this study was to assess perspectives on establishing feedback loops across all levels of the organizational hierarchy. This study took place in a community mental health organization that provides services across four different states. Champions in each state were identified and connected with leaders and teams. The champions supported the engagement of leaders and the design of feedback loops. Champions remained engaged throughout the process of assessing needs and sharing workforce wellness data. A qualitative content analysis was conducted on data collected during meetings that were intended to create organizational practice to policy feedback loops. Staff across all levels of the organizational hierarchy shared feedback and participated in facilitated reflective discussion. Participants offered several suggestions for addressing burnout. Across all participants, workplace connections were perceived as a protective factor against burnout. This implementation science strategy to help combat burnout is an effective and feasible way to include frontline staff voices and build connection and trust between leaders and staff in health and human services settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predictors of length of time in service: Characteristics of people in intensive case management for longer than 5 years.

The purpose of this study was to examine the characteristics of people who stay in intensive case management (ICM) for longer than 5 years. We conducted a secondary analysis of client data collected by a community mental health organization from 2012 to 2022. Using the Gelberg-Andersen Model for Access to Health Services, we conducted a logistic regression with 22 predictor variables, predicting clients in ICM for 5 years or less (N = 531) and those in ICM for longer than 5 years (N = 289). People who were older and those with psychotic disorder, co-occurring substance use disorder, dual diagnosis (with developmental disability), chronic medical condition, and also in another program in the same agency were more likely to be in ICM for longer than 5 years. People who were returning ICM clients and those who completed the ICM program (rather than withdrawing or disengaging) were more likely to be in ICM for 5 years or less. Higher dose of ICM (in contacts) predicted a shorter time in ICM. People with serious mental illness, dual diagnosis, concurrent substance use, and chronic medical conditions and those who are older may need additional supports within ICM and when transitioning out of ICM. People in ICM for a longer time have lower numbers of contacts, indicating that a less intense service may meet their needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Role of Black Churches in Promoting Mental Health for Communities of Socioeconomically Disadvantaged Black Americans.

Churches in socioeconomically disadvantaged neighborhoods serve as safe havens in many Black communities. Churches provide faith and charitable services but often have limited resources to address the mental health needs of their communities. This article reports on a collaborative effort, driven by members of a Black church, to understand mental health needs, coping strategies, and resilience factors in a community of socioeconomically disadvantaged Black Americans. A community-based participatory research effort was established among a church, a community mental health organization, clinicians, and researchers to interview and survey individuals residing near the church. The sample consisted of 59 adults, most of whom were ages 46-65 years, men (N=34, 58%), and unemployed (N=46, 78%). Mean scores on the Patient Health Questionnaire-9 (9.2±7.7) and Generalized Anxiety Disorder-7 scale (9.4±6.7) were almost three times higher than those reported by studies of other Black populations in the United States. Five themes emerged: prolonged poverty and daily exposure to violence trigger emotional distress, mental health stigma affects help seeking, spirituality promotes mental relief and personal recovery, spirituality helps in coping with poverty and unsafe neighborhoods, and church-based programs are needed. Uptake of traditional mental health services was low, and reliance on faith and resource distribution by the church was high. Church-led interventions are needed to promote mental health at the individual and community levels. Mental health stigma, and negative attitudes toward mental health promotion in the community, may be addressed by integrating traditional mental health services in church-based recreational and leisure activities.

A Community-Engaged Process for Adapting a Cardiovascular Health Intervention for Persons with Serious Mental Illness.

