Understanding the Lived Experience of Formerly Homeless Adults as They Transition to Supportive Housing

The researchers conducted in-depth interviews with formerly homeless adults who had moved to supportive housing to understand their perceived occupational needs and the factors that affected their transition. A qualitative research design with four participants who had a history of substance abuse and mental illness was used. Participant interviews that addressed categories of daily living and personal satisfaction produced data that were coded for analysis using conventional content analysis. Mega themes emerged that related to factors shaping the housing transition and maintenance experience. Occupational therapists can use these findings to create informed interventions to enhance this population's occupational performance.     

Visualizing homelessness: a study in photography and estrangement

This article reports a qualitative study of how homeless people visualize their life in hostels and on the streets of London. Using a photo‐production technique, the research enabled participants to show their situation as well as to tell about their experiences. Participants were given cameras and asked to take photographs typical of their day as homeless people, this material being the subject of a subsequent interview. This provided both visual and text data that were analysed together so as to establish different engagements of the participants with the city and with domiciled people. Presenting the material from six of the participants, these different engagements are described with reference to issues of estrangement, exclusion and visualization employed as explanatory concepts. The article identifies and compares the different ways in which homeless people attempt not only to survive but also to [make their home] in the city. Copyright © 2005 John Wiley & Sons, Ltd.     

Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data

This study tests a typology of homelessness using administrative data on public shelter use in New York City (1988–1995) and Philadelphia (1991–1995). Cluster analysis is used to produce three groups (transitionally, episodically, and chronically homeless) by number of shelter days and number of shelter episodes. Results show that the transitionally homeless, who constitute approximately 80% of shelter users in both cities, are younger, less likely to have mental health, substance abuse, or medical problems, and to overrepresent Whites relative to the other clusters. The episodically homeless, who constitute 10% of shelter users, are also comparatively young, but are more likely to be non-White, and to have mental health, substance abuse, and medical problems. The chronically homeless, who account for 10% of shelter users, tend to be older, non-White, and to have higher levels of mental health, substance abuse, and medical problems. Differences in health status between the episodically and chronically homeless are smaller, and in some cases the chronically homeless have lower rates (substance abuse in New York; serious mental illness in Philadelphia). Despite their relatively small number, the chronically homeless consume half of the total shelter days. Results suggest that program planning would benefit from application of this typology, possibly targeting the transitionally homeless with preventive and resettlement assistance, the episodically homeless with transitional housing and residential treatment, and the chronically homeless with supported housing and long-term care programs.     

Understanding Dignity in the Lives of Homeless Persons

The current investigation is a planned, systematic study of dignity as critical to understanding the experience of homelessness and improving services and programs for the homeless. Specifically, we conducted a thematic content analysis of interviews with 24 homeless men and women to identify their perception of specific environmental events that validate and invalidate dignity. In addition, we explored the impact that these events have on homeless persons. Eight types of events were identified that sustain dignity such as being cared for by staff and having resources available to meet basic needs. Eight types of events were found that undermine dignity, such as being yelled at or insulted by staff persons and having staff use rules in an excessive and arbitrary way. Two outcomes followed the sustenance of dignity including increased self-worth and motivation to exit homelessness. Three outcomes followed the undermining of dignity including anger, depression, and feelings of worthlessness. The results suggest that dignity is an important variable to consider in understanding the experience of homelessness. Policies and programs that support validating the dignity of homeless persons are encouraged.     

The Psychology of Health and Illness: The Mental Health and Physiological Effects of Intimate Partner Violence on Women

Violence against women is a global public health problem with about one in three women experiencing either physical and or sexual intimate partner violence during their lifetime. Globally as many as 38% of homicides committed against women are by a male intimate partner. Violence against women may have negative effects on their mental, physical, and reproductive health (WHO fact sheet, 2016). Untreated individuals who have experienced violence or life-threatening situations may develop posttraumatic stress disorder (PTSD). This disorder has the potential to be life-changing and cause negative psychological and medical issues (Rokach, Ahmed, & Patel, 2017). This potentially life-changing nature and consequence of violence affecting women world-wide deserves greater attention to ensure elimination of risk factors, financial support of investigational studies to promote detection of victims, and research to increase therapeutic efficacy of remediation. These efforts should be bolstered by all physicians, mental health experts, social service specialists, and public health advocates.     

