Social Relationships Among Persons Who Have Experienced Serious Mental Illness, Substance Abuse, and Homelessness: Implications for Recovery
Corresponding Author
Deborah K. Padgett PhD
Silver School of Social Work, New York University
Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003. E-mail: [email protected]Search for more papers by this authorBen Henwood LCSW
Silver School of Social Work, New York University
Search for more papers by this authorCourtney Abrams MA
Silver School of Social Work, New York University
Search for more papers by this authorRobert E. Drake MD, PhD
Dartmouth Psychiatric Research Center, Dartmouth Medical School.
Search for more papers by this authorCorresponding Author
Deborah K. Padgett PhD
Silver School of Social Work, New York University
Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003. E-mail: [email protected]Search for more papers by this authorBen Henwood LCSW
Silver School of Social Work, New York University
Search for more papers by this authorCourtney Abrams MA
Silver School of Social Work, New York University
Search for more papers by this authorRobert E. Drake MD, PhD
Dartmouth Psychiatric Research Center, Dartmouth Medical School.
Search for more papers by this authorAbstract
The new paradigm of recovery has highlighted the importance of positive social relationships, but little is known about their role in recovery among homeless individuals with serious mental illness and comorbid substance abuse. This study used within- and across-case analyses of longitudinal data from qualitative interviews with 41 dually diagnosed individuals entering residential programs to exit homelessness and receive needed services. Thematic findings include (a) “loner talk” and the need for privacy; (b) family ties as “good news, bad news”; (c) when it comes to a partner, other things come first; and (d) in search of positive people. Analyses of change in individual trajectories revealed that stronger social relationships did not coincide exactly with positive outcomes. Although positive life changes were gradual, negative changes could be precipitous. Social relationships were threatened by concentrated disadvantage, that is, a lack of social and economic currency. Findings are discussed with implications for improving services for the most vulnerable individuals who stand to benefit from the era of recovery.
References
- Alverson, H., Alverson, M., & Drake, R. E. (2000). An ethnographic study of the longitudinal course of substance abuse among people with severe mental illness. Community Mental Health Journal, 36, 557–569.
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders ( 4th ed.), Washington, DC: Author.
-
Anthony, W. (1993). Recovery from mental illness: The guiding vision of the mental health system in the 1990s.
Psychosocial Rehabilitation Journal, 16, 11.
10.1037/h0095655 Google Scholar
- Becker, D., Whitley, R., Bailey, E. L., & Drake, R. E. (2007). Long-term employment trajectories among participants with severe mental illness in supported employment. Psychiatric Services, 58, 922–928.
- Breier, A., & Strauss, J. S. (1984). The role of social relationships in the recovery from psychotic disorders. American Journal of Psychiatry, 141, 949–955.
- Corin, E., & Lauzon, G. (1992). Positive withdrawal and the quest for meaning: The reconstruction of experience among schizophrenics. Psychiatry: Journal for the Study of Interpersonal Processes, 55, 266–278.
- Davidson, L., Haglund, K., Stayner, D., Rakfeldt, J., Chinman, M., & Tebes, J. (2001). “It was just realizing … that life isn't one big horror”: A qualitative study of supported socialization. Psychiatric Rehabilitation Journal, 24, 275–292.
- Deegan, P. (2005). The importance of personal medicine: A qualitative study of resilience in people with psychiatric disabilities. Scandinavian Journal of Public Health, 33(Suppl. 66), 29–35.
- Deegan, P., & Drake, R. (2006). Shared decision making and medication management in the recovery process. Psychiatric Services, 57, 1636–1639.
- Dordick, G. (1996). More than refuge: The social world of a homeless shelter. Journal of Contemporary Ethnography, 24, 373–404.
- Drake, R. E., Wallach, M. A., Alverson, H. S., & Mueser, K. T. (2002). Psychosocial aspects of substance abuse by clients with severe mental illness. Journal of Nervous and Mental Disease, 190, 100–106.
- Farkas, M., Gagne, C. Anthony, W., & Chamberlin, J. (2005). Implementing recovery oriented evidence based programs: Identifying the critical dimensions. Community Mental Health Journal, 41, 141–158.
