Abstract

The recovery movement is reshaping approaches to treatment of mental illness, substance abuse, and traumatic stress disorders. Yet recovery principles have not been well integrated into the homeless assistance network, despite high prevalence of mental illness, substance abuse, and trauma histories among people who are chronically homeless in the United States. We review approaches to recovery and recovery-oriented care and propose recommendations for adopting recovery oriented care within the homeless assistance network.

Introduction

Over the past two decades, the concept and principles of recovery have gained acceptance in the areas of mental health, substance use, and traumatic stress treatment as they have demonstrated improved outcomes. Multidisciplinary research in the behavioral health fields demonstrates that people can and do recover from mental illness, substance use disorders, and traumatic stress disorders [1-3] with and without traditional intervention [4]. In the United States, many people experiencing homelessness also suffer from cooccurring mental illness, substance use, and traumatic stress disorders, and could benefit significantly from programs employing a recovery-oriented approach.

However, a review of the literature shows little evidence that recovery principles have been systematically integrated across the homelessness assistance network.
While individual programs and providers may be providing care that integrates recovery principles, there is little evidence that homeless services have embraced the recovery movement to the same degree as the broader behavioral health fields. Homelessness assistance programs involve a diverse array of housing, emergency shelter, food service, employment assistance, medical care, mental health, addictions, and social services programs. Constructing a unified, recovery-oriented model of care across this multidisciplinary network of providers—often separated by different federal funding streams—poses unique challenges.

This paper argues that given the population it serves, the homeless assistance network must consider a system-wide adoption of a recovery orientation. It reviews the emergence of the concept of recovery and recovery-oriented care across the areas of mental health, addictions, and traumatic stress. It then turns to a discussion of the challenges of operationalizing a recovery-oriented approach to homeless services and systems, drawing from lessons from mental health and addiction services. We identify the need for a shift in the service delivery model and the need for an increased role for consumers as “recovery ambassadors” [5] and for consumer integration at all levels. Lastly, we discuss lessons learned from implementation of recovery-oriented mental health and addiction treatment programs in the state of Connecticut, and the challenge of translating recovery principles into standards and objective practices that can be observed and measured. The paper concludes with a discussion of the adoption of recovery principles across the homelessness assistance network, and the implications for research, practice, and policy.