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...ly, McKenna, Parahoo, & DuSoir, 2001). Other scholars argue that a focus on material resources is needed to counter a continuing tendency to explain barriers to social participation in medical terms (=-=Thoits, 1995-=-; Cohen, 2000a; Yanos, Rosenfield, & Horwitz, 2001). Measuring QOL QOL can be understood conceptually to encompass three broad dimensions: what an individual is capable of doing (functional status); a...

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... had savings at the time of the interview. Family relations Positive relationships with family members constitute an important influence on mental health and well-being for the population as a whole (=-=Kawachi & Berkman, 2001-=-). Moreover, studies indicate that supportive interactions with family members contribute to overall QOL for people with mental illness more specifically (Corrigan & Buican, 1995; Hannum et al., 1994;...

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...sing a case study of residential care facility tenants in Hamilton, Ontario. Method Case study research Case studies allow researchers to explore the interplay of multiple factors in a given context (=-=Orum, Feagin, & Sjoberg, 1991-=-). While it can be difficult to generalize from case studies, those grounded in theory (Burawoy, 1991) and representative of other cases (Walton, 1992) can offer broader insight. In this paper, the ca...

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...nclusion and to reduce the stigma of mental illness. In this sense, the goal of increasing tenants’ income is consistent with the larger aims of community mental health care and consumer empowerment (=-=Rappaport, 1987-=-).15 It is also consistent with research identifying a ‘minimum income for healthy living’ that provides decent food, shelter and clothing plus opportunities for activities that foster social integrat...

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...allow researchers to explore the interplay of multiple factors in a given context (Orum, Feagin, & Sjoberg, 1991). While it can be difficult to generalize from case studies, those grounded in theory (=-=Burawoy, 1991-=-) and representative of other cases (Walton, 1992) can offer broader insight. In this paper, the case study is explicitly connected to QOL scholarship. In addition, the study is grounded in an analysi...

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...le of the social context (1993, p. 3). In 1995, a neo-conservative ‘Progressive Conservative’ party won a landslide victory in Ontario, promising sweeping economic and social reforms in the province (=-=Peck, 2001-=-). In 1998, the ministry of health released Making It Happen, outlining key components of a reformed mental health system (Ontario Ministry of Health, 1998). Income supports and sources are identified...

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...ed by mental illness, people face structural barriers such as poverty, social stigma, a lack of affordable housing and limited employment opportunities (Boydell, Gladstone, Crawford, & Trainor, 1999; =-=Wahl, 1999-=-; Ware and Goldfinger, 1997). The purpose of this paper is to examine the implications of these ongoing developments in mental health care and social assistance for people with serious mental illness ...

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...Patton, 1990). Semi-structured interviews using open-ended questions allow for responses that are unexpected, and may describe people’s views and feelings more closely than fixed response categories (=-=Fowler, 1993-=-). Second, through in-depth consideration of individuals’ experiences, qualitative methods allow for an examination of ways in which multiple factors intersect in and shape particular social contexts ...

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...from proximate risk factors affecting the health of individuals to an understanding of the health at the level of the population as it is influenced by the social, economic and physical environments (=-=Frank & Mustard, 1994-=-). This conceptual link recognizes that mental health care requires the adequate provision of social supports. In 1993, the left-leaning New Democratic Party (NDP) government released Putting People F...

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... has been the continuing movement away from the provision of institutional care to community-based programs for people with serious mental illness1 (Dear &Wolch, 1987; Dickinson, 2001; Goldman, 1999; =-=Nelson, Lord, & Ochocka, 2001-=-; Rosenheck, 1999). During the same period, there have also been significant changes in the provision of social welfare that hold implications for people with serious mental illness living in communit...

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...pressed interest in participating the opportunity presented itself. The focus group took place in the facility dining room and provided an opportunity to validate findings from one-on-one interviews (=-=Hoggart, Lees, & Davies, 2002-=-). Participants Twenty-two people participated in the study.6 All participants had been diagnosed as having a serious mental illness, most commonly schizophrenia. Fourteen participants were male and e...

