Michael Rowe, PhD

My research proceeds from the idea that the foundation of mental health and mental illness is social; thus mental health care must include attention to the client/patient as a person living in society and in relationship with others. In the 1990s I studied mental health outreach to people who are homeless (outreach work). In outreach work, clinicians leave their offices to find, make contact, and build trust with people who, often, are avoiding contact with mental health professionals due to their previous negative experiences with them. Outreach workers move at the client’s pace, gradually introducing a range of services including primary care, access to entitlement income, and housing, hoping eventually to persuade people to accept mental health care. I see the encounters between homeless people and outreach workers as social encounters taking place at the psychological, socioeconomic, and physical boundaries of society. These social encounters involve transactions and negotiations regarding both instrumental goods such as housing and access to income, and affective goods including one’s future identity as a ‘mental patient.’

I found that, in addition to making health care and substantial resources such as housing and income available to their clients, outreach workers often were, at the same time, conferring upon them a status of ‘program citizenship,’ with dependence on clinicians and other care workers for much of their social contact. This finding led me to citizenship as a framework for support of the social inclusion and participation in society of people with mental illnesses. My colleagues and I define citizenship as the person’s strong connection to the 5 R’s of rights, responsibilities, roles, resources, and relationships that society makes available to its members through public and social institutions and associational and civic life. Our research has included individual and group citizenship interventions with program manualization, development of an individual measure of citizenship, and citizenship-oriented mental health care with community supports and access to valued community roles, for people with mental illness including those who are further marginalized by homelessness, addictions, and criminal charges. This research includes a randomized clinical trial (RCT) that found reduced substance and alcohol use and increased quality of life for citizenship participants compared to those receiving usual care. The deployment of peers as staff, and later as researchers, has been a core principle and practice of citizenship interventions since our finding, from another RCT, that peer staff have a unique facility for engaging previously unengaged persons into treatment and self-help groups such as AA and NA.

My research and writing in the fields of bioethics and narrative medicine are, in one way, distinct from my research and writing in mental health. A thread that runs through both domains, however, is the relationship between patients (or clients) and doctors, clinicians, and other helpers in the context of the professional, social, and institutional settings within which these relationships, and these forms of care, occur. In addition, I am now conducting cutting edge research on 'motive control' for people with strong vengeance cravings for past wrongs with my colleague James Kimmel, J.D. and other researchers at the Yale Program for Recovery and Community Health (PRCH).