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Lesley A. Tarasoff, MA PhD Candidate, Social & Behavioural Health Sciences

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Lesley A. Tarasoff, MA PhD Candidate, Social & Behavioural Health Sciences Dalla Lana School of Public Health, University of Toronto Doctoral Student Research Trainee Schizophrenia Program, Centre for Addiction & Mental Health Canadian Public Health Association Conference – May 29, 2014. - PowerPoint PPT Presentation

Interrogating food insecurity and community integration: The example of low-income people with schizophrenia in an urban setting

Interrogating food insecurity and community integration: The example of low-income people withschizophrenia in an urban settingLesley A. Tarasoff, MAPhD Candidate, Social & Behavioural Health SciencesDalla Lana School of Public Health, University of TorontoDoctoral Student Research TraineeSchizophrenia Program, Centre for Addiction & Mental Health

Canadian Public Health Association Conference May 29, 20141AcknowledgementsResearch Team: Sean Kidd (PI), Tyler Frederick, Gursharan VirdeeSteering Committee: Kwame McKenzie, Steve Lurie, Larry Davidson, David Morris, Janet Mawhinney, Susan Pigott, Tatum WilsonLucy Costa and the Empowerment Council Advisory CommitteeSummer students and volunteersParticipantsFunded by the Ontario Mental Health Foundation

2ObjectivesTo consider the role of food in the lives of low-income people with schizophrenia in an urban setting, and in turn, what meanings of food and food access suggest about how we understand food insecurity and community integration

3MethodsPurposeful, stratified samplingNeighbourhood, ethnicity, genderLongitudinal3 meetings over 8-10 monthsInterviews, participatory mapping, walking tours, survey

A diverse group of 31 individuals with schizophrenia or psychosis residing in downtown Toronto were recruited, primarily through CAMH outpatient case workers and other service providers, and a few snowball sampling (from the same provider or from another participant)Most of the literature on people with serious mental illness focuses on white men; wanted to get a diverse sample, to be more representative of peoples experiences and the demographic make-up of downtown Toronto. - Neighbourhood focus: Moss Park, Regent Park, Niagara, Trinity-Bellwoods, and ParkdaleThree times throughout the course of a year, each participant was interviewed and completed a survey, measuring quality of life, discrimination, neighbourhood climate, among others. As food began to emerged as a major theme in the qualitative data, interview questions regarding food were also asked.4Sample31 participants residing primarily in the neighbourhoods of Moss Park, Regent Park, and ParkdaleAge: Mean = 45; Min. = 28; Max. = 62; SD = 10.9Gender: 16 female (51.6%); 15 male (48.4%)Ethnicity: 1 Latin American (3.2%); 9 African/African-Caribbean (29%); 7 South Asian/Middle Eastern (22.6%); 6 East Asian/Southeast Asian (19.4%); 8 White European/White Canadian (25.8%)Sexual Orientation: All identified as heterosexual (100%)Marital Status: 5 in dating relationship or married (16%)

Note: many first generation immigrants (not born in Canada); path to Canada varied: Family Sponsorship 15; Refugee 5; Other 1Other types of employment status: volunteer, work program, looking for work, in school (e.g., George Brown)

Sample Immigration Status: 19 first generation immigrants (61%)Employment Status: 17 not in the labour force (not working, not looking) (54.8%)Housing Type: 16 live alone in supported/subsidized housing (51.6%); 9 live in supported/subsidized housing with others (29%)Age of diagnosis ranged from youth/teen to late 50sNumber of hospitalizations ranged from 0 to 30A few participants were hospitalized during the study (between sessions)

Education levels varied: most completed high schoolMarket housing alone, with others, with familyNote: 3 Cantonese-speaking participants (worked with an interpreter)Within weeks of exiting hospital to upwards of 20 years ago; most between 1-7 years agoOther types of employment status: volunteer, work program, looking for work, in school (e.g., George Brown)

Results ICommunity participation is a dynamic process, shaped by illness and non-illness associated social relationships and spaces, self-concept, and the resources available to a person

