Fostering social support for women living with serious mental illness.

The people in a social support network can help someone find solutions to problems, validate an individual's identity, direct the individual to helpful information, and provide comfort when that is all that can be done. Because connections to others contribute to a sense of well-being and give meaning to life, social support has been identified as one of the determinants of health. For people living with schizophrenia, it is a painful irony that a vital support system is placed at risk by the very illness that needs the support of relationships.

Schizophrenia can cause disorganized thinking, hallucinations and delusions. It can cause depression, lack of motivation and can inhibit a person's ability to make meaningful connections with others. Like most mental illnesses, schizophrenia is a condition that is also highly stigmatized. Thus, over time, developing and maintaining relationships can be difficult for people with the condition.

In a 2000 study, "The Perspectives of Women Living with Schizophrenia," Chernomas, Clarke and Chisholm found that women with schizophrenia expressed the need for more people in their lives, particularly friendships. (1) The current study, "Social Support and Women Living with Serious Mental Illness," builds on that earlier research with an in-depth exploration of the formal and informal sources of support for women with schizophrenia. In personal interviews, 14 Manitoba women living in the community who self-identified as being diagnosed with schizophrenia talked about support in the context of their everyday lives, their responsibilities, and their sense of self in light of having a serious mental illness. The women were asked about their experiences in negotiating support from both formal and informal resources, barriers to finding and accessing social support, and their perceptions of the links between social support and the ability to manage their lives. The research was supported by the Prairie Women's Health Centre of Excellence.

Most of the women were unemployed, lived in poverty, and relied on social assistance. Two thirds reported incomes of less than $10,000 annually. Some lived with physical health problems as well their mental illness. Most women had few responsibilities or activities to occupy their days, outside of limited social contacts and some structured activities. They relied on public transportation to get to appointments or other activities. The telephone was an important medium to connect them with members of their support system, especially in times of crisis.

The women identified family members and mental health care providers as the most socially supportive people in their lives. These people provided a wide range of both practical and emotional supports. Although women friends were largely confined to those who also lived with serious mental illness, these friends were identified as providing meaningful sources of connection. In contrast to family members and health care providers, friends offered largely affective support. Significantly, the women in the study conveyed a sense of reciprocity as they talked about these relationships and their place within the community as women with a serious mental illness.

Although living with a serious mental illness and the social context of these women's lives made establishing and maintaining social support systems difficult, this study suggests that such connections are important for women with schizophrenia. Policy makers, health care providers and program planners could improve the lives of women living with serious mental illness through actions that help foster their social support systems.

The findings from this study reinforce those cited in other discussions promoting gender-sensitive health policies and a women-centred, primary health care approach for women with serious mental illness. (2) Developing innovative ways to facilitate the implementation of these recommendations would support women with serious mental illness during recovery and re-integration into their communities.

Recommendations

1. Provide support for community-based services, activities, and supports, specifically for women with serious mental illnesses.

2. Provide education and support for women with serious mental illness who support each other.

3. Provide education to family members about the role of social support in the lives of women with schizophrenia; family members also need support.

4. Provide women with serious mental illness with access to a health care worker who is knowledgeable about available resources and can assist women in making choices about suitable resources in the community.

5. Improve intersectoral partnerships among agencies serving women in general and women with serious mental illness in particular.

6. Increase access to female health care providers to discuss sensitive health care issues.

7. Support telephone services as part of social assistance.

8. Provide support for a bus pass as part of social assistance.

9. Enhance opportunities for women with serious mental illness to participate in vocational training programs.

NOTES

(1.) Chernomas WM, Clarke DE, Chisholm FA. The perspectives of women living with schizophrenia. Psychiatric Services 2000;51(12):1517-21.

(2.) Morrow M, Chappel M. Hearing Women's Voices: Mental Health Care for Women. Vancouver: British Columbia Centre of Excellence for Women's Health, 1999. Thielen-Wilson L, Hinton L, Macphail S, Scarrow S, Kelly NJ. Barriers to the Implementation of Gender-sensitive Policy and Principles of Service in Ontario's Mental Health System. London, ON: Women's Mental Health Action and Research Coalition, 2001.

Wanda M. Chernomas, University of Manitoba and Diana E. Clarke, University of Manitoba and Health Sciences Centre, Winnipeg