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Predictors of Mental Health Recovery in Homeless Adults with Mental Illness


For people with mental illness, experiences of homelessness can complicate mental health recovery processes. This study used longitudinal data from a randomized controlled trial of housing first (HF) to examine predictors of recovery among homeless people with mental illness. Findings showed that health and community predictors were most strongly associated with mental health recovery. Receipt of HF did not have any effect on changes in recovery scores at follow-up. Overall, the findings suggest that interventions aimed at preventing chronic homelessness, strengthening social networks and community involvement, and providing case management services will facilitate mental health recovery.

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  1. Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16, 11–23. https://doi.org/10.1037/h0095655.

  2. Aubry, T., Goering, P., Veldhuizen, S., Adair, C. E., Bourque, J., Distasio, J., et al. (2016). A multiple-city RCT of housing first with assertive community treatment for homeless Canadians with serious mental illness. Psychiatric Services, 67, 275–281. https://doi.org/10.1176/appi.ps.201400587.

  3. Aubry, T., & Myner, J. (1996). Community integration and quality of life: A comparison of persons with psychiatric disabilities in housing programs and community residents who are neighbours. Canadian Journal of Community Mental Health, 15, 5–20. https://doi.org/10.7870/cjcmh-1996-0001.

  4. Boothroyd, R. A., & Chen, H. J. (2008). The psychometric properties of the Colorado symptom Index. Administration and Policy in Mental Health, 35, 370–378. https://doi.org/10.1007/s10488-008-0179-6.

  5. Castellow, J., Kloos, B., & Townley, G. (2015). Previous homelessness as a risk factor for recovery from serious mental illness. Community Mental Health Journal, 51, 674–684. https://doi.org/10.1007/s10597-014-9805-9.

  6. Chang, Y.-C., Heller, T., Pickett, S., & Chen, M.-D. (2013). Recovery of people with psychiatric disabilities living in the community and associated factors. Psychiatric Rehabilitation Journal, 36, 80–85. https://doi.org/10.1037/h0094975.

  7. Corrigan, P. W., Giffort, D., Rashid, F., Leary, M., & Okeke, I. (1999). Recovery as a psychological construct. Community Mental Health Journal, 35, 231–239.

  8. Corrigan, P. W., & Phelan, S. M. (2004). Social support and recovery in people with serious mental illnesses. Community Mental Health Journal, 40, 513–523.

  9. Corrigan, P. W., Salzer, M., Ralph, R. O., Sangster, Y., & Keck, L. (2004). Examining the factor structure of the recovery assessment scale. Schizophrenia Bulletin, 30, 1035–1041.

  10. Davidson, L., O’Connell, M. J., Tondora, J., Lawless, M., & Evans, A. C. (2005). Recovery in serious mental illness: A new wine or just a new bottle? Professional Psychology: Research and Practice, 36, 480–487. https://doi.org/10.1037/0735-7028.36.5.480.

  11. Davidson, L., Stayner, D. A., Nickou, C., Styron, T. H., Rowe, M., & Chinman, M. L. (2001). “Simply to be let in”: Inclusion as a basis for recovery. Psychiatric Rehabilitation Journal, 24, 375–388.

  12. Davidson, L., & White, W. (2007). The concept of recovery as an organizing principle for integrating mental health and addiction services. Journal of Behavioral Health Services & Research, 34, 109–120.

  13. Dennis, M. L., Chan, Y.-F., & Funk, R. R. (2006). Development and validation of the GAIN short screener (GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. American Journal of Addictions, 15, 80–91. https://doi.org/10.1080/10550490601006055.

  14. Ecker, J., Aubry, T., Wasylenki, D., Pettey, D., Krupa, T., & Rush, B. (2012). Predicting alcohol use and drug use among consumers of community mental health programs. Journal of Dual Diagnosis, 8, 188–199. https://doi.org/10.1080/15504263.2012.697861.

  15. Ellison, M. L., Belanger, L. K., Niles, B. L., Evans, L. C., & Bauer, M. S. (2018). Explication and definition of mental health recovery: A systematic review. Administration and Policy in Mental Health and Mental Health Services Research, 45, 91–102. https://doi.org/10.1007/s10488-016-0767-9.

  16. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14, 245–258.

  17. Girard, V., Tinland, A., Mohamed, E., French Housing First Study Group, Boyer, L., & Auquier, P. (2015). Psychometric properties of the recovery measurement in homeless people with severe mental illness. Schizophrenia Research, 169, 292–297. https://doi.org/10.1016/j.schres.2015.10.00.

