Recovery as a Guide for Environmental Enhancement in Group Homes for People With a Mental Illness: a Social-Ecological Approach

Abstract

Background: As the paradigm underlying mental health care slowly shifts from an approach primarily institutional and medical in its orientation toward one more community-based and recovery-oriented, housing needs have come to the forefront. Many people with persistent mental illness accept group home living situations that do not necessarily meet their needs, and do not align with the recovery vision. Research focused on recovery for residents of group homes is all but absent in the literature. Purpose: The purpose of this study was to identify the challenges and opportunities for enabling group homes to increase their capacity to serve as an environment that integrates the recovery vision. Method: Using ethnographic methods, this case study examined the cultural milieu of a group home, how recovery is understood within the setting, and the impact of policies and practices on enacting the recovery vision. By converging multiple strategies for data collection (participant observation, key informant interviews, and document analysis), a multi-level perspective was achieved. The use of the social-ecological model, with its attention to multiple levels of influence, emerged as a highly relevant perspective, without which the recovery vision cannot be realized. Findings: The culture within the home revealed a comfortable atmosphere, basic needs being met, access to planned and unplanned activity, and caring relationships with staff, which contribute to a place attachment that could be difficult to loosen. There is a lack of awareness of recovery-enabling practice at multiple levels, which emerged as a key challenge to its implementation. Although some policies at the government level support self-sufficiency as an important objective, others make progress towards this ideal difficult, if not impossible, such as those related to funding. The focus on enhancing well-being in the day-to-day setting subsumes the growth goals associated with recovery. Conclusion: Integrating the recovery vision within group home could benefit from confronting well-established approaches, embracing advocacy roles, and addressing mechanisms for change at multiple levels. Only then will people with mental illness living in group homes reap the benefits of social justice, social inclusion and full citizenship that come with recovery.