Recovery in homelessness: The influence of choice and mastery on physical health, psychiatric symptoms, alcohol and drug use, and community integration.

Abstract

Objective: Recovery is the process through which one learns to overcome, manage, or live with the negative consequences of physical illness, mental illness, alcohol or drug misuse, or trauma. Homeless individuals endure many, or all, of these experiences. Previous research has shown that characteristics of homeless services, particularly the amount of choice they afford to service users, can influence recovery experiences, potentially by increasing a sense of mastery. The purpose of this study was to test the hypothesis that choice in housing and services would predict recovery in a number of domains, and that these relationships would be mediated by mastery. Method: Using survey data collected from a sample of homeless services users (n = 160) in Ireland, we conducted a series of cross-sectional mediation analyses to predict recovery in domains of physical health, psychiatric symptoms, alcohol and drug use, and community integration. Results: We observed the hypothesized mediational relationship for each recovery domain except alcohol use. That is, personal mastery mediated the relationship of perceived choice to self-appraised physical health, psychiatric symptoms, drug use, and physical and psychological aspects of community integration, but not alcohol use. Conclusions and Implications for Practice: Findings add further support to the growing body of evidence that suggests choice is centrally important to recovery experiences among individuals in homelessness.

Beyond behaviour: rethinking integration for people experiencing homelessness

“…Some studies have found that having lower psychopathology was associated with higher psychological integration Gulcur et al, 2007); others found that social integration was largely independent of clinical symptoms . Recently, Manning and Greenwood (2019) demonstrated that personal mastery mediates the relationship of perceived choice to physical and psychological integration. Despite the wide range of studies on this subject, we found several challenges related to studying integration and homelessness.…”

Mechanisms of change and participant outcomes in a Recovery Education Centre for individuals transitioning from homelessness: a qualitative evaluation

“…Our findings suggest that similar mechanisms of change and participant outcomes are observed in a subpopulation experiencing or transitioning out of homelessness as in broader samples. In this context, it is important to highlight that the key elements and mechanisms of change in RECs are aligned with the central roles of choice, social relationships, meaningful activities and valued social roles, previously identified as central in facilitating the process of recovery for this population [16,18,22,23], and in keeping with this populations' service needs and preferences [13]. This, in turn, suggests that RECs can have an important role to play in supporting the process of recovery within the homeless services sector.…”

“…Despite the growing literature, little is known about how REC participation and outcomes might differ in diverse service delivery contexts and for diverse subpopulations, such as people experiencing homelessness and unique barriers to recovery. As homeless individuals experience complex health, mental health and social needs, recovery from homelessness has been conceptualized as largely overlapping with the process of recovery from mental health and substance use challenges in prior research [16,18,22,23]. Prior studies have also highlighted the central roles of housing and choice in services, as well as the importance of social relationships, meaningful activities and valued social roles in facilitating the process of recovery for this population [16,18,22,23].…”

Community integration when moving on from permanent supportive housing

“…Based on prior research, housing quality, neighborhood quality, and mastery were selected as factors that may be associated with community integration (Manning & Greenwood, 2019;Segal et al, 1980;Wong & Stanhope, 2009;Yanos, Felton, Tsemberis, & Frye, 2007). Subscales of the Housing Quality Survey (Kloos & Shah, 2009) were used to assess housing and neighborhood quality.…”