  18. Goering, P. N., Streiner, D. L., Adair, C., Aubry, T., Barker, J., Distasio, J., et al. (2011). The at home/chez soi trial protocol: A pragmatic, multi-site, randomized controlled trial of a housing first intervention for homeless individuals with mental illness in five Canadian cities. British Medical Journal Open, 1, 1–18. https://doi.org/10.1136/bmjopen-2011-000323.

  19. Green, C. A., Perrin, N. A., Leo, M. C., Janoff, S. L., Yarborough, B. J. H., & Paulson, R. I. (2013). Recovery in serious mental illnesses: Trajectories, characteristics and the role of mental health care in the STARS study. Psychiatric Services, 64, 1203–1210. https://doi.org/10.1176/appi.ps.201200545.

  20. Hawkins, R. L., & Abrams, C. (2007). Disappearing acts: The social networks of formerly homeless individuals with co-occurring disorders. Social Science & Medicine, 65, 2031–2042. https://doi.org/10.1016/j.socscimed.2007.06.019.

  21. Hendryx, M., Green, C. A., & Perrin, N. A. (2009). Social support, activities, and recovery from serious mental illness: STARS study findings. Journal of Behavioral Health Services & Research, 36, 320–329.

  22. Herrman, H., Evert, H., Harvey, C., Gureje, O., Pinzone, T., & Gordon, I. (2004). Disability and service use among homeless people living with psychotic disorders. Australian and New Zealand Journal of Psychiatry, 38, 965–974.

  23. Kaplan, K., Salzer, M. S., & Brusilovskiy, E. (2012). Community participation as a predictor of recovery-oriented outcomes among emerging and mature adults with mental illnesses. Psychiatric Rehabilitation Journal, 35, 219–229. https://doi.org/10.2975/35.3.2012.219.229.

  24. Lloyd, C., King, R., & Moore, L. (2010). Subjective and objective indicators of recovery in severe mental illness: A cross-sectional study. International Journal of Social Psychiatry, 56, 220–229. https://doi.org/10.1177/0020764009105703.

  25. Lumley, T., Diehr, P., Emerson, S., & Chen, L. (2002). The importance of the normality assumption in large public health data sets. Annual Review of Public Health, 23, 151–169. https://doi.org/10.1146/annurev.publheath.23.100901.140546.

  26. Mental Health Commission of Canada. (2010). At home/chez soi instrument protocol. Calgary: Author.

  27. Nelson, G., & MacLeod, T. (2017). Theory and research on housing programs for people with serious mental illness. In J. Sylvestre, G. Nelson, & T. Aubry (Eds.), Housing, citizenship, and communities for people with serious mental illness: Theory, research, practice, and policy perspectives (pp. 155–185). New York: Oxford University Press.

  28. Padgett, D. K., Henwood, B., Abrams, C., & Davis, A. (2008a). Engagement and retention in services among formerly homeless adults with co-occurring mental illness and substance abuse: Voices from the margins. Psychiatric Rehabilitation Journal, 31, 226–233. https://doi.org/10.2975/31.3.2008.226.233.

  29. Padgett, D. K., Henwood, B., Abrams, C., & Drake, R. E. (2008b). Social relationships among persons who have experienced serious mental illness, substance abuse, and homelessness: Implications for recovery. American Journal of Orthopsychiatry, 78, 333–339. https://doi.org/10.1037/a0014155.

  30. Padgett, D. K., Smith, B. K., Choy-Brown, M., Tiderington, E., & Mercado, M. (2016a). Trajectories of recovery among formerly homeless adults with serious mental illness. Psychiatric Services, 67, 610–614. https://doi.org/10.1176/appi.ps.201500126.

  31. Padgett, D. K., Smith, B. K., Henwood, B. F., & Tiderington, E. (2012). Life course adversity in the lives of formerly homeless persons with serious mental illness: Context and meaning. American Journal of Orthopsychiatry, 82, 421–430. https://doi.org/10.1111/j.1939-0025.2012.01159.x.

  32. Padgett, D. K., Tiderington, E., Smith, B. T., Derejko, K.-S., & Henwood, B. F. (2016b). Complex recovery: Understanding the lives of formerly homeless adults with complex needs. Journal of Social Distress and the Homeless, 25, 60–70. https://doi.org/10.1080/10530789.2016.1173817.

  33. Pernice-Duca, F., & Onaga, E. (2009). Examining the contribution of social network support to the recovery process among clubhouse members. American Journal of Psychiatric Rehabilitation, 12, 1–30. https://doi.org/10.1080/15487760802615566.