People with serious mental illness experience grave disparities in cardiovascular disease risk factors. To promote scale-up of effective cardiovascular disease risk reduction interventions from clinical trials, it is important to involve end-users in adapting interventions to fit the needs of community-based settings. We describe a novel, theory-informed process of garnering community input to adapt IDEAL Goals, an evidence-based intervention for improving cardiovascular disease risk factors in persons with serious mental illness. Outpatient community mental health programs in Maryland and Michigan implementing behavioral health homes, which provide enhanced support to people living with both physical and mental illnesses. Clinicians, frontline staff, and administrators from community mental health organizations and persons with serious mental illness. Our approach to community engagement is based on the Replicating Effective Programs (REP) framework. During the REP preimplementation phase, we used 2 community engagement activities: (1) a "needs assessment" to identify anticipated implementation barriers and facilitators, and (2) "community working groups" to collaboratively engage with end-users in adapting the intervention and implementation strategies. We used the Stakeholder Engagement Reporting Questionnaire to describe our processes for conducting a needs assessment, involving site-level surveys (N=26) and individual interviews (N=94), and convening a series of community working groups with clinicians and staff (mean, 24 per meeting) and persons with serious mental illness (mean, 8 per meeting). By specifying the nature and extent of our community engagement activities, we aim to contribute to the evidence base of how to better integrate and measure community-engaged processes in the adaptation of evidence-based interventions.

Developing an innovative pediatric integrated mental health care program: interdisciplinary team successes and challenges.

Children and adolescents often do not receive mental healthcare when they need it. By 2021, the complex impact of the COVID-19 pandemic, structural racism, inequality in access to healthcare, and a growing shortage of mental health providers led to a national emergency in child and adolescent mental health in the United States. The need for effective, accessible treatment is more pressing than ever. Interdisciplinary, team-based pediatric integrated mental healthcare has been shown to be efficacious, accessible, and cost-effective. In response to the youth mental health crisis, Rady Children's Hospital-San Diego's Transforming Mental Health Initiative aimed to increase early identification of mental illness and improve access to effective treatment for children and adolescents. A stakeholder engagement process was established with affiliated pediatric clinics, community mental health organizations, and existing pediatric integrated care programs, leading to the development of the Primary Care Mental Health Integration program and drawing from established models of integrated care: Primary Care Behavioral Health and Collaborative Care. As of 2023, the Primary Care Mental Health Integration program established integrated care teams in 10 primary care clinics across San Diego and Riverside counties in California. Measurement-based care has been implemented and preliminary results indicate that patient response to therapy has resulted in a 44% reduction in anxiety symptoms and a 62% decrease in depression symptoms. The program works toward fiscal sustainability via fee-for-service reimbursement and more comprehensive payor contracts. The impact on patients, primary care provider satisfaction, measurement-based care, funding strategies, as well as challenges faced and changes made will be discussed using the lens of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Preliminary results suggest that the Primary Care Mental Health Integration is a highly collaborative integrated care model that identifies the needs of children and adolescents and delivers brief, evidence informed treatment. The successful integration of this model into 10 primary care clinics over 3 years has laid the groundwork for future program expansion. This model of care can play a role addressing youth mental health and increasing access to care. Challenges, successes, and lessons learned will be reviewed.

A Qualitative Study of the Delivery of Tele-Mental Health Services to People with Severe and Persistent Mental Illness with a History of Homelessness

Covid-19 has presented challenges to community mental health organizations that have historically almost exclusively delivered in-person services. This study uses qualitative methods to examine the launch of tele-mental health case management delivery in response to the Covid-19 pandemic in a community mental health organization, from the perspectives of case managers and clients. Tele-mental health challenges included access to and use of technology, and limitations of technology. Our findings suggest that tele-mental health case management delivered via the phone and videoconferencing is viewed, for the most part, positively by both clients and case managers, although it cannot fully replicate in-person services.

What innovative practices and processes are used to deliver psychosocial care in India? A qualitative case study of three non-profit community mental health organisations

