Like anyone else, persons who have serious mental illnesses need a sense of belonging and a feeling of satisfaction with their lives. Efforts to help people feel a part of their communities and have a good quality of life usually focus on helping them get decent housing, meaningful employment, education and health care, as well as fostering self-determination and social support. However, recreational and leisure activities may also be central to feeling connected to community life.
Research has consistently indicated that physically and socially active recreation and leisure activities are related to a higher quality of life in the general population, as well as in people with various disabilities. This is especially true of activities that help people feel a part of neighborhood life, including such simple activities as eating in a restaurant, visiting a library or walking in a park. But research has also found strong relationships between physical activity and physical health as well as between physical activity and mental health. Yet individuals with serious mental illnesses are significantly less active than the general population and their leisure involvement tends to be much more passive. Community inclusion initiatives need to focus more strongly in this ‘domain’ of community life.
Involvement with a variety of leisure activities can help individuals with serious mental illnesses lead more active and healthier lives. Many recreational activities require the movement of large muscle groups and can be aerobic, which improves cardiovascular health. Hiking, biking, swimming, gardening and dancing are good examples. Physically active pastimes such as these are most beneficial if they are done routinely, and the pleasure derived from them makes this more likely. Recreational and leisure involvement also promotes health by providing a buffer for stress and creating a sense of balance. For instance, recreation and leisure can give people a break from a stressful situation. Indeed, physically active recreational activities can be powerful proactive coping strategies, (i.e., efforts to prevent stressful events before they occur). Social support, sport/exercise and miscellaneous non-social activities, such as painting or writing, are examples.
Socially active recreation is also important to one’s health. In fact, friendships may be the hidden factor in greater longevity. Research supports the importance of social networks in maintaining health and reducing re-hospitalizations of persons with mental illnesses. Recreational activities have the potential to increase social involvement and friendships in many way, for many recreational activities, such as playing cards or being on a sports team, need the involvement of others.
Other recreational pursuits allow persons with serious mental illnesses to meet new friends who share common interests. Talking with acquaintances about movies or books or taking an adult education class or a course at a YMCA helps individuals with serious mental illnesses to have a social life outside of their family and give them opportunities to forge new relationships. Finally, some recreational activities, such as movies or concerts, are often just reasons to get together with friends and help maintain social relationships.
Many people with psychiatric disabilities nonetheless find it difficult to develop physically or social active recreational and leisure pursuits for themselves:
- service providers are hesitant to regulate or prescribe a person’s free-time activities: the freedom to do what we want in our free time is central to the very idea of leisure. So choosing to watch television or simply do nothing is inherent to a person’s right to self-determination. However, clients with serious mental illnesses may need assistance with choosing recreational and leisure activities for themselves, particularly if they have had these choices made for them in the past. While self-directed care ultimately involves choices, each choice should be based on informed decisions. It is often assumed that it is relatively easy to find opportunities for enjoyable and socially constructive pastimes. Yet research suggests that this is not automatic, especially for people with mental illnesses. Just as such individuals may benefit from a job coach, they may also benefit from ‘leisure coaching’. Leisure coaching would help them identify and explore personal values and interests that are associated with physically and socially active recreational and leisure activities, develop or refine skills needed to pursue personal interests, and locate personal and community resources to support their involvement in community recreation. Most importantly, leisure coaching would help remove barriers to participation in community and social life.
- research has also shown that leisure behavior is an important aspect of the coping response, yet few individuals consciously recognize the role that recreation and leisure play in helping them cope with stress or in their overall health and well-being. This is true for both individuals with serious mental illnesses and for service providers, such as case managers and peer supporters. This may inadvertently lead to undervaluing this aspect of a person’s life.
- finally, it may be that the health and human service system rarely sends the message that persons with serious mental illnesses should take the time or have the opportunity to find health and happiness through physically and socially active leisure involvement. Other important issues often take priority, and the commitment to building a recreation/leisure agenda may be lost in the shuffle. While it seems logical that a case manager would be the ideal person to provide leisure coaching, this may not occur beyond the verbal encouragement to a client to “do something fun this weekend”,“join a club”, or “get out there and meet some people and make some friends.”
