在过去十年中，永利app新版本官网地址心理健康的对话一直在稳步增加. As discussion on this once-taboo subject becomes more mainstream, 认识和了解目前的治疗方案及其疗效是很重要的. 研究 in this arena will ensure those who seek mental health services can receive the most effective, 基于研究的治疗方法.
患有严重精神疾病(SMI)的亚群是那些接受许多这些不同治疗服务的人. 重度精神障碍被更好地描述为精神疾病的一个特定子集，它会导致严重的功能损害，干扰日常生活活动. 比如重度抑郁症, 焦虑, 精神分裂症, and obsessive-compulsive disorder are common examples of SMI. 到2020年，这一数字约为14.美国有200万人患有重度精神障碍(NIMH, 2022). The onset for these diagnoses typically starts among young people aged eighteen to twenty-five, and the prevalence decreases as age continues to rise (NIMH, 2022). 研究 into the effective treatment of SMI is necessary to identify the social mechanisms connecting 空间, 耻辱, 归属感, 以及这些历史上被边缘化的人群的社区参与.
2023年夏天，我利用哈默尔大学本科生研究中心的暑期本科生研究奖学金(SURF)进行了一个混合方法的研究项目. 我的探索性项目旨在收集参与社区精神卫生服务的初步证据. I was introduced to 这个研究领域 by my mentor, Nikhil喝教授, who conducts research within the domain of mental health, and I soon became interested in spearheading my own project. My research site in New Hampshire was a clubhouse, which is a community-based psychosocial rehabilitation facility, 我的研究开始于在同一地点为上一节课完成一学期的志愿者经历之后. 有了这样的经历, 我很好奇这个康复项目内部和周围的空间是如何影响其成员的参与的. 在这种情况下, 空间被定义为用于促进康复的环境的物理和社会/文化方面. 我分析了一个俱乐部会所的空间对社区参与和参与的影响, looking at the 空间 within the facility and the surrounding area.
社区-based Treatment and Rehabilitation
俱乐部会所采用一种特殊的社会心理康复模式，以社区心理健康服务的形式，帮助有严重精神疾病史的人. The clubhouse model uses a nonclinical setting, 对任何有精神病史的人开放，并由提供者介绍. These individuals are referred to as members in the clubhouse.
俱乐部模式是按一天的计划运行的，通常是在早上9点开始.m.–5 p.m. 时间表，在此期间，成员执行不同的任务并承担责任. This schedule helps members engage in meaningful work at the clubhouse during typical workday hours. It is important to note that the usual provider/patient relationship does not exist; instead, a collaborative approach is used to promote rehabilitation.
通过社区及其支持提供的治疗和康复服务, as opposed to the traditional medical or hospital setting, 一个新兴的实践领域是否已经被研究人员科学地探索过. 然而, it continues to experience policy and social challenges because of its nontraditional care paradigm. 因此, 这个研究领域, 与比较突出的研究领域在职业治疗的评估和治疗方案的疗效, 通过研究治疗发生的空间来填补这一关键空白, 通过生活经历和严重精神疾病患者的声音. 在这一领域增加的研究也将更好地促进职业治疗师在社区精神卫生服务中的有效性, 哪个是新兴领域.
社区心理健康和耻辱
更深入地了解重度精神分裂症患者的治疗历史以及俱乐部模式是如何形成的，对于理解其重要性以及为什么这一领域需要更多的研究是不可或缺的. 重度精神障碍群体是一个历史上被污名化/边缘化的群体. 因此, places and strategies of care for this population of people have dramatically changed over the years. Starting in the early nineteenth century, mental hospitals for “insane persons” were common, 但在第二次世界大战后，由于医学协会开始相信有更有效的治疗方案，制度化的优先级降低了, 1994), 特别是考虑到在精神病院提供治疗的可怕条件. This change in view was reflected in legislation with the Mental 健康 Care Act of 1946 (Hamm, 2020年)，并于1949年建立了国家精神卫生研究所(Grob, 1994).
尽管在很大程度上推动了从机构治疗和护理的转变, such as via the 社区 Mental 健康care Act of 1963, 过渡并不顺利. 健康 care challenges for both individuals with SMI and their service providers persist to this day, 一些社会心理模型, 就像俱乐部一样, 试着解决.
