Session: Mental Health Recovery and Homelessness: Qualitative and Mixed Method Approaches to Understanding What Works (and How) in Service Delivery (Research that Promotes Sustainability and (re)Builds Strengths (January 15 - 18, 2009))

As the mental health recovery movement gains momentum, the promise of living with and beyond serious mental illness has become a reality for many persons. Yet the significant subgroup of these individuals beset by substance abuse and homelessness is overlooked by advocates of this movement. The plight of dual diagnosed homeless adults has been the subject of recent debates about the effectiveness of mainstream approaches requiring abstinence and other types of compliance before independent housing is provided. The ‘housing first' approach, which reverses this ‘treatment first' continuum by offering apartments without such contingencies, has been found to increase long-term housing stability and consumer satisfaction (Tsemberis et al., 2004). Despite recent endorsements by Federal policymakers, the ‘housing first' approach is in an early stage of dissemination and its impact on mental health recovery remains poorly understood.

The papers in this symposium address unanswered questions about the role of housing in mental health recovery among homeless mentally ill adults with co-occurring substance abuse problems. All but one paper draws upon findings from the New York Services Study (NYSS), an NIMH-funded qualitative study in which sample sizes were large enough to address an important quantitative outcome (see Paper #2 below). The NYSS is a prospective 12-month follow-up of homeless mentally ill clients and their case managers in the year after enrolling in a ‘housing first' or one of three ‘treatment first' programs in New York City. Most of the NYSS analyses focus on contrasting these two fundamentally different approaches and what this means for clients and their recovery.

Paper #1 uses case study methods to examine case managers' perspectives of their clients who disengaged prematurely from the program (almost all of whom were in ‘treatment first' programs). Paper #2 uses both qualitative and quantitative methods to assess substance use as a key (but heretofore missing) outcome in research contrasting the two approaches. Paper #3 reports findings based upon extending Anthony Giddens' theory of ontological security to an understanding of the impact of the social environment on mental health recovery among newly housed mentally ill adults. Paper #4 presents findings from a qualitative study carried out in the United Kingdom to highlight the cross-national challenges of providing effective services to homeless adults with serious mental illness and co-occurring substance abuse.

All of the symposium papers draw on data derived from multiple in-depth interviews and prolonged engagement with study participants. They also use differing qualitative (or quantitative) methods and apply relevant theories to gain a deeper understanding of the fit (or lack of fit) between the needs of homeless mentally ill consumers and mainstream service delivery systems and policies. Taken together, they provide a consumer-focused perspective on the role of housing and services in trajectories of mental health recovery among one of society's most vulnerable groups.

The NYSS was funded by NIMH (#R01 MH-69865)