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The Role of Peer Support in Ending Social Exclusio ...
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Hello and welcome. I'm Tristan Grinda, Deputy Medical Director and Director of Education for the American Psychiatric Association. I'm so pleased that you are joining us for today's SMI Advisor webinar, The Role of Peer Support in Ending Social Exclusion and Loneliness. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoting to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Now, I'd like to introduce you to today's faculty, Patrick Hendry. Patrick is Vice President of Peer Advocacy Supports and Services for Mental Health America. There, he provides national advocacy and develops new training and services for peers and consumers within the behavioral health system. He has worked as an advocate and initiator of peer-run services for 27 years in a variety of leadership roles, including as the former director of NCSTAC and as a consultant for the National Council for Behavioral Health, the University of South Florida, SAMHSA, NASHVID, and a number of other agencies. Patrick also serves as a member of SMI Advisor's Clinical Expert Team. Patrick, welcome back to the webinar series, and we're so excited for today's talk. Well, thank you, Tristan. Just to start off, I just want to make sure everybody knows I have no conflicts of interest with this material. So this subject is becoming more and more evident to be extremely important to mental health across the spectrum. Our objectives for today are to identify negative psychiatric and physical health effects of loneliness and social isolation, describe multiple ways in which individuals, communities, and society discriminates against individuals with serious psychiatric disorders resulting in exclusion and loneliness, and to evaluate the positive effects of peer support on assisting individuals in connecting to their communities and establishing friendships and personal relationships. So as I said, we're beginning to become very aware of the full range of negative effects of loneliness and social exclusion. It has a major effect on health across the spectrum. It also has a tremendous effect on society at large. Loneliness has been linked to various psychiatric and physical disorders and also early mortality. We find that rates of almost all illnesses are heightened when people experience loneliness or isolation on an ongoing basis. So it's really important that we begin to develop interventions to help prevent loneliness. Social networks and social ties have a beneficial effect on our whole health outcomes. This includes everything from stress reactions and psychological well-being and physiological distress, depression, and anxiety. And also by providing support and companionship for people, it opens up the ability for people to regain their sense of self-esteem, their coping skills, to deal with depression and other problems that they face with their mental health. And it creates a sense of well-being. Strong social connections have a tremendous effect, as I said. So when people are in a situation where they have connections, longevity is increased. Your immune system is heightened. It helps you to recover from disease faster. And then it also, as we all know, fosters better mental health. When people are connected, they have a lower level of depression, anxiety, and other types of stressful situations. People who are low in social connections have an increased vulnerability to anxiety and depression, antisocial behavior, and even suicidal behavior. And then this tends to further increase their feeling of isolation and loneliness. A recent study showed that the lack of connections and the experience of loneliness predicts vulnerability to disease and death beyond traditional risk factors like smoking, blood pressure, and physical activity. So I think we would all agree that this is something that should be addressed throughout health care. Social exclusion and inclusion are very subjective matters. We feel excluded when we are pushed out. We feel alienated. And this can be based on community attitudes, economic situation, employment, and equality of rights. And then we feel included when we feel like we're where we're supposed to be with the people we're supposed to be with and as the person that we really are. And again, this is very subjective and can be based on community attitudes and other types of influences within a person's life. Exclusion and inclusion can both be a fluid state, moving from one to the other based on what's going on in a person's life and the attitudes of the people around them. So these feelings can be tied also to the expectations of our culture. And culture plays a very important part in how we learn to deal with the feelings of isolation and loneliness. As I said, they're very subjective. So loneliness is also quite subjective and influenced by the same type of influences as isolation. Cultural norms, though, affect the manner, degree, and timing of how we experience loneliness. So people across cultures experience it in different ways because some cultures rely very heavily on family and community ties to define the quality of life, whereas some cultures use independence as a mark of a successful life. Some of the research that's come out recently has shown that cultures that focus on the strong ties and interpersonal connections, it creates a stronger expectation of being connected to the world around you. And so when people are alone and not connected, the feelings of loneliness are more intense than the cultures that are more individualistic. In individualistic cultures, people experiencing loneliness are more likely to blame themselves than they are to blame society at large. So if we look at some of these effects that are based on culture and a person's mental health situation and the things going on within their life, we can see that culture creates a lot of differences in the ways that we describe our symptoms, the ways that families treat their family members with psychiatric problems, and the way society does. This in turn then affects the individual's attitudes