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...adults with mental illness were living in poverty in 1991, compared with 12.6% of non-disabled people, and the figure for people with serious mental illness is undoubtedly much higher (Capponi, 1997; =-=Fawcett, 1996-=-). While there has been considerable research on poverty and mental health, much of it concerns socioeconomic status as a causal factor in the development of mental ill health (Cohen, 2000a; Saraceno ...

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...ett, 1996). While there has been considerable research on poverty and mental health, much of it concerns socioeconomic status as a causal factor in the development of mental ill health (Cohen, 2000a; =-=Saraceno & Barbui, 1997-=-; Shore, 1997). Recent work has begun to examine the effects of poverty on community living and the mental health of consumers. Studies show that poverty effects people’s ability to find decent housin...

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...fare rates have often been frozen or reduced and time limits for assistance introduced, with the justification that these strategies provide added incentive for people to escape ‘welfare dependency’ (=-=Russell, 1998-=-). These changes are part of a broader transformation away from the postwar universal welfare state toward the selective provision of social welfare to address ‘real needs’ (Langan, 1998). While perso...

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...tive deprivation on health. In addition to the impact of absolute deprivation (material scarcity), standard of living relative to other people affects health at both individual and collective levels (=-=Kawachi, Kennedy, & Wilkinson, 1999-=-). While research on relative deprivation has focused on the population at large, the implications may have relevance for people with serious mental illness as a disproportionately poor and stigmatize...

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...iple factors in a given context (Orum, Feagin, & Sjoberg, 1991). While it can be difficult to generalize from case studies, those grounded in theory (Burawoy, 1991) and representative of other cases (=-=Walton, 1992-=-) can offer broader insight. In this paper, the case study is explicitly connected to QOL scholarship. In addition, the study is grounded in an analysis of the broader transformation of the welfare st...

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...It is also consistent with research identifying a ‘minimum income for healthy living’ that provides decent food, shelter and clothing plus opportunities for activities that foster social integration (=-=Morris, Donkin, Wonderling, Wilkinson, & Dowler, 2000-=-). Last but by no means least, the goal of increasing the PNA is consistent with the recognition that poverty restricts disabled people’s rights to social and political participation (Beresford, 1996)...

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...ial Science & Medicine 58 (2004) 25–3926 measure the objective and/or subjective dimensions of QOL for people with serious mental illness (e.g., Bigelow, Gareau, & Young, 1990; Huxley & Warner, 1992; =-=Lehman, 1983-=-; Oliver, 1992). In a review of twenty-eight instruments, the five most frequently utilized ‘life domains’ were: health, self esteem/wellbeing, community/productivity, social/love relationships, and l...

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...usness in the daily lives of many disabled people. Within the context of ongoing changes, people with serious mental illness continue to face multiple challenges to full participation in social life (=-=Capponi, 1992-=-; Carne, 1998; Wilson, 1996). In addition to the challenges posed by mental illness, people face structural barriers such as poverty, social stigma, a lack of affordable housing and limited employment...

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...ir, 2001). Other scholars argue that a focus on material resources is needed to counter a continuing tendency to explain barriers to social participation in medical terms (Thoits, 1995; Cohen, 2000a; =-=Yanos, Rosenfield, & Horwitz, 2001-=-). Measuring QOL QOL can be understood conceptually to encompass three broad dimensions: what an individual is capable of doing (functional status); access to resources and opportunities, and a sense ...

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..., & Dowler, 2000). Last but by no means least, the goal of increasing the PNA is consistent with the recognition that poverty restricts disabled people’s rights to social and political participation (=-=Beresford, 1996-=-). However, this goal will not be easy to accomplish. While the ministry of health identifies income support as essential to a reformed mental health system, a primary aim of the government in recent ...

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... satisfy specific criteria are often able to access additional supports and are exempted from workfare requirements, welfare restructuring has had important implications for people with disabilities (=-=Batavia & Beaulaurier, 2001-=-). Rosenheck (1999) argues that reductions in welfare ARTICLE IN PRESS *Tel.: +1-905-525-9140; fax: +1-905-546-0463. E-mail address: wiltonr@mcmaster.ca (R. Wilton). 1Serious mental illness refers to ...

