Assignment: Chronic Homelessness and Mental Health
Assignment: Chronic Homelessness and Mental Health
An Exploratory Analysis of Unhealthy and Abusive Relationships for Adults with Serious Mental Illnesses Living in Supportive Housing
Brad Forenza1 · Autumn M. Bermea2
Received: 1 September 2016 / Accepted: 28 April 2017 / Published online: 3 May 2017 © Springer Science+Business Media New York 2017
Literature Review
Serious Mental Illness and Chronic Homelessness
Serious mental illness (SMI) refers to a mental health diagnosis that substantially impedes an individual’s everyday life (Center for Behavioral Health Statistics and Quality 2015). Roughly 4% of U.S. adults were assumed to have SMI in 2014 (National Institute of Mental Health 2016). In urban communities, the proportion of residents living with SMI is generally higher than national averages (Slade et al. 2014). One explanation that Padgett et al. (2012) found is that having experienced life-course adversity (e.g., intimate partner violence victimization) often correlates with SMI diagnosis.
Since the closure of myriad psychiatric hospitals and state institutions, individuals with SMI who are left with a paucity of physical resources are at greater risk for expe- riencing homelessness than ever before (Bengtsson-Tops et al. 2014). According to the United States Department of Housing and Urban Development (2011), 26.2% of home- less individuals using American shelters had SMI in 2010. Roughly 8.5% points more (34.7% total) homeless individ- uals using American shelters had been diagnosed with sub- stance abuse problems, which may have been co-occurring with SMI (U.S. Department of Housing and Urban Devel- opment 2011). In fact, much of the existing SMI literature documents the co-occurrence of SMI and substance abuse (e.g. Collins et al. 2013; Oh and DeVylder 2014; Viron et al. 2014). In a systematic review of empirical literature, Roy et al. (2014) determined that adults with SMI who are homeless are more likely to be victimized than those who are not.
Abstract Individuals living with serious mental illness are at high risk of chronic homelessness, victimization, and intimate partner violence. In recent years, supportive hous- ing programs have emerged as one way to prevent home- lessness and victimization for this population, while also expanding social interactions and social networks. In con- cert with a focal supportive housing program, this research conducted two focus groups with 18 individuals who have a serious mental illness diagnosis. The authors sought to answer the research question, “What are perceptions of healthy and unhealthy relationships among formerly home- less people with serious mental illness?” To this end, the eight-item questionnaire was created around dimensions of power and control, as well as relationship equality. Find- ings from an inductive thematic analysis reveal three broad families of themes (relationship ideals, lived experiences, and risk/resources in supportive housing), around which smaller themes and subthemes are organized. Implications for policy, practice, and future research are also discussed.
Keywords Serious mental illness · Chronic homelessness · Intimate partner violence · Supportive housing · Social networks · Healthy relationships · Relationship skills
* Brad Forenza forenzab@mail.montclair.edu
1 Center for Child Advocacy and Policy, Montclair State University, 372 Dickson Hall, 1 Normal Avenue, Montclair, NJ 07043, USA
2 Family Studies, Montclair State University, Montclair, NJ 07043, USA
680 Community Ment Health J (2017) 53:679–687
Supportive Housing and Social Relationships
In recent years, the Housing First movement has empha- sized supportive housing as one approach to mediate the risk factors of having SMI and experiencing negative out- comes related to homelessness. The State of New York, Office of Mental Health (2015) defines supportive hous- ing as “an initiative to facilitate an increase in long-term/ permanent housing options for people with mental illness” (p. 5). This form of supportive housing allows individuals with SMI to become more independent in meeting personal needs, while maintaining on-site access to helping profes- sionals (Haskell et al. 2016). Cultivating pro-social rela- tionships is among the primary aims of supportive housing for psychiatric consumers of the Housing First movement (Temple University Collaborative 2011; Yanos et al. 2004; Wong and Solomon 2002).
Adults with SMI tend to report smaller social networks when compared to the general population (Casas et al. 2014; Kilbourne et al. 2007; Padgett et al. 2008; Pernice- Duca 2008). This may be due, in part, to the difficulties of establishing lasting social relationships in the context of the chronic homelessness that plagues this population (Padgett et al. 2008). In other words, it may be a struggle to main- tain consistent relationships within the transient nature of a homeless living condition (Patterson et al. 2015).
However, entering supportive housing can offer home- less adults with SMI increased, positive social interaction that can transcend into building healthy, emotionally inti- mate relationships both inside and outside the residence (Haskell et al. 2016). Furthermore, adults with mental dis- orders who have entered supportive housing as a resource from homelessness have also reported increases in social support from both family (Henwood et al. 2014) and other members of their housing community (Patterson et al. 2105). Additionally, sometimes the small social networks of individuals with SMI are buttressed by the usage of tech- nology (Naslund et al. 2016; Townsend et al. 2016).
More frequently, however, adults with SMI report feel- ings of isolation and loneliness (Perese and Wolf 2005; Wright and Kloos 2007) and difficulty in developing and maintaining social relationships (Padgett et al. 2008). Sup- portive housing is assumed capable of expanding a men- tal health consumer’s relational network and impacting his or her overall perceptions of wellbeing (Brunt and Hans- son 2002; Haskell et al. 2016; Patterson et al. 2015; Wright and Kloos 2007). For instance, participants in Haskell et al. (2016) study described how residents at care facili- ties benefited from activities, including regular socializa- tion. Furthermore, formerly homeless research participants from other studies have noted growth in their social circle, including in their romantic relationships (Patterson et al. 2105). Assignment: Chronic Homelessness and Mental Health.