Approaching Homelessness: An Integral Re-Frame

This article explores a metaview of the many faces of homelessness. It analyzes an evolutionary meaning of home and suggests that ever-complexifying life conditions influence how societies enforce conformity to the status quo of homefulness. It goes on to describe how homelessness might be reframed as a complex adaptive form of survival for diversity generators who cannot or will not conform to the status quo. The article proposes an integral framework on which intervention strategies could be structured to provide evolutionary, appropriate, and flexible approaches to homelessness.     

Who uses services for homeless people? An investigation amongst people sleeping rough in London

From a sample of 389 homeless people in London, the characteristics of those who used services for homeless people are presented and the implications for service planning and delivery explored. Staff providing services for this client group need knowledge about drug use and the confidence to work effectively with homeless drug users. Copyright © 2002 John Wiley & Sons, Ltd.     

The refugee’s flight: homelessness,hospitality, and care of the self

This paper argues that the contemporary international refugee regime is grounded in a paradigm of ‘homesickness’, which puts the refugee in an inferior position of the supplicant, whose subjectivity is framed by the regime of fixed belonging. In order to address this situation, we need to challenge the ontological primacy of homesickness and embrace ‘homelessness’, which offers the possibility of rethinking the positions of both refugees and non-refugees in ethical terms. While the responsibility of the non-refugees lies in cultivating an ethos of hospitality, the refugee can take hold of her subjectivity through the practice of care of the self. This paper first examines Nietzsche’s thought on homelessness and compares it with Foucault’s reading of the role of anakhōrēsis in the Hellenistic practice of care of the self. It then suggests how, by building on the project of universal hospitality, we can interpret the figure of the refugee through the prism of an ethic of freedom, anchored in a positive break with the city. From this perspective, the refugee regains her ethico-political agency by cultivating the relationship with her own living self, which offers new avenues for resistance against the dominant paradigm of ‘homesickness’ that governs her subjectivity today.     

Decreasing Psychiatric Symptoms by Increasing Choice in Services for Adults with Histories of Homelessness

Despite the increase in consumer-driven interventions for homeless and mentally ill individuals, there is little evidence that these programs enhance psychological outcomes. This study followed 197 homeless and mentally ill adults who were randomized into one of two conditions: a consumer-driven “Housing First” program or “treatment as usual” requiring psychiatric treatment and sobriety before housing. Proportion of time homeless, perceived choice, mastery, and psychiatric symptoms were measured at six time points. Results indicate a direct relationship between Housing First and decreased homelessness and increased perceived choice; the effect of choice on psychiatric symptoms was partially mediated by mastery. The strong and inverse relationship between perceived choice and psychiatric symptoms supports expansion of programs that increase consumer choice, thereby enhancing mastery and decreasing psychiatric symptoms.     

The splitting between separate and symbiotic stätes of the self in the psychodynamic of schizophrenia

Abstract

We explore the problematic dynamics in the relationship between societal systems of care and the chronically excluded, with particular reference to severe personality disorder and the “difficult-to-reach” patient. The individual who “refuses” is often met with a violent response: yet his violence must be understood as related to an experience of being violently excluded. We reformulate personality disorder as a disturbance of “groupishness” and suggest, as a paradigm for the problem of refusal, the story of Diogenes the Cynic, who “holed himself up” in a barrel; and of his legendary encounter with Alexander the Great, who tried unsuccessfully to persuade him to “come in from the cold.” We suggest it may be as important to focus on Alexander's violence as on that of Diogenes, and we examine modes of violence deployed by society against the excluded outsider, with particular reference to the hostile attribution of intentionality to the personality disordered individual's acts of violence and self-harm. We conclude by considering both the merits of the democratic therapeutic community model as a response to severe personality disorder and the dangers, inherent in this model among others, in an unconscious identification with Diogenes in his barrel.