about their own disorder and their feeling of exclusion and loneliness. And then also, conversely, it affects their feelings of inclusion and belonging. One of the things that we have found to be a major problem with feelings of loneliness and exclusion is self-stigma. There was a recent report in 2009, not so recent, but anyway, that said that self-stigma can actually predict service use independent of psychopathology, diagnosis, and levels of stigma that we perceive from the society around us. So self-stigma has a greater effect than does external social stigma. One of the factors that can positively influence our tendencies to incorporate stigmatizing ideas about ourselves is strong group identification. And we see throughout the history of modern peer movement that people have banded together and created this kind of feeling of group identification as being part of a peer community. And this has a great effect on increasing self-esteem and feelings of not being alone and not being the only person facing the kind of issues that we face. Peer support and the peer movement foster group identification, so they reduce self-stigmatization and loneliness. We also see that people living with mental health problems can benefit from interacting with each other online and through social media. We often hear how social media is a factor in loneliness and the disconnection of people from their own communities, but for many people, it can be their only connection to community. So in those cases, it can be a very positive factor. This occurs when self-forming communities, people coming together online to create groups and to create ability to communicate between people, despite where they are geographically, it allows them to share their experiences and their feelings. And a critical part of a person's life with experience living with a mental health disease is seeking social connection and support. We know that the power of peer support can be leveraged through technology and can really help people to adopt a lifestyle that's more conducive to a sense of well-being and the life that we choose for ourselves. The presence of stigmatizing attitudes in the public has always been a major problem for people living with psychiatric disorders, and it's a challenge worldwide. It exists throughout all cultures to some degree or another. And stigma kind of results, you know, stigma is a strange word because stigma has a connotation of it being something about the individual, when in reality, it's really more about ignorance and prejudicial attitudes and discrimination. So an important part in recovery is to accept the reality of a mental health condition and not accept that sense of shame that may be cast upon us by the society around us or even our own community or people that we're close to. Lack of access to care and then social marginalization also creates loneliness and isolation. National and international groups, peer groups and other types of groups have addressed these concepts of prejudice and they've promoted mental health systems that do away with discrimination based on the premise that some non-clinical needs can be addressed by people with lived experience. So this is peer support and we're finding more and more that peer support can provide some of the answers that have been difficult to ascertain when people were just functioning in a clinical world and without the support of their own personal communities. The UK has done a lot of really groundbreaking work in the areas of loneliness and isolation and so much so that there was a report that came out a few years ago called the Joe Cox Commission. Joe Cox was a member of parliament who was killed during the Brexit movement before the first vote. After this report came out, the prime minister, May, appointed actually a minister of loneliness, Tracy Crouch. It's since changed with the new administration and the new prime minister. But prime minister May said that for too many people, loneliness is the sad reality of modern life. I want to confront this challenge for our society, for all of us to take action to address the loneliness endured by the elderly, by carers, by those who have lost loved ones, people who have no one to talk to and share their thoughts and experiences with. And that's really important. Some of the information that came out of the Cox report, the population of adults in the United Kingdom is about 52 million people. Nine million people report experiencing loneliness on a regular or ongoing basis. That's 17% of all the adults. So nearly one in five people report loneliness on a regular basis. 43% of people 17 to 25 report ongoing loneliness. One in three over 75 years old experience it all the time. 58% of even the migrant population, which is significant in the United Kingdom, a lot of migrants have come in recent years, and 58% of new migrants who have not yet fully assimilated into their culture report also extreme loneliness and isolation. We know that one of the root causes of loneliness is evolution. The way that we began to form our societies, which were originally very community-based, and modern society does not lend itself to being community-based. People are very mobile. They move from job to job. They move from neighborhood to neighborhood, city to city, state to state. Humans are really social animals. And it makes, I like this statement that I found, it makes no more sense to consider a person in isolation to be in a normal state than it does for an ant or a bee, a collective type society. So even as adults, we're dependent on our groups. And that separation from them has a really, it's like a de facto death sentence for some people, particularly people who come from these very social and interconnected societies. We evolved really as human beings to experience social rejection the same way that we experience physical pain. Some brain scans that have been done show that social pain is experienced in the same parts of the brain that physical pain is, and as bodily trauma. Also this hyper alert state creates errors in social thinking, and this causes us to misinterpret information that's coming into us. So we can really misread people's