Moving Forward, Together
Why Integrate People with Experiences of Homelessness?
Integrating people with experiences of psychiatric disability, substance use, trauma, and homelessness is necessary to transform organizational culture (New Freedom Commission on Mental Health, 2003). People with experiences of recovery acting in valued social roles improve organizational effectiveness in service delivery, policy development, and evaluation. Their presence leads to greater dialogue across constituencies, increases diversity within organizations, and helps to create systems that are more responsive to the articulated needs of those receiving services.
- Improves organizational effectiveness
- Consumer presence offers hope to others (providing services and receiving them)
- Affirms recovery is possible
- Improves quality of care
- Increases diversity
- It is the right thing to do
Consumers act as recovery ambassadors to the community, conveying messages affirming hope and the possibility of having a rich, fulfilling life that extends way beyond survival, “symptom management,” and maintenance. Consumer-providers serve as living examples of an agency’s recovery-oriented mission (Hutchinson et al., 2006; McCabe and Unzicker, 1995; Fisher, 1994).
Benefits to Consumers
Consumers involved in the delivery of homeless services, policy, planning, and evaluation report numerous personal and professional benefits. These range from increased self-esteem, reduced stigma, new connections and relationships with others, and the acquisition of new skills while affirming existing ones (“Consumer Practitioners in PATH-Funded Programs,” 2006; Hutchinson et al., 2006; Prescott, 2001). The last decade witnessed a growing emphasis on consumer integration in research, policy, and services that address homelessness (Barrow et al., 2007; “Consumer Practitioners in PATH-Funded Programs,” 2006).
- Fosters hope
- Promotes positive role models
- Supports recovery and well-being
- Increases self-esteem and self-efficacy
- Creates social/professional relationships
- Decreases stigma
- Supports skills acquisition
- Promotes vocational development
Regardless of how the involvement of people with experiences of homelessness takes place—whether in research, policy, planning, evaluation, or services—they naturally model recovery. Visible consumer involvement can reduce the stigma and shame associated with living with poverty, emotional distress, and trauma. Peer/consumer-providers can be powerful beacons of hope for others receiving services (Carlson, Rapp, and McDiarmid, 2001; Boykin, 1997; Shepard, 1992). A staff member relates, “The biggest benefit is that they’re living the recovery model. When clients find out about a consumer employee, they’re shocked and hopeful.” Meaningful involvement motivates people to tend to their own wellness in order to facilitate the experience of recovery for others (“Consumer Practitioners in PATH-Funded Programs,” 2006). Consumer-providers learn to overcome their own internalized stigma, shifting their self-perception from helpless “patient/client” to valuable “worker/citizen” through the process of integration. Simultaneously, they redefine their relationships with the service system and “institutions of power” in a more positive light (Hutchinson et al., 2006; Prescott, 2001).
“Involvement changes your status in the world” (Tripp, Corey, and Denton, 2005, p. 7)
For consumers in the work force, the professional benefits can be significant. Besides the security of having a steady income, involvement can lead to new coping skills and greater confidence, increased networking opportunities, and a sense that others hear them (Hutchinson et al., 2006; Tripp et al., 2005). Consumers may also feel inspired to further their education or envision new professional opportunities for themselves (Tripp et al., 2005). William Davison is a living example of the transformative impact a valued social role has on recovery. Currently, Mr. Davison is the Assistant Director of the Brattleboro Area Drop In Center in Vermont, a majority consumer-run nonprofit providing services to people who are homeless. Mr. Davison’s recovery story began in large part with his employment at the organization. He went from a part-time file clerk, advancing to Client Advocate to Reach-Up Coordinator to Assistant Director, and from homelessness to home ownership, in the span of two years.
Benefits to Agencies
When consumers feel that they make a difference, both in their own lives and in the lives of others, they can have a positive impact on their organizations, agencies, and on systems as a whole. These benefits range from an increased sense of enthusiasm and hope among all agency staff, to improved service delivery, to promoting greater awareness of stigma within organizations.
- Fosters hope
- Increases credibility and trust among clients
- Fosters engagement
- Enhances relevance of policies
- Improves responsiveness of services and programs
- Decreases stigma and provides role-modeling
- Promotes diversity
People with experiences of homelessness who are in leadership positions inspire hope in others. Their very presence stands in sharp contrast to negative stereotypes of incompetence, conveying instead a promise of recovery, efficacy, and dignity. As one provider said, “We see an increased sense of self-worth among the clients working here. It brings a sense of purpose and value to their lives. That is of great value to the agency. When people feel that sense of purpose, you can just see it, and it’s infectious. It creates a domino effect, and it makes our jobs easier, too.”