  34. Resnick, S. G., Rosenheck, R. A., & Lehman, A. F. (2004). An exploratory analysis of correlates of recovery. Psychiatric Services, 55, 540–547. https://doi.org/10.1176/appi.ps.55.5.540.

  35. Rog, D. J., Marshall, T., Dougherty, R. H., George, P., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Permanent supportive housing: Assessing the evidence. Psychiatric Services, 65, 287–294. https://doi.org/10.1176/appi.ps.201300261.

  36. Salzer, M. S., & Brusilovskiy, E. (2014). Advancing recovery science: Reliability and validity properties of the recovery assessment scale. Psychiatric Services, 65, 442–453. https://doi.org/10.1176/appi.ps.201300089.

  37. SAMSHA. (2012). SAMSHA’s working definition of recovery: 10 guiding principles of recovery. Retrieved from https://www.samhsa.gov/recovery.

  38. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.

  39. Shern, D. L., Wilson, N. Z., Coen, A. S., Patrick, D. C., Foster, M., Bartsch, D. A., & Demmler, J. (1994). Client outcomes II: Longitudinal client data from the Colorado treatment outcome study. Milbank Quarterly, 72, 123–148. https://doi.org/10.2307/3350341.

  40. Sokal, J., Messias, E., Dickerson, F. B., Kreyenbuhl, J., Brown, C. H., Goldberg, R. W., & Dixon, L. B. (2004). Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services. Journal of Nervous and Mental Disease, 192, 421–427. https://doi.org/10.1097/01.nmd.0000130135.78017.96xw.

  41. Stergiopolous, V., Hwang, S. W., Gozdzik, A., Nisenbaum, R., Latimer, E., Rabouin, D., et al. (2015). Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: A randomized trial. JAMA, 313, 905–915. https://doi.org/10.1001/jama.2015.1163.

  42. Stumbo, S. P., Yarborough, B. J. H., Paulson, R. I., & Green, C. A. (2015). The impact of adverse child and adult experiences on recovery from serious mental illness. Psychiatric Rehabilitation Journal, 38, 320–327. https://doi.org/10.1037/prj0000141.

  43. Sylvestre, J., Notten, G., Kerman, N., Polillo, A., & Czechowki, K. (2018). Poverty and serious mental illness: Toward action on a seemingly intractable problem. American Journal of Community Psychology, 61, 153–165. https://doi.org/10.1002/ajcp.12211.

  44. Townley, G., & Kloos, B. (2011). Examining the psychological sense of community for individuals with serious mental illness residing in supported housing environments. Community Mental Health Journal, 47, 436–446. https://doi.org/10.1007/s10597-010-9338-9.

  45. Townley, G., Kloos, B., & Wright, P. A. (2009). Understanding the experience of place: Expanding methods to conceptualize and measure community integration of persons with serious mental illness. Health & Place, 15, 520–531. https://doi.org/10.1016/j.healthplace.2008.08.011.

  46. Tsemberis, S., McHugo, G., Williams, V., Hanrahan, P., & Stefancic, A. (2007). Measuring homelessness and residential stability: The residential time-line follow-back inventory. Journal of Community Psychology, 35, 29–42. https://doi.org/10.1002/jcop.20132.

  47. Zhornitsky, S., Aubin, G., Desfossés, J., Rizkallah, É, Pampoulova, T., Lipp, O., et al. (2013). Predictors of community functioning in schizophrenia and substance use disorder patients. Community Mental Health Journal, 49, 317–322. https://doi.org/10.1007/s10597-012-9525-y.

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Financial support for this study was provided to the lead author by Mental Health Research Canada (MHRC). The original trial (registered as ISRCTN42520374) was made possible through a financial contribution from Health Canada provided to the Mental Health Commission of Canada (MHCC). The authors thank Dr. Jayne Barker (2008–2011), Mr. Cameron Keller (2011–2014), and the MHCC At Home/Chez Soi national project leads; Dr. Paula Goering, the national research lead; the national research team; and the five site research teams, site coordinators, and service and housing providers, as well as the many persons with mental illness who have contributed to this project and the research. Neither the MHCC nor the MHRC had any role in the analysis and interpretation of the data or in the preparation of the manuscript.

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Correspondence to Nick Kerman.

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Kerman, N., Sylvestre, J., Aubry, T. et al. Predictors of Mental Health Recovery in Homeless Adults with Mental Illness. Community Ment Health J 55, 631–640 (2019). https://doi.org/10.1007/s10597-018-0356-3

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