Abstract
This study examines community integration among homeless adults with mental illness 6 and 12 months after random assignment to Housing First (independent apartments or congregate residence) with support services or to treatment as usual (TAU). Residence in independent apartments was associated with increased ‘psychological integration’ for participants with less severe needs; however, no significant improvement in ‘physical integration’ was observed among any of the intervention groups. Analysis of individual items on the Psychological Integration subscale revealed that, compared to TAU, participants assigned to independent apartments were more likely to endorse statements related to the emotional components of community but not statements related to neighboring. Participants assigned to the congregate residence were more likely to endorse knowing their neighbors, but not interacting with neighbors or the emotional components of community. Findings are discussed in terms of housing program as well as broader contextual factors.
This is a preview of subscription content, log in via an institution to check access.
Notes
Support services were available to participants assigned to ACT, CONG, and ICM but were not mandatory. The only requirement for housing was compliance with the terms of the rental lease and weekly visits with a case manager to ensure safety and well-being (Stefancic and Tsemberis 2007).
The CONG residence was located in downtown Vancouver in a neighborhood consisting of primarily businesses, including an inner-city hospital and a number of affluent condominiums.
References
Adair, C., Holland, A., Patterson, M., Mason, K., Hwang, S., & Goering, P. (2011). Cognitive interviewing methods for questionnaire pre-testing in homeless persons with serious mental disorders. Journal of Urban Health, 89, 36–52.
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.
Barker, S., Barron, N., McFarland, B. H., et al. (1994). A community ability scale for chronically mentally ill consumer. Community Mental Health Journal, 30, 459–472.
Carling, P. (1990). Major mental illness, housing, and supports: The promise of community integration. American Psychologist, 45, 969–975.
Colombo, M., Mosso, C., & DePiccoli, N. (2001). Sense of community and participation in urban contexts. Journal of Community and Applied Social Psychology, 11, 457–464.
Dorvil, H., Morin, P., Beaulieu, A., & Robert, D. (2005). Housing as a social integration factor for people classified as mentally ill. Housing Studies, 20, 497–519.
Dovey, K., Fitzgerald, J., & Choi, Y. (2001). Safety becomes danger: Dilemmas of drug-use in public space. Health and Place, 7, 319–331.
Fast, D., Shoveller, J., Shannon, K., & Kerr, T. (2010). Safety and danger in downtown Vancouver: Understandings of place among young people entrenched in an urban drug scene. Health and Place, 6(1), 51–60.
Field, D. (2011). Emotional refuge? Dynamics of place and belonging among formerly homeless individuals with mental illness. Emotion, Space and Society, 4, 258–267.
Goering, P., Streiner, D., Adair, C., Aubry, T., Barker, J., Distasio, J., et al. (2011). The At Home/Chez Soi trial protocol: a pragmatic, multi-site, randomised controlled trial of a Housing First intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open, 1(2), e000323.
Gulcur, L., Tsemberis, S., Stefancic, A., & Greenwood, R. (2007). Community integration of adults with psychiatric disabilities and histories of homelessness. Community Mental Health Journal, 43, 211–228.
MacMillan, D. W., & Chavis, D. M. (1996). Sense of community: A definition and theory. Journal of Community Psychology, 14, 6–23.
Manzo, L. (2003). Beyond house and haven: Toward a revisioning of emotional relationships with places. Journal of Environmental Psychology, 23, 47–61.
Marsden, J., Gossop, M., Stewart, D., Best, D., Farrell, M., Strang, J. (1998). The Maudsley addiction profile (MAP): A brief instrument for treatment outcome research. Development and user manual. London UK, National Addiction Centre/Institute of Psychiatry. Accessed on April 25, 2012 at http://www.iop.kcl.ac.uk/iopweb/blob/downloads/locator/l_346_MAP.pdf.
Nemiroff, R., Aubry, T., & Klodawsky, F. (2011). From homelessness to community: Psychological integration of women who have experienced homelessness. Journal of Community Psychology, 39, 1003–1018.
Patterson, M., Markey, M., & Somers, J. (2012). Multiple paths to just ends: Using narrative interviews and timelines to explore health equity and homelessness. International Journal of Qualitative Methods, 11(2), 132–151.
