Individuals with serious mental illness (SMI) are at considerably higher risk for morbidity and mortality than those in the general population. The current pilot trial is a preliminary examination of a peer health navigation intervention for improving health and healthcare utilization called the Bridge. Twenty-four individuals with SMI were randomly assigned to either peer navigation or treatment as usual (TAU). Navigators encouraged development of self-management of healthcare through a series of psychoeducation and behavioral strategies. Outcomes included a range of health consequences, as well as health utilization indices. After 6 months, compared to the TAU group, participants receiving the intervention experienced fewer pain and health symptoms. Participants changed their orientation about seeking care to a primary care provider (44.4 % vs. 83.3 %, χ(2) = 3.50, p < .05) rather than the emergency room (55.6 % vs. 0 %, χ(2) = 8.75, p < .01). Therefore, the Bridge intervention demonstrated considerable promise through positively impacting health and healthcare utilization.

Objective Community integration is recognized as a crucial component of recovery from serious mental illness. Although the construct of community integration can be measured with structured instruments, little is known about the subjective and experiential meaning of community and community involvement for persons with serious mental illness. Methods In 2010, 30 individuals with serious mental illness treated in two public mental health clinics completed semistructured interviews that elicited the places and people that they associate with the experience of community and the larger meaning of community in their lives. Results Participants described four experiences as integral to their concepts of community: receiving help, minimizing risk, avoiding stigma, and giving back. Participants looked for communities that provide reliable support, and they described the need to manage community contact in order to protect themselves and others from their symptoms and from discrimination. Most participants experienced communities centered on mental health treatment or mentally ill peers as providing opportunities for positive engagement. Conclusions The experience of having a serious mental illness shapes preferences for and perceptions of community in pervasive ways. Participants describe community involvement not as a means to move away from illness experiences and identities but as a process that is substantially influenced by them. Mental health communities may help individuals with serious mental illness to both manage their illness and recognize and enjoy a sense of community. The findings indicate the need for further research on the relationship between community integration and outcome in serious mental illness.

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Nondisclosure of suicidal thoughts limits suicide risk management. Consistent with disclosure models for other stigmatized statuses, understanding suicidal disclosure requires accounting for features of the discloser (individual factors) and the discloser-recipient relationship (relational factors). In a sample of 30 adults with schizophrenia, bipolar disorder, or major depressive disorder (Level 2) who nominated 436 social network members (Level 1), we examined disclosure patterns and identified individual and relational correlates of disclosure intent. Most individuals disclosed in the past (77%; n = 23) and all intended on disclosing (100%; n = 30). Disclosure was highly selective, with 14% (n = 62) of network members identified as prior confidants and 23% (n = 99) identified as intended confidants. Multilevel modeling indicated that relational factors were more central to disclosure than individual factors. Network members who were prior confidants and who provided social support were attractive targets for intended disclosure. Our findings suggest that "targeted" gatekeeper training may be a promising strategy and reveal relational characteristics to identify "high-probability confidants."

The findings suggest opportunities and possible incongruities in the experience of community integration.