The Ties That Bind and Unbound Ties: Experiences of Formerly Homeless Individuals in Recovery from Serious Mental Illness and Substance Use

Background and Purpose:

Strong social ties have been shown to have a positive influence on the course of mental illness and recovery from substance abuse for individuals with severe mental illness (SMI). However, compared to the general population, individuals with SMI are known to have smaller and less reciprocal networks, which are associated with lower social support and fewer environmental resources, especially in times of stress. These problems are further exacerbated if individuals with SMI also struggle with substance use and/or homelessness. In this report, we explore the nature and quality of social ties of formerly homeless individuals in recovery from SMI and substance use and how these ties relate to their experience of community.

Methods:

Using principles of grounded theory with thematic and cross-case analysis, we analyzed 34 qualitative interviews conducted with predominantly racial/ethnic minority individuals (64% African American) receiving services from two New York City area programs (76% male, mean age=51.8, SD=9.3). The analysis focused on each participant’s perceived community of choice, level of integration, social ties that individuals had in each community and their overall sense of belonging with respect to their communities as a way to get an in-depth understanding of their social ties and degree of community integration. 

Results:

Participants described a range of involvement and experiences in the mental health service and the mainstream communities indicating a combination of weak or strong ties to these communities. Across participants, two broad themes emerged that shed light on the nature of individuals’ relationships with their social ties in the context of their communities: ties that bind and obstacles that “get in the way” of forming meaning social ties. Supportive family ties was the most salient subtheme related to a strong connection with the mainstream community whereas loss of family ties was more salient for those with stronger connections to the mental health service community. Sub-themes that resonated with participants included ties to cultural spaces such as churches, ties to employment, avoiding substance-using peers and stigma. Individual case-study analyses lead us to develop five typologies of individuals with respect to their social ties ranging from individuals with no social ties to individual with ties primarily in the mental health community to individuals with ties primarily in the mainstream community and equally strong ties in both communities. As a last step of the analysis, we integrated the case-study typologies with our thematic findings for a deeper understanding into the individuals’ social ties.

Conclusions and Implications:

The current study integrates our understanding of the positive and negative aspects of social ties, and goes beyond the notion that individuals with SMI and substance use disorders have limited social ties. Instead we provide a theoretical framework that highlights the complicated nature of ties to family, friends, cultural spaces and mental health service providers and peers within the community and as such, provides a more complex and multidimensional representation of the social ties within the contexts of the communities for formerly homeless individuals with SMI and co-occurring substance abuse problems