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... in the policy documents reviewed above.11 At the same time, people with serious mental illness tend to have smaller than average social networks, and rely more heavily on family members for support (=-=Caron, Tempier, Mercier, & Leouffre, 1998-=-; Hannum et al., 1994). While the smaller networks may be partly a product of reduced interpersonal functioning (Lehman et al., 1995), participants’ experiences indicate that poverty also works agains...

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...N PRESS R. Wilton / Social Science & Medicine 58 (2004) 25–3926 measure the objective and/or subjective dimensions of QOL for people with serious mental illness (e.g., Bigelow, Gareau, & Young, 1990; =-=Huxley & Warner, 1992-=-; Lehman, 1983; Oliver, 1992). In a review of twenty-eight instruments, the five most frequently utilized ‘life domains’ were: health, self esteem/wellbeing, community/productivity, social/love relati...

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...udies argue that efforts to improve QOL among people with serious mental illness need to recognize the complex interrelationships between a wide variety of demographic, clinical and social variables (=-=Lam & Rosenheck, 2000-=-; UK700 Group, 1999), but there remains a tendency to trivialize the social environment (Cohen, 2000a). In policy terms, a better understanding of the links between poverty and QOL is urgent given the...

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...tly higher than the general population, but it is not clear why this is the case (Leonard et al., 2001). Smoking may function as a form of self-medication, particularly for people with schizophrenia (=-=Lawn, Pols, & Barber, 2002-=-). At the same time, smoking is a stigmatized activity, doubly so for people on social assistance, and several participants expressed concern that others would view their financial predicament less fa...

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...n the larger tenant population. As a result, they may be more likely to have encountered the constraints of poverty in their efforts to participate in leisure activities and social relationships (see =-=Corrigan & Buican, 1995-=-). Individuals who expressed interest in participating then met with the author, who conducted all interviews and the focus group. All but one of the potential participants had no contact with the aut...

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...e. In 1988, the Liberal government released Building Community Support for People. The document and the consultations that informed it are seen as marking a significant break in mental health policy (=-=Everett, 2000-=-). Nelson et al. (2001, p. 78) argue that this was the first time consumers and their families: ‘were given a voice in what they wanted in mental health policy in Ontario.’ In the report, explicit com...

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...rty on the QOL of people with serious mental illness. Poverty Poverty means having insufficient money, goods or means of support. The precise definition of the term varies between different contexts (=-=Lott & Bullock, 2001-=-). In Canada, poverty is determined by Statistics Canada’s ‘‘Low-Income Cut-Offs’’ (LICO). LICOs vary depending upon family and settlement size, but in general terms, people are considered to poor if ...

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...Medicine 58 (2004) 25–3926 measure the objective and/or subjective dimensions of QOL for people with serious mental illness (e.g., Bigelow, Gareau, & Young, 1990; Huxley & Warner, 1992; Lehman, 1983; =-=Oliver, 1992-=-). In a review of twenty-eight instruments, the five most frequently utilized ‘life domains’ were: health, self esteem/wellbeing, community/productivity, social/love relationships, and leisure/creativ...

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...th emphasis placed on services such ARTICLE IN PRESS 2 In those instruments that do include financial status it frequently emerges as a significant indicator of QOL (e.g., Lehman, 1983; Oliver, 1992; =-=Trauer, Duckmanton, & Chiu, 1998-=-). R. Wilton / Social Science & Medicine 58 (2004) 25–39 27 as crisis and residential support, case management, selfhelp and family support, and social/vocational support. For the purposes of this pap...

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...y more heavily on family members for support (Caron, Tempier, Mercier, & Leouffre, 1998; Hannum et al., 1994). While the smaller networks may be partly a product of reduced interpersonal functioning (=-=Lehman et al., 1995-=-), participants’ experiences indicate that poverty also works against an ability to sustain close ties with family, limiting communication and affecting people’s willingness to engage in social activi...

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...se questions about the material dimension of social network transactions. In existing work, networks facilitate four kinds of supportive transactions: emotional, social, tangible and problem solving (=-=Nelson, Hall, Squire, & Walsh-Bowers, 1992-=-), but it is not clear how material relations intersect with these transactions. Participants’ experiences may shed further light on this issue. Alongside the direct constraints of material shortage, ...

