Bread and Shoulders: Reversing the Downward Spiral, a Qualitative Analyses of the Effects of a Housing First-Type Program in France

Abstract

This paper is a qualitative analysis of the effects of accompagnement, a support framework, on recovery trajectories of people with long-term homelessness and severe psychiatric disorders during 24 months in a Housing First-type program in France. A comprehensive methodology based on grounded theory was used to construct an interview guide, conduct multiple interviews with 35 Housing First participants sampled for heterogeneity, and produce memos on their trajectories before and after entering the program based on interview information. Thematic analysis of a representative subsample (n = 13) of memos identified 12 objective factors and 6 subjective factors key to the recovery process. An in-depth re-analysis of the memos generated four recovery themes: (1) the need for secure space favorable to self-reflexivity; (2) a “honeymoon” effect; (3) the importance of even weak social ties; (4) support from and hope among peers. Three challenges to recovery were identified: (1) finding a balance between protection and risk; (2) breaking downward spirals; (3) bifurcating the trajectory. This study provides new insight into the recovery process, understood as a non-linear transformation of an experience—the relationship between objective life conditions and subjective perception of those conditions—which reinforces protective support over risk elements.

“My Hope Is . . . ”: A Hope-Based Typology of Homeless Youth

“…Importantly, Epel et al (1999) recognized that although important as a correlate of attempted extrication from homelessness, self-efficacy was not correlated with successful extrication, given local housing crises. Our study is also consistent with previous findings that hope increases among formerly homeless adults and among formerly homeless youth when they are housed (Kidd et al, 2016; Rhenter et al, 2018). A Vancouver-based study examining the effects of housing on hope found an initial decrease in hope among formerly homeless youth due to demoralization, but a longer term increase in hope among those youth who later experienced success (Kidd et al, 2016).…”

Community‐based social interventions for people with severe mental illness: a systematic review and narrative synthesis of recent evidence

“…There were 16 eligible studies in this domain, nine of which were quantitative [28][29][30][31][32][33][34][35][36] and seven qualitative [37][38][39][40][41][42][43] Full-text articles excluded (N=184) ies were conducted in eight different countries: six in Canada 28,[35][36][37]42,43 , three in the UK 31,33,34 , two in the US 30,41 , and one each in Australia 32 , France 39 , India 38 , the Netherlands 29 and Norway 40 .…”

Effectiveness of a housing support team intervention with a recovery-oriented approach on hospital and emergency department use by homeless people with severe mental illness: a randomised controlled trial

“…Participants in the HF group, with the support of the team, applied for housing allowances, welfare and disability allowances. This explains the simultaneous increase in welfare benefits over the 2 years of follow up (Rhenter et al ., 2018). Costs of justice were not impacted by the intervention due to very small sample size to capture an effect on this service use.…”