Following deinstitutionalization, services and housing for people with serious mental illnesses (SMI) became concentrated in economically disadvantaged urban centers. As these areas gentrify, affordable housing for people with SMI is increasingly found in nonurban areas. Although nonurban environments provide benefits for the general population, people with SMI living in nonurban areas perceive higher levels of mental illness stigma. Thus, the relationship between perceived stigma and negative outcomes such as high psychological distress and low sense of community may be stronger in nonurban areas. Data collected from 300 adults with SMI living in urban and nonurban areas were analyzed using a moderated regression design. Urbanicity did not moderate the relationships between perceived stigma and negative outcomes. However, associations were found between urbanicity, perceived stigma, sense of community, and psychological distress, supporting the need to address mental illness stigma in all settings.
Public Policy RelevanceAffordable housing for people with SMI is increasingly found in nonurban areas as urban centers gentrify. People with SMI perceive higher levels of stigma in nonurban compared to urban areas. This study investigates the impact of this perceived stigma on people with SMI in nonurban areas. aaa F ollowing the deinstitutionalization movement of the 1960s, services and housing for people with serious mental illnesses (SMIs) became concentrated in economically disadvantaged urban areas (Dear & Wolch, 1987). Since the 1990s, there have been government efforts to reduce public housing in city centers and prime these areas for gentrification (Reese et al., 2010). Thus, the proportion of affluent white residents in historically affordable downtown neighborhoods is rising (Katz & Lang, 2003;Wyly & Hammel, 2005). Already, approximately a quarter of adults with SMI report utilizing subsidized housing, one-third report living in poverty, and one-third have a history of homelessness (Pratt, 2012). People with SMI seeking affordable housing (including permanent supportive housing) may find themselves increasingly pushed to less urban areas, such as suburban and rural locales, where access to mental health services is limited (Dear & Wolch, 1987;Wyly & Hammel, 2005;Yanos, 2007).Due to this shift in housing availability, investigation is needed to understand the experiences of people with SMI in nonurban areas. As of 2017, 14% of U.S. residents live in nonurban counties, spread out over 72% of the land in the country (USDA Economic Research Service, 2013). In recent studies, the proportion of people with SMI living in nonurban areas was roughly comparable, or slightly higher, than the proportion of the general population living in nonurban areas (Breslau et al., 2014;Townley et al., 2017). As affordable Tessa L. Dover https://orcid.