A Social–Ecological Model for Navigating Safety Across Time: The Experience of Black Adults With Serious Mental Illnesses

Objective: Coupled with disproportionate experiences of community violence, Black adults with serious mental illnesses are also vulnerable to racism, discrimination due to mental illness, and/or stigma that can negatively impact their sense of safety. As such, the present study explored the role of safety in the experiences of community living and receipt of mental health services for Black adults with serious mental illnesses. Method: Using principles of constructivist grounded theory and framework analysis, we conducted and analyzed qualitative interviews with 23 Black adults with serious mental illnesses receiving community-based mental health services in a major urban city in the Mid-Atlantic United States. Results: Participants described unsafe spaces related to high crime/violent neighborhoods, stigma, and racism, which they managed through individual coping mechanisms, relationships, and community supports. Mental health services, agency housing placement, and church affiliations mitigated risks to physical and psychological safety. Conclusions: A social– ecological model for navigating safety best represents participants’ experiences managing unsafe environments on individual, interpersonal, and community levels. Community-based mental health service settings and churches were focal points of protection, highlighting the urgent need for increased funding for mental health services and the importance of leveraging church as a safe haven.