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...Leisure activities Leisure activity and community participation more broadly are domains that make significant contributions to overall QOL for people with serious mental illness (Kelly et al., 2001; =-=Nelson et al., 1995-=-; Trauer et al., 1998). In the current study, participants were asked about their weekly activities in and outside the house with particular emphasis on leisure. Activities most commonly listed includ...

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... illness, people face structural barriers such as poverty, social stigma, a lack of affordable housing and limited employment opportunities (Boydell, Gladstone, Crawford, & Trainor, 1999; Wahl, 1999; =-=Ware and Goldfinger, 1997-=-). The purpose of this paper is to examine the implications of these ongoing developments in mental health care and social assistance for people with serious mental illness living in community setting...

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...ilson, 1996). In addition to the challenges posed by mental illness, people face structural barriers such as poverty, social stigma, a lack of affordable housing and limited employment opportunities (=-=Boydell, Gladstone, Crawford, & Trainor, 1999-=-; Wahl, 1999; Ware and Goldfinger, 1997). The purpose of this paper is to examine the implications of these ongoing developments in mental health care and social assistance for people with serious men...

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...ue for research on strategies people use to cope with poverty, and the impact of those strategies on their mental health (Estroff, Zimmer, Lachiotte, Benoit, & Patrick, 1996; Ware & Goldfinger, 1997; =-=Kelly, McKenna, Parahoo, & DuSoir, 2001-=-). Other scholars argue that a focus on material resources is needed to counter a continuing tendency to explain barriers to social participation in medical terms (Thoits, 1995; Cohen, 2000a; Yanos, R...

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...one half of some participants’ income. The incidence of smoking among people with serious mental illness is significantly higher than the general population, but it is not clear why this is the case (=-=Leonard et al., 2001-=-). Smoking may function as a form of self-medication, particularly for people with schizophrenia (Lawn, Pols, & Barber, 2002). At the same time, smoking is a stigmatized activity, doubly so for people...

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...(2001) argue that a lack of material resources works against consumer empowerment, while Kearns (1990) found consumer satisfaction with community life significantly correlated with income (also UK700 =-=Group, 1999-=-). Some scholars argue that economic marginalization faced by consumers is a form of social oppression (Lord & Dufort, 1996), and others contend that material deprivation poses a greater challenge tha...

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... almost 27% of adults with mental illness were living in poverty in 1991, compared with 12.6% of non-disabled people, and the figure for people with serious mental illness is undoubtedly much higher (=-=Capponi, 1997-=-; Fawcett, 1996). While there has been considerable research on poverty and mental health, much of it concerns socioeconomic status as a causal factor in the development of mental ill health (Cohen, 2...

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...01) terms a series of bold experiments and seismic shifts away from traditional welfare states toward ‘workfare’ programs that impose mandatory work requirements for people who receive benefits (also =-=Evans, 2002-=-; Handler & Hasenfeld, 1997). At the same time, welfare rates have often been frozen or reduced and time limits for assistance introduced, with the justification that these strategies provide added in...

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...L QOL can be understood conceptually to encompass three broad dimensions: what an individual is capable of doing (functional status); access to resources and opportunities, and a sense of well-being (=-=Lehman, 1999-=-). As these broad dimensions imply, QOL comprises both objective and a subjective elements (Atkinson & Zibin, 1996). In addition, more specific topical areas or ‘life domains’ can be identified, inclu...

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...rgue that economic marginalization faced by consumers is a form of social oppression (Lord & Dufort, 1996), and others contend that material deprivation poses a greater challenge than mental illness (=-=Lurigio & Lewis, 1989-=-). Existing studies also identify several avenues for further research. Cohen (1993) called for research that gives serious consideration to the social context to examine the different ways in which c...

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... many disabled people. Within the context of ongoing changes, people with serious mental illness continue to face multiple challenges to full participation in social life (Capponi, 1992; Carne, 1998; =-=Wilson, 1996-=-). In addition to the challenges posed by mental illness, people face structural barriers such as poverty, social stigma, a lack of affordable housing and limited employment opportunities (Boydell, Gl...

