SOCIAL INTEGRATION: Inviting, Including, In Community Laurie C. Curtis, M.A. At its core social integration is not a program; it is opportunity, welcome, and inclusion. Roger lives with three other mental health clients in a duplex in a nice neighborhood. Agency staff help him with daily living tasks and collect his rent. Once a month with the help of their case manager, Roger, his housemates and the four clients living in the next duplex get together for an enjoyable dinner and a video. Three days a week Roger goes to a voc-rehab program to learn work skills. In the afternoons he hangs out at an agency drop in center, sometimes going to their special "double trouble" group for persons with mental illness and alcohol problems. On evenings and week-ends, Roger usually watches TV, drinks a few beers, and cares for his aquarium of tropical fish. His favorite person is Chris, a support worker who shares his interest in fish. Sometimes they go look at fish in a pet store. Some may consider Roger successfully integrated into his community. The places he lives, works, and socializes are all in the community. But, is this really long-term success? The places he goes, the people he associates with, the opportunities available to him, and nearly everyone's vision of his future are all related to mental health services. In many ways, his life is enveloped by mental health programs and staff. Roger has little opportunity or help to build relationships with people outside the formal mental health system, relationships that, over time, could replace much of the paid support in his life. He is profoundly segregated by both tangible and subtle barriers separating him from everyday society. Social Integration vs. Community Living During the past decades, mental health services have made great strides in recognizing the benefits of helping people with disabilities to live, work, learn and socialize in community settings. But "community" is not just a place to be, it is a feeling of belonging (Taylor, 1987). Services and programs do not substitute for real relationships and for connections with people who are not paid to like you. These relationships sustain us and are the primary source of support for each of us. Reidy (1992) defines social integration as affording people with psychiatric disabilities the opportunity to participate in all aspects of community life. This means helping people live in typical housing, work in regular employment settings, be educated in community schools, and participate in worship, recreation, and other pursuits alongside other community members. But it also means more. It means that the efforts and resources of formal mental health services should be directed toward maximizing contact and mutual support between people with psychiatric disabilities and a wide range of potential friends or supporters (Carling, 1994). Framework for Support Based on the view that people should not live within service systems, but within communities, the Canadian Mental Health Association (Trainor et al., 1984) has developed the framework for support to illustrate key components of successful community living. In this framework professional and non-professional supports are re-balanced in the life of an individual. The goal is self-help and family and community support. Professionals help each individual to intentionally develop and sustain a personal support network which may be augmented, but not dominated, by formal services. A FRAMEWORK FOR SUPPORT PEER SUPPORT INFORMAL CARING PERSON SELF HELP NETWORKS Why Is Social Integration Important? Through fellowship with others we each seek companionship, understanding and affirmation, shared interests, intellectual, emotional and physical stimulation, recreation, and a sense of belonging. Fellowship is an important remedy for loneliness and isolation and is an important ingredient in recovery and rehabilitation. Peer self-help groups and clubhouse programs, for example, both rely heavily on the restorative powers of fellowship. Research is beginning to validate our colloquial understanding about the importance of social networks on the course of mental illness (Goering, 1992; Breier & Strauss, 1984). As part of the growing civil rights movement, people with psychiatric disabilities are challenging current mental health treatment practices and demanding that they be accorded the rights and opportunities of any other citizens. Shrinking public resources make it impossible to maintain a service system which tolerates, or even fosters dependency. Ensuring ongoing, long-term support should not mean enveloping a person with professional services. It means helping each person develop and sustain a personal support network which may include both professional and non-professional connections. Obstacles to Social Integration Fears of Rejection. Concerns about social rejection or isolation prompt many professionals to "place" consumers in sheltered group settings. The same fears makes some consumers reluctant to leave these settings. Program Orientation. Although psychosocial rehabilitation programs include social skill development, they often use primarily segregated settings or activities to build skills. While many agencies are now helping people live in regular housing and work in typical jobs, few proactively help individuals build personal connections with neighbors or co- workers. Some programs work very hard to help consumers develop a feeling of community and belonging within the program, but then limit their capacity to help people find these qualities in the wider community (Beard, 1992). Staff Attitudes and Roles. Traditional staff roles do not emphasize community organizing or social network development. Many workers lack the necessary skills for building social networks and teaching others to do so. Many are simply shy and struggle with