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.
AubryTKlodawskyFCoulombeD (2011) Comparing the housing trajectories of different clusters within a diverse homeless population. American Journal of Community Psychology49: 124–155.
2.
BhugraD (2007) Homelessness and Mental Health. Cambridge University Press.
3.
BronfenbrennerU (1979) The Ecology of Human Development: Experiments by Nature and Design. Cambridge: Harvard University Press.
4.
BuntingTWalksRAFilionP (2004) The uneven geography of housing affordability stress in Canadian Metropolitan Areas. Housing Studies19(3): 361–393.
5.
CalsynRWinterJP (2006) Social support, psychiatric symptoms, and housing: A causal analysis. Journal of Community Psychology30(3): 247–259.
6.
CharmazK (2006) Grounded theory. In: Hesse-BiberSNLeavyP (eds) Approaches to Qualitative Research: A Reader on Theory and Practice. New York: Oxford University Press, pp. 496–521.
7.
City of Vancouver (2011) City of Vancouver, Housing and Homelessness Strategy. Vancouver, B.C.: City of Vancouver, Social Development Department.
8.
EnnsR (2005) Immigrant households and homelessness. In: SiemiatyckiM (ed.) Immigration and the Intersection of Diversity. Canadian Issues/Themes Candiens. Ontario: Association for Canadian Studies/Association d’etudes canadiennes, pp. 127–130.
9.
FischerBRehmJBrissetteS. (2005) Illicit opioid use in Canada: Comparing social, health, and drug use characteristics of untreated users in five cities (OPICAN Study). Journal of Urban Health82: 250–266.
10.
Fitzpatrick-LewisDGanannRKrishnaratneS. (2011. Effectiveness of interventions to improve the health and housing status of homeless people: A rapid systematic review. BMC Public Health11: 638.
11.
FleuryMJGrenierGLesageA. (2014) Network collaboration of organisations for homeless individuals in the Montreal region. International Journal of Integrated Care14.
12.
GaetzS (2010) The struggle to end homelessness in Canada: How we created the crisis, and how we can end it. The Open Health Services and Policy Journal3: 21–26.
13.
GaetzSDonaldsonJRichterT. (2013) The State of Homelessness in Canada 2013. Canadian Homelessness Research Network Press.
14.
GoeringPNStreinerDLAdiarC. (2011) The At Home/Chez Soi trial protocol: A pragmatic, multi-site, randomized controlled trial of a housing first intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open.
15.
HulchanskiJD (2010) The Three Cities Within Toronto: Income Polarization Among Toronto’s Neighborhoods, 1970–2005. University of Toronto.
16.
HwangSW (2001) Homelessness and health. Canadian Medical Association Journal162: 229–233.
17.
HwangSWAubreyTPalepuA. (2011) The Health and Housing in Transition study: A longitudinal study of the health of homeless and vulnerably housed adults in three Canadian cities. International Journal of Public Health56(6): 609–623.
18.
HwangSWStergiopoulosVO’CampoP. (2012) Ending homelessness among people with mental illness: The At Home/Chez Soi randomized trial of a housing first intervention in Toronto. BMC Public Health12: 787.
19.
IsaakC (2012) ‘At Home/Chez Soi’ Research Demonstration Project Winnipeg Baseline Consumer Narrative Report. Winnipeg Site Report, At Home/Chez Soi.
20.
KauppiCBraedleyS (2003) Structural Factors Associated With Homelessness: A Review of the International Literature. Social Planning Council of Sudbury.
21.
KimMMFordJDHowardDL. (2010) Assessing trauma, substance abuse, and mental health in a sample of homeless men. Health & Social Work35(1): 39–48.
22.
KirstMHarrisDWPlenertE. (2012) ‘At Home/Chez Soi’ Project Baseline Consumer Narrative Report. Toronto Site Report, At Home/Chez Soi.
23.
KloosBShahS (2009) A social ecological approach to investigating relationships between housing and adaptive functioning for persons with serious mental illness. American Journal of Community Psychology33: 316–326.
24.
KvaleS (1996) Interviews: An Introduction to Qualitative Research Interviewing. Thousand Oaks, CA: Sage.
25.
LambHR (2001) Deinstitutionalization at the beginning of the new millennium. New Directions for Mental Health Services90: 3–20.
26.
LoweJGibsonS (2011) Reflections of a homeless population’s lived experience with substance abuse. Journal of Community Health Nursing28: 92–100.
27.
