Table 3.

Illustrative Quotes About Social Issues

Issue	Quote
Substance abuse	“If you have mental illness and you’re not taking care of yourself and if you self-medicate with a drug that’s deteriorating your brain and body-your whole being-then that’s going to cause something else.”
Immigration stress	“People who have severe mental illness and are not institutionalized need a lot of social support which really is not there. Particularly if they’re an immigrant and don’t speak English and again if they have an educational disadvantage.”
Housing	“With our adults, a lot of the issues impacting them are [related to] quality of living. Many of our families are living in very poor, unkempt buildings, and there’s a sense of frustration at not being able to provide better for their children as well as fighting the system to get repairs done in the home.”
Difficulties navigating the health system	“Because the majority of clients, they’re not aware of the services, they’re not aware of where they can go. Those who do [know where to go], maybe after a while, feel like they do need some help: ‘How can I advocate for myself? What do I do when I get there? What will I say?’”
Unemployment and underemployment	“If people are mentally well then they can cope with adverse life events and they can cope with chronic stress. I think investing in a community . . . is going to lead to less chronic stress and a better living environment with people that are developed to their fullest capacity because they have employment, and they can provide for themselves and their families.”
Interpersonal violence	“People that have a history of trauma or abuse or intimate partner violence . . . that’s where people start to have a lot of chronic mental health problems.”
Incarceration	“I have one patient [whose] 16-year-old son was wrongfully incarcerated. She told me her son was on camera somewhere else at the time that the crime was committed. He had a public defender and he’s just been locked away for months. He’s a kid so of course that [experience] is taking an incredible toll on her mental health.”