intentions and feel like we're being pushed even further away than perhaps was the intent of the people around us, because it's a protective reaction to when you feel that social pain to kind of begin to build walls between you and the world around you, and this exacerbates feelings of loneliness. So we're far less likely to see things from the perspective of others when we're experiencing these feelings of loneliness and exclusion. Psychosocial interventions, including peer support, can help to reduce stigma among people with mental illness. It allows people to find new ways to relate to the world around them, and most of the more successful programs that have developed to assist people in creating social bonds and personal relationships kind of come out of these psychosocial interventions. So peer support aims to encourage people to think more positively about their future, because when you're first diagnosed with a major psychiatric disorder, your initial experience is one of being told all of the negatives. You're told that you have a mental illness. You're told that you will always have a mental illness. You're told that you probably need to be on medications, and if so, you'll probably always be on medications. And frequently, because of the losses that people experience when they're going through the symptoms of psychiatric problems, frequently there are losses of job, of family, of community, of sense of self. And so peer support can help people to realize that this is not a permanent situation, that recovery is, in fact, possible for many of us. The personal stories that we tell each other in overcoming stigma helps people to see connections to the broader world. You know, when someone comes out of a long-term hospitalization or through a very traumatic event, and they've withdrawn from society, when they come out and you ask them about their goals, frequently what you'll hear is their goals are to stay out of the hospital, or to stay out of jail, or to take their medications. But they have this tunnel vision of what's really available to them. And as someone who's worked in peer support, I can tell you that one of the best feelings of all is when you see that moment when a person begins to realize that their horizons are way broader than they thought, that they have the possibility of really developing the life that they want going forward. Excuse me. Mental Health America has developed a social inclusion program called It's My Life Peer Partners. And it uses a really unique combination of peer support, psychiatric rehabilitation, and self-directed care to address these issues. Our program is currently in use in six states, and in not only the United States, but also in Scotland. And it's expanding throughout the United Kingdom as well as here. We have, I think, six more states that are going to be beginning the program fairly soon. The programs are available online through the Mental Health America website at no charge. And technical assistance is also available to any organization or group of people that want to implement it in their communities. It was conceived as a peer-led intervention for people who were experiencing social exclusion and the isolation feelings. And a lot of isolation is not only caused by the societal issue. It's also sometimes caused by, as a result of symptoms of the underlying disorder. So we have, when we begin to face these type of problems, we really have to face it on so many levels, almost simultaneously, that it becomes very difficult without somebody there to support us as we go through it. So we've created peer partners as a support group model, where individuals work together to identify their social goals, what they want their lives to be like. And when we first begin to work with people who have experienced this type of isolation and feelings of exclusion, the most common goal that we hear from people is that they want a friend or more friends. We did some, when we first started talking about recovery in the peer community in the mid-90s, we did as peer organizations, a number of groups around the country did surveys of people asking them, what was the most important part of your recovery, of your feeling of moving towards wellbeing? And for three years in a row, when we did these surveys, the number one issue at the very top for everybody was having at least one person in your life that supported you, at least one friend. So when these groups come together, these support groups, they work as a team, and each person goes through a goal-setting process that helps them to identify the goals that are so personally important to them that they're willing to make really fundamental changes in not only their behavior, but the way that they view their lives. And that's not an easy task for many people. You know, when you ask people to set goals, even when they're doing relatively well, for instance, in a whole health goal, the program Whole Health Action Management, WHAM, when we ask people to set physical and mental health goals, most frequent goal that people state in those situations is that they wanna lose weight. And when you ask a person why they wanna lose weight, they may be because they want to deal with their diabetes or they want to be able to go out in public more and not feel so much that they stand out because of the obesity that frequently comes with the treatment and the experience of living with major psychiatric disorders. And so people set these goals very small, and then you have to really dig down deep to find out what's really driving those goals. And I remember in one group when we were teaching this process, WHAM, one woman had stated that her goal was to lose weight. And the first part of it was so that she could go out into public and maybe she could meet more people and her life would be a little better. And then we dug a little deeper and she was pre-diabetic and she knew that if she lost weight, that would be helpful. And we continued to dig until she came up with the statement that the real reason she wanted to lose weight was because she wanted to live longer so she could see her children grow up, get married and create their own lives. And