The global mental health field seeks to close the “treatment gap” for mental illness in low-and middle-income countries by scaling evidence-based interventions. The evidence base has often bypassed psychosocial interventions by local organizations who do not fit a biomedical approach to evidence building. In India, non-profit mental health organizations are addressing care gaps through novel approaches that emphasize social recovery and inclusion.This study seeks to better understand the nature and dynamic of this innovation by examining what was working well in the practices and processes of three such community mental health care organizations. A comparative case approach was chosen for its strength as an exploratory means for inductive theory building. Three case organizations in Kerala, West Bengal and Uttarakhand states were selected based on their diverse socio-cultural and health systems settings. Qualitative data was collected in 2018–20, to examine their practices and processes using mixed methods and data sources including interviews, focus groups, participant observation and document analysis.Common strategies observed across the three organizations, included engaging community, prioritising beneficiaries, co-opting resources, devolving care, reorganising communication and recovery and integration. These strategies were further categorized into three domains: constructing a sustainable resource base, managing knowledge and redefining meanings. In contrast with conventional problem-solving approaches, these cases used an approach that built on assets and strengths using inclusive governance which enabled coordination of the community health system.This study argues that these organizations incorporate reflexive practice and two-way flows of knowledge to enable them to address complex social determinants of mental health. This has implications for how psychosocial care in CMH is conceptualized. We argue that the ways the organizations respond to the complexities of mental health difficulties contributes to reframing mental health as a social development issue, centering inclusion of people with psychosocial disabilities. Our findings argue against a polarization between biomedical and psychosocial CMH models and illustrate ways of integrating both approaches and their centrality to effective mental health care.

Community psychoanalysis and the generative landscape of our times

AbstractIn this paper five members of the “Community Psychoanalytic Track and Consortium” (CPT&C) in San Francisco, California, each holding different positionalities and functioning in different roles, come together in dialog with the shared aim to bring themselves and their readers inside the CPT&C. This writing project recapitulates principles of the CPT&C's vision itself: to form polyvocal groups with the shared task of supporting each other in our various roles, and members of community mental health organizations in their work and lives. From that effort new forms of psychoanalytic learning and work are generated; in this instance the process translates into a new writing form.

Applying Theater-Based Training Methods to Address Anti-Black Racism in Community-Based Mental Health Services: A Pilot Feasibility Study

The present study investigated the acceptability, feasibility, and potential effectiveness of using theater as an interdisciplinary tool to train mental health clinicians to discuss race and racism with Black youth clients. The training was developed using findings from a statewide survey of clinicians’ perceived barriers and facilitators to discussing race and racism. Development survey data were analyzed to generate didactic content that addressed common misperceptions and to develop scripted performances of interactions between a therapist and two Black youth clients. Mental health clinicians and clinical supervisors (N = 23) from community mental health organizations viewed and responded to the videos of the scripted scenes before the training. Black clinician collaborators co-presented didactic information and facilitated small-group breakouts. Trained actors improvised participant suggestions in the large group, and breakouts allowed for debriefing, discussing, and practicing through improvisation with actors. The training was evaluated with a pre- and posttraining survey. Training significantly improved multicultural counseling self-efficacy (measured by the Multicultural Counseling Self-Efficacy Scale—Racial Diversity form; t[13] = –5.83, p < .001), decreased concerns about counseling Black clients (measured by the Concerns About Counseling Racial Minority Clients scale; t[13] = 7.05, p < .001), and improved intentions to discuss race and racism with Black clients specifically, t(13) = –6.11, p < .001, as well as all clients of color, t(13) = –3.16, p = .008. Qualitative and quantitative measures converged to suggest that the training was highly acceptable (M = 4.7, SD = 0.6) and appropriate (M = 4.7, SD = 0.6). We end with clinical implications.

Planning and Implementing an Organizational Health Assessment in a Community Mental Health Setting.

The workforce is the essential driver behind mental health service provision and the most valuable asset to any community mental health organization. To build and retain a stable and healthy workforce, systematic recruitment and retention strategies are needed. An organizational health assessment is a valuable tool in developing targeted organizational interventions to create a positive work environment and retain an engaged workforce. Starting in 2017, a large community mental health organization in Southern California implemented such an assessment to drive actionable steps to improve employee experience and decrease turnover. This case study describes the development and implementation of a low-cost organizational health assessment through five phases: development of the assessment, data collection, analysis, metrics and data visualization, and dissemination of findings and development of interventions. Key lessons learned include the importance of utilizing the findings and achieving staff and leadership buy-in.