Prince, P., & Prince, C. (2002). Perceived stigma and community integration among clients of assertive community treatment. Psychiatric Rehabilitation Journal, 25, 323–331.
Schutt, R. (2011). Homelessness, housing, and mental illness. Cambridge, Massachusetts: Harvard University Press.
Segal, S., Baumohl, J., & Moyles, E. (1980). Neighborhood types and community reaction to the mentally ill: A paradox of intensity. Journal of Health and Social Behavior, 21, 345–359.
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl 20), 22–33.
Somers, J., Patterson, M., Moniruzzaman, A., et al. (2013). Vancouver at home: Pragmatic randomized trials investigating Housing First for people who are homeless and mentally ill. Trials, 14, 365.
Stefancic, A., & Tsemberis, S. (2007). Housing First for long-term shelter dwellers with psychiatric disabilities in a suburban county: a 4-year study of housing access and retention. Journal of Primary Prevention, 28, 265–279.
Townley, G., & Kloos, B. (2009). Development of a measure of sense of community for individuals with serious mental illness residing in community settings. Journal of Community Psychology, 37, 362–380.
Tsemberis, S., & Eisenberg, R. (2000). Pathways to housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services, 51, 487–493.
Vancouver Foundation (2012). Connections and engagement: A survey of metro Vancouver. Sentis Market Research. Retrieved July 5, 2012 from http://www.vancouverfoundation.ca/connect%2Dengage/2012survey.htm.
Vangeest, J., & Johnson, T. (2002). Substance abuse and homelessness: Direct or indirect effects? Annals of Epidemiology, 12(7), 455–461.
Ware, N., Hopper, K., Tugenberg, T., Dickey, B., & Fisher, D. (2007). Connectedness and citizenship: redefining social integration. Psychiatric Services, 58(4), 469–474.
Wolf, J., Burnam, A., Koegel, P., Sullivan, G., & Morton, S. (2001). Changes in subjective quality of life among homeless adults who obtain housing: A prospective examination. Social Psychiatry and Psychiatric Epidemiology, 36, 391–398.
Wong, Y., Metzendorf, D., & Min, S. (2006). Neighborhood experiences and community integration: Perspectives from mental health consumers and providers. Social Work in Mental Health, 4, 45–59.
Wong, Y., & Solomon, P. (2002). Community integration of persons with psychiatric disabilities in supportive independent housing: A conceptual model and methodological considerations. Mental Health Services Research, 4, 13–28.
Yanos, P. (2007). Beyong “Landscapes of Despair”: The need for new research on the urban environment, sprawl, and the community integration of persons with severe mental illness. Health and Place, 13, 672–676.
Yanos, P., Barrow, S., & Tsemberis, S. (2004). Community integration in the early phase of housing among homeless persons diagnosed with severe mental illness: Successes and challenges. Community Mental Health Journal, 40, 133–150.
Yanos, P., Felton, B., Tsemberis, S., & Frye, V. (2007). Exploring the role of housing type, neighborhood characteristics, and lifestyle factors in the community integration of formerly homeless persons diagnosed with mental illness. Journal of Mental Health, 16, 703–717.
Zabkiewicz, D., Patterson, M., Frankish, C. J., & Somers, J. (2012). The Vancouver at home study: overview and methods of a Housing First trial among individuals who are homeless and living with mental illness. Journal of Clinical Trials,. doi:10.4172/2167-0870.1000123.
Acknowledgments
Special thanks to the service teams who are working with participants to increase their sense of community. The authors also thank the At Home/Chez Soi Project collaborative at national and local levels; National project team: J. Barker, PhD (2008–2011) and C. Keller, National Project Leads; P. Goering, RN, PhD, Research Lead; approximately 40 investigators from across Canada and the US; 5 site coordinators; numerous service and housing providers; and persons with lived experience.
Conflict of interest
This research was funded by Health Canada and the Mental Health Commission of Canada. The views expressed herein solely represent the authors.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Patterson, M.L., Moniruzzaman, A. & Somers, J.M. Community Participation and Belonging Among Formerly Homeless Adults with Mental Illness After 12 months of Housing First in Vancouver, British Columbia: A Randomized Controlled Trial. Community Ment Health J 50, 604–611 (2014). https://doi.org/10.1007/s10597-013-9672-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-013-9672-9