In service delivery, involving people with lived experience of homelessness in outreach can go a long way in fostering relationships with clients who would not otherwise engage with the team (Glasser, 1999). So many individuals who were formerly and are currently homeless received damaging overt or covert messages, undermining faith in themselves and connection to others. Eventually, they stop believing in possibilities altogether because it is too painful. It becomes easier to stay numb and distant because then despair and loneliness will not take up residence too close to the heart. People living on the streets are much more likely to open up to someone who can directly empathize with what they experience (Glasser, 1999). One provider said, “When consumers go out in the field to engage the community, the stigma of mental illness is not a barrier…It's been an asset…It really instills trust and decreases fear people have about accessing services.” Another provider noted that consumers have a “sensitivity that you don’t get from academia.” Other positive attributes include flexibility, patience, responsiveness, and ability to engage in advocacy (Van Tosh, 1993).
In research and policy planning, consumer involvement “operationalizes empowerment” leading to improved collaboration, better training methods, and greater organizational efficacy (Prescott, 2001, p. 6). Consumer involvement in research can result in more relevant research designs as well as fostering innovative and participatory research methods (Prescott, 2001; Barrow et al., 2007).
Consumers promote diversity within organizations and systems, reducing stigma and discrimination. People who disclose their experiences of homelessness, trauma, psychiatric disability, and substance recovery can serve as pioneers, breaking down the barriers among and between consumers and providers. People with experiences of homelessness play an important role in educating others and helping to bring unacknowledged stigma to light (Carlson and McDiarmid, 1999; Chinman, Young, Hassell, and Davidson, 2006). When consumers choose to disclose their experiences, this can help create compassionate cultures of acceptance within agencies and systems.
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Barrow, S., Tsemberis, S., McMullin, L., & Tripp, J. (2007, March). Consumer integration and self-determination in homelessness research, policy, planning and services. Paper presented at 2007 National Symposium on Homelessness Research, Washington, DC.
Boykin, C. D. (1997). The consumer provider as role model. In C. T. Mowbray, D. P. Moxley, C. A. Jasper, & L. L. Howell (Eds.), Consumers as Providers in Psychiatric Rehabilitation (pp. 374–386). Columbia, MD: International Association of Psychosocial Rehabilitation Services.
Carlson, L. & McDiarmid, L. (1999). Consumers as Providers of Mental Health Services: A Literature Review and Summary of Strategies to Address Barriers. Lawrence, KS: University of Kansas, School of Social Welfare.
Carlson, L., Rapp, C., & McDiarmid, D. (2001). Hiring consumer-providers: Barriers and alternative solutions. Community Mental Health Journal, 37(3), 199–213.
Chinman, M. J., Young, A. S., Hassell, J., & Davidson, L. (2006). Toward the implementation of mental health consumer provider services. Journal of Behavioral Health Services and Research, 3(22), 176–195.
Consumer Practitioners in PATH-Funded Programs: Report of the Consumer Involvement Workgroup (2006)
Fisher, D. B. (1994). A new vision of healing as constructed by people with psychiatric disabilities working as mental health providers. Psychosocial Rehabilitation Journal, 17(3), 67–81.
Glasser, N. (1999). Giving voice to homeless people in policy, practice, and research. In L. B. Fosburg & D. L. Dennis (Eds.), Practical Lessons: The 1998 National Symposium on Homelessness Research. Rockville, MD: U.S. Department of Housing and Urban Development and the U.S. Department of Health and Human Services.
Hutchinson, D., Anthony, W. A., Ashcroft, L., Johnson, E., Dunn, E. C., Lyass, A., et al. (2006). The personal and vocational impact of training and employing people with psychiatric disabilities as providers. Psychiatric Rehabilitation Journal, 29(3), 205–213.
McCabe, S. & Unzicker, R. E. (1995). Changing roles of consumers/survivors in mature mental health systems. New Directions for Mental Health Services, 66, 61–73.
New Freedom Commission on Mental Health, 2003
Prescott, L. (2001). Consumer/survivor/recovering women: Partnerships in collaboration. Delmar, NY: Policy Research Associates.
Shepard, L. (1992). So you want to hire a consumer? Employing people with psychiatric disabilities as staff members in mental health agencies. Burlington, VT: Trinity College, Center for Community Change through Housing and Support.
Tripp, J., Freeman, K., Corey, L. & Denton, A. (2005). The benefit of consumer involvement in homeless management information systems: An edited transcript of the PATH national teleconference sponsored by SAMHSA, July 27, 2005.
Van Tosh, L. (1993). Working for a change: Employment of consumers/survivors in the designand provision of services for persons who are homeless and mentally disabled. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.