In the twenty-first century, a common place for community mental health is within a clubhouse. The clubhouse model was founded in 1943 in New York and has slowly expanded to over 350 locations worldwide. 该模型用于支持和维持重度精神障碍患者的康复. Unlike other clinical or psychosocial models, 在这个非临床康复环境中的成员和工作人员共同承担运营会所的责任, eliminating the divide between the clinician and patient roles. 与员工建立公平的关系被视为康复不可或缺的一部分，因为它的平衡和对人的价值和机构的重视(Tanaka等人)., 2015). 通过“工作安排日”，会员们一起完成个人和俱乐部的任务和责任. These tasks are split into three units. 厨房单位负责购买食品杂货和烹饪每天的午餐. 会员单位的重点是出席，会员外展，和通讯. 最后，业务部门关注筹款工作和日常预算. 在我的实地工作中，我与成员一起参与了所有这些任务.
The work-mediated interactions allow members to become close, creating community bonds (Tanaka et al., 2021). These positive relationships can help with recovery. 建立人际关系, 同时注重个人需求, allows members to build a sense of community with each other (Chen, 2017).
会所外, members feel connected to a community and have a sense of 归属感 through community participation. 在你的社区中感受到联系会带来许多积极的结果. 例如, 拥有高水平的感知社区归属感可以降低心理压力水平(Terry等)., 2019). 然而, people living with SMI are typically preoccupied with managing their illness as their major occupation (Andonian, 2010). One reason for this is the lack of focus on community participation within health care structures and policies. 此外，精神疾病的污名化也起着重要作用. Perceived 耻辱 around SMI negatively affects individuals’ ability to participate (Gonzales et al., 2018). 除了感知到的耻辱, 内化的耻辱(即, 重度精神障碍患者的偏见观念内化也成为参与的重大障碍.
Partly because of 耻辱 within policies, 定义为结构病耻感, individuals with SMI live in neighborhoods with higher levels of physical and structural inadequacy, 犯罪, and drug-related activities (Bryne et al., 2013). 这些社会经济劣势较大的社区更有可能报告长期的耻辱(Gonzales等)., 2018). 因此, whether someone is experiencing internal or perceived 耻辱, 它的影响很难解决. 由于这些因素, when such individuals create relationships in the community, their social networks are much smaller compared with people without mental health issues (Dorer et al., 2009). 虽然永利app新版本官网地址耻辱和社区参与的研究不断增加, 很少有证据表明空间是如何被感知的，以及如何促进或阻碍这一历史上被边缘化的人口的社区参与.
方法
Clubhouse内部布局示意图(来源:作者图纸).
为了解决这一研究缺口, 我通过参与者自己的声音探索了会所内外的空间如何阻碍和促进重度精神障碍患者的社区参与. By volunteering at this clubhouse before starting research, 我和它的成员建立了积极的关系和友好的关系. Daily there were typically seven to ten members present with a 1:5 staff-to-member ratio. 这种信任和熟悉有助于我招募参与者，也有助于我为任何希望参与的人创造一个安全舒适的环境.
对于定性方法, I conducted semi-structured interviews, 因为他们允许探索性的问题，并为参与者提供了分享重要观点的机会，但这些观点与研究问题只有很小的关系. 对于定量方法, 我使用社区参与领域测量(CPDM)进行了一项调查。. The scale measures individual community participation, divided into three major factors: productive activities, 社会参与, 娱乐和休闲. This twenty-five-item scale allows for both subjective and objective answers from participants. 该工具允许更广泛地了解参与者在社区中的参与情况，并在我分析访谈时用于提供背景, as well as to allow the participants to think about their participation before the interview.
从7月开始，我在两个不同的时间收集了参与者的定量数据, with the second data collection six to eight weeks later. This was done to minimize the effect of confounding variables, such as participation concerns during a specific period of time in the life of a participant, 还有一年中的时间. The time frame between data collections was chosen because of the time constraints of the research project. 这些工具的共同使用提供了参与者社区参与的更全面的视图，以及他们如何看待周围空间中对他们重要和有意义的东西.