The role of self-efficacy and self-esteem in mediating positive associations between functional social support and psychological wellbeing in people with a mental health diagnosis

Background Previous research has observed positive associations between perceived quality of social support and mental well-being. Having access to functional social support that provides sources of care, compassion and helpful information have shown to be beneficial for mental health. However, there is a need to identify the psychological processes through which functional social support can elicit therapeutic outcomes on mental well-being. Aims The present cross-sectional study aimed to examine the extent to which self-efficacy and self-esteem mediated the association between functional social support and mental well-being. Method Seventy-three people with a mental health diagnosis, who attended group-based activities as facilitated by a third sector community mental health organisation, took part in the present study. Participants were required to complete measures that assessed perceived quality of functional social support, self-efficacy, self-esteem, and subjective mental well-being. Results A multiple mediation analysis revealed that self-efficacy and self-esteem fully mediated the positive association between perceived functional social support and mental well-being. Conclusions The implications of these results are that social interventions, which aim to facilitate the delivery of functional social support, could enhance mental well-being via their positive effects on self-efficacy and self-esteem.

Lived Experience as a Protective Factor for Mental Health Workers.

When clients do not seem to be improving, mental health workers have more negative job attitudes, experience higher levels of client-related burnout, and are more interested in leaving the field. Nonetheless, it is unclear whether all mental health workers are equally susceptible to burnout caused by feelings that their clients are not improving. Specifically, people with lived experience of mental illness are intimately familiar with their own recovery challenges and thus may be less susceptible to this source of burnout. To test this possibility, mental health providers (N=179) from a nongovernmental community mental health organization in Australia completed a survey assessing their perceptions of client improvement from treatment, their feelings of client-related burnout, and a range of organizational outcomes (job satisfaction, job engagement, workplace well-being, and intentions to resign). Moderated mediation analyses revealed that although mental health providers who felt that their clients were not improving experienced client-related burnout, lived experience served as a buffer. Staff with lived experience were less susceptible to burnout associated with perceptions that their clients were not improving from treatment. Mental health providers with lived experience also reported more positive job attitudes compared with providers without lived experience. Given the high rates of burnout in the mental health profession, future research should examine why lived experience appears to buffer staff from burnout when they believe that their clients are not improving. This knowledge could aid in the development of interventions to boost resilience, engagement, and longevity in the field.

Organizational factors associated with community therapists' self-efficacy in EBP delivery: The interplay between sustainment leadership, sustainment climate, and psychological safety.

Inner context organizational factors proximally shape therapist experiences with evidence-based practice (EBP) implementation and may influence therapist self-efficacy, which has been linked to sustained use of EBPs in community mental health settings. Research has primarily focused on constructs such as implementation leadership and climate. However, the effects of such factors may depend upon other inner context dimensions, such as psychological safety. Psychologically safe environments are conducive to taking risks, speaking up about problems, and requesting feedback and may promote therapist self-efficacy during implementation. This study examines whether organizational sustainment leadership and sustainment climate relate to therapist EBP self-efficacy only under conditions of psychological safety. Data were collected from 410 clinicians in 85 programs during the sustainment phase of a system-driven implementation of multiple EBPs in children's mental health services. Therapists reported on their organization's sustainment leadership, sustainment climate, psychological safety, and their own self-efficacy in delivering specific EBPs. Multilevel regression analyses were conducted to account for nested data structure. Among program-level variables, sustainment leadership and psychological safety both significantly predicted therapist self-efficacy. However, there were no significant interactions between program-level sustainment climate and psychological safety. Exploratory post-hoc analyses revealed a significant interaction between program-level sustainment leadership and therapist-level perceptions of psychological safety such that that the conditional effect of psychological safety on EBP self-efficacy was significant at high levels of sustainment leadership, but not at low or average levels. We noted independent links between sustainment leadership, organizational psychological safety and therapists feelings of confidence and mastery with EBPs. Therapists' individual perceptions of psychological safety were linked to self-efficacy only in programs with high sustainment leadership. Thus, sustainment leadership and psychological safety may both represent implementation intervention targets, but it may not be critical to assess for perceptions of psychological safety before deploying organizational leadership strategies.Plain language abstract Therapist self-efficacy is a therapist's belief that they are capable, knowledgeable, and skilled enough to deliver evidence-based practices (EBPs), and is thought to promote improved clinical and implementation outcomes, such as therapists' sustained use of EBPs. Conditions within community mental health organizations may influence therapists' sense of EBP self-efficacy. Leaders' support and expectations for EBP implementation, and collective staff perceptions about the organization's climate to support EBPs are linked to positive therapist attitudes and EBP adoption. However, less is known about how these implementation-specific organizational factors associated with therapist EBP self-efficacy in the long-term, and how this may depend on general workplace conditions. Specifically, psychologically safe environments - where therapists feel safe taking risks such as asking questions, admitting mistakes, and trying new skills - may be needed to promote self-efficacy when therapists are tasked with learning and using complex multi-component EBP innovations. The current study tested the prediction that leader-driven and program-wide focus on EBP sustainment may promote therapist EBP self-efficacy only in organizations where conditions for learning are psychologically safe. Our findings confirmed that fostering strong sustainment focused leadership and psychologically safe environments may each be important for increasing therapists' EBP self-efficacy. The model results suggested that individual therapist perceptions of psychological safety were more strongly related to EBP self-efficacy in programs with greater implementation leadership. Findings suggest the importance of increasing EBP leadership behavior to fully potentiate other facilitating conditions for therapist learning in the sustainment phase of EBP implementation initiatives.