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...of doing (functional status); access to resources and opportunities, and a sense of well-being (Lehman, 1999). As these broad dimensions imply, QOL comprises both objective and a subjective elements (=-=Atkinson & Zibin, 1996-=-). In addition, more specific topical areas or ‘life domains’ can be identified, including health, family, social relations, and living situation. In recent decades, a number of instruments have been ...

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...rk has begun to examine the effects of poverty on community living and the mental health of consumers. Studies show that poverty effects people’s ability to find decent housing in safe neighborhoods (=-=Carling & Curtis, 1997-=-; Newman, 1994). There is some evidence to suggest that poverty negatively impacts opportunities to develop social networks (Hannum et al., 1994). Nelson et al. (2001) argue that a lack of material re...

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...aily lives of many disabled people. Within the context of ongoing changes, people with serious mental illness continue to face multiple challenges to full participation in social life (Capponi, 1992; =-=Carne, 1998-=-; Wilson, 1996). In addition to the challenges posed by mental illness, people face structural barriers such as poverty, social stigma, a lack of affordable housing and limited employment opportunitie...

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...er satisfaction with community life significantly correlated with income (also UK700 Group, 1999). Some scholars argue that economic marginalization faced by consumers is a form of social oppression (=-=Lord & Dufort, 1996-=-), and others contend that material deprivation poses a greater challenge than mental illness (Lurigio & Lewis, 1989). Existing studies also identify several avenues for further research. Cohen (1993)...

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...nt away from the provision of institutional care to community-based programs for people with serious mental illness1 (Dear &Wolch, 1987; Dickinson, 2001; Goldman, 1999; Nelson, Lord, & Ochocka, 2001; =-=Rosenheck, 1999-=-). During the same period, there have also been significant changes in the provision of social welfare that hold implications for people with serious mental illness living in community settings. Count...

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...t-Offs’’ (LICO). LICOs vary depending upon family and settlement size, but in general terms, people are considered to poor if they spend more than 56.2% of gross income on food, clothing and shelter (=-=Chappell, 2000-=-). However, official definitions say little about the manifold effects of poverty on people’s daily lives. Poverty has profoundly negative implications for physical and mental health, self-esteem, edu...

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...s a major barrier to participation and inclusion for people with serious mental illness (Wahl, 1999). While stigma derives in part from enduring stereotypes about the ‘strangeness’ of mental illness (=-=Dear, Gaber, Takahashi, & Wilton, 1997-=-), it may also be reproduced by the intersection of mental illness and poverty where the latter contributes to the ‘visibly different’ status of people with serious mental illness. For example, chroni...

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...alzer, Culhane, & Hadley (2002) and Boydell et al. (1999). Several studies argue for research on strategies people use to cope with poverty, and the impact of those strategies on their mental health (=-=Estroff, Zimmer, Lachiotte, Benoit, & Patrick, 1996-=-; Ware & Goldfinger, 1997; Kelly, McKenna, Parahoo, & DuSoir, 2001). Other scholars argue that a focus on material resources is needed to counter a continuing tendency to explain barriers to social pa...

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...bility to find decent housing in safe neighborhoods (Carling & Curtis, 1997; Newman, 1994). There is some evidence to suggest that poverty negatively impacts opportunities to develop social networks (=-=Hannum et al., 1994-=-). Nelson et al. (2001) argue that a lack of material resources works against consumer empowerment, while Kearns (1990) found consumer satisfaction with community life significantly correlated with in...

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...inks between poverty and dimensions of QOL made a qualitative approach apposite for this study. Qualitative methods facilitate the elucidation of subjective meanings attached to social circumstances (=-=Patton, 1990-=-). Semi-structured interviews using open-ended questions allow for responses that are unexpected, and may describe people’s views and feelings more closely than fixed response categories (Fowler, 1993...

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...thing is important to one’s presentation of self to others and one’s self-esteem (Turner-Bowker, 2001). Studies also suggest that people present themselves more confidently if they feel well dressed (=-=Schneider, 1974-=-), something that may hold implications for participants’ interactions in the community. A closely related issue concerns the link between poverty and social stigma. Stigma is a major barrier to parti...

