In the Shadow of illness: A Social Geography of the Chronically Mentally Disabled in Hamilton, Ontario

Abstract

<p>This thesis adopts a socio-ecological perspective on health and examines everyday life for the community-based chronically mentally disabled (CMD) in Hamilton, Ontario. As with most larger North American cities, this population is residentially concentrated in inner city census tracts. This shared central location implies common experience of aspects of the urban environment.</p> <p>An analytical framework is developed, based on socio-ecological principles. Coping and satisfaction are identified as two dimensions of community experience that may augment conventional measures of post-hospital outcome. On the framework, seven subsets of client and community variables are identified: personal characteristics, psychiatric profile, psychiatric services, housing, social support, lifestyle and beliefs and attitudes. Survey data collected in two rounds of interviews from an initial sample of 66 CMD clients from three aftercare programs are used to undertake both quantitative and qualitative analysis. In the former, composite measures of coping and satisfaction are constructed and the relationship between these indices and client and community variables are examined using bivariate and multivariate techniques. Qualitative analysis is based on narrative accounts offered by clients in the course of interviews. An interpretation of these texts and analysis of daily activity patterns is undertaken at both the level of particular individuals and the sample as a whole. This analysis of the experience of time, space and community life for the sample complements the evidence from quantitative inquiry.</p> <p>Findings from the quantitative analysis indicate that clients coping well in the community were more involved in gregarious activities, had enough to do, had more significant others and were more involved in mental health services. Those more satisfied were older, had more significant others, did not live in a lodging home, were more residentially stable, had enough to do and were not recipients of an income supplement. Results of the qualitative analysis of narrative accounts and time budget data indicate that poverty and unemployment compound the effects of illness and lead to a monotonous experience of relatively unconstrained time within a highly constrained activity space.</p>