I also conducted observations in the clubhouse two to three times a week over the course of two months. 在此期间, 除了参与和支持俱乐部成员的日常工作外，我还完成了调查和访谈. Some of these activities were inputting attendance, 撰写时事通讯文章, 准备每日午餐. 通过这个过程, I fully immersed myself in the culture of the site, understanding all the ins and outs, and building rapport with participants.
I then conducted thematic analysis on the collected data, 以采访记录的形式存储在Word文档中. I used the CPDM survey and observational notes to provide context throughout the analysis process, 它遵循了Braun和Clarke(2006)提出的六阶段方法. The first step was to become familiar with the data, 通过积极, 反复阅读我已经开始做笔记的采访记录，并标出参与者分享相似经历的部分. 第二步是通过识别数据中的模式来生成初始代码. 这些都是短句, 句子, or paragraphs within the transcripts, created by systematically analyzing the data set. 每个代码在相关上下文中标识数据的特定特征. 例如, 这句成员的话之所以被选为准则，是因为这种情绪在其他采访中很普遍:“他们真的很支持我们, and they seem to respect what we do here, 这地方到底是怎么回事, 它为人们提供了什么. 所以它是正的. 肯定.“通过将调查结果和采访记录进行对比，我可以在采访答案中看到更深层次的背景.
The third step was to establish themes. 我将之前创建的代码分类为潜在的总体主题，这些主题存在于从每个转录本中提取的代码中. 视觉表征的使用，比如思维导图，在这一步中是不可或缺的. 我主要使用Excel来帮助将所有代码组织到后续主题中.
In the fourth step, I reviewed the themes. A first-level refinement was done to eliminate unsupported themes, 把它们, 让别人崩溃. In the second-level refinement, I compared these overarching themes with the entire data set. 第五步涉及最后确定和命名这些已确定的主题, 从我创建了一个代表数据的坚实的专题地图开始. 这个过程的最后一步是就我的发现编写一份报告.
The Effects of Space on Participation in 社区 Mental 健康
通过我的分析，我确定了四个主要主题，每个主题都有不同的子主题. 每个主题都与空间和参与有关:在会所内部, 会所外, 耻辱, 和人际关系.
已确定主题的概念图.
当看到空间和参与的主题在会所, the three subthemes of member perspectives, 供应商的角度, and overall 空间 inside the clubhouse were identified. 委员们强调了一些因素，例如高天花板和一个开放空间会产生很多噪音, which challenges their ability to focus on daily tasks. 然而, this open 空间 is also beneficial in feeling connected to everyone in the clubhouse throughout the day. 在这个主题中，供应商与成员分享了类似的观点, highlighting the use of large whiteboards that are easy to see and area-specific locations to organize tasks. 整体, 会所内部的空间散发出一种积极和温馨的氛围，受到所有参与者的欢迎.
第二个主题是会所外的空间和参与，也分为三个成员视角的子类别, 供应商的角度, and overall 空间 会所外. Members noted having many supportive and welcoming businesses within the walkable area surrounding the clubhouse, encouraging participation in outreach and fundraising events. 成员们感受到来自周围社区的全面支持, 但也有一些永利app新版本官网地址可达性的担忧，以及一些人在这个空间内行走和参与户外活动的能力. Providers shared many of the same ideas, 强调与当地企业的联系为在俱乐部内完成有意义的工作提供了很多机会，这对会员来说是有趣和吸引人的. 整个外部空间是各种设施的所在地，并以允许个人差事轻松地在白天运行而闻名.
The third theme of 耻辱 was divided into two subthemes of inside and 会所外. A few members said that feelings of exclusion within the clubhouse were inhibiting their participation. 有这种感觉的成员说，目睹别人的自我耻辱，不想被认为是俱乐部的一部分，影响了他们自己的自我耻辱经历, 减少他们的参与. 会所外, there was an overall sense of neutrality within the neighboring businesses and apartments. 在俱乐部之外，会员们没有任何影响他们参与的耻辱, simply coexisting in the same 空间s together.
关系的最后一个主题, 空间, and participation in the clubhouse was divided into subthemes of member and 供应商的角度. 成员和提供者都透露了处理自己个人心理健康斗争和坚持自己的影响. 这导致了成员之间在努力接受他人的行为和缺点的表面上的不同的人际问题, and not taking those behaviors personally. 具体地说, many members cited the issue of staff involvement and felt there was favoritism for certain members. 他们还表示，总体上缺乏预防和解决所有人际关系问题的人员, as an inhibitor to overall participation in the clubhouse.
