Mental Health Recovery for Individuals Who Have Experienced Chronic Homelessness

Background and Purpose: Mental health recovery has been characterized as a unique, personal journey. Focusing on the individual, however, risks missing larger societal and environmental factors that also determine a person’s well-being and that contribute to one’s “recovery potential.” The majority of studies about mental disorders in general, and mental health recovery in particular, rarely address issues of poverty, inequality, or social class except when controlling for such variables. This study considers individuals with psychiatric disabilities who have experienced chronic homelessness in order to understand how, if at all, mental health recovery occurs for individuals most marginalized in the United States. The study is informed by Amartya Sen’s Capabilities Theory, which has been proposed as an alternative approach to thinking about poverty, economic development, and social welfare, and has more recently been applied to the idea of mental health recovery (Hopper, 2007).

Methods: As part of a federally-funded qualitative study, 40 individuals who met a minimum, objective criteria for recovery (e.g. stably housed, drug-free, employed, socially connected, etc.) were purposively sampled from either a traditional supportive housing program or a housing first (HF) program. Researchers conducted in-depth qualitative interviews and used case study and cross case analyses to examine the context and degree of mental health recovery broadly defined. All protocols were approved by the authors’ Institutional Review Board.

Results: Thematic findings demonstrate that while on their own participants can attain various markers of mental health recovery, cumulative adversity and high rates of adverse life events limit one’s recovery potential. Further, such challenges are often independent of mental illness. Interestingly, interventions and programs designed to initially support recovery (e.g. medication, supportive housing, sheltered employment, and disability benefits) can subsequently limit recovery. Accordingly, consumers expressed ambivalence both about accepting supports and graduating from these supports.

Conclusions and Implications: Findings show although the public mental health system can function as a safety net for those individuals most marginalized it does not adequately support a promise of mental health recovery. Individuals with serious mental illness who have experienced homelessness face overcoming a lifetime of multiple and overlapping struggles. Designing a service system that addresses both health and social conditions is required in order to realize a recovery orientation. Such a system must also be flexible and accommodate different stages of an individual’s journey in order to promote recovery.