The first paper we have submitted for publication from this study provides an overview of the qualitative interview data, specifically focusing on experiences, beliefs, behaviours, and spaces constitute community participation for people with schizophreniaMy focus for this presentation will be on where and how food fits into this picture so I am diverging away from the title of this presentation and the abstract I submitted thus, I am somewhat doing away with an interrogation of food insecurity and community integration but ideas related to this interrogation of concepts still form my analysis

Food plays an important role in the lives of participants. Food matters in terms of basic food securityand nutrition, but it also connect peoples to their friends, family, and ethnic communities. For many,going to get groceries or meals represent a major portion of their social interaction. Many encounterrestrictions to food (e.g., boarding home rules, what types of food they can access and where they canaccess it).7Results IIFood as it relates to social relationships and spacesLimits the types of relationships you can have (e.g., dating)The types of spaces one (can) frequent (e.g., meal programs (to eat and/or volunteer at), restaurants) is limitedI would go to parties, I would go to restaurants, I would do fun things man, I would shop, I would buy my girl stuff

Spaces to meet people like you and not like you (is this really community integration? What types of communities can you really participate in? poverty and mental health communities, necessities, not social)

Results IIIFood as it relates to self-conceptIll be glad when I get home. That way I can open the fridge and they [workers] close the fridge, [with a] lock, you know, they close the fridge, the cupboards, everything and so you cant get any food. You only get served dinner 4:30. Seven oclock is tea and one cookie. And she [worker] watches how many cookies you have, only one cookie each person. Its hard. I used to do the cooking and now I dont do any cooking because the house they do the cooking. Thats why I didnt want to get food bank. If you get the food bank it means you have no way to get food. The bottom of the society, you get the food bank.

- Many experience a lack of freedom/choice regarding the type of food they eat (healthy? cultural-specific?), when they eat, where they eatNot really a pleasant experience to stand outside and wait to be let into a food bank or meal programDont want to be associated with poor people talk about poverty and mental illness as a co-current conditionResults IVFood as it relates to available resourcesI try not to go there because I dont want to like I dont want to go there to eat because Im still hungry when I leave and I want seconds.

No, I dont get three meals there. I just get If Im lucky I get breakfast and then I get maybe a hotdog or two for lunch. And supper, maybe a can of stew or something. But its not really a meal, the way its supposed to be.- Types of food available at food banks and meal programs (not always the healthiest); not only about what type of food is available but when it is available (certain times of day, etc. related to choice)Really take an intersectional approach to this workAbout culture, gender, housing situation, poverty, traumaThink about the relationship between healthy eating and mental health status; a number of (female) participants talked about diabetes ConclusionThe role of food in the lives of low-income people with schizophrenia reveals a lot about various systems, how we think about food insecurity and the weakness/limits of community integration as a recovery goalImplications beyond this populationPoverty as a social determinant of (mental) health; poverty is the main issue that must be addressed to improve the health of Canadians and eliminate health inequities (http://www.cma.ca/to-improve-health-tackle-poverty)

Positioning low-income people with schizophrenia as "food insecure" as it is traditionally understoodmay not be accurate. The ways in which people with schizophrenia think about food and access foodmay have implications for self-concept as well as for how we think about "food insecurity" and"community integration.

Co-morbid condition = mental illness & poverty part of the growing body of work and advocacy among medical practitioners and researchers recognizing poverty as a determinant of health

Conclusions:What are the implications of your research on practice or policy?Interrogating the origins of the concepts food insecurity and community integration is important inorder to have a better understanding of peoples lives. Considering the role that food plays in the lives ofpeople with schizophrenia may prove important when developing recovery plans and programs.

I think the self-concept piece here is key --- not just about integrating people back in the neighbourhood to be healthy or to recover lack of attention to individuals self-concept and sense of sense --- sense of self as a determinant of health

Implications beyond this population definitely some things related to food are specific, e.g., boarding home situation but much of we found can be applied to low-income people more broadly but if different than model of food insecurity many often think about (e.g., single mother working many jobs to feed her kids; immigrants working in low wage jobs, etc. many of our participants are middle-aged, not working, single, only supporting themselves, can go to meal programs during the day)

All of the access to resources stuff wasnt super surprising most interesting around rules and self-concept and social relationships

Thank you!Questions?

Contact Information: lesley.tarasoff@camh.ca 12

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