结论
完成研究项目的机会让我对研究过程有了重要的了解，并了解了自己作为未来的临床医生和研究人员. 在进行定性分析方面, 混合法研究, 我能够亲身体验沉浸在人群中的感觉. 顺利地融入这个社区对于保持俱乐部会所的典型和休闲环境至关重要, to ensure that my data collection was authentic. 此外，我现在明白了如何以合乎道德的方式执行进入和退出站点. This means building a rapport at a site before beginning a project, 以及在你的研究结束后与参与者保持联系，而不是在完全沉浸在他们的日常生活中后消失.
Personally, I improved my confidence and communication when working in a professional role. 作为一名研究者, 在进行半结构化的面试和观察时要自信, and making decisions through the analytical process, 是至关重要的. 今年我完成了我的本科学位，开始了我在永利app新版本官网地址攻读职业治疗博士学位的旅程, 我将用这个项目作为我的高级顶点的起点. 我的研究将有助于填补职业治疗和科学以及更大的心理健康文献中永利app新版本官网地址空间及其感知如何影响社区参与和归属感的关键证据空白. 我期待着继续在这一领域的研究，以更好地了解影响参与精神卫生界的机制.
我作为一名研究人员的经验和我在这个过程中获得的技能将在我过渡到临床医生的角色时帮助我. I always had an interest in working in mental/behavioral health, but through this experience my desire continued to grow. I can see myself thriving in an environment that is focused on mental and behavioral health. When thinking about my future field workplaces, this new insight has given me the opportunity and motivation to find sites that align with my passions.
首先，我要感谢. Nikhil喝 for his guidance throughout this research project. 我非常感谢他在整个过程中的每一步支持. 没有他的指导和鼓励，我作为一个学生研究员, my efforts would not have been possible. 感谢我的研究网站慷慨地允许我进行研究，也感谢参与研究的成员. 我还要感谢哈默尔大学本科生研究中心为我提供这次机会以及我的赞助人. 达纳·哈默, 职业治疗50周年本科生研究基金， 和女士. Catherine Latham for funding this project. 最后的, I would like to thank my family for their continued support of my academic and research endeavors.
参考文献
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作者和导师简介
Sana Syed 将于2024年5月毕业于永利app新版本官网地址，获得职业治疗(OT)学士学位. 她在利用俱乐部模式治疗严重精神疾病的研究中投入了她对OT的热情. Sana’s interest in her research began with her volunteer work at a clubhouse and blossomed alongside her mentor, Dr. Nikhil喝, who works in a similar line of research. 夏季本科生研究奖学金(SURF)由哈默尔本科生研究中心授予，允许Sana进行这项研究, which she also used for her honors thesis. Sana learned through her experience with this research the challenges research protocol can present, but nonetheless appreciates her experience as she formed new connections and gained valuable knowledge. Sana对OT的热情促使她在《永利app新版本官网地址》杂志上发表文章，因为她相信该杂志对向更广泛的人群传播研究成果的重要性. 萨那毕业后, she plans on staying at UNH to obtain her doctorate in OT, which she hopes to begin her professional career in mental health.
Dr. Nikhil喝 是职业治疗系的助理教授，并于2018年开始在永利app新版本官网地址任教. 他是一名混合方法研究人员，专门研究对历史上边缘化人群的耻辱的理论和实证研究, 比如那些有精神疾病的人, BIPOC individuals and/or sexual/gender minority individuals. Dr. Tomar met Sana when she was a student in his class, and he could tell she would be a dedicated researcher. 他说，指导Sana是一段很好的经历，她对这项研究的奉献和专注令人钦佩. Dr. 托马尔说，萨娜的项目是由她自己的好奇心发起的, rather than as part of a larger project. He also describes Sana as having great in interpersonal skills, making it “really fun to conduct research with her.他希望Sana的同龄人看到她的经历，并有动力从事让他们兴奋的研究，并将他们的热情调动到研究调查中.
版权所有2024©Sana Syed
