This qualitative study examined changes in community mental health care as described by adults diagnosed with schizophrenia with long-term involvement in the mental health system to situate their experiences within the context of mental health reform movements in the United States. A sample of 14 adults with schizophrenia who had been consumers of mental health services from 12 to 40 years completed interviews about their hospital and outpatient experiences over time and factors that contributed most to their mental health. Overall, adults noted gradual changes in mental health care over time that included higher quality of care, more humane treatment, increased partnership with providers, shorter hospital stays, and better conditions in inpatient settings. Regardless of the mental health reform era in which they were hospitalized, participants described negative hospitalization experiences resulting in considerable personal distress, powerlessness, and trauma. Adults with less than 27 years involvement in the system reported relationships with friends and family as most important to their mental health, while adults with more than 27 years involvement reported mental health services and relationships with professionals as the most important factors in their mental health. The sample did not differ in self-reported use of services during their initial and most recent hospitalization experiences, but differences were found in participants' reported use of outpatient services over time. Findings underscore the importance of the lived experience of adults with schizophrenia in grounding current discourse on mental health care reform.
We argue for community psychology to include digital communications technology in research on ways that the social environment shapes fundamental human experiences. We present a qualitative study that examined the narrative accounts of 20 young adults who experienced the death of a close friend to describe both traditional and digital forms of remembrance in coping with loss. Findings suggest that young adults' activities both online and offline were intended to acknowledge the loss, exchange social support, create and sustain memories of their deceased friend, and facilitate continued communication with the deceased. Participants described both costs and benefits to their real and virtual remembrance activities. Findings illustrate ways that the study of digital technology adds to our understanding of grief and bereavement and contributes to dominant cultural narratives about coping with death. Implications of findings for research in community psychology are discussed.
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