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November 2023 | VISN 5 MIRECC Link

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Social Functioning: Key to Understanding Mental Health Symptoms and Personal Recovery for People with SMI

Research Publication:

Howell, M. K., Marggraf, M., Taylor, M. L., Hammer, L. A., Girón-Hernández, C. Y., Coakley, G. N., Brown, C. H., Drapalski, A. L., & Hack, S. M. (2023). Social functioning mediates the relationship between psychiatric symptoms and recovery among veteran and community service users with serious mental illness. Psychiatric Rehabilitation Journal, 46(2), 156.

Previous research has found that mental health symptoms can make social functioning harder. Research also shows us that people with mental illness can experience personal recovery—an individual’s sense that they are improving in various aspects of life. Personal recovery can happen even when people are still experiencing mental health symptoms. However, there is little research on how social functioning relates to personal recovery. This study examined whether certain kinds of social functioning—social engagement, interpersonal communication, and satisfaction with support in relationships—explain the relationship between psychiatric symptoms and personal recovery.

In a cross-sectional study, patient self-report and provider assessment data were collected for 250 patients with serious mental illness (SMI). These participants were recruited across four community and VA mental health service sites. A parallel mediation model was used for analyses.

Here are some of the things we learned. Social functioning explained nearly half of the relationship between general psychological distress and personal recovery. Social functioning explained nearly all of the relationship between positive symptoms (like hallucinations and delusions) and personal recovery. Both interpersonal communication and satisfaction with social supports partially explained the relationship between general psychological distress and depressive symptoms and personal recovery. Interpersonal communication partially explained the relationship between positive and negative symptom (like lack of motivation or decreased speech) clusters and personal recovery. You can read the paper for complete findings.

There may be several important takeaways for clinical care providers. Providers working with persons with SMI should regularly discuss social functioning when they ask about patients’ mental health symptoms and personal recovery. Providers may consider including social skills education in SMI group and individual treatments, such as Social Skills Training (SST). SST is an evidence-based group intervention for individuals with SMI. Social functioning as a treatment goal may be especially helpful for patients who haven’t liked other treatments or who have gotten all they can from other therapies. Treatments that address social functioning may provide a unique way to support personal recovery.

What Can Providers Do?

  • Consider assessing social functioning during assessments and periodically throughout treatment. In addition to informal or semi-structured social functioning inquiries, self-report measures like the 6-item Social Support Questionnaire—Brief Version (SSQ; Sarason et al., 1983, 1987) or clinician-administered structured measures like the Social Functioning Scale (SFS; Birchwood et al., 1990) may be helpful.
  • Consider assessing personal recovery periodically during treatment by administering the 25-item self-report measure, the Maryland Assessment of Recovery in People With Serious Mental Illness (MARS; Drapalski et al., 2016).
  • Talk with Veterans to understand how their social functioning may be impacted by their psychiatric symptoms, but also about how it may be interacting with (hindering or promoting) their personal recovery regardless of symptom status.
  • Get trained to facilitate Social Skills Training (SST) groups. To learn about how receive training in delivering SST, refer to the SST website
  • Ask your Evidence-Based Psychotherapy (EBP) coordinator to help you identify SST Groups being held at your facility, if you would like to refer a Veteran. Here is a link to the SST provider brochure.
  • Sign up for VISN 5 MIRECC resources for updates about treatment for Veterans with SMI: join the mailing list.

What Can Veterans and their Families Do?

  • It is normal for Veterans with SMI to worry that their mental health symptoms could hurt their relationships with family, friends, neighbors, or coworkers.
  • Please tell your providers about the social or communication challenges you face. Talk to your providers about the people in your life and your relationships with them. You can also tell your provider about what kinds of social support you wish you had.
  • Let your providers know if you’d like to try treatments that address your social and relational needs.
  • VA offers resources to address Veterans’ social needs:
    Social Skills Training (SST) is an evidence-based group intervention for people with serious mental illness. It is available as a group at many VA medical centers. SST can also often be added to individual therapy and psychosocial interventions. Ask your VA providers about SST so they can help you find a group you may be able to participate in at your VA. To learn more about SST, check out the SST brochure.
    Recreation Therapy Service is a service at most VA medical centers that uses fun activities to support Veterans’ health. Recreation Therapy works with other services within the VHA and community partners.
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