their own social competence. Sometimes it is hard to see beyond our programs. Personal Fears. A social integration orientation challenges professionals to recognize their own desire for social separation from persons with psychiatric disabilities. Asking community members to welcome persons with differences dares workers to critically review whether they are making room in their own lives for others with differences. Individual Characteristics. Shyness, limited scope of known interests, eroded or undeveloped social skills, and atypical dress or behavior may be barriers to developing diverse social networks. Deegan (1992) points out that many people are caught in a cycle of learned helplessness and internalized stigma which allows them to believe that they are not worthy, capable, or loveable. Logistics. Transportation, cost of social activities, and lack of companions are common logistical barriers. Goals of Social Integration It is time to move beyond the "place and hope" approach of introducing a person into a social milieu and hoping that connections will occur. Descriptive and qualitative criteria for effective social integration are evolving. Carling (1994) includes: Opportunities for Choice and Diversity. For many, paid staff constitute the majority of their personal network (Beard, 1992; Goering et al., 1992). An individual needs support and opportunity to choose a diverse social network (e.g. paid staff, other consumers, regular community members). The service system itself should not limit opportunities for diversity in social connections. Continuity in Relationships. Transience and discontinuity are common in the lives of many persons with psychiatric disabilities. High school friendships fall away; families become disconnected. Dislocations in geography, services, housing, work, staff turnover, and so forth, often result in disrupted and lost relationships. Freely Given Relationships. Freely given relationships are based on mutuality, reciprocity, and shared interest. They are not paid or based on the premise that one person should "fix" another. Intimacy in Relationships. Intimacy is often inclusive of, but not limited to, sexual relationships. Intimacy involves shared trust, candor, continuity, safety, and involvement in celebratory or developmental rituals. Accessibility of Relationships. Size and diversity of a personal network is not necessarily a measure of its quality. Accessibility of mutual caring and support is key. The larger the network, the easier for an individual to find someone available for a chat, to help with a problem, or to provide companionship. Peer Support, Choice, and Social Integration Social integration. Circles of support. Separatism. Asylum. Each of these concepts focuses on the degree of separateness and difference between the lives of persons with psychiatric disabilities and those who do not have that label. Inherent in any discussion of these concepts is the question: "Who decides?" Peer support and self-help are a important components of a framework for support. Some people prefer to associate exclusively with persons who share their particular history or perspective. Others prefer to build a diverse community with many perspectives represented. At its core social integration is not a program; it is opportunity, welcome, and inclusion. While some individuals are very adept at identifying and meeting their social needs, many others want and need help. Although mental health services can increase their attention to helping people build a strong network of supportive relationships, providers must be careful not to create yet one more program for shaping a person's life according to an external set of ideals. Real friendships cannot be prescribed. (sm logo) Friends Never Feel They Must Fix You Adapted from Perske & Perske (1988) Somehow, when you don't qualify as "normal," you often become the center of a wide array of relationships with goals such as these attached to them. Teach Control Guide Motivate Heal Advise Stabilize Rehabilitate Shape Train Modify Enlighten CoachManage Habilitate Instruct Prepare Evaluate Persuade Supervise Monitor Maintain Oversee After an overly full experience with such relationships, try to sense how you might feel if you suddenly found someone who: o Became attracted to you exactly as you are o Just liked being with you o And never -- repeat never -- felt the need to fix you. REFERENCES Beard, M.L. (1992). Social Networks. Psychosocial Rehabilitation Journal. 16:2, 111-116. Breier, A. & Strauss, J. (1984). The Role of Social Relationships in the Recovery from Psychotic Disorders. American Journal of Psychiatry, 141:8, 949-955. Carling, P.J. (1994). Promoting Social Integration. Chapter in Carling, P.J., (in press), Coming Home: Integrating People with Psychiatric Disabilities into Our Communities. New York: Guildford Press. Deegan, P.E. (1992). The Independent Living Movement and People with Psychiatric Disabilities: Taking Back Control Over Our Own Lives. Psychosocial Rehabilitation Journal, 15:3, 3-19. Goering, P., Durbin, J., Foster, R., Boyles, S., Babiak, T., Lancee, B. (1992). Social Networks of Residents in Supportive Housing. Community Mental Health Journal, 28:3, 199-214. Perske. R. & Perske M. (1988). Circles of Friends: People with Disabilities and Their Friends Enrich the Lives of One Another. Nashville, TN: Parthenon Press. Reidy, D. (1992). Shattering Illusions of Difference. Resources, 4:2, 3-6. Trainor, J., Pomeroy, E., Pape, B. (1984) A New Framework for Support for Persons with Serious Mental Problems. Toronto: Canadian Mental Health Association. Taylor, S.J., Bilken, D., & Knoll, J. (ed.s) (1987). Community Integration for People with Severe Disabilities, New York: Teachers College Press. Laurie Curtis Center for Community Change Trinity College of Vermont 208 Colchester Ave Burlington VT 05401