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Publication Date

7-12-2011

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Primary capstone advisor:

Rickie Brawer, PhD, MPH, Jefferson School of Population Health & Department of Family and Community Medicine, TJU

Abstract

Background: Addressing the health needs of individuals with a history of chronic homelessness and mental illness is a challenge to physicians, health institutions, local, state and federal governments. These individuals are often disabled by addiction, mental illness, chronic illness or disability and often misunderstood by healthcare providers and the general public. Research has repeatedly demonstrated that patient centered medical care is essential to the management of socially complex patients afflicted with multiple chronic medical conditions. Central to this model is an understanding of the population’s perceptions regarding health and wellness. Housing First is an evidence-based program that provides housing for people afflicted with homelessness and mental illness to ensure a safe and sanitary housing before offering support services. Pathways to Housing in Philadelphia has begun to integrate primary care services into the Housing First model to address the health needs of this population. Aims: This study aims to explore how chronically homeless individuals with a history of mental illness engaged in a housing first program define health and wellness and what ways, if any, housing has impacted clients’ definitions of health and health capabilities. Methods: 13 in-depth, individual, semi-structured, in person interviews were held to discuss the aforementioned aims. Thematic content analysis was performed using NVIVO 9 software. Nodal structure was agreed upon and discrepancies were resolved through triangulation to ensure reliability and validity. Results: Overwhelmingly, clients agree that health is comprehensive in nature, incorporating physical, mental, social and spiritual domains. Stigma regarding mental illness, skepticism regarding pharmaceuticals, and fear of losing control of ones’ mental state were a few prevailing themes relating to mental health. The recovery process (from homelessness, mental illness, and addiction) is closely related to one’s perception of personal health. Clients felt that Pathways to Housing looked beyond the label of ‘homeless’ or ‘mental health’ and saw each client as a unique person, essential to the success of the Housing First initiative when compared to other services accessed in the past. A sense of unconditional positive regard helped clients succeed in this program. Access to a shower and control over one’s physical and social environment are a few themes that evolved regarding important factors for health maintenance. Bonding and bridging social capital gained through involvement in Pathways to Housing, advocacy projects, and community based participatory research models were emerged as important factors for wellness. The importance of spirituality and the varying roles faith plays in one’s health was noted as an important health indicator. Impact: Insight gained through this qualitative investigation will be used to guide healthcare related services at Pathways to Housing in Philadelphia and other Housing First initiatives as they begin to incorporate primary care services. The impact of the housing first model on health and wellness will help influence further implementation of Housing First models. Lastly, the words of these individuals will offer insight to healthcare providers, government and the general public concerning a disenfranchised and often misunderstood population.

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