McAllCLupienPLRodeA. (2012) Chez Soi: Projet de Recherché et de Demonstration sur la Santé Mentale et l’itinerance de Montreal: Premier Rapport sur les Recits de vie. Montreal Site Report, At Home/Chez Soi.
28.
McLarenLHaweP (2005) Ecological perspectives in health research. Journal of Epidemiological Community Health59: 6–14.
29.
MackNWoodsongCMacQueenKM. (2005) Qualitative Research Methods: A Data Collector’s Field Guide. Family Health International.
30.
MallettSRosenthalDKeysD (2005) Young people, drug use and family conflict: Pathways into homelessness. Journal of Adolescence28(2): 185–199.
31.
MartijnCSharpeL (2006) Pathways to youth homelessness. Social Science and Medicine62(1): 1–12.
32.
Mental Health Commission of Canada (2014) National Final Report: Cross-site At Home/Chez Soi project. Mental Health Commission of Canada.
33.
MoosRH (1976) The Human Context: Environmental Determinants of Behavior. New York: Wiley.
34.
Morrell-BellaiTGoeringPNBoydellKM (2000) Becoming and remaining homeless: A qualitative investigation. Issues in Mental Health Nursing21: 581–604.
35.
NooeRMPattersonDA (2010) The ecology of homelessness. Journal of Human Behavior in the Social Environment20: 105–152.
36.
OkamotoY (2007) A comparative study of homelessness in the United Kingdom and Japan. Journal of Social Issues63: 525–542.
37.
PadgettDK (2007). There’s no place sike (a) home: Ontological security among persons with serious mental illness in the United States. Social Science and Medicine64: 1925–1936.
38.
PadgettDKSmithBTHenwoodBF. (2012) Life course adversity in the lives of formerly homeless persons with serious mental illness: Context and meaning. American Journal of Orthopsychiatry82(3): 421–430.
39.
PattersonMMarkeyMAEiboffF (2012a) Baseline Personal Story Interviews from the Vancouver ‘At Home’ Study. Vancouver Site Report: At Home/Chez Soi.
40.
PattersonMLMarkeyMASomersJM (2012b) Multiple paths to just ends: Using narrative interviews and timelines to explore health equity and homelessness. International Journal of Qualitative Methods11(2): 132–151.
41.
PecoraPKesslerRWilliamsJ. (2005) Improving Family Foster Care: Findings from the Northwest Foster Care Alumni study. Seattle,WA: Casey Family Programs.
42.
PhilippoPLecocqCSempouxF. (2007) Psychological research on homelessness in Western Europe: A review from 1970–2001. Journal of Social Issues63: 483–504.
43.
PiatMPolvereLTownleyG. (2012) Baseline consumer narratives of lived experience of the Mental Health Commission of Canada’s At Home/Chez Soi project: Cross-site report. Available at: www.mentalhealthcommission.ca/English/node/14031.
44.
PrevostNNolinDFlowersL. (2012) Rapport sur les Récits de vie de Base. Moncton Site Report, At Home/Chez Soi.
45.
RickardsLDMcGrawSAArakiL. (2010) Collaborative initiative to help end chronic homelessness: Introduction. The Journal of Behavioral Health Services & Research37(2): 149–166.
46.
ShinnM (2007) International homelessness: Policy, socio-cultural, and individual perspectives. Journal of Social Issues63(3): 657–677.
StraussALCorbinJM (1990) Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Thousand Oaks, CA: Sage Publications.
49.
SullivanGBurnhamAKoegelP (2000) Pathways to homelessness among the mentally ill. Social Psychiatry/Psychiatric Epidemiology35: 444–450.
50.
ToroP (2007) Toward an international understanding of homelessness. Journal of Social Issues63(3): 461–481.
51.
ToroPTrickettEWallDD. (1991) Homelessness in the United States: An ecological perspective. American Psychologist46: 1208–1218.
52.
TsemberisSGulcurLNakaeM (2004) Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health94(4): 651–656.
53.
Wellesley Institute (2010) Precarious Housing in Canada. Wellesley Institute.
54.
WilliamsSStickleyT (2011) Stories from the streets: People’s experiences of homelessness. Journal of Psychiatric and Mental Health Nursing18: 432–439.
55.
WrightPAKloosB (2006) Housing environment and mental health outcomes: A levels of analysis perspective. Journal of Environmental Psychology27: 79–89.
56.
ZugazagaC (2004) Stressful life event experiences of homeless adults: A comparison of single men, single women, and women with children. Journal of Community Psychology32(6): 643–654.
