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Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless

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Abstract

Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.

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Notes

  1. A job is considered competitive employment if the pay is at least minimum wage, and the job is open to anyone and is not reserved for people with a disability or people receiving social assistance benefits. These jobs are distinguished from social enterprises, work programs, and sheltered workshops.17

  2. Researchers supported by clinical psychologists use the MINI International Neuropsychiatric Interview 6.0.26 and file review to determine the presence of major depression, mania or hypomania, post-traumatic stress disorder, panic disorder, mood disorder with psychotic features, and psychotic disorder.

  3. Homelessness was defined as either having been in absolute homelessness for seven nights or more or having been precariously housed with at least two episodes of absolute homelessness in the past year at time of recruitment.

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Acknowledgments

This study was made possible through a financial contribution from Health Canada to the Mental Health Commission of Canada for the conduct of the At Home/Chez Soi Research and Demonstration Project on Mental Health and Homelessness. The authors thank Jayne Barker (2008–2011), Ph.D., Cameron Keller (2011–2012), and Catharine Hume (2012–present), Mental Health Commission of Canada, At Home/Chez Soi National Project Leads, Paula Goering, Ph.D., National Research Lead, the National Research Team, as well as housing and clinical providers associated with the Douglas Mental Health University Institute, CSSS Jeanne-Mance and Diogène. The authors also thank the Montreal site lead researcher Eric Latimer, Ph.D.; Rob Whitley, Ph.D. for his help with qualitative methods; research coordinator, Cécile Leclercq, Ph.D., and Véronique Denis, M.Sc., field research coordinator, as well as their team of interviewers, for assistance in implementing the study. Special thanks go to the participants who agreed to be interviewed. The views expressed herein solely represent the authors.

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Authors and Affiliations

  1. Centre for Research on Inner City Health, the Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Canada

    Daniel Poremski, Julia Woodhall-Melnik & Vicky Stergiopoulos

  2. Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore

    Daniel Poremski

  3. Department of Psychiatry, McGill University, Montreal, Canada

    Ashley J. Lemieux

  4. Department of Psychiatry, University of Toronto, Toronto, Canada

    Vicky Stergiopoulos

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  1. Daniel Poremski
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  2. Julia Woodhall-Melnik
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  3. Ashley J. Lemieux
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  4. Vicky Stergiopoulos
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Correspondence to Daniel Poremski.

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Poremski, D., Woodhall-Melnik, J., Lemieux, A.J. et al. Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless. J Urban Health 93, 96–108 (2016). https://doi.org/10.1007/s11524-015-0012-y

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