when she attached to that purpose in her goal, she was ready to make real fundamental changes in terms of her physical health. As people are introduced into the program, the facilitator or peer coach gets some baseline information. And so we're looking at things like, how many hospitalizations have you had due to mental health reasons in the previous two years? We talk about goals. Everybody goes through experience of being interviewed using the Personal Outcome Measures tool, which was developed by the Council on Quality and Leadership. And I've used that tool for almost 20 years now. And it's a very good tool. It's a longer process. It's about a 30 minute interview that you do with a person. But it really establishes how they feel about the quality of their own life in many different domains. The coach also gathers a brief history about, say the use of emergency services over the prior years. So we have this baseline information so that when we go forward, we have something to compare where people are going to their previous experience. The coach serves a double role. They're a group facilitator, because it is a support group. And they also act as a teacher. And they explore a variety of social skills, psychiatric rehabilitation skills that will better equip people for participating in community activities. And then they help the groups to locate activities that are of interest to everybody in the community at low or no cost. Most of the people that enter into the Peer Partners Program are people living with a serious mental illness diagnosis. There also have been primarily people on SSI. So they're living below the poverty line. So it's very difficult for them to participate in many activities in the community that other people would have access to. When they do participate in activities that are of specific interest to them, they get the opportunity to meet other people who have a similar interest. And this is what we do in life anyway. This is how we make personal connections. Originally, we make our new friends through schools or neighborhoods. We do it through work or religious organizations, and then also through personal interest groups. So if we can open up those kinds of connections to people, where they can find people that relate to what they enjoy doing, and we've had people go through these groups where they choose things like, you know, they wanna take art lessons. And so they go and take art lessons and they meet other people who are interested in art. We've had people who wanted to do cooking. We had one woman who loved to bake. So we found a meetup group on baking for her. And so every week she would meet with this group and it became an ongoing group. And they would have these baking tests or contests between each other. And then we always benefited because she would bring us what she'd baked that week to the staff. So we really enjoyed that. But we also had one woman that when we talked to her and did this original interview with her and trying to figure out what she really wanted her life to be like, it came out that she had never experienced having a conversation or even addressing a stranger other than in a cashier line at the grocery store or some other condition like that. But never on a social level had she had interaction with a stranger. And so our coach was meeting with her outside the group and they decided to meet at a coffee shop. And in this case, they actually went to Starbucks and they were sitting there talking and she was talking about her group. And out of that conversation, this woman came to the idea that she liked sitting in that environment. She liked the people and the activity and the conversations going on around her. And she didn't feel like she stood out because she was sitting there drinking a cup of coffee. So what she said is her action plan to make change in her life and to find friends, she began to go to Starbucks on the same day of the week at the same time. And then she gradually increased that to multiple times a week. And she used a social budget that we'll talk about in a minute to pay for that. Over a period of time, she began to see the same people coming in, people coming from their job or people getting out of classes or whatever, but they tended to show up at the same time, possibly on the same days of the week. And I remember in her journal, when she reported that she had first said hello to a stranger and the person had said, oh, you come here a lot too. And they began a very simple conversation. That was a breakthrough for her. And she was in our original pilot group, which was five years ago. And I was in touch with her about a year ago. And she continues to have what she refers to as her Starbucks friends. And so her life is far more complete from that simple activity. Each participant is provided with a very small social budget by the program. So budgets, depending on the organization running it can be anywhere from 35 to $60 a month. And the level of $60 is set because that's the amount that you can receive when you're on SSI without having any effect on your benefits whatsoever. So for people living on SSI, which is about what $730 a month, there's really no opportunity to spend money from their budget on doing things outside. Woman would not have been able to pay for going to even Starbucks once a week based on just living off of SSI. So by giving people the small budget, it gives them the opportunity to go out and try things. And then meanwhile, the group and the coach are trying to find activities that are similar to what the person likes that are of no cost or extremely low cost. So people develop weekly or bi-weekly plans depending on how often the group meets that will lead towards achieving their goals. And they set their initial goals at very small. So for instance, with the lady who goes to Starbucks, her first couple of weeks was just to go there one day a week for an hour at the same time on the same day. As you go forward and you succeed, even in those small little goals, she felt this sense of pride that she was able to get herself to go out of her house, to go to a place where she was surrounded by strangers and to just be