Response to “Doing My Best: Poverty and Self-Care Among Individuals With Schizophrenia and Diabetes Mellitus” by Peggy El-Mallakh

OVERTY, SCHIZOPHRENIA (SZ), and diabetes mellitus (DM) compose a ferocious triad of co-occurring social and psychiatric conditions that could interrupt anyone’s life regardless of the capacity to purchase goods and services. In the article bDoing My Best: Poverty and Self-Care Among Individuals With Schizophrenia and Diabetes Mellitus,Q the author posited that DM is more common among individuals diagnosed with SZ than among the general population. Recent standards of care for individuals with SZ include screening for DM and related conditions that could occur because of their long-term use of atypical psychotropic medications, obesity, and lifestyle. Using the grounded theory, the sample in this study was composed of 11 individuals with comorbid SZ and one of its five subtypes (schizoaffective disorder) and DM (Type I or Type II). The mean age of the sample was 50 years; all participants were recipients of Medicaid and received their mental health services from a community mental health center located in an urban setting. The author used the conceptual framework of Evolving Self-Care, which describes the process by which respondents developed self-care health beliefs over time to help them successfully manage their SZ and DM. The author identified the domains of Mastering Mental Illness, Accommodating Diabetes, and Striving for Health; however, a discussion about the access and quality of health care that the individuals received is missing. The issue about the therapeutic, economic, and social benefits of work was not explored. The author neglected to discuss the process of informed consent gathering and the methods of recruitment of the individuals into the study. Nevertheless, the author made a compelling case about the lives of individuals with SZ and DM and how these disorders influence poverty and health outcomes. She described how mental illness helps create and maintain mental health risks and poverty. She used the World Health Organization’s definition of poverty, which has two dimensions, human and income. Human poverty is embedded in multiple dimensions that encompass deprivation of knowledge and a decent standard of living. Income poverty is a major determinant of human poverty that can be immediately linked to health status and quality of life. When poverty interdigitates with SZ and DM, a ferocious triad emerges, regardless of which condition preceded which. Based on the model and the data, the author appropriately identified the overarching theme of Doing My Best and used it to discuss how the individuals with SZ addressed their daily health needs that were interwoven with their self-care for DM. One of the lessons learned by the individuals was confronting and navigating the barriers and constraints that exist when individuals with this triad (SZ, DM, and poverty) are accessing health care and other essential support services. They have to decide between essential medications for DM, SZ, and other health problems related to cardiovascular and gastrointestinal conditions. Other data abounded and illuminated the same or similar choices, which are not choices at all. Others in the study related that their finances would not allow for the purchase of the medications and basic essentials, such as food, decent housing, and other personal items, that support their health. However, the individuals persevered and tried to overcome