- Fisher, D. (1994). Health care reform based on an empowerment model of recovery by people with psychiatric disabilities. Hospital and Community Psychiatry, 45, 913–915.
- Hawkins, R., & Abrams, C. (2007). Disappearing acts: The social networks of formerly homeless individuals with co-occurring disorders. Social Science & Medicine, 65, 2031–2042.
- Hopper, K. (2003). Reckoning with homelessness. Ithaca, NY: Cornell University Press.
- Jacobson, N. (2004). In recovery: The making of mental health policy. Nashville, TN: Vanderbilt University Press.
- Jacobson, N., & Greenley, D. (2001). What is recovery? A conceptual model and explication. Psychiatric Services, 52, 482–485.
- Lovell, A. (1997). “The city is my mother”: Narratives of schizophrenia and homelessness. American Anthropologist, 99, 355–368.
- Morgan, C., Burns, T., Fitzpatrick, R., Pinfold, V., & Priebe, S. (2007). Social exclusion and mental health. British Journal of Psychiatry, 191, 477–483.
- Morrow, S. L., & Smith, M. L. (1995). Constructions of survival and coping by women who have survived childhood sexual abuse. Journal of Counseling Psychology, 42, 24–33.
- Muhr, T. (2004). ATLAS. ti (Version 5.0) [Computer software]. Berlin, Germany: Scientific Software Development.
- Padgett, D. K. (2008). Qualitative methods in social work research ( 2nd ed.) Thousand Oaks, CA: Sage.
- Padgett, D. K., Hawkins, R., Abrams, C., & Davis, A. (2006). In their own words: Trauma and substance abuse in the lives of formerly homeless women with serious mental illness. American Journal of Orthopsychiatry, 76, 461–467.
- Patton, M. Q. (2002). Qualitative research and evaluation methods ( 3rd ed.), Thousand Oaks, CA: Sage.
- Phelan, J., & Link, B. G. (2004). Fear of people with mental illnesses: The role of personal and impersonal contact and exposure to threat or harm. Journal of Health and Social Behavior, 45, 68–80.
- Ridgway, P. (2001). Re-storying psychiatric disability: Learning from first person recovery narratives. Psychiatric Rehabilitation Journal, 24, 335–343.
- Sampson, R., Morenoff, J., & Raudenbush, S. (2005). Social anatomy of racial and ethnic disparities in violence. American Journal of Public Health, 95, 224–232.
- Scheff, T. (1966). Being mentally ill: A sociological theory. Chicago: Aldine.
- Scott, J., & Dixon, L. (1995). Psychological interventions for schizophrenia. Schizophrenia Bulletin, 21, 621–630.
- Sells, D. J., Stayner, D. A., & Davidson, L. (2004). Recovering the self in schizophrenia: An integrative review of qualitative studies. Psychiatric Quarterly, 75, 87–97.
- Spaniol, L., Bellingham, R., & Cohen, B., (2003). The recovery workbook: II. Connectedness. Boston: Boston University Center for Psychiatric Rehabilitation.
- Todd, J., Green, G., Harrison, M., Ikuesan, B., Self, C., Pevalin, D., et al. (2004). Social exclusion in clients with comorbid mental health and substance misuse problems. Social Psychiatry & Psychiatric Epidemiology, 39, 581–587.
- Ware, N., Hopper, K., Tugenberg, T., Dickey, B., & Fisher, D. (2007). Connectedness and citizenship: Redefining social integration. Psychiatric Services, 58, 469–474.
- Ware, N., Hopper, K., Tugenberg, T., Dickey, B., & Fisher, D. (2008). A theory of social integration as quality of life. Psychiatric Services, 59, 27–33.
- Whitley, R., Harris, M., & Drake, R. E. (2008). Safety and security in small-scale recovery housing for people with severe mental illness: An inner-city case study. Psychiatric Services, 59, 1–5.
- Wong, Y., & Solomon, P. (2002). Community integration of persons with psychiatric disabilities in supportive independent housing: A conceptual model and methodological considerations. Mental Health Services Research, 4, 13–28.