Surviving versus living life: Capabilities and service use among adults with mental health problems and histories of homelessness

Abstract

The capabilities approach is a framework that can be applied to marginalised populations, including people with mental health problems and histories of homelessness, to measure well‐being. Although a range of health and social services exist to address the many challenges associated with mental health problems and homelessness, the extent to which these services impact capabilities is unknown. This qualitative study explored the perspectives of people with mental health problems and histories of homelessness to understand how they perceived their service use as affecting their capabilities. In‐depth interviews were conducted over a 1‐year period beginning in October 2016 with 52 adults with mental health problems who were currently or formerly homeless and living in Ottawa, Canada. Data were analysed using first and second cycle coding, which involved line‐by‐line, descriptive coding followed by focused coding to categorise the data within a broadly applied capabilities framework. Findings showed that participants perceived many capability impairments in their lives, including nutritious food scarcities, limited material rights, social role deprivations, social isolation and insufficient income to participate in recreational activities. Services used by participants had mixed, for better and worse, and limited effects on their capabilities (e.g., unable to overcome affordable housing shortages or financial barriers associated with some capability impairments). Furthermore, service use could promote one capability while hindering another, forcing people to choose between competing needs when using services. Overall, the capabilities approach offers a comprehensive, human rights‐based framework that is relevant to people with mental health problems and histories of homelessness but the services used by this population primarily help people to survive life but not necessarily live life.

Finding home: Community integration experiences of formerly homeless women with problematic substance use in Housing First

“…The findings are consistent with past research, highlighting the detrimental effects of poverty, stigma, and social isolation in quality of life of formerly homeless people (Henwood et al, 2015; Kerman & Sylvestre, 2020; Waldbrook, 2013). As Sylvestre (2017) noted, housing is a necessary but insufficient foundation for full community participation.…”

“…People transitioning out of homelessness can encounter a range of challenges after becoming housed that may limit their community integration or make it a complicated and nonlinear process (Coltman et al, 2015). Continued unemployment and poverty have been identified as financial barriers to involvement in community activities and pursuit of educational goals (Cherner, Aubry, & Ecker, 2017; Coltman et al, 2015; Henwood, Derejko, Couture, & Padgett, 2015; Kerman & Sylvestre, 2020). Isolation and loneliness are also impediments to community integration.…”

A Multilevel Intervention Framework for Supporting People Experiencing Homelessness with Pets

“…For example, in Ontario, Canada, it is illegal for landlords to reject housing applications or evict tenants on the basis of pet ownership. However, the law is poorly enforced, with many people also being unaware of their rights in this area [ 41 , 68 ]. As such, it is not uncommon for housing rentals to continue to be advertised as not allowing pets, deterring pet owners from pursuing the unit given the potential hassle and stress associated with dealing with an unaccepting landlord.…”

“…Pets can also yield barriers and vulnerabilities that complicate people’s experiences of homelessness. Most notably, many homeless sector services, including emergency shelters, have policies that forbid pets [ 25 , 41 ]. For example, in a recent U.K. study, slightly over 60% of homeless sector services were not accepting of pets [ 42 ].…”

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

“…Nicholls (2010) suggested that staircase services afford services users' bodily health and integrity but at the expense of their control over environment, which underpinned their freedom: how they lived their life, and what they could do or could be. Similarly, in a study that compared the experiences of service users in emergency shelters with those in housing, Kerman and Sylvestre (2019) reported that shelter users were able to address bodily health and integrity, but the restrictions associated with shelter life did little else to improve their lives. In a study of the capabilities and resilience of homeless service users, Smith (2010) indicated that while staircase services were initially supportive and allowed people in homelessness to address bodily health and integrity, staying there long-term was inappropriate.…”