What motivates community mental and behavioral health organizations to participate in LGBTQ+ cultural competency trainings?

The constantly evolving language, understanding, and cultural context regarding the mental health of lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse individuals (LGBTQ+) require mental health providers to obtain LGBTQ+ cultural competency training to be affirmative and effective with this population. Unfortunately, many providers are not obtaining this ongoing training and mental health disparities continue to plague LGBTQ+ populations. Guided by the Consolidation Framework for Implementation Research (CFIR), we conducted eight focus groups with community mental and behavioral health organization (MBHO) administrators (e.g., directors, clinical supervisors) and therapists to explore what factors facilitated or inhibited their adoption and implementation of a multicomponent LGBTQ+ cultural competency training program that required administrator and therapist participation in multiple learning sessions over several months (i.e., workshop, clinical consultation, and organizational technical assistance). Results from template analysis supported CFIR-aligned themes, including characteristics of individuals, inner setting, outer setting, and process, and two additional codes-marketing and other/previous training opportunities-emerged from the focus group data. Findings suggest that therapists are motivated to engage in such a program because they want to feel more efficacious, and administrators see the benefits of LGBTQ+ training programs for their clientele and marketing. Barriers to adoption and implementation include cost and personnel resistance, although participants believed these barriers were surmountable. Emphasizing therapist efficacy, clientele need, and benefits for marketing mental and behavioral health services could motivate MBHOs' and therapists' adoption and implementation of LGBTQ+ cultural competency training. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An examination of work engagement's antecedents and consequences in a sample of U.S. community mental health providers.

The study examined the relationship between job demands and resources, work engagement, and turnover intentions in a community mental health context. Using path analysis, we tested a conceptual model where we hypothesised that job demands (pressure to produce and role ambiguity) had a negative relationship to work engagement (H1) and resources (team commitment, supervisor relationship, and connection to organisational mission) were positively related to engagement (H2). Furthermore, greater engagement would be related to lower intention to leave the job (H3). Additionally, we hypothesised that there was an indirect effect of job demands and resources on turnover intention mediated via engagement (H4). The study used cross-sectional data collected in 2018 from a sample of N=170 mental health providers employed in a community mental health centre in the Southwest region of the United States. The study findings suggest that the job demands tested, pressure to produce and role ambiguity, were negatively related to engagement (H1). Of the job resources tested, only team commitment and connection to mission were positively related to engagement (H2). Work engagement was negatively related to intention to leave (H3). There were indirect effects of job demands and job resources (pressure to produce, role ambiguity and connection to the organisation mission) on intention to leave mediated through engagement (H4). The findings suggest that managers and administrators in community mental health organisations may help promote a more stable workforce by bolstering the resources that lead to greater work engagement and mitigating the job demands that reduce engagement.