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...as been considerable research on poverty and mental health, much of it concerns socioeconomic status as a causal factor in the development of mental ill health (Cohen, 2000a; Saraceno & Barbui, 1997; =-=Shore, 1997-=-). Recent work has begun to examine the effects of poverty on community living and the mental health of consumers. Studies show that poverty effects people’s ability to find decent housing in safe nei...

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...ecause of mental illness and/or medication. Others expressed interest in working but were concerned, and sometimes confused, about rules governing employment earnings while on social assistance (also =-=Turton, 2001-=-).8 None of the women participants had paid employment, a finding consistent with Lehman, Rachuba, and Postrado (1995) who suggest that male board-and-care residents tended to be better off materially...

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...signed specifically to ARTICLE IN PRESS R. Wilton / Social Science & Medicine 58 (2004) 25–3926 measure the objective and/or subjective dimensions of QOL for people with serious mental illness (e.g., =-=Bigelow, Gareau, & Young, 1990-=-; Huxley & Warner, 1992; Lehman, 1983; Oliver, 1992). In a review of twenty-eight instruments, the five most frequently utilized ‘life domains’ were: health, self esteem/wellbeing, community/productiv...

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...nting these meals with other food items. Their concerns are supported by research that found over half of the city’s lodging homes were providing tenants with meals that had little nutritional value (=-=Davy, 1992-=-). Meeting basic needs is particularly difficult for people who smoke. Cigarettes consume between one third and one half of some participants’ income. The incidence of smoking among people with seriou...

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...policy of many Western countries has been the continuing movement away from the provision of institutional care to community-based programs for people with serious mental illness1 (Dear &Wolch, 1987; =-=Dickinson, 2001-=-; Goldman, 1999; Nelson, Lord, & Ochocka, 2001; Rosenheck, 1999). During the same period, there have also been significant changes in the provision of social welfare that hold implications for people ...

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...stern countries has been the continuing movement away from the provision of institutional care to community-based programs for people with serious mental illness1 (Dear &Wolch, 1987; Dickinson, 2001; =-=Goldman, 1999-=-; Nelson, Lord, & Ochocka, 2001; Rosenheck, 1999). During the same period, there have also been significant changes in the provision of social welfare that hold implications for people with serious me...

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...amilton, Ontario, a city of approximately 500,000. In Hamilton, Residential Care Facilities (RCFs) provide accommodation for more than 700 people with serious mental illness (Hamilton District Health =-=Council, 2001-=-).5 Facilities are privately owned and have been an important source of accommodation since the 1970s. Operators are paid by municipal and provincial governments to provide food, shelter and basic car...

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...eries of bold experiments and seismic shifts away from traditional welfare states toward ‘workfare’ programs that impose mandatory work requirements for people who receive benefits (also Evans, 2002; =-=Handler & Hasenfeld, 1997-=-). At the same time, welfare rates have often been frozen or reduced and time limits for assistance introduced, with the justification that these strategies provide added incentive for people to escap...

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...dependency’ (Russell, 1998). These changes are part of a broader transformation away from the postwar universal welfare state toward the selective provision of social welfare to address ‘real needs’ (=-=Langan, 1998-=-). While persons with recognized disabilities who satisfy specific criteria are often able to access additional supports and are exempted from workfare requirements, welfare restructuring has had impo...

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...the effects of poverty on community living and the mental health of consumers. Studies show that poverty effects people’s ability to find decent housing in safe neighborhoods (Carling & Curtis, 1997; =-=Newman, 1994-=-). There is some evidence to suggest that poverty negatively impacts opportunities to develop social networks (Hannum et al., 1994). Nelson et al. (2001) argue that a lack of material resources works ...

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...to emerge in analysis involved clothing. Almost all participants were concerned about old, poorly fitting or cheap clothing, but younger participants may be acutely aware of an inability to ‘fit in’ (=-=Segal & Vandervoort, 1996-=-). For example, Mike is in his mid-twenties and has a diagnosis of schizophrenia. He had moved into his facility a few months before, after a short stay at a psychiatric hospital. Prior to that, he ha...