The following are recommendations for service providers on improving recreational and leisure opportunities for people with mental illnesses:
- Create and evaluate model demonstration programs that use leisure coaching to promote proactive coping, community inclusion, life satisfaction and other positive outcomes for persons with serious mental illnesses;
- Involve peer supporters who can model positive leisure coping strategies;
- Train case managers to more specifically assess leisure coping beliefs and to include recreation and leisure as a focus;
- Develop and evaluate a manualized training program to promote self-determination and proactive coping for persons with serious mental illnesses through recreation and leisure involvement;
- Develop and evaluate a manualized training program to increase environmental supports for recreation and leisure involvement, including self-advocacy and education for family and friends.
The following Web sites may be helpful for individuals and agencies interested in promoting physically and socially active recreation involvement and community inclusion in persons with serious mental illnesses:
http://www.ncpad.org, National Center on Physical Activity and Disability, University of Illinois at Chicago
http://www.camh.net/printable/healthybodieserious mental illnessesnd_crcuspring2004_pr.html, Active bodies and healthy minds: Physical activity promotes recovery from mental illness: CrossCurrents Spring 2004. Center for Addictions and Mental Health
http://ici.umn.edu/products/impact/162/over2.html, Institute on Community Integration, The College of Education and Human Development, University of Minnesota
http://prevention.sph.sc.edu/palinks/index.htm, Physical Activity Links, Arnold School of Public Health Prevention Research Center, University of South Carolina
http://www.recreationtherapy.com/tx/txfit.htm, Therapeutic Recreation Directory, Resources for Therapeutic Recreation Professionals
The following references are suggested for further information on the importance of physically and socially active recreation for persons with serious mental illnesses:
- Brown, S., Birtwistle, J, Roe L, Thompson, C. (1999). The unhealthy lifestyles of people with schizophrenia. Psychological Medicine 29(3), 697-701.
- Dench, L (2002). Exercise and movement as an adjunct to group therapy for women with chronic mental illness. Women & Therapy, 25(2) 39-55.
- Dunn, A., Andersen, R., Jakici, J. (1998). Lifestyle Physical Activity Interventions: history, Short- and Long-term effects, and recommendations. American Journal of Preventive Medicine, 15(4), 398-412.
- Faulkner, G., Sparkes, A. (1999). Exercise as therapy for schizophrenia: An ethnographic study. Journal of Sport and Exercise Psychology, 21(1) 52-69.
- Fox, D (2000), Physical activity and mental health promotion: the natural partnership. International Journal of Mental Health Promotion, 2(1) 4-12.
- Richardson, C., Faulknes, G., McDevitt, J., Skrianar, G., Hutchinson, D., Piette, J. (2005). Integrating physical activity into mental health services for persons with serious mental illness. Psychiatric Services, 56(3), 324-331.
- Aspinwall, L. & Taylor, S. (1997). A stitch in time: Self-regulation and proactive coping. Psychological Bulletin, 121, 417-435.
- Brown, S., Birtwistle, J., Roe L., & Thompson, C. (1999). The unhealthy lifestyle of people with schizophrenia. Psychological Medicine, 29, 697-701.
- Chan, S., Krupa, T., Stuart, J, & Eastabrook, S. (2005). An outcome in need of clarity: Building a predictive model of subjective quality of life for persons with severe mental illness living in the community. American Journal of Occupational Therapy, 59(2), 181-190.
- Community Integration and Social Roles, Collaborative on Community Integration at Temple University, retrieved at http://www.upennrrtc.org/issues/issue_socialroles.html, 7/18/05.
- Davidson, S., Judd, F., Jolley, D., et al. (2001). Cardiovascular risk factors for people with mental illness. Australian and New Zealand Journal of Psychiatry, 35, 196-202.
- Iwasaki, Y. & Mannell, R. (2000). Hierarchical dimensions of leisure stress coping. Leisure Sciences, 22, 163-181.
- Krupa, T., McLean, H., Eastabrook, S., Bonham, A., & Baksh, L., (2003). Daily time use as a measure of community adjustment for persons served by assertive community treatment teams. The American Journal of Occupational Therapy, 57(5), 558-565.
- McCormick, B., (1999). Contribution of social support and recreation companionship to the life satisfaction of people with persistent mental illness. Therapeutic Recreation Journal, 33(4), 320-332.
- Taylor, S. (2002). The Tending Instinct. New York: Henry Holt.
- Yanos, P. (2001). Proactive coping among persons diagnosed with severe mental illness: An exploratory study. Journal of Nervous and Mental Disease, 189(2), 121-123.
- The above materials were developed for the Temple University Collaborative by Kathy Coyle, Ph.D. and John Shank, Ed.D. Temple University Department of Therapeutic Recreation.