There’s no place like (a) home: ontological security among people with serious mental illness in the United States. Social Science and Medicine 64: 1925-36

School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA.
Social Science & Medicine (Impact Factor: 2.89). 06/2007; 64(9):1925-36. DOI: 10.1016/j.socscimed.2007.02.011
Source: PubMed


As the homelessness 'crisis' in the United States enters a third decade, few are as adversely affected as persons with serious mental illness. Despite recent evidence favoring a 'housing first' approach, the dominant 'treatment first' approach persists in which individuals must climb a ladder of program requirements before becoming eligible for an apartment of their own. Drawing upon the concept of 'ontological security', this qualitative study examines the subjective meaning of 'home' among 39 persons who were part of a unique urban experiment that provided New York City's homeless mentally ill adults with immediate access to independent housing in the late 1990s. The study design involved purposively sampling from the experimental (housing first) group (N=21) and the control (treatment first) group (N=18) and conducting two life history interviews with each participant. Markers of ontological security-constancy, daily routines, privacy, and having a secure base for identity construction-provided sensitizing concepts for grounded theory analyses designed to also yield emergent, or new, themes. Findings revealed clear evidence of the markers of ontological security among participants living in their own apartments. This study expands upon previous research showing that homeless mentally ill persons are capable of independent living in the community. The emergent theme of 'what's next' questions and uncertainty about the future points to the need to address problems of stigma and social exclusion that extend beyond the minimal achievement of having a 'home'.

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Available from: Deborah K Padgett, Mar 31, 2014
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    • "For the most part, their accompanying narratives centered on the security, comfort and privacy that housing afforded them. These factors have been identified as markers of ontological security and a platform for identity reconstruction (Padgett, 2007). Ontological security has been defined as a sense of constancy and security in a Table 1 Categorical distribution of photos. "
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    ABSTRACT: Photo-elicitation interviews (PEIs) were conducted to explore the role of place in recovery - specifically, narrative identity reconstruction - among persons with complex needs. PEIs with 17 formerly homeless adults with co-occurring disorders in New York City produced 243 photos. Content analysis of photos revealed three categories - apartment, neighborhood and people. Two narrative themes - having my own and civic identity - were mapped onto the apartment and neighborhood categories, respectively. Three additional cross-categorical narrative themes were identified: (re)negotiating relationships and boundaries, moving beyond old identities and future possibilities. Housing was central across themes. Understanding of recovery is enhanced when viewed through participant-controlled visual methods. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Health & Place 05/2015; 33. DOI:10.1016/j.healthplace.2015.03.002 · 2.81 Impact Factor
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    • "The rationale behind the HF model is that providing immediate access to housing and promoting choice is a more respectful and effective way to foster consumer engagement and recovery (Padgett, 2007; Tsemberis et al., 2004). "
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    ABSTRACT: This qualitative study examined how homeless individuals with mental illness experience pathways into homelessness. Study participants were enrolled in the At Home/Chez Soi project, a Pan-Canadian Randomized Controlled Trial comparing the Housing First approach with Treatment as Usual for homeless individuals. This inquiry is grounded in social ecological perspective, which considers interactions between individual and structural factors. Findings from consumer narrative interviews (n = 219) revealed that individual factors, such as substance abuse, relationship conflicts and mental health issues significantly contributed to homelessness, in addition to structural transitions from foster care and institutional settings into the community. Additional structural factors entrenched participants in unsafe communities, created obstacles to exiting homelessness and amplified individual risk factors. The study findings confirm the role of individual risk factors in pathways into homelessness, but underscore the need for policies and interventions to address structural factors that worsen individual risks and create barriers to exiting homelessness.
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    • "Living in supportive housing for people with SMI was experienced by the users, to some extent, as an opportunity to rest in a calm, safe, and private atmosphere. These findings are supported by results from previous studies, which also showed that living in supportive housing for people with SMI provides privacy and safety, and gives individuals opportunities to recover (Carpenter-Song et al. 2012; Padgett 2007). In the present study, the user's apartment/room was perceived as a place in which the user could be self-absorbed and free from outside demands on how to act. "
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    ABSTRACT: Since the closure of large psychiatric institutions, various types of community-based supportive housing for people with serious mental illness (SMI) have been developed. There is currently limited knowledge about users' experiences of living in supportive housing. The aim of the present study was to describe user experiences of living in supportive housing for people with SMI. Twenty-nine people living in such facilities participated in open, qualitative interviews. Data were subjected to latent content analysis. Three main themes emerged from this analysis: (i) having a nest, which included the subthemes of a place to rest and having someone to attach to; (ii) being part of a group, with the subthemes of being brought together and a community spirit; and (iii) leading an oppressive life, including the subthemes of questioning one's identity, sense of inequality, and a life of gloom. It could be concluded that user experiences of living in supportive housing are complex and paradoxical. In order to provide supportive housing, staff need to recognize and work within social group processes, and perform continual and structural evaluations of users' social and emotional needs.
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