there for a while. And this made her feel more proud of herself and a little bit stronger. And when people succeed in smaller goals, then they're more willing to take on larger goals. And so they begin to develop their work towards their real primary goal. And in her case, it was to have friends and to be able to talk to people. Participants engage in a comprehensive process of establishing goals, much like what I was describing a few minutes ago. The 90-minute groups are designed to do three things principally. One is to support people as a group. So people, when they come to the group each week or every other week, depending on how it's held, part of that 90 minutes is devoted to just being a support group. People will talk about their activities over the previous week. They might talk about successes they had or they might talk about problems that they encountered. And the group is there like any support group to provide them with support, to provide them with input and possibility of ideas and to discuss new ways to address problems where perhaps when the person's out there on their own, they haven't figured out. They also spend some time setting their next week's goal and the group supports each other. And then part of the reason for having these peer support groups is that people in the groups tend to team up when they go out first in the social activities. So for instance, if the woman who likes baking was gonna go out for the first time and she's been at home isolating for a long time, one of the other people would go with her as a team and then perhaps she would accompany them on their social activity. So they have that peer support, which is very important in the beginning. And then as people move forward and feel more confident, they take on more of the helper role with other people, new people coming into the group and tend to be on their own and pursuing their own goals. And then 30 minutes of the group is also used for practicing skill building techniques. And so each team or each support group is provided as part of the materials for the program with a wide range of activities to build social skills. It's had some very good outcomes in pilot programs we ran. 75% of participants said that they had achieved their primary goals and would continue in their community activities. And that's pretty amazing when you consider that in those pilot programs, we chose to work only with people that had a diagnosis of schizophrenia or schizoaffective disorder, because people with these disorders tend to have the most difficult time in creating social bonds. We also chose people that were only on SSI in the initial groups, because they had the most need for support in going out into social roles. And then we also chose people that were receiving treatment from the ACT model, Assertive Community Treatment Teams. And the reason for this was that we would know that if anything else was influencing the changes that came about in their quality of life, because the services by working closely with the ACT team, we knew if anything changed from the type of services they were receiving, and therefore could account for it in our results. Emergency department usage and crisis usage was reduced by 70%, re-hospitalization rates by 70% in a year compared to the prior two years. 95% of the participants, and we did two years of these pilots, 95% of the people who went through it rated their experience with the groups with the highest possible rating on anonymous satisfaction surveys. And we chose to do the surveys anonymously because often people tend to give you the answers they think you want to hear. The Temple Collaborative at Temple University is an amazing group of people and amazing amount of knowledge about social interaction. The Temple Collaborative on Community Inclusion does research and knowledge development activities that then are translated into practical information that can be used with people in their real lives. The collaborative states that it targets obstacles that prevent people with mental illnesses from becoming full members of their communities, identifies the supports consumers and communities need to enhance the prospects for community integration, and it expands the range of opportunities for people who have these type of diagnoses to participate in community as active and equal members. And they do this in a number of different ways. They provide evidence-based resources that agencies, policymakers, individuals can use to engage people into the community life. One of the resources is really excellent, Jumpstarting Community Inclusion, a toolkit for promoting participation in community life. And it has 66 steps that people can take to increase community connections and activities in the community and that sense of belonging as opposed to feeling that you're outside of the world around you. It offers doable steps that, and it has links to over 100 other publications and products that then can support this work. And it's available through the TempleTUCollaborative.org. In 2016, Mark Salzer, who's the director, and Richard Barron, who is the transition director, did a 120-page survey that really pointed out the types of community inclusion and documented the justifications for making inclusion a priority. And very much like what's going on in the UK, every time we start to look into what's going on with people in communities or feeling disaffected from their communities, we see these horrible increases in negative effects on people. So they go into the theory justifications behind each of the activities, and they look at core principles involved in helping people and the type of programs that will be most beneficial in creating inclusion. The collaborative offers a whole range of toolkits, and one of the best ones, I think, is the Peer-Facilitated Community Inclusion Toolkit. So this is one that talks about peer support and its importance in helping people to relate to their community. This toolkit focuses on peer-run programs, and they list over a dozen programs and tools that are available through them to help people engage in community life. And they also provide people with over three dozen community