Mastery matters: consumer choice, psychiatric symptoms and problematic substance use among adults with histories of homelessness

Abstract

Previous research demonstrated the importance of consumer choice and mastery to residential stability and psychiatric functioning for adults with histories of homelessness. In the present study, we investigated whether these relationships hold, even in the context of problem-related substance misuse. Questionnaire data were collected in Ireland from 101 residents of long-term homeless accommodation in 2010. Hayes' PROCESS macro for mediation and moderation analysis in SPSS was employed to test our hypotheses. Findings demonstrated that the indirect effect of choice through mastery on psychiatric functioning was stronger for individuals with more recent problem-related substance use than for those with no or distant histories of problem-related substance use. Our findings confirm that consumer choice in housing and services is important to homeless services users' recovery experiences. Because of its relationship with mastery, consumer choice in housing and services protects homeless services users' psychiatric functioning, especially when substance use-related choices have had negative consequences. Our findings suggest that if homeless services take away consumer choice when substance use causes problems, they may actually undermine, rather than foster, service users' psychiatric functioning.

Microsystems of Recovery in Homeless Services: The Influence of Service Provider Values on Service Users’ Recovery Experiences

“…Also, substance use was measured only in terms of frequency, missing other important aspects of recovery in this domain (e.g., decreases in use‐related problems). In previous research (Greenwood & Manning, ), an indirect effect of choice through mastery on psychiatric symptoms was strongest for individuals with recent problem‐related substance use. This research suggests that choice and mastery are indeed important in recovery from alcohol and drug use.…”

Home as a Base for a Well-Lived Life: Comparing the Capabilities of Homeless Service Users in Housing First and the Staircase of Transition in Europe

“…Similar to King's (King 2003) contention, we found that home gave service users a place where they could exist free from the surveillance and interference of others and construct meaningful aspects of a well-lived life. For adults experiencing homelessness, choice over housing is associated with fewer psychiatric symptoms and better quality of life (Greenwood et al 2005;Greenwood and Manning 2017;Nelson et al 2007), and findings from this study captured a transformation that took place in participants' lives when they moved out of a low-choice situation in SS to a high-choice situation in HF. When given a secure base, tailored supports, and all the associated freedoms of home, service users began to exert control over their lives.…”

Exploring the Association of Community Integration in Mental Health among Formerly Homeless Individuals Living in Permanent Supportive Housing

“…While PSH may be seen as a form of harm reduction for individuals who use substances, sobriety is often not a prerequisite to obtain housing. Additionally, an individual’s autonomy to treatment is an important tenet of PSH (Greenwood & Manning, 2017) and further complicates substance use and mental health treatment and the simultaneous treatment of both in such settings.…”

“…While neighborhood quality should be considered when placing homeless individuals into housing, PSH is likely to be located in impoverished areas (Hsu et al, 2016) as previously discussed and an individual’s choice regarding housing may further be restricted by an individual’s limited income, influence from others (i.e., treatment providers, family members), and/or stigma regarding mental illness (Tsai et al, 2010). It is also of note that choice in services (i.e., housing, mental health services, substance use treatment) has been linked to better mental health outcomes (Greenwood & Manning, 2017).…”