From Structural Chaos to a Model of Consumer Support: Understanding the Roles of Structure and Agency in Mental...

Current understandings of the effect that mental health services on consumers' daily lives are still heavily informed by research conducted during the era of institutional treatment. This is problematic considering that changes to mental health care have shifted the locus of treatment to community settings for the majority of those living with serious and persistent mental illness (SPMI). With this shift there has been a greater focus on consumer-centered recovery in mental health care. In this paper I seek to develop a deeper understanding of the effect that the organization of mental health services offered in community settings has on the recovery process. I do this by presenting findings from the analysis of focus group and interview data collected from research informants (consumers and staff) at four Housing First programs located in a large Midwestern city. Housing First is based in a human rights approach to services that has been demonstrated to be more successful at housing chronically homeless consumers with dual diagnoses than traditional approaches to housing. My findings highlight the importance of understanding the connection that exists between social structure and personal agency and the recovery process.