Narratives of people with serious mental illness in Housing First: a qualitative analysis of factors contributing to housing instability and housing stability

ABSTRACT

There has been little previous research that has examined factors related to housing stability and instability among Housing First (HF) tenants. Qualitative research was used to determine themes related to housing stability and instability for people with mental illness participating in a HF program implemented in five Canadian cities. Data were gathered for all participants who completed qualitative interviews at baseline and an 18-month follow-up. At the 18-month follow-up interviews, those who were stably housed (n = 110) were significantly more likely to report positive life changes than those who were unstably housed (n = 75). Among a sub-sample of these participants, in-depth narratives were compared for stably housed (n = 25) and unstably housed (n = 21) tenants. Challenges to achieving housing stability included substance use and continued exposure to substance-using networks, evictions/multiple housing losses, incarceration and/or involvement with the legal system, and neighborhood location of housing. Themes promoting housing stability were having positive relationships with the HF program staff and program, achieving greater community integration, and making progress towards recovery. Recommendations for promoting housing stability were provided.

KEYWORDS:

• Housing First
• mental illness
• homelessness
• housing stability
• qualitative

Acknowledgements

The authors thank Jayne Barker, Cameron Keller, Catharine Hume, and the late Paula Goering, formerly the Mental Health Commission of Canada’s At Home / Chez Soi national project leaders; the national qualitative research team that included staff from the five site research teams, including Michelle Patterson, Chris McAll, and Danielle Nolin; Myra Piat, Co-lead for the qualitative research; the site coordinators; the numerous service and housing providers; and the persons with lived experience who contributed to this project and the research. The views expressed are those of the authors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Questions about the data should be directed to the first author.

Additional information

Funding

This research was made possible through a financial contribution from Health Canada.

Notes on contributors

Geoffrey Nelson

Geoffrey Nelson, Ph.D., is Professor Emeritus of Psychology at Wilfrid Laurier University. His research has examined housing for people with lived experience of mental illness and/or homelessness.

Maryann Roebuck

Maryann Roebuck, Ph.D., is a Postdoctoral Researcher at the University of Ottawa and the Ottawa Branch of the Canadian Mental Health Association. Her research focuses on community mental health and homelessness.

Ayda Agha

Ayda Agha is a Ph.D. Student in Community Psychology at the Centre for Research on Educational and Community Services at the University of Ottawa. She holds a Master of Science in Community Health with a specialization in Addictions and Mental Health from the Dalla Lana School of Public Health, University of Toronto.

Tim Aubry

Tim Aubry, Ph.D., is a Professor in the School of Psychology at the University of Ottawa and Senior Researcher at the Centre for Research on Educational and Community Services. His research examines community mental health services, housing, and homelessness.

Sarah Purcell

Sarah Purcell has a B.A. in Psychology and B.Sc. in Biology from the University of New Brunswick, Fredericton. She is in the graduating class of 2024 in Dalhousie Medicine, Saint John, New Brunswick.

Oeishi Faruquzzaman

Oeishi Faruquzzaman is a Master’s student in the Community Psychology Program at Wilfrid Lauier University. Her research focuses on community mental health and improving access to mental health services for South Asian youth.

Maritt Kirst

Maritt Kirst, Ph.D., is Associate Professor in Community Psychology at Wilfrid Laurier University. Her research focuses on program evaluation in community mental health, homelessness, and addictions.

Eric Macnaughton

Eric Macnaughton, Ph.D., works for the Building Capacity Project at the University of British Columbia and is a consultant to the Pathways Housing First Institute. His research has examined program planning and implementation in community mental health and homelessness.

Corinne Isaak

Corinne Isaak, M.Sc., was the research manager for At Home / Chez Soi in Winnipeg (University of Manitoba). Her research has focused on homelessness, mental illness, and suicide prevention for Indigenous people.

Sam Tsemberis

Sam Tsemberis, Ph.D. is Chief Executive Officer for Pathways Housing First Institute and Associate Professor, Department of Psychiatry at UCLA. His research has focused homelessness, mental illness and recovery.