Maslow and Mental Health Recovery: A Comparative Study of Homeless Programs for Adults With Serious Mental Illness
Maslow’s hierarchy of needs is a well known psychological theory that posits having one’s basic needs met as a necessary prerequisite to pursuing a fulfilling life. This paper applies Maslow’s theory to understanding recovery among adults with serious mental illness who have experienced chronic homelessness. Research questions include 1) does meeting one’s basic need for housing (at the base of Maslow’s pyramid) make the pursuit of recovery more likely? 2) what other needs must be met before focusing on recovery? 3) do hierarchies of needs change over time, and if so what factors are associated with this change?
Hierarchies of needs, and whether they change over the course of a year, were examined among 57 individuals enrolled in programs serving formerly homeless adults with serious mental illness. These individuals were new enrollees of either a “housing first” (HF) program that provides immediate access to permanent housing or a “treatment first” (TF) program that focuses on clinical outcomes before providing permanent housing. Interviews at baseline and 12-months yielded data that were analyzed using a case study approach to construct a case summary and Maslovian pyramid for each individual. Cross-case analysis (Patton, 2002) was then used to determine if individuals progressed from lower level needs toward self-actualization (recovery) at the top of the pyramid in a linear fashion.
Results indicate that fulfilling a Level 1 need through permanent housing was associated with higher self-reported goals closer to the top of the pyramid. At baseline 55% of the HF group reported higher level goals compared to 29% of TF, perhaps reflecting differences in housing permanence when entering the distinct programs. However, at follow up, both groups reported higher level goals, (64% of HF and 69% of TF), suggesting having shelter allowed for the pursuit of higher level goals. Apart from housing at Level 1, there were no significant differences found at baseline between rates of goals being pursued in different levels of the hierarchy. However at follow up, the HF group was more likely to be pursuing health goals (level 2 in the hierarchy), while the TF group was more likely to be pursuing social goals (level 4 in the hierarchy), perhaps a result of TF programs having a required treatment component. Although Maslow’s theory posits that needs drive goals, the TF group saw a decline in the self-reported need for housing (17%) that was disproportionately smaller than the decline in the self-reported pursuit of housing (36%), indicating that needs do not necessarily drive the pursuit of goals.
Invoking Maslow’ hierarchy to help guide mental health and social service policy decisions can be useful but risks understating the complex relationship between an individual’s environment, identifiable needs, and the pursuit of goals. The application of a capabilities framework may be a more suitable approach to understanding recovery, as it is predicated on individual choice and structural factors shaping this choice.