Connectedness and citizenship: redefining social integration.
OBJECTIVE
Despite decades of deinstitutionalization, individuals with psychiatric disabilities living outside the hospital may be described as in the community, but not of it. To effectively address the persisting problem of social exclusion of persons with psychiatric disabilities, new conceptual tools are needed. To address this need, a new definition of social integration is offered.


METHODS
The definition is based on data from a qualitative study. Data collection consisted of individual, unstructured interviews with 56 adults who have been psychiatrically disabled (N=78 interviews) as well as ethnographic visits to five service sites working to promote social integration for their users (N=8 visits). An interpretive approach was used to analyze the data.


RESULTS
Social integration is defined as a process, unfolding over time, through which individuals who have been psychiatrically disabled increasingly develop and exercise their capacities for connectedness and citizenship. Connectedness denotes the construction and successful maintenance of reciprocal interpersonal relationships. Social, moral, and emotional competencies are required to sustain connectedness. Citizenship refers to the rights and privileges enjoyed by members of a democratic society and to the responsibilities these rights engender. The definition calls for full rights and responsibilities of citizenship.


CONCLUSIONS
The new definition sets an ideal, but not unrealistic, standard for social integration in the context of psychiatric disability. High standards encourage mental health professionals and policy makers to rethink what is possible for mental health services and to raise expectations for connectedness and citizenship among persons once disabled by mental illness.
Ware
Norma C
NC
Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA. norma_ware@hms.harvard.edu
Hopper
Kim
K
Tugenberg
Toni
T
Dickey
Barbara
B
Fisher
Daniel
D
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000884:Anthropology, Cultural; D003156:Community Mental Health Services; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007406:Interview, Psychological; D008019:Life Style; D008297:Male; D008875:Middle Aged; D019989:Persons with Intellectual Disabilities / Q000523:psychology / Q000534:rehabilitation*; D011287:Prejudice; D011788:Quality of Life / Q000523:psychology; D012922:Social Change; D012941:Social Responsibility; D012945:Social Values; D012951:Socialization