Commonwealth Research Center
Laboratory of Social Process and Psychiatric
Illness
Introduction – Research Questions – Recent Projects – References
Russell K. Schutt, Ph.D., Director
Massachusetts Mental Health Center and
Beth Israel Deaconess Medical Center
Department of Psychiatry
The Landmark Center
401 Park Drive, 2nd Floor East
Boston, MA 02215
Phone: (617) 998-5034
Fax: (617) 998-5007
Email: [email protected]
Faculty Collaborators
Brina Caplan, Ph.D., Ed.D.; Larry J. Seidman, Ph.D.
The goal of the Laboratory of Social Process and Psychiatric Illness is to improve understanding of the role of the social environment in psychiatric illness, to synthesize this understanding with the biopsychosocial paradigm, and thereby to improve the efficacy of psychosocial treatment.
Introduction
The biopsychosocial paradigm provides a unified perspective on the development and course of psychiatric illness. It highlights the contributions to mental illness of both biological and social processes and it grounds psychological theories within an empirically verifiable model of brain functioning. Although specific estimates vary, most research indicates that social processes explain at least half of the variance in the likelihood of onset of psychiatric illness and are even more important in shaping the course of illness. In spite of this considerable impact, however, the salient variable features of the social environment, the manner in which these features are constructed and their effects transmitted are not well understood. In spite of increasing evidence of interactions between biologically-based vulnerability and social processes, research about the social environment continues to develop largely apart from the biopsychosocial paradigm. It is these deficits that work in the Laboratory is designed to remedy, by extending understanding of the contribution of the social environment to the biological and psychological processes involved in psychiatric illness.
Research Questions
Projects focus on two general research questions: (1) How is the social environment relevant to psychiatric illness constructed? (2) How does the social environment influence psychiatric illness? Other topics relevant to psychosocial treatment have also been investigated.
(1) How is the social environment constructed?
Individuals select their social environment in part through their housing and service preferences and their treatment motivation. The social environment is also shaped by clinicians’ service recommendations and by others’ beliefs about mental illness.
(a) Housing preferences
The preferences of homeless persons with mental illness for independent housing are notoriously discrepant with the housing recommendations of clinicians. The bases of these preferences have been investigated both through surveys of relevant populations and within the larger Boston McKinney Project’s study of housing placement and outcomes (Schutt and Goldfinger, 1996; Schutt and Goldfinger, 2000; Schutt, Feldman, Reilly and Schinagle, 2004).
(b) Professional service recommendations
The housing and service recommendations of clinicians, and hence treatment options for clients are shaped by clinician backgrounds as well as by individual service consumers’ needs. This research builds on analysis of clinician housing placement preferences in the Boston McKinney Project (Goldfinger and Schutt, 1996) and on a NAMI-funded survey of medical students by Ken Duckworth and Russell Schutt (reported in a MA thesis by Connie Burke).
(c) Stigma
The larger society shapes service opportunities and service preferences, and hence treatment outcomes, through processes that stigmatize, or de-stigmatize, mental illness. These processes were the subject of research on news media representations of schizophrenia by Ken Duckworth, John Halpern, and Russell Schutt (Duckworth, Halpern, Schutt & Gillespie, 2003).
(2) How does the social environment influence psychiatric illness?
A substantial body of research indicates that the social environment influences the course of psychiatric illness. The social environment shapes the likelihood of support being provided and the social networks from which support is generated. Individual capacities and orientations also affect the likelihood of receiving, perceiving, and internalizing social support.
(a) Group and individual forms of service provision
Through placement in group or individual housing and other service decisions, the service system influences the availability of social support. Findings from Mass Mental’s Boston McKinney Project indicate the differential benefit of structured group rather than individual housing for housing stability and cognitive functioning (Goldfinger et al., 1999; Schutt et al., 1997; Seidman et al., 2003).
(b) Sensitivity to the social environment
Substance abuse acts as a barrier to environmental influence, as do deficient levels of cognitive functioning and processes of dissociation subsequent to traumatic experience. Analysis of Boston McKinney Project data indicates the impact of substance abuse on housing stability (Goldfinger et al., 1999) and cognitive functioning (Caplan et al., 2006).
