Project SUCCESS compares two programs that are both designed to improve social functioning. Why is this important? In this week’s post, I’ll discuss the research that helped me recognize the importance of social connection for improving mental health and quality of life.
Many prior studies of social connection in the general population show that social connection improves physical and mental health and that social isolation shortens lifespans and increases the risk of depression. Workplace management that enhances social connection results in more satisfied employees and communities organized to stimulate social interaction have lower rates of crime.
In the last three decades, many of us who conduct research on programs to improve mental health have also learned that programs that improve social connection can improve the quality of life of persons who have a experienced serious mental illness like bipolar disorder, schizophrenia, or bipolar disorder for extended periods of time. But figuring out how to improve social connection can be challenging.
The Boston McKinney Project was funded in 1990 by the National Institute of Mental Health to compare the value of two types of housing for persons living in one of Boston’s shelters for homeless persons and diagnosed with a serious mental illness. Those persons who agreed to participate in the project were assigned randomly to live either in an independent apartment or in a staffed group home. The random assignment assured that the people living in both settings were similar at the outset.
Our research project, led by psychiatrist Steve Goldfinger, MD, planned to manage the group homes so support staff were reduced over 1½ years, as residents began to manage the homes themselves. We called them Evolving Consumer Households (ECH). Residents who moved into the apartments (Independent Living, or IL) were visited by case managers, but otherwise lived on their own.
Ethnographers on our team visited the homes every week and observed activities. An ethnographer who visited the same group home for months wrote about the change in social interaction:
A moving evening tonight. Quiet and almost spiritual--a house filled with the sounds of a newborn baby, the flickering of eight candles in the window, the glistening of a tall pine tree in the living room, the shared camaraderie of a group of former strangers from all walks of life. Staff convened, everyone joking and laughing. Mood was very relaxed, friendly, warm. Stark contrast to meetings in the past, where everyone was usually quiet, non-communicative, even tense. Staff comment that “people are really hanging out together—talking, helping each together out.” It feels much more comfortable than it did a year ago when I first came! The group was so different a year ago--it was all individuals in one space....
It may come as no surprise that people with this type of experience were less likely to experience homelessness again—even after the project ended—and their thinking skills improved.
But this kind of positive social interaction didn’t develop in all the group homes. Conflicts between residents, desires to avoid social interaction, and issues with staff engagement could get in the way. Just bringing people together and encouraging discussion does not ensure success.
For Project SUCCESS, our research group turned to two evidence-based psychosocial programs with manualized treatments: Cognitive Enhancement Therapy and HOPES (a type of social skills training). Both CET and HOPES guide clinicians as they deliver a year-long menu of activities to bring participants together in a group and develop social skills. What we learn from the project will help improve the effectiveness of both these approaches. The work goes on, thanks to a wonderful group of colleagues and participants. More about the Boston McKinney Project. More about Project SUCCESS.
More about the Boston McKinney Project.
More about Project SUCCESS.
Russ
Russell K. Schutt, PhD
Dual Principal Investigator
Project SUCCESS