inclusion initiatives that are going on around the country. The Temple Collaborative and the National Mental Health Consumers Self-Help Clearinghouse developed a 50-page compendium of these community inclusion initiatives, and so that's available through the collaborative also. And it really provides inspiration in a group of alternatives that peer-run organizations can use as a resource for transforming their own programs. You know, we know that peer support is extremely important, and we know that when peers come together and begin to form organizations or groups where they work together, that they can accomplish great things. But sometimes the guidance from outside experience really shortcuts that working towards success in connecting people to their communities. The compendium looks at a bunch of different domains, so housing and employment, family life, religious and spiritual life, leisure and recreational activities, civic life, healthcare, finances, community integration. These are all programs, and there's many more, that have been developed by peer groups and have proven successful in the communities where they've been implemented. The center is directed by expert researchers in partnership with people with lived experience and also policymakers and providers. And the collaborative seeks to target obstacles that prevent people from fully participating in their communities, develop services and supports that help people to promote full integration in all aspects of community life, and to expand the range of opportunities that are available for people experiencing isolation and social inclusion. So as I've talked about, loneliness is an incredibly negative factor. Going back to the programs going on in the UK, they've started an end loneliness campaign in the UK. And besides those figures that I gave you before, they realized that the experience of loneliness and social exclusion, not only was creating more health problems, it was creating more healthcare costs, but it was also dragging down the economy. When you have that percentage of adults, 17% of your adult population, feeling excluded and isolated and lonely, they become far less productive and actually then require far more services. So we know the same things are going on in our society and we're really starting to look at them very seriously. Almost every mental health facility program has had some type of community inclusion program, but very frequently they're not tremendously effective. And when they are, it's usually in connecting people together who are also have diagnoses. So you're helping to build their peer connections, but that doesn't necessarily connect them to the greater world around them. We know that peer support can be a really powerful tool for ending exclusion and loneliness. And this is something that we have to confront and deal with and we never hope to have a society that's healthy and really able to reach its full potential and give people an opportunity for a sense and feeling of wellbeing.
Video Summary
The video transcript is a discussion on the role of peer support in ending social exclusion and loneliness, presented by Patrick Hendry, the Vice President of Peer Advocacy Supports and Services for Mental Health America. Loneliness and social isolation have negative effects on both physical and mental health, as well as societal well-being. Research shows that social connections have a major impact on health outcomes, including stress, psychological well-being, depression, anxiety, and overall mental health. Loneliness has been linked to various psychiatric and physical disorders, early mortality, and increased vulnerability to anxiety, depression, and suicidal behavior.<br /><br />The video emphasizes the importance of addressing social exclusion and inclusion, which are subjective matters influenced by community attitudes, economic situations, employment, and equality of rights. Cultural norms also play a role in how individuals experience loneliness, as some cultures value strong interpersonal connections, while others prioritize independence. Stigma, including self-stigma, is a major factor contributing to loneliness and social exclusion. Self-stigma can lead to a reluctance to seek help and a sense of shame. Lack of access to care and social marginalization further contribute to isolation and loneliness.<br /><br />Peer support programs, such as Mental Health America's It's My Life Peer Partners, provide a unique combination of peer support, psychiatric rehabilitation, and self-directed care to address these issues. The program focuses on goal setting and skill building to improve individuals' social connections and overall quality of life. Participants are provided with a small social budget to engage in community activities and meet new people. Successes in achieving goals and developing meaningful connections have been reported in pilot programs, leading to reduced emergency department usage, hospitalization rates, and improved overall satisfaction with life.<br /><br />The Temple Collaborative at Temple University conducts research and provides evidence-based resources and toolkits to promote community inclusion and enhance the prospects for individuals with mental illness to become active and equal members of their communities. Peer-run programs and initiatives have been successful in addressing social exclusion and promoting social connections. The collaborative's resources offer practical steps and examples for organizations and individuals to increase community engagement and a sense of belonging.<br /><br />In conclusion, addressing social exclusion and loneliness requires efforts to reduce stigma, promote peer support, and provide opportunities for individuals to connect with their communities. Peer support programs and community inclusion initiatives play a crucial role in improving mental health outcomes and overall well-being for individuals living with serious mental illness.
Keywords
Peer support
Social exclusion
Loneliness
Mental health
Community inclusion
Stigma
Self-stigma
Peer-run programs
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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