Negotiating the boundaries of mental health and illness: A study of recovery in permanent supportive housing.

摘要

Current sociological understandings of the effect that mental health services on consumers' daily lives are still heavily informed by research conducted during the era of institutional treatment. This is problematic considering that changes to mental health care have shifted the locus of treatment to community settings for the majority of those living with serious and persistent mental illness (SPMI). With this shift there has been a greater focus on consumer-centered recovery in mental health care. The current study addresses this gap in the research by studying the recovery process for formerly chronically homeless individuals with dually diagnosed serious and persistent mental illness (SPMI) and substance use disorder who are living Housing First programming. Housing First is a model of permanent housing with supportive services that has been demonstrated to produce positive outcomes for "hard-to-serve" dually diagnosed consumers. I employed a combined case study and grounded theory approach that involved the collection and analysis of administrative, consumer, and staff data at four Housing First organizations in a large Midwestern city. My findings demonstrate that the recovery process in the programs was a negotiation between mental health and illness that consumers engaged in order to attain the highest quality of life possible in spite of symptoms related to their diagnosis. The structure of mental health services is key to this process, as it is more often than not the policies that guide programming that determine access to the resources that are necessary for consumers to engage in this negotiation.