TA organizations supporting MH workforce during pandemic

As the pandemic continues to bring about structural changes in the public mental health sector, including a shift to telehealth and financial strain for community mental health organizations and clinicians — not to mention a risk of burnout among clinicians and staff — technical assistance (TA) organizations have supported community mental health providers in adapting to these changes, an opinion piece in the October issue of Psychiatric Services stated.

Supporting the Mental Health Workforce During and After COVID-19.

The COVID-19 pandemic has catalyzed structural changes in the public mental health sector, including a shift to telehealth and telesupervision, financial strain for community mental health organizations and clinicians, and risk of burnout among clinicians and staff. This Open Forum considers how technical assistance organizations have supported community mental health providers in adapting to these changes. Moving forward, knowledge gained through this work can help to build the body of practice-based evidence to inform future technical assistance activities in a postpandemic world.

Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study

BackgroundPeople with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder experience excess mortality driven in large part by high rates of poorly controlled and under-treated cardiovascular risk factors. In the USA, integrated “behavioral health home” models in which specialty mental health organizations coordinate and manage physical health care for people with SMI are designed to improve guideline-concordant cardiovascular care for this group. Such models have been shown to improve cardiovascular care for clients with SMI in randomized clinical trials, but real-world implementation has fallen short. Key implementation barriers include lack of alignment of specialty mental health program culture and physical health care coordination and management for clients with SMI and lack of structured protocols for conducting effective physical health care coordination and management in the specialty mental health program context. This protocol describes a pilot study of an implementation intervention designed to overcome these barriers.MethodsThis pilot study uses a single-group, pre/post-study design to examine the effects of an adapted Comprehensive Unit Safety Program (CUSP) implementation strategy designed to support behavioral health home programs in conducting effective cardiovascular care coordination and management for clients with SMI. The CUSP strategy, which was originally designed to improve inpatient safety, includes provider training, expert facilitation, and implementation of a five-step quality improvement process. We will examine the acceptability, appropriateness, and feasibility of the implementation strategy and how this strategy influences mental health organization culture; specialty mental health providers’ self-efficacy to conduct evidence-based cardiovascular care coordination and management; and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes mellitus among people with SMI.DiscussionWhile we apply CUSP to the implementation of evidence-based hypertension, dyslipidemia, and diabetes care, this implementation strategy could be used in the future to support the delivery of other types of evidence-based care, such as smoking cessation treatment, in behavioral health home programs. CUSP is designed to be fully integrated into organizations, sustained indefinitely, and used to continually improve evidence-based practice delivery.Trial registrationClinicalTrials.gov, NCT04696653. Registered on January 6, 2021

Wanna grab some dinner? Social relations between helping professionals and members of community mental health or other human service organizations.

Could practitioners and members (consumers) of mental health or other organizations interact socially by regularly going out for drinks or dinner together, for example? The American Psychological Association explicitly states for example, "your psychologist shouldn't also be your friend." However such social interactions have occurred for decades in certain clubhouse-modeled community mental healthcare, and maybe research and a more balanced perspective is warranted. We interviewed six clubhouse staff that interact socially with members and held three focus groups with 20 members. In relation to what we call a social interaction policy, we herein highlight: (a) four policy dimensions (e.g. activity types; relationship closeness); (b) a spectrum of policy challenges (e.g., dealing with romantic overture; feelings of exclusion or hurt and effects on mental health; symptom flare-up while out socializing; financial constraints of members such as dinner costs on limited incomes); and (c) a wide variety of policy benefits such as: (a) learning opportunities for members who can process with staff the ups and downs of social relationships; (b) social skill and network development; (c) enhanced assessment across different times/settings; (d) addressing stigma among staff who must grapple with internal resistance to spend free time with members; (e) enrichment of staff social life; (f) reducing internalized stigma among members when staff value them more holistically; and (g) empowerment of members when staff freely (and optionally) offer a valuable resource (spare time). We offer suggestions for certain types of agencies that may wish to implement social interaction policies. (PsycInfo Database Record (c) 2021 APA, all rights reserved).