Coping amidst an assemblage of disadvantage: A qualitative metasynthesis of first‐person accounts of managing severe mental illness while homeless

Karadzhov, Dimitar; Yuan, Yeqing; Bond, Lynden

doi:10.1111/jpm.12524

Cited by 16 publications

(17 citation statements)

References 90 publications

(222 reference statements)

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“…As such, working relationships that are grounded in trust, respect, fairness and honesty are key to providing recovery-oriented care to currently and formerly homeless people with mental illness. Moreover, as many people with mental illness and histories of homelessness have limited social ties and networks (Hawkins & Abrams, 2007; Karadzhov et al, 2020; Pahwa et al, 2019), the relationships developed in service settings may partially compensate for unmet social needs.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this, conceptualizations of recovery have largely neglected how poverty may restrict people from living the lives that they want (Padgett et al, 2016; Sylvestre et al, 2018). For example, research has shown that homelessness and adulthood victimization are detrimental to recovery (Castellow et al, 2015; Karadzhov et al, 2020; Kerman, Sylvestre, et al, 2019; Stumbo et al, 2015). Further, the stability provided by safe and affordable housing, with the necessary supports, can be the foundation to recovery for people with serious mental illness (Kirkpatrick & Byrne, 2009; Padgett, 2007; D.…”

Section: Introductionmentioning

confidence: 99%

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Service use and recovery among currently and formerly homeless adults with mental illness

Kerman

Sylvestre

2020

Int J Soc Psychiatry

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Background: A range of health and social services exist to address the many life adversities experienced by people with mental illness. However, the effects of services on their recovery in the context of ongoing homelessness and poverty have been minimally examined. Aims: This qualitative study sought to better understand the role of health and social services in the recovery processes of people with mental illness and histories of homelessness. Similarities and differences in the perceived impacts of services on recovery between currently and formerly homeless participants were also explored. Method: In-depth interviews were conducted with 52 currently and formerly homeless people with mental illness. Informed by a recovery framework, qualitative data were analyzed using two cycles of coding. Results: Services were perceived to affect recovery by (1) finding ways to cope and get by, (2) feeling less alone, (3) giving back, (4) being dehumanized or seen as someone and (5) encountering restrictions when getting help. Experiences of discrimination, fewer opportunities to give back and limited service options were heightened among participants experiencing homelessness compared to the housed group. Conclusion: Health and social services can promote and hinder recovery among currently and formerly homeless people with mental illness. Despite several differences between the two groups, the relationship between recovery and service use was similar for currently and formerly homeless participants, suggesting that both groups access services to address needs related to social connection, health and functioning and meaningful activities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Service use and recovery among currently and formerly homeless adults with mental illness

Kerman

Sylvestre

2020

Int J Soc Psychiatry

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“…In the context of homelessness, however, those recovery-promoting processes are often severely disrupted (e.g. Karadzhov, Yuan, & Bond, 2019). For many, homelessness is a profoundly alienating and dehumanising experience, which can impede the individual's capabilities of maintaining meaningful social relationships.…”

Section: Analysis Of Personal Recoverymentioning

confidence: 99%

Explaining mental health recovery in the context of structural disadvantage: the unrealised potential of critical realism

Karadzhov

2019

Soc Theory Health

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Despite the acknowledgement that mental health inequalities are shaped by the interaction of macro-level (structural) and micro-level (individual, agentic) powers, dominant paradigms in mental health research have been ill-equipped to integrate those different levels of influence theoretically and empirically. As a result, an 'explanatory deficit' persists as to the causal mechanisms underpinning the impact of social inequalities on mental well-being, particularly mental health recovery. To redress this gap, critical realism has been put forward as a useful metatheoretical alternative. This paper begins by offering a succinct critique of extant mental health recovery research. Mental health recovery is problematised in relation to its dynamic embeddedness in contextual, including macro-structural, conditions. The core tenets and principles of critical realism are then invoked to address the identified philosophical and theoretical inadequacies. This paper argues that critical realism offers promise for explaining how inequality-generating mechanisms, such as social exclusion, may impede recovery. The analytico-conceptual potential of critical realism has remained largely untapped by the extant mental health scholarship. Critical realism offers a holistic and inclusive set of conceptual tools to re-examine the structure-agency nexus in order to advance mental health recovery and inequalities research, and an equity-based policy agenda.

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“…However, PEH with SMI have incredibly high needs and health disparities. [2][3][4][5][6][7][8][9][10] Little is known about similarities and differences in pathways to homelessness for patients with and without psychiatric illness. One study suggests that PEH with mental illness have similar pathways to homelessness as their peers without psychiatric problems.…”

Section: Discussionmentioning

confidence: 99%

Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey

Gabrielian

Jones

Hoge

et al. 2021

J Prim Care Community Health

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Objectives: Patients experiencing homelessness (PEH) with serious mental illness (SMI) have poor satisfaction with primary care. We assessed if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs)) provide this population with superior experiences than mainstream primary care and explored whether integrated behavioral health and social services were associated with favorable experiences. Methods: We surveyed VA PEH with SMI (n = 1095) to capture the valence of their primary care experiences in 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs). We surveyed clinicians (n = 52) from 29 H-PACTs to elucidate if their clinics had embedded mental health, addiction, social work, and/or housing services. We counted these services in each H-PACT (0-4) and classified H-PACTs as having high (3-4) versus low (0-2) service integration. We controlled for demographics, housing history, and needs in comparing H-PACT versus mainstream experiences; and experiences in high versus low integration H-PACTs. Results: Among respondents, 969 (91%) had complete data and 626 (62%) were in H-PACTs. After covariate adjustment, compared to mainstream respondents, H-PACT respondents were more likely ( P < .01) to report favorable experiences (AORs = 1.7-2.1) and less likely to report unfavorable experiences (AORs = 0.5-0.6) in all 4 domains. Of 29 H-PACTs, 27.6% had high integration. High integration H-PACT respondents were twice as likely as low integration H-PACT respondents to report favorable access/coordination experiences (AOR = 1.7). Conclusions: Homeless-tailored clinics with highly-integrated services were associated with better care experiences among PEH with SMI. These observational data suggest that tailored primary care with integrated services may improve care perceptions among complex patients.

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Coping amidst an assemblage of disadvantage: A qualitative metasynthesis of first‐person accounts of managing severe mental illness while homeless

Cited by 16 publications

References 90 publications

Service use and recovery among currently and formerly homeless adults with mental illness

Service use and recovery among currently and formerly homeless adults with mental illness

Explaining mental health recovery in the context of structural disadvantage: the unrealised potential of critical realism

Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey

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