Recent Projects
Housing alternatives, housing stability, and cognitive change. This research is based on analysis of data from the Boston McKinney Project (Stephen M. Goldfinger, PI), a randomized field test of group and independent living funded by the National Institute of Mental Health, 1990-1995. The analyses focus on the individual characteristics and social processes that influence sensitivity to environmental influence.
The Housing First initiative. Project with Metro Boston Department of Mental Health focused on understanding the residential preferences of homeless persons with mental illness and evaluating their correspondence to clinicians’ residential recommendations.
Psychosocial rehabilitation. In collaboration with Boston University’s Center for Psychiatric Rehabilitation, research is ongoing and under development on the functioning and effectiveness of strategies to stabilize and empower persons with mental illness, through vocational and service interventions.
Case management and health outreach. This project has focused on improving the ability of community health programs to deliver services to underserved communities. “The Women’s Health Network: Reviewing the Past, Planning the Future” was funded by the Massachusetts Department of Public Health in 2005. See https://www.massmentalhealthcenter.org/whnrppf/.
Stigma and the media. A content analysis of newspaper references to schizophrenia by Ken Duckworth, John Halpern, Russell Schutt, and Chris Gillespie, funded by the National Alliance for the Mentally Ill.
References
Caplan, Brina, Russell K. Schutt, Winston M. Turner, Stephen M. Goldfinger, and Larry J. Seidman. 2006 (Forthcoming). “Change in Neurocognition by Housing Type and Substance Abuse among Formerly Homeless Seriously Mentally Ill Individuals.” Schizophrenia Research.
Duckworth, Kenneth, John Halpern, Russell Schutt, Chris Gillespie. 2000. “A New Illness as Metaphor: American Newspapers and Schizophrenia.” Psychiatric Services, 54:1402-1404.
Goldfinger, S.M., B. Dickey, S. Hellman, M. O’Bryan, W. Penk, R.K. Schutt, L.J. Seidman, N. Ware et al. 1994. “The Boston Project: Promoting Housing Stability and Consumer Empowerment.” Pp. 43-61 in Making a Difference: Interim Status Report of the McKinney Demonstration Program for Homeless Adults with Serious Mental Illness. Washington, DC: Center for Mental Health Services, U.S. DHHS. NIMH #1R18MH4808001, Stephen M. Goldfinger, MD, P.I.
Goldfinger, SM and RK Schutt. 1996. “Comparison of Clinicians’ Housing Recommendations and Preferences of Homeless Mentally Ill Persons.” Psychiatric Services, 47(4):413-415.
Goldfinger, SM, RK Schutt, G Tolomiczenko, W Turner, N Ware, WE Penk, et al. 1997. “Housing Persons Who Are Homeless and Mentally Ill: Independent Living or Evolving Consumer Households?” Pp. 29-49 in Mentally Ill and Homeless: Special Programs for Special Needs, edited by William R. Breakey and James W. Thompson. Amsterdam: Harwood Academic.
Goldfinger, SM, RK Schutt, LJ Seidman, WM Turner, WE Penk, G Tolomiczenko. 1996. “Self-report and Observer Measures of Substance Abuse Among Homeless Mentally Ill Persons, in the Cross Section and Over Time.” Journal of Nervous and Mental Disease, 184:667-672.
Goldfinger, SM, RK Schutt, W Turner, G Tolomiczenko, and M Abelman. 1996. “Assessing Homeless Mentally Ill Persons for Permanent Housing: Screening for Safety.” Community Mental Health Journal, 32(3):275-288.
Goldfinger, Stephen M., Russell K. Schutt, George S. Tolomiczenko, Larry J. Seidman, , Walter E. Penk, Winston M. Turner, Brina Caplan. 1999. “Predicting Homelessness After Rehousing: A Longitudinal Study of Mentally Ill Adults.” Psychiatric Services, 50:674-679.
Schutt, RK and SM Goldfinger. 1992. “Mentally Ill Persons in Emergency and Specialized Shelters: Distress and Satisfaction.” New England Journal of Public Policy. 8(Spring/Summer):407-18.
Schutt, RK and SM Goldfinger. 1996. “Housing Preferences and Perceptions of Health and Functioning Among Homeless Mentally Ill Persons.” Psychiatric Services, 47:381-386.
Schutt, RK, SM Goldfinger and WE Penk. 1992. “The Structure and Sources of Residential Preferences Among Seriously Mentally Ill Homeless Adults.” Sociological Practice Review, 3(3):148-156.
Schutt, RK, SM Goldfinger, WE Penk. 1997. “Satisfaction With Residence and With Life: When Homeless Mentally Ill Persons are Housed.” Evaluation and Program Planning, 20:185-194.
Schutt, Russell K. 1988. “Dynamics of Homelessness.” Pp. 22-38 in Committee on Health Care for Homeless People, Institute of Medicine, Homelessness, Health, and Human Needs. Washington, D.C.: National Academy Press.
Schutt, Russell K. 1990. “The Quantity and Quality of Homelessness: Research Results and Policy Implications.” Sociological Practice Review, 1(2):77-87.
Schutt, Russell K. 1992. “Homeless Persons’ Interest in Basic and Health Services: The Role of Absolute, Relative, and Repressed Needs.” Journal of Sociology and Social Welfare, 19(4):221-233.
Schutt, Russell K. 2001. “Implementing a Mental Health Case Management System: Technological Change and Organizational Structure.” Pp. 89-103 in The Organizational Response to Social Problems: Research in Social Problems and Public Policy, Vol.8, edited by S.W. Hartwell & R.K.Schutt.Oxford:Elsevier Science Ltd.
Schutt, Russell K. 2003. “Shelterization in Theory and Practice.” Anthropology of Work Review, 24:4-13.
Schutt, Russell K. and G.R. Garrett. 1988. “Social Background, Residential Experience, and Health Problems of the Homeless.” Psychosocial Rehabilitation Journal, 12:67-70.
Schutt, Russell K. and M. L. Fennell. 1992. “Shelter Staff Satisfaction with Services, the Service Network and their Jobs: The Influence of Disposition and Situation.” Current Research on Occupations and Professions, 7:177-200. JAI Press.
Schutt, Russell K. and Stephen M. Goldfinger. 2000. “The Contingent Rationality of Housing Preferences: Homeless Mentally Ill Persons’ Housing Choices Before and After Housing Experience.” Research in Community and Mental Health, 11:131-156.
Schutt, Russell K., Benjamin Weinstein, Walter E. Penk. 2005. “Housing Preferences of Homeless Veterans With Dual Diagnoses.” Psychiatric Services, 56:350-352.
Schutt, Russell K., James Feldman, Eileen Reilly, and Martha Schinagle. 2004. Homeless Persons’ Residential Preferences and Needs: A Pilot Survey of Persons with Severe Mental Illness in Boston Mental Health and Generic Shelters. Boston: Massachusetts Mental Health Center, Unpublished report.
Schutt, Russell K., Robert E. Rosenheck, Walter E. Penk, Charles E. Drebing, and Catherine Leda Seibyl. 2005. “The Social Environment of Transitional Work and Residence Programs: Influences on Health and Functioning.” Evaluation and Program Planning, 28(3)291-300.
Schutt, Russell K., Suzanne Gunston and John O’Brien. 1992. “The Impact of AIDS Prevention Efforts on AIDS Knowledge and Behavior among Sheltered Homeless Adults.” Sociological Practice Review, 3(1):1-7.
Schutt, Russell K., Tatjana Meschede, and Jill Rierdan. 1994. “Distress, Suicidal Thoughts, and Social Support Among Homeless Adults.” Journal of Health and Social Behavior, 35(June):134-142.
Seidman, LJ, B Caplan, GS Tolomiczenko, WM Turner, RK Schutt, SM Goldfinger. 1997. “Neuropsychological Function in Homeless Mentally Ill Individuals.” Journal of Nervous and Mental Disease, 185:3-12.
Seidman, LJ., RK. Schutt, B. Caplan, GS. Tolomiczenko, WM. Turner, and SM. Goldfinger. 2003. “Effects of Housing Interventions on Neuropsychological Function in Homeless Mentally Ill